General considerations for the management of pain with any medication that contains an opioid mechanism of action
The following general aspects should be considered:
- An individualized, patient-centered approach for the diagnosis and treatment of pain is essential to establish a therapeutic alliance between patient and clinician.
- Consider patient variables that may affect opioid dose for each patient prior to opioid use1
- In patients with acute pain e.g. post-surgery pain, the use of medication should be for the shortest necessary time1.
All patients should be carefully selected, abuse risk factors evaluated and regular monitoring and follow-up implemented to ensure that opioids are used appropriately3-4 and in alignment with treatment goals (pain intensity and functionality) as agreed with the patient3-4
- Patients should be made aware of the potential side effects of opioids and the potential for developing tolerance, dependence and addiction3-4.
- It is important to optimally use multimodal, non-opioid approaches in acute and chronic pain before escalating to opioids or in conjunction with opioid therapy1
- Addiction is possible even when opioids are taken as directed. The exact prevalence of abuse in patients treated with opioids for chronic pain is difficult to determine5
- Regular clinical reviews are required for long-term opioid treatment to assess pain control, impact on lifestyle, physical and psychological well-being, side effects and continued need for treatment2
- Any long term treatment with opioids should be monitored and re-evaluated regular incl. tapering down the dose or discontinuing treatment3-4
- Signs of opioid use disorder should be monitored and addressed3-4
- Patients and the general public can benefit from clear educational materials and awareness interventions to support the responsible use of opioids6.
- DHHS Pain Management Best Practices Inter-Agency Taskforce Report May 2019
- O’Brien T et al. Eur J Pain 2017;21:3-192
- Faculty of Pain Medicine, Opioids Aware https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware Accessed September 2019
- Kosten TR et al, Scie Pract. Perspect 2002;1:13-20
- Rosenblum A et al Exp. Clin. Psychopharmacol. 2008;16(5):405-416
- OECD Health Policy. Addressing Problematic opioid use in OECD Countries May 2019 http://www.oecd.org/health/addressing-problematic-opioid-use-in-oecd-countries-a18286f0-en.htm