The Journal of Pain
Volume 10, Issue 2 , Pages 113-130.e22 , February 2009

Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain

  • Roger Chou

      Affiliations

    • Oregon Evidence-based Practice Center, Department of Medicine, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
    • Corresponding Author InformationAddress reprint requests to Dr Roger Chou, 3181 SW Sam Jackson Park Road, Mail Code BICC, Portland, OR 97239.
    • ,
  • Gilbert J. Fanciullo

      Affiliations

    • Pain Management Center, Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
    • ,
  • Perry G. Fine

      Affiliations

    • Pain Research Center, Department of Anesthesiology, University of Utah, Salt Lake City, Utah
    • ,
  • Jeremy A. Adler

      Affiliations

    • Pacific Pain Medicine Consultants, Encinitas, California
    • ,
  • Jane C. Ballantyne

      Affiliations

    • Division of Pain Medicine, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston
    • ,
  • Pamela Davies

      Affiliations

    • Seattle Cancer Care Alliance, Seattle, Washington
    • ,
  • Marilee I. Donovan

      Affiliations

    • Pain Management Clinic, Kaiser Permanente Northwest, Portland, Oregon
    • ,
  • David A. Fishbain

      Affiliations

    • School of Medicine, Neurological Surgery and Anesthesiology, University of Miami, Miami, Florida
    • ,
  • Kathy M. Foley

      Affiliations

    • Pain and Palliative Care Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York
    • ,
  • Jeffrey Fudin

      Affiliations

    • Samuel S. Stratton Department of Veterans Affairs Medical Center, and Albany College of Pharmacy & Health Sciences, Albany, New York
    • ,
  • Aaron M. Gilson

      Affiliations

    • Pain and Policy Studies Group, Paul P. Carbone Comprehensive Cancer Center, University of Wisconsin, Madison
    • ,
  • Alexander Kelter

      Affiliations

    • Epidemiology and Prevention for Injury Control (EPIC) Branch, California Department of Health Services, Sacramento, California (retired 2005)
    • ,
  • Alexander Mauskop

      Affiliations

    • New York Headache Center, New York, New York
    • ,
  • Patrick G. O'Connor

      Affiliations

    • Section of General Internal Medicine, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, Connecticut
    • ,
  • Steven D. Passik

      Affiliations

    • Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York
    • ,
  • Gavril W. Pasternak

      Affiliations

    • Laboratory of Molecular Neuropharmacology, Department of Molecular Pharmacology and Chemistry, Memorial Sloan-Kettering Cancer Center, New York, New York
    • ,
  • Russell K. Portenoy

      Affiliations

    • Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, New York
    • ,
  • Ben A. Rich

      Affiliations

    • School of Medicine, Division of Bioethics, University of California Davis
    • ,
  • Richard G. Roberts

      Affiliations

    • School of Medicine and Public Health, University of Wisconsin, Madison
    • ,
  • Knox H. Todd

      Affiliations

    • Pain and Emergency Medicine Institute, Beth Israel Medical Center, New York, New York
    • ,
  • Christine Miaskowski

      Affiliations

    • Department of Physiological Nursing, University of California, San Francisco
    • ,
  • American Pain Society–American Academy of Pain Medicine Opioids Guidelines Panel

References 

  1. Angst MS, Clark JD. Opioid-induced hyperalgesia: A qualitative systematic review. Anesthesiology. 2006;104:570–587
  2. Arnold RM, Han PK, Seltzer D. Opioid contracts in chronic nonmalignant pain management: Objectives and uncertainties. Am J Med. 2006;119:292–296
  3. Baron MJ, McDonald PW. Significant pain reduction in chronic pain patients after detoxification from high-dose opioids. J Opioid Manag. 2006;2:277–282
  4. Belgrade MJ, Schamber CD, Lindgren BR. The DIRE score: Predicting outcomes of opioid prescribing for chronic pain. J Pain. 2006;7:671–681
  5. Benjamin L, Dampier C, Jacox A, Odesina V, Phoenix D, Shapiro B, Strafford M, Treadwell M: Guideline for the management of acute and chronic pain in sickle-cell disease. Glenview, IL: The American Pain Society, 2007
  6. Bennett DS, Simon S, Brennan M, Shoemaker SA. Prevalence and characteristics of breakthrough pain in patients receiving opioids for chronic back pain in pain specialty clinics. J Opioid Manag. 2007;3:101–106
  7. Bennetto L, Patel NK, Fuller G. Trigeminal neuralgia and its management. BMJ. 2007;334:201–205
  8. Braithwaite R, Jarvie D, Minty P, Simpson D, Widdop B. Screening for drugs of abuse, I: Opiates, amphetamines and cocaine. Ann Clin Biochem. 1995;32:123–153
  9. Office of Applied Studies, Substance Abuse and Mental Health Service Administration: Results from the 2004 National Survey on Drug Use and Health. Rockville, MD: Department of Health and Human Services, 2005
  10. Butler SF, Budman SH, Fernandez K, Jamison RN. Validation of a screener and opioid assessment measure for patients with chronic pain. Pain. 2004;112:65–75
  11. Butler SF, Budman SH, Fernandez KC, Houle B, Benoit C, Katz N, et al. Development and validation of the Current Opioid Misuse Measure. Pain. 2007;130:144–156
  12. Butler SF, Fernandez K, Benoit C, Budman SH, Jamison RN. Validation of the revised screener and opioid assessment for patients with pain (SOAPP-R). J Pain. 2008;9:360–372
  13. Byas-Smith M, Chapman SL, Reed B, Cotsonis G. The effect of opioids on driving and psychomotor performance in patients with chronic pain. Clin J Pain. 2005;21:345–352
  14. Caudill-Slosberg MA, Schwartz LM, Woloshin S. Office visits and analgesic prescriptions for musculoskeletal pain in US: 1980 vs 2000. Pain. 2004;109:514–519
  15. Center for Substance Abuse Treatment: Methadone-associated mortality: Report of a national assessment, May 8–9, 2003. Rockville, MD: Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 2004
  16. Centers for Disease Control and Prevention: Prevalence of disabilities and associated health conditions among adults: United States, 1999. MMWR 50:120–125, 2001
  17. Chou R, Clark E, Helfand M. Comparative efficacy and safety of long-acting oral opioids for chronic non-cancer pain: A systematic review. J Pain Symptom Manage. 2003;26:1026–1048
  18. Chou R, Fanciullo G, Fine P, Miaskowski G, Passik S, Portenoy P. Opioids for chronic noncancer pain: Prediction and identification of aberrant drug-related behaviors: A review of the evidence for an American Pain Society and American Academy of Pain Medicine clinical practice guideline. J Pain. 2009;10:131–146
  19. Chou R, Huffman L: The use of opioids for chronic non-cancer pain: Evidence review. Glenview, IL: The American Pain Society, 2009 (in press). Available at: http://ampainsoc.org/pub/opioid.htm
  20. Chu LF, Clark DJ, Angst MS. Opioid tolerance and hyperalgesia in chronic pain patients after one month of oral morphine therapy: A preliminary prospective study. J Pain. 2006;7:43–48
  21. Chugh SS, Socoteanu C, Reinier K, Waltz J, Jui J, Gunson K. A community-based evaluation of sudden death associated with therapeutic levels of methadone. Am J Med. 2008;121:66–71
  22. Cowan DT, Wilson-Barnett J, Griffiths P, Vaughan DJ, Gondhia A, Allan LG. A randomized, double-blind, placebo-controlled, cross-over pilot study to assess the effects of long-term opioid drug consumption and subsequent abstinence in chronic noncancer pain patients receiving controlled-release morphine. Pain Med. 2005;6:113–121
  23. Cruciani RA, Sekine R, Homel P, Lussier D, Yap Y, Suzuki Y, et al. Measurement of QTc in patients receiving chronic methadone therapy. J Pain Symptom Manage. 2005;29:385–391
  24. Daniell HW. DHEAS deficiency during consumption of sustained-action prescribed opioids: Evidence for opioid-induced inhibition of adrenal androgen production. J Pain. 2006;7:901–907
  25. Daniell HW. Hypogonadism in men consuming sustained-action oral opioids. J Pain. 2002;3:377–384
  26. Daniell HW. Opioid endocrinopathy in women consuming prescribed sustained-action opioids for control of nonmalignant pain. J Pain. 2008;9:28–36
  27. Donahue KE, Gartlehner G, Jonas DE, Lux LJ, Thieda P, Jonas BL, et al. Systematic review: Comparative effectiveness and harms of disease-modifying medications for rheumatoid arthritis. Ann Intern Med. 2008;148:124–134
  28. Edlund MJ, Steffick D, Hudson T, Harris KM, Sullivan M. Risk factors for clinically recognized opioid abuse and dependence among veterans using opioids for chronic non-cancer pain. Pain. 2007;129:355–362
  29. Fajemirokun-Odudeyi O, Sinha C, Tutty S, Pairaudeau P, Armstrong D, Phillips T, et al. Pregnancy outcome in women who use opiates. Eur J Obstet Gynecol Reprod Biol. 2006;126:170–175
  30. Federation of State Medical Boards . Model policy for the use of controlled substances for the treatment of pain. J Pain Palliat Care Pharmacother. 2004;19:73–78
  31. Fishbain DA, Cutler RB, Rosomoff HL, Rosomoff RS. Validity of self-reported drug use in chronic pain patients. Clin J Pain. 1999;15:184–191
  32. Fishbain DA, Cutler RB, Rosomoff HL, Rosomoff RS. Are opioid-dependent/tolerant patients impaired in driving-related skills? A structured evidence-based review. J Pain Symptom Manage. 2003;25:559–577
  33. Fishbain DA, Cutler RB, Rosomoff HL, Rosomoff RS. Can patients taking opioids drive safely? A structured evidence-based review. J Pain Palliat Care Pharmacother. 2002;16:9–28
  34. Fishman SM, Bandman TB, Edwards A, Borsook D. The opioid contract in the management of chronic pain. J Pain Symptom Manage18. 1999;27–37
  35. Fleming MF, Balousek SL, Klessig CL, Mundt MP, Brown DD. Substance use disorders in a primary care sample receiving daily opioid therapy. J Pain. 2007;8:573–582
  36. Flor H, Fydrich T, Turk DC. Efficacy of multidisciplinary pain treatment centers: a meta-analytic review. Pain. 1992;49:221–230
  37. Franks P, Fiscella K. Primary care physicians and specialists as personal physicians: Health care expenditures and mortality experience. J Fam Pract. 1998;47:105–109
  38. Fredheim OM, Borchgrevink PC, Hegrenaes L, Kaasa S, Dale O, Klepstad P. Opioid switching from morphine to methadone causes a minor but not clinically significant increase in QTc time: A prospective 9-month follow-up study. J Pain Symptom Manage. 2006;32:180–185
  39. Fredheim OM, Kaasa S, Dale O, Klepstad P, Landro NI, Borchgrevink PC. Opioid switching from oral slow release morphine to oral methadone may improve pain control in chronic non-malignant pain: A nine-month follow-up study. Palliat Med. 2006;20:35–41
  40. Freye E, Anderson-Hillemacher A, Ritzdorf I, Levy JV. Opioid rotation from high-dose morphine to transdermal buprenorphine (Transtec) in chronic pain patients. Pain Pract. 2007;7:123–129
  41. Fudin J, Levasseur DJ, Passik SD, Kirsh KL, Coleman J. Chronic pain management with opioids in patients with past or current substance abuse problems. J Pharm Pract. 2003;16:291–308
  42. Furlan AD, Sandoval JA, Mailis-Gagnon A, Tunks E. Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects. CMAJ. 2006;174:1589–1594
  43. Gaertner J, Radbruch L, Giesecke T, Gerbershagen H, Petzke F, Ostgathe C, et al. Assessing cognition and psychomotor function under long-term treatment with controlled release oxycodone in non-cancer pain patients. Acta Anaesthesiol Scand. 2006;50:664–672
  44. Gagajewski A, Apple FS. Methadone-related deaths in Hennepin County, Minnesota: 1992-2002. J Forensic Sci. 2003;48:668–671
  45. Galski T, Williams JB, Ehle HT. Effects of opioids on driving ability. J Pain Symptom Manage. 2000;19:200–208
  46. Gilson AM, Maurer MA, Joranson DE. State medical board members' beliefs about pain, addiction, and diversion and abuse: A changing regulatory environment. J Pain. 2007;8:682–691
  47. Gilson AM, Maurer MA, Joranson DE. State policy affecting pain management: Recent improvements and the positive impact of regulatory health policies. Health Policy. 2005;74:192–204
  48. Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA. 2004;292:2388–2395
  49. Goodman F, Jones W, Glassman P: Methadone dosing recommendations for treatment of chronic pain: US Department of Veterans Affairs, 2004. Available at: http://www.pbm.va.gov/archive/methadonedosing.pdf. Accessed December 5, 2008
  50. Gourlay DL, Heit HA. Pain and addiction: Managing risk through comprehensive care. J Addictive Diseases. 2008;27:23–30
  51. Gureje O, Von Korff M, Simon GE, Gater R. Persistent pain and well-being: A World Health Organization study in primary care. JAMA. 1998;280:147–151
  52. Guyatt GH, Gutterman D, Baumann MH, Addrizzo-Harris D, Hylek EM, Phillips B, et al. Grading strength of recommendations and quality of evidence in clinical guidelines: Report from an American College of Chest Physicians Task Force. Chest. 2006;129:174–181
  53. Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C. Multidisciplinary rehabilitation for chronic low back pain: systematic review. BMJ. 2001;322:1511–1516
  54. Hadi I, da Silva O, Natale R, Boyd D, Morley-Forster PK. Opioids in the parturient with chronic nonmalignant pain: A retrospective review. J Opioid Manag. 2006;2:31–34
  55. Heit HA, Gourlay DL. Urine drug testing in pain medicine. J Pain Symptom Manage. 2004;27:260–267
  56. Hoffman BM, Chatkoff DK, Papas RK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychology. 2007;26:1–9
  57. Hojsted J, Sjogren P. Addiction to opioids in chronic pain patients: A literature review. Eur J Pain. 2007;11:490–518
  58. IASP Task Force on Taxonomy . Pain terms, a current list with definitions and notes on usage. Seattle, WA: IASP Press; 2007;pp 209-214. Available at: http://www.lasp-pain.org/AM/Template.cfm?Section=Publications&Template=/CM/HTMLDisplay.cfm&ContentID=2687#Pain. Accessed December 5, 2008
  59. International Association for the Study of Pain. Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl S1–S226, 1986
  60. Ives TJ, Chelminski PR, Hammett-Stabler CA, Malone RM, Perhac JS, Potisek NM, et al. Predictors of opioid misuse in patients with chronic pain: A prospective cohort study. BMC Health Serv Res. 2006;6:46
  61. Jamison RN, Schein JR, Vallow S, Ascher S, Vorsanger GJ, Katz NP. Neuropsychological effects of long-term opioid use in chronic pain patients. J Pain Symptom Manage. 2003;26:913–921
  62. Joranson DE, Carrow GM, Ryan KM, Schaefer L, Gilson AM, Good P, et al. Pain management and prescription monitoring. J Pain Symptom Manage. 2002;23:231–238
  63. Kalso E, Edwards J, Moore R, McQuay H. Opioids in chronic non-cancer pain: Systematic review of efficacy and safety. Pain. 2004;112:372–380
  64. Karjalainen K, Malmivaara A, van Tulder MW, Roine R, Jauhiainen M, Hurri H, et al. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain in working-age adults: A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine. 2001;26:262–269
  65. Katz N, Fanciullo GJ. Role of urine toxicology testing in the management of chronic opioid therapy. Clin J Pain. 2002;18:S76–S82
  66. Katz N, Adams E, Chilcoat H, Colucci R, Comer S, Goliber P, et al. Challenges in the development of prescription opioid abuse-deterrent formulations. Clin J Pain. 2007;23:648–660
  67. Katz NP, Sherburne S, Beach M, Rose RJ, Vielguth J, Bradley J, et al. Behavioral monitoring and urine toxicology testing in patients receiving long-term opioid therapy. Anesth Analg. 2003;97:1097–1102
  68. Krantz M, Lewkowiez L, Hays H, Woodroffe M, Robertson A, Mehler P. Torsade de pointes associated with very-high-dose methadone. Ann Intern Med. 2002;137:501–504
  69. Labby D, Koder M, Amann T. Opioids and Chronic Non-Malignant Pain: A Clinician's Handbook. CareOregon. 2003;Available at: http://www.careoregon.org/provider/documents/Opioids_Pain_Management.pdf. Accessed December, 5, 2008
  70. Lee C, Ludwig S, Duerksen D. Low serum cortisol associated with opioid use: Case report and review of the literature. Endocrinologist. 2002;12:5–8
  71. Lynch ME. A review of the use of methadone for the treatment of chronic noncancer pain. Pain Res Management. 2005;10:133–144
  72. Manchikanti L, Giordano J, Boswell MV, Fellows B, Manchukonda R, Pampati V. Psychological factors as predictors of opioid abuse and illicit drug use in chronic pain patients. J Opioid Manag. 2007;3:89–100
  73. Mao J. Opioid-induced abnormal pain sensitivity: Implications in clinical opioid therapy. Pain. 2002;100:213–217
  74. Martell B. Systematic review: Opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. Ann Intern Med. 2007;146:116–127
  75. Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, et al. Expenditures and health status among adults with back and neck problems. JAMA. 2008;299:656–664
  76. Maxwell JC, Pullum TW, Tannert K. Deaths of clients in methadone treatment in Texas: 1994-2002. Drug Alcohol Depend. 2005;78:73–81
  77. McCarthy J, Leamon M, Parr M, Anania B. High-dose methadone maintenance in pregnancy: Maternal and neonatal outcomes. Am J Obstet Gynecol. 2005;193:606–610
  78. McCracken LM, Turk DC. Behavioral and cognitive-behavioral treatment for chronic pain: Outcome, predictors of outcome, and treatment process. Spine. 2002;27:2564–2573
  79. Menefee LA, Frank ED, Crerand C, Jalali S, Park J, Sanschagrin K, et al. The effects of transdermal fentanyl on driving, cognitive performance, and balance in patients with chronic nonmalignant pain conditions. Pain Med. 2004;5:42–49
  80. Mercadante S, Bruera E. Opioid switching: a systematic and critical review. Cancer Treat Rev. 2006;32:304–315
  81. Mercadante S, Radbruch L, Caraceni A, Cherny N, Kaasa S, Nauck F, et al. Episodic (breakthrough) pain. Cancer. 2002;94:832–839
  82. Merza Z, Edwards N, Walters S, Newell-Price J, Ross R. Patients with chronic pain and abnormal pituitary function require investigation. Lancet. 2003;361:2203–2204
  83. Miaskowski C, Cleary J, Burney R, Coyne P, Finley R, Foster R, et al. Guideline for the management of cancer pain in adults and children. Glenview, IL: The American Pain Society; 2005;
  84. Michna E, Jamison RN, Pham L-D, Ross EL, Janfaza D, Nedeljkovic SS, et al. Urine toxicology screening among chronic pain patients on opioid therapy: Frequency and predictability of abnormal findings. Clin J Pain. 2007;23:173–179
  85. Michna E, Ross EL, Hynes WL, Nedeljkovic SS, Soumekh S, Janfaza D, et al. Predicting aberrant drug behavior in patients treated for chronic pain: importance of abuse history. J Pain Symptom Manage. 2004;28:250–258
  86. Moore RA, McQuay HJ. Prevalence of opioid adverse events in chronic non-malignant pain: Systematic review of randomised trials of oral opioids. Arthritis Res Ther. 2005;7:R1046–R1051
  87. Morley S, Eccleston C, Williams A. Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain. 1999;80:1–13
  88. Nicholas AS, Molloy AR, Brooker C. Using opioids with persisting noncancer pain: A biopsychosocial perspective. Clin J Pain. 2006;22:137–146
  89. Office of National Drug Control Policy (ONDCP): Proper Disposal of Prescription Drugs. Available at: http://www.whitehousedrugpolicy.gov/publications/pdf/prescrip%5Fdisposal.pdf. Accessed March 17, 2008
  90. Olsen Y, Daumit GL, Ford DE. Opioid prescriptions by US primary care physicians from 1992 to 2001. J Pain. 2006;7:225–235
  91. Oregon Department of Human Services: Methadone deaths (and distribution) on the rise. CD Summary. 2003;52:Available at: http://www.oregon.gov/DHS/ph/cdsummary/2003/ohd5214.pdf. Accessed December 5, 2008
  92. Ostelo R, van Tulder M, Vlaeyen J, Linton S, Morley S, Assendelft W. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews: Article No.: CD002014. 2005;
  93. Pain & Policy Studies Group . Achieving balance in federal and state pain policy: A guide to evaluation. 4th edition. Madison: University of Wisconsin, Paul P. Carbone Comprehensive Cancer Center; 2007;
  94. Pain and Policy Studies Group. Achieving balance in state pain policy: A progress report card. 3rd edition. University of Wisconsin, Paul P. Carbone Comprehensive Cancer Center; 2007;
  95. Pain and Policy Studies Group, University of Wisconsin. Database of state laws, regulations, and other official governmental policies. Available at: http://www.painpolicy.wisc.edu/matrix.htm. Accessed March 14, 2008
  96. Passik SD, Kirsh KL. The need to identify predictors of aberrant drug-related behavior and addiction in patients being treated with opioids for pain. Pain Med. 2003;4:186–189
  97. Passik SD, Kirsh KL: An opioid screening instrument: Long-term evaluation of the utility of the pain medication questionnaire by Holmes et al Pain Pract 6:69–71, 2006
  98. Passik SD, Kirsh KL, Whitcomb L, Portenoy RK, Katz NP, Kleinman L, et al. A new tool to assess and document pain outcomes in chronic pain patients receiving opioid therapy. Clin Ther. 2004;26:552–561
  99. Patient-Centered Primary Care Collaborative: Patient centered medical home, patient centered primary care: A revolution in health care in the US. Available at: www.pcpcc.net. Accessed March 14, 2008
  100. Paulson DM, Kennedy DT, Donovick RA, Carpenter RL, Cherubini M, Techner L, et al. Alvimopan: An oral, peripherally acting, mu-opioid receptor antagonist for the treatment of opioid-induced bowel dysfunction: a 21-day treatment-randomized clinical trial. J Pain. 2005;6:184–192
  101. Pereira J, Bruera E. Emerging neuropsychiatric toxicities of opioids. J Pharm Care Pain Symptom Control. 1997;5:329
  102. Pereira J, Lawlor P, Vigano A, Dorgan M, Bruera E. Equianalgesic dose ratios for opioids: A critical review and proposals for long-term dosing. J Pain Symptom Manage. 2001;22:672–678
  103. Pincus T, Burton AK, Vogel S, Field AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine. 2002;27:E109–E120
  104. Portenoy R. Fentanyl buccal tablet (FBT) for relief of breakthrough pain in opioid-treated patients with chronic low back pain: A randomized, placebo-controlled study. Curr Med Res Opin. 2007;23:223–233
  105. Portenoy R, Farrar J, Backonja M, Cleeland C, Yang K, Friedman M, et al. Long-term use of controlled-release oxycodone for noncancer pain: Results of a 3-year registry study. Clin J Pain. 2007;23:287–299
  106. Portenoy RK, Bennett DS, Rauck R, Simon S, Taylor D, Brennan M, et al. Prevalence and characteristics of breakthrough pain in opioid-treated patients with chronic noncancer pain. J Pain. 2006;7:583–591
  107. Potter M, Schafer S, Gonzalez-Mendez E, Gjeltema K, Lopez A, Wu J, et al. Opioids for chronic nonmalignant pain: Attitudes and practices of primary care physicians in the UCSF/Stanford Collaborative Research Network. J F Pract. 2001;50:145–151
  108. Quigley C. Opioid switching to improve pain relief and drug tolerability. Cochrane Database Syst Rev. Article No.: CD004847. 2004;
  109. Ralphs JA, Williams AC, Richardson PH, Pither CE, Nicholas MK. A comparison of patient-controlled reduction and staff controlled cocktail methods. Pain. 1994;56:279–288
  110. Ready LB, Sarkis E, Turner JA. Self-reported vs actual use of medications in chronic pain patients. Pain. 1982;12:285–294
  111. Reid MC, Engles-Horton LL, Weber MB, Kerns RD, Rogers EL. O'Connor PG: Use of opioid medications for chronic noncancer pain syndromes in primary care. J Gen Intern Med. 2002;17:173–179
  112. Ripamonti C, Groff L, Brunelli C, Polastri D, Stavrakis A, De Conno F. Switching from morphine to oral methadone in treating cancer pain: What is the equianalgesic dose ratio?. J Clin Oncol. 1998;16:3216–3221
  113. Risdahl J, Khanno K, Peterson P, Molitor T. Opiates and infection. J Neuroimmunol. 1998;83:4–18
  114. Rohling ML, Binder LM, Langhinrichsen-Rohling J. Money matters: A meta-analytic review of the association between financial compensation and the experience and treatment of chronic pain. Health Psych. 1995;14:537–547
  115. Rosenblum A, Parrino M, Schnoll SH, Fong C, Maxwell C, Cleland CM, et al. Prescription opioid abuse among enrollees into methadone maintenance treatment. Drug Alcohol Depend. 2007;90:64–71
  116. Roy S, Loh HH. Effects of opioids on the immune system. Neurochem Res. 1996;21:1375–1386
  117. Sabatowski R, Schwalen S, Rettig K, Herberg KW, Kasper SM, Radbruch L. Driving ability under long-term treatment with transdermal fentanyl. J Pain Symptom Manage. 2003;25:38–47
  118. Salvarani C, Macchioni P, Boiardi L. Polymyalgia rheumatica. Lancet. 1997;350:43–47
  119. Saper JR, Lake AE, Hamel RL, Lutz TE, Branca B, Sims DB, et al. Daily scheduled opioids for intractable head pain: Long-term observations of a treatment program. Neurology. 2004;62:1687–1694
  120. Savage SR, Joranson DE, Covington EC, Schnoll SH, Heit HA, Gilson AM. Definitions related to the medical use of opioids: Evolution toward universal agreement. J Pain Symptom Manage. 2003;26:655–667
  121. Schonstein E, Kenny DT, Keating J, Koes BW. Work conditioning, work hardening and functional restoration for workers with back and neck pain. Cochrane Database Syst Rev. Article No.: CD001822. 2003;
  122. Schur E, Afari N, Furberg H, Olarte M, Goldberg J, Sullivan P, et al. Feeling bad in more ways than one: Comorbidity patterns of medically unexplained and psychiatric conditions. J Gen Intern Med. 2007;22:818–821
  123. Sharpe C, Kuschel C. Outcomes of infants born to mothers receiving methadone for pain management in pregnancy. Arch Dis Child Fetal Neonatal Ed. 2004;89:F33–F36
  124. Shi L, Macinko J, Starfield B, Wulu J, Regan J, Politzer R. The relationship between primary care, income inequality, and mortality in US states, 1980-1995. J Am Board Fam Pract. 2003;16:412–422
  125. Simpson DM, Messina J, Xie F, Hale M. Fentanyl buccal tablet for the relief of breakthrough pain in opioid-tolerant adult patients with chronic neuropathic pain: A multicenter, randomized, double-blind, placebo-controlled study. Clin Ther. 2007;29:588–601
  126. Sjogren P, Thomsen AB, Olsen AK. Impaired neuropsychological performance in chronic nonmalignant pain patients receiving long-term oral opioid therapy. J Pain Symptom Manage. 2000;19:100–108
  127. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83:457–502
  128. Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. JAMA. 2003;290:2443–2454
  129. Sullivan MD, Edlund MJ, Zhang L, Unutzer J, Wells KB. Association between mental health disorders, problem drug use, and regular prescription opioid use. Arch Int Med. 2006;166:2087–2093
  130. Tassain V, Attal N, Fletcher D, Brasseur L, Degieux P, Chauvin M, et al. Long term effects of oral sustained release morphine on neuropsychological performance in patients with chronic non-cancer pain. Pain. 2003;104:389–400
  131. Tennant FS, Rawson RA, Miranda L, Obert J. Outpatient treatment of prescription opioid dependence: Comparison of two methods. NIDA Res Monograph. 1983;43:315–321
  132. The American Academy of Pain Medicine, the American Pain Society. The use of opioids for the treatment of chronic pain: A consensus statement from the American Academy of Pain Medicine and the American Pain Society. Clin J Pain. 1997;13:6–8
  133. van Tulder M, Ostelo R, Vlaeyen J, Linton S, Morley S, Assendelft W. Behavioral treatment for chronic low back pain: A systematic review within the framework of the Cochrane Back Review Group. Spine. 2000;25:2688–2699
  134. Verhaak P, Kerssens J, Dekker J, Sorbi M, Bensing J. Prevalence of chronic benign pain disorder among adults: A review of the literature. Pain. 1998;77:231–239
  135. Von Korff M, Saunders K, Ray GT, Bourdreau D, Campbell C, Merrill J, et al. De facto long-term opioid therapy for noncancer pain. Clin J Pain. 2008;24:521–527
  136. Von Korff M, Lin E, Fenton J, Saunders K. Frequency and priority of pain patients' health care use. Clin J Pain. 2007;23:400–408
  137. Webster LR, Butera PG, Moran LV, Wu N, Burns LH, Friedmann N. Oxytrex minimizes physical dependence while providing effective analgesia: A randomized controlled trial in low back pain. J Pain. 2006;7:937–946
  138. Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: Preliminary validation of the Opioid Risk Tool. Pain Med. 2005;6:432–442
  139. Wu SM, Compton P, Bolus R, Schieffer B, Pham Q, Baria A, et al. The Addiction Behaviors Checklist: Validation of a new clinician-based measure of inappropriate opioid use in chronic pain. J Pain Sympt Manage. 2006;32:342–351

 Editor's Note: The American Pain Society and the American Academy of Pain Medicine present this first of 3 articles in this 3-part report as a guideline for opioid treatment of noncancer pain.

 This article is based on research conducted at the Oregon Evidence-based Practice Center with funding from the American Pain Society (APS). The authors are solely responsible for the content of this article and the decision to submit for publication.

PII: S1526-5900(08)00831-6

doi: 10.1016/j.jpain.2008.10.008

The Journal of Pain
Volume 10, Issue 2 , Pages 113-130.e22 , February 2009

Article Tools