![]() ![]() 4, 5 Chronic pain conditions have a substantial financial impact, accounting for an estimated annual total economic loss of $100 billion (in 1998 dollars), 6 including $61.2 billion attributed to lost workplace productivity. 3 Individuals with chronic pain may also experience depression, impaired sleep, and a diminished ability to perform normal activities of daily living (ADLs). 1, 2 Chronic pain affects an estimated 75 million people in the United States and is the nation's leading cause of disability. The International Association for the Study of Pain defines chronic pain as persistent pain lasting longer than the time required for normal tissue healing for chronic noncancer pain (CNCP), this is generally defined as 3 months or longer. English-only randomized controlled trials and nonrandomized studies were considered.ĪDL = activities of daily living AE = adverse effect ATC = around-the-clock BPI = Brief Pain Inventory CNCP = chronic noncancer pain CR = controlled-release DN = diabetic neuropathy ER = extended-release IR = immediate-release LAO = long-acting opioid LBP = low back pain NSAID = nonsteroidal anti-inflammatory drug PHN = postherpetic neuralgia QOL = quality of life SAO = short-acting opioid SNRI = serotonin norepinephrine reuptake inhibitor SR = sustained-release TCA = tricyclic antidepressant MEDLINE and PubMed searches were conducted to locate relevant studies published from January 1975 to April 2008 using the following search terms: opioids, short-acting opioids, long-acting opioids, chronic pain, chronic pain AND opioids, and narcotics. The LAOs may provide more stable analgesia with less frequent dosing however, opioid therapy should be tailored to the pain state and the individual patient, and SAOs may be appropriate for some patients with CNCP. A review of published studies found no data to suggest that either SAOs or LAOs are generally more efficacious for treating any particular CNCP condition. Studies suggest that SAOs and LAOs are both effective for most types of CNCP. When making initial decisions, physicians should decide whether to prescribe a short-acting opioid (SAO) with a relatively quick onset of action and short duration of analgesic activity, a long-acting opioid (LAO) with a longer duration of analgesic action but a potentially longer onset of action, or both. Physicians should consider the available evidence of efficacy, the routes of administration, and the pharmacokinetics and pharmacodynamics of the various formulations as they relate to the temporal characteristics of the patient's pain. For many patients with CNCP, the analgesic regimen will include opioids. Management of chronic noncancer pain (CNCP) requires a comprehensive assessment of the patient, the institution of a structured treatment regimen, an ongoing reassessment of the painful condition and its response to therapy, and a continual appraisal of the patient's adherence to treatment. ![]()
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