D. C. Turk, Ph.D., J. P. Robinson., M.D., R. Landau, M.D.
The use of long-term opioid therapy (LOT) for patients with chronic noncancer pain (CNP) is fraught with controversy. In addition to the societal concerns regarding abuse potential and threats of aberrant behaviors, morbidity, and mortality associated with opioids, observers of patients with CNP are repeatedly confronted by a vexing question: Why do so many of the patients place such high value on opioids? This question has long challenged clinicians, especially when they interact with patients who insist on continuing use of opioids, even when the clinicians cannot detect much evidence that the patients are benefitting from the medications. More recently, researchers have added to the conundrum, as most well-controlled studies on opioids for CNP have found that the medications are only modestly effective in reducing pain, and have limited if any benefits on physical and emotional functioning. Results of randomized control trials on the use of LOT suggest that 60%-76% of patients treated will achieve a reduction in pain, with an average reduction, however, of only 35%.1,2 Additionally, patients in these trials report significant side effects and frequently drop out of the trials prematurely. Moreover, during long-term, open label extensions for patients who have achieved a significant reduction of pain with tolerable side effects, approximately 40% of patients choose to terminate treatment.