COMMENTARY

The Pitfalls of Opioids for Chronic Nonmalignant Pain of Central Origin

Stephen G. Gelfand, MD

Disclosures

February 25, 2002

Conclusions

The lessons of OxyContin could serve to strengthen the importance of good clinical judgment and the need to evaluate each patient in context. This includes determining whether chronic pain originates from peripheral or central mechanisms, and adhering to the narcotic guidelines for adequate psychosocial evaluation prior to prescribing opioids.

Pain should not be treated in isolation without understanding of its roots, just as fever mandates a search for causes. Undertreatment should refer not only to drug therapy, but also to the absence of important nondrug interventions. The appropriate management of chronic pain is multimodal, including nonpharmacologic therapies, especially for pain of central origin. Diagnosis and care should be individualized and involve other disciplines as indicated, including clinical psychology, psychiatry, stress management, health education, and physical and/or occupational therapy.

As a result of the OxyContin problem, certain pain societies are now calling for a more balanced approach to the diagnosis and management of chronic pain.[24] It is likely that the aftermath of OxyContin will show that a "one drug fits all" orientation to chronic pain is a risky practice with many pitfalls. In the public interest, more attention must be paid to proper patient selection rather than to marketing ploys intended to increase drug sales.

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