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Narcotics for chronic nonmalignant pain
CMAJ 2001;164(4):461 [PDF]


In an article in CMAJ's rheumatology series, Simon Huang states that "narcotic analgesics should be avoided in patients with chronic musculoskeletal pain [Review]."1 Nothing could be further from the truth.

The general consensus as stated in guidelines on the use of narcotics2 as well as among physicians dealing with chronic pain disorders is that narcotics are almost certainly underutilized in the treatment of chronic musculoskeletal pain. Several studies have confirmed the relatively low risk of the development of drug dependence among these patients, provided they are adequately screened for addiction risk.3,4 The use of narcotics has improved the level of function and quality of life for many patients with chronic musculoskeletal pain, and elderly patients with arthritis are among the most satisfied clients.

Statements such as this are all too common and result in undertreatment of many chronic pain disorders by primary care physicians. We are now in the same position with respect to chronic nonmalignant pain as were our colleagues 15 years ago when patients with malignancies were often undertreated because of fears of creating drug addicts. Thankfully that situation has changed, and I am confident that in time so will the use of narcotics in the management of chronic musculoskeletal pain.

S.C. Bodley
Director
Pain Management Clinic
North Bay General Hospital
North Bay, Ont.


References

    1.   Huang SHK. Rheumatology: 7. Basics of therapy. CMAJ 2000;163(4):417-23.
    2.   Use of opioid analgesics for the treatment of chronic noncancer pain — a consensus statement and guidelines from the Canadian Pain Society. Pain Res Manage 1998;3(4; Winter 1998). (accessed 2001 Jan 19).
    3.   Fishbain DA, Rosomoff HL, Rosomoff RS. Drug abuse, dependence, and addiction among chronic pain patients. Clin J Pain 1992;8:77-85. [MEDLINE]
    4.   Brown RL, Patterson JJ, Rounds LA, Papasouliotis O. Substance abuse among patients with chronic back pain. J Fam Pract 1996;43:152-60. [MEDLINE]

 

 

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