Finding
Guidelines strongly recommend that these patients receive formal medical assistance to reduce opioid use, but they do not explore which strategies are most effective [2, 3].
Paper
Cochrane in CORR®: Interventions for the Reduction of Prescribed Opioid Use in Chronic Non-cancer Pain
Abstract
Opioid use and its associated harms have become a major area of concern for patients, healthcare professionals, and the public. Adverse effects of opioid use can include death, addiction/dependence, hyperalgesia, sedation, impaired cognition, and fractures, among others [1, 7]. Additionally, there is little evidence that opioids are effective for pain management long-term [6]. Orthopaedic surgeons rank third among physicians—behind family practitioners and internists—in terms of the amount of opioids prescribed [9]. With increased attention on the risks of opioid use, several groups have developed evidencebased guidelines for responsible opioid prescription including the CDC [3], and a McMaster University-led Canadian guidelines group [2]. Both guidelines recommend maximizing nonopioid therapy before opioid therapy for chronic noncancer pain, using the minimum effective dose of opioids if they are needed, and for patients who are using greater than 90 mg morphine equivalents daily, to attempt tapering to the lowest effective dose. Because many patients with chronic noncancer pain have been on high doses of opioids for a long time, it can be challenging or impossible to reduce their opioid dosage without serious increases in pain, decreases in function, and withdrawal symptoms. Guidelines strongly recommend that these patients receive formal medical assistance to reduce opioid use, but they do not explore which strategies are most effective [2, 3].
Authors
K. Madden, M. Bhandari
Journal
Clinical Orthopaedics and Related Research