Chronic opioid therapy provides pain management for patients with chronic pain unrelated to cancer. Certain medical conditions as well as old injuries can cause persistent pain that does not resolve with other treatment measures, which may necessitate the use of opioids for more effective control. In addition to chronic opioid therapy, patients may use other pharmacological options as well as pursuing psychosocial treatments like counseling and therapy, which some people find beneficial. Concerns about opioid medications can be an issue with this form of therapy, as controlled, extensive studies on the chronic use of these drugs for non-cancer pain are limited.
Patients with chronic pain can experience a significantly diminished quality of life. In some cases the pain is disabling, making it difficult to work, care for family members, and perform other routine tasks. Chronic pain can also cause irritability, depression, and other psychological side effects. A physician evaluating a patient for chronic pain needs to determine the cause and work with the patient on a treatment plan which may eventually involve chronic opioid therapy.
Before a doctor will recommend this treatment, careful documentation may be required. The doctor can provide a diagnosis or confirmation that the patient experiences chronic pain of unknown origins, along with an indication that the patient has been informed about the risks and benefits of chronic opioid therapy. If the patient tried other treatments, these can be discussed.
Low doses are typically used at the start to achieve control with minimal side effects. Patients on chronic opioid therapy can experience issues like constipation, fatigue, and confusion. Over time, they can also develop a dependence on the drug, which makes it important to keep dosing consistent and be careful about withdrawal. This is not the same thing as an addiction, where the patient develops an unhealthy relationship with opioids; a patient who needs daily management is not addicted, while a patient who uses increasingly dangerous measures to access drugs is.
Over the course of chronic opioid therapy, the patient can visit the doctor for periodic checkups. These can be used to determine if medication is still necessary and if the dose is sufficient. Patients may prefer to work with a pain specialist, who is more likely to have experience and training in handling chronic pain. While using opioids, they can discuss other options for managing their conditions with the goal of supplementing the medication to achieve greater control. Some people, for example, find Transcutaneous Electrical Nerve Stimulation (TENS) helpful for keeping pain levels low.