OBJECTIVE: To assess the effects of long term opioid therapy on pain, mood, and social and leisure activities in patients with chronic nonmalignant pain.METHODS: Fourteen patients (eight males and six females) were treated with opioid medications for chronic nonmalignant pain not improved by previous treatments. Baseline measures of pain intensity were obtained before introducing opioids. Patients were monitored throughout the study, with outcome measured four to 32 months after opioids were started. The final measures examined drug dose, side effects, pain level, pain relief, emotional status, and involvement in social and leisure activities.RESULTS: A total of 64.3% of patients reported good to excellent pain relief with opioid medication, and 64.3% reported reduced pain intensity, the decrease ranging from 25% to 100% (from baseline measures) on a scale rated from 0 to 10. As well, 64.3% scored their emotional state as 5 or better on the 0 to 10 scale (0 indicating greatest distress), and 64.3% reported at least moderate (at least 5 on the 0 to 10 scale) involvement in leisure and social activities. There was a significant negative correlation between pain intensity and amount of leisure and social activity; 88.9% of patients who reported moderate to full involvement in leisure and social activities also noted decreased pain on the 0 to 10 scale. Other than one patient who developed tolerance, there were no notable problems with dose escalation or with any other form of substance abuse.CONCLUSIONS: Some patients with chronic nonmalignant pain benefit from long term opioid therapy without developing unmanageable side effects, tolerance or substance abuse problems. These results, together with previous findings, show that opioids can be a safe and useful long term treatment for chronic nonmalignant pain.
Intraspinal opioid therapy for chronic nonmalignant pain: Current practice and clinical guidelines