A clinical ethics approach to opioid treatment of chronic noncancer pain

Abstract

Untreated chronic pain, both cancer-related and not, remains unacceptably prevalent and costly, even in medically sophisticated settings across the United States and Europe. Available treatments for chronic nonmalignant pain have not been shown efficacious by robust data, whether the treatment in question is cognitive behavioral therapy, biofeedback, interventional anesthesia, or ongoing opioid medication [16, 42, 43]. Combining these treatments in the setting of multidisciplinary treatment programs, on the other hand, has been demonstrated efficacious in more than 60 studies [44], so the negative results may be partly due to studying available treatments in isolation. Although we need better long-term data showing opioids' efficacy, the same can be said for all available treatments for chronic pain. In the meantime, data to date suggest that opioids are at least partly efficacious for reducing pain and improving quality of life, with acceptable safety, for those with various chronically painful conditions. Given the status of our current knowledge, we have suggested a six-step decision-making process for opioid treatment that is based in clinical ethics and relies on comprehensive evaluation and data accrued through longitudinal care.