Risk Factors in Opioid Treatment of Chronic Non-Cancer Pain: A Multidisciplinary Assessment

Abstract

When pain becomes chronic it assumes an almost absolute central role in the disease experience: it characterises and qualifies it, and constantly interferes with the daily life of the patient (Bonica, 1992). It could be said that chronic pain becomes a disease in itself in the patient’s perception; daily activities, interpersonal relationships, feelings, are profoundly disturbed by living with pain (Loeser, 2000). While modern medicine has made notable progress in understanding, diagnosing and treating chronic pain, it continues to be a very widespread problem that significantly compromises the professional, social and family life of the patient, and is often not adequately managed (Manchikanti et al., 2010). The problem of inadequately managed pain is still a considerable one (Breivik et al., 2006), although the World Health Organization [WHO] (1990) has stated that to be pain free should be considered a right of every patient. The consequences of inadequately treated pain not only have an impact in terms of the physical and psychological suffering of the patient and his family, they also have an enormous economic impact on society as a whole (Brennan et al., 2007; van Leeuwen et al., 2006). Options for the treatment of chronic pain include both pharmacological treatments (e.g. non steroidal anti-inflammatory drugs, opioids) and non-pharmacological treatments (e.g. physical therapies, acupuncture, cognitive-behavioural therapy, surgical procedures). Choice of treatment should be guided by a complex initial assessment of the patient, which includes the collection of historical information (e.g. pain history and treatments tried, surgical procedures, psychosocial and family history), a physical examination and appropriate diagnostic tests (Passik, 2009). Opioids are considered one of the most efficacious groups of drugs in treating mediumsevere pain (Portenoy, 2000), and their use can result in a significant improvement in the patient’s quality of life (Dillie et al., 2008); while there is unanimous agreement on their use in acute and cancer pain, their long-term use for non-cancer chronic pain remains controversial (Dews & Mekhail, 2004; Manchikanti et al., 2010; Rosenblum et al., 2008). The discovery of the properties of these substances, and their use as analgesics, is lost in the mists of time: the Sumerians were starting to cultivate poppies as early as 3400 B.C. (Booth, 1986, as cited in Dews & Mekhail, 2004). In 1803, Friedrich Serturner, a German pharmacist,