EVALUATION OF MORPHINE IN THE MANAGEMENT OF CHRONIC PAIN

Abstract

The use of opioids to treat severe pain associated with nonterminal disease states should not be considered as a first line of treatment. These patients should undergo a full assessment of physical and psychological components of the pain complaint in a multidisciplinary pain unit and all non-invasive treatments given a reasonable trial.

However, those patients with a predominant nociceptive focus to their pain complaint can be considered for long-term opioid therapy if the psychiatric/psychological assessment reveals no drug seeking behaviour or dependency traits in an otherwise psychologically stable patient. Once the decision to use opioid drugs (usually in combination with appropriate adjuvant drugs) has been made, the drug, dose, route of administration and possible drug delivery devices must be considered.

Guidelines covering conditions under which opioids will be prescribed, ongoing assessments goals of therapy and the frequency of therapeutic drug monitoring will require detailed attention. Patients with a predominant neuropathic component to their pain can be considered under the above conditions, but the likelihood of successful outcome is less than for nociceptive pain.