Opioid use in chronic non-cancer pain part 2: prescribing issues and alternatives

Background: Managing pain requires time and effort to attend to its biopsychosocial characteristics. This requires proper planning and a whole-of-practice approach. Objective: This article describes how to prepare your practice for quality chronic pain care, and details a non-judgemental and effective management approach, including the minimisation of opioid harms. Discussion: It is helpful to have a consistent, whole-of-practice approach when a patient new to the practice presents with a compelling case for opioids. Assessing patients with chronic pain includes a full medical history and detailed examination according to a biopsychosocial approach and applying 'universal precautions' to make a misuse risk assessment. A management plan should consider a range of non-opioid modalities, with a focus on active rather than passive strategies. Integrated multidisciplinary pain services have been shown to improve pain and function outcomes for patients with complex chronic pain issues, but access is often limited. Time-limited opioid use is recommended with initial and regular monitoring, including pain and function scores, urine toxicology, compliance with regulatory surveillance systems and assessment for adverse reactions and drug related aberrant behaviours. When ceasing prescribing, opioids should be weaned slowly, except in response to violence or criminal activity.