Opioids for chronic pain.

A S PRACTICING PHYSICIANS, WE HAVE OBserved that the problems associated with opioid medications for the treatment of chronic pain are growing rapidly. In primary and specialty care, chronic nonmalignant pain is common, with 20% to 40% of adults reporting chronic pain. Opioids are the most common means of treatment for chronic pain; 15% to 20% of office visits in the United States now include the prescription of an opioid, and 4 million Americans per year are prescribed a long-acting opioid. Opioids have become the most commonly prescribed drug category in the United States, and the increasing prevalence of their prescription closely parallels the increasing emphasis, which began in the mid-1990s, on treatment of chronic pain. A partial explanation of why we got to this point is that the lessons learned from the undertreatment of pain in patients with cancer were generalized to patients with chronic pain and no clear end point of cure or death. The practice of using opioids for chronic pain treatment also has been reinforced by continuing medical education classes and state regulations encouraging physicians to adequately treat pain.