Opioids for persistent non-cancer pain: recommendations for clinical practice

Open Access
Publisher Website
Google Scholar
Abstract
Pain is the commonest symptom that causes patients to seek health care. Pain is described as persistent when it has been present for about 3 months. Pain may be constant, for example low back pain, osteoarthritis, and post‐herpetic neuralgia, or episodic, for example sickle cell crises, osteoporotic fractures, and pancreatitis. Persistent pain affects all age groups, but is commoner in the elderly, when co‐existing pathology may limit prescribing and other therapies. The prevalence of persistent pain in the population is difficult to quantify, partly because of problems with case definition; several studies suggest that it occurs in about 10% of people.1 A postal survey of 4600 patients in Scotland who were randomly selected from a general practice database, showed that 16% were moderately to severely disabled by persistent pain.2 In a follow‐up study, by the same group, of persistent pain in more than 2000 patients in primary care, 79% of those with pain at initial assessment still had pain 4 yr later.3 This suggests that about 2–6 million people in the UK would describe themselves as having persistent, severe pain not associated with cancer. In England and Wales 1.3–1.75 million people have osteoarthritis, and 0.25–0.5 million have rheumatoid arthritis. The economic burden of musculoskeletal problems is high; it accounts for 1–2.5% of the gross national product of many western countries.4 Back pain is one of the top 10 most costly health conditions.5 In 1998, in the UK, the direct health care cost of back pain was £1632 million, and the cost of informal care and lost production was £10 668 million. The direct costs were distributed as 37% for physiotherapy and allied professionals, 31% hospital, 14% primary care, 7% medication, 6% community care, and 5% radiology.6 Persistent pain is a big problem, and provision of effective treatments has important clinical and economic implications.