Opioids for Chronic Noncancer Pain: The Need for Balance

Russell K. Portenoy, MD

Applying an American Academy of Neurology position paper to clinical practice

In this position paper, the American Academy of Neurology reviews the rise in opioid-associated harms, the lack of evidence for long-term effectiveness, and the policy response to rising abuse and overdose. The paper includes proposals for best practices for safe opioid prescribing, including tracking pain and function; documenting all opioid sources; conducting random urine testing; screening for histories of substance abuse and depression, anxiety, or posttraumatic stress disorder; using a “patient treatment agreement”; and prescribing doses above about 120 morphine-equivalent mg/day only when the patient has “sustained meaningful” improvements in pain and function, in consultation with a pain management specialist.

Citation(s):

Franklin GM.Opioids for chronic noncancer pain: A position paper of the American Academy of Neurology. Neurology 2014 Sep 30; 83:1277.