Managing chronic nonmalignant pain: overcoming obstacles to the use of opioids

Adv Ther. 2000 Mar-Apr;17(2):70-83. doi: 10.1007/BF02854840.


Physicians involved in cancer pain management treat thousands of patients with opioids, whose effective analgesia improves overall functioning. Side effects generally are tolerable, and treatment can be maintained with stable doses for long periods. Problems with addiction are infrequent. Many physicians, however, assume that opioids should be used only for chronic malignant pain. Research and clinical experience have demonstrated that opioids can safely and effectively relieve most chronic moderate to severe nonmalignant pain. Fears of addiction, disciplinary action, and adverse effects result in ineffective pain management. With current information on the use of opioids in chronic nonmalignant pain, primary care physicians can overcome these obstacles. Guidelines must clearly define the role of the primary care physician in the proper management of pain and the integration of opioid therapy. Used appropriately, opioids may represent the only source of relief for many patients.

Publication types

  • Review

MeSH terms

  • Analgesics, Opioid / adverse effects*
  • Analgesics, Opioid / therapeutic use*
  • Constipation / chemically induced
  • Constipation / prevention & control
  • Drug and Narcotic Control / legislation & jurisprudence
  • Humans
  • Nausea / chemically induced
  • Nausea / prevention & control
  • Opioid-Related Disorders* / diagnosis
  • Opioid-Related Disorders* / prevention & control
  • Pain, Intractable / drug therapy*
  • Practice Guidelines as Topic
  • United States


  • Analgesics, Opioid