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Exploring the Use of Chronic Opioid Therapy for Chronic Pain: When, How, and for Whom?

Medical Clinics of North America, Volume 100, Issue 1, January 2016, Pages 81 - 102

This article provides a broad overview regarding intent to initiate and consider ongoing chronic opioid therapy (COT) for treatment of chronic noncancer pain (CNCP). COT should be an individualized decision based on a comprehensive evaluation, assessment, and monitoring. It is imperative that providers discuss various risks and benefits of COT initially and at follow-up visits, and continue appropriate monitoring and follow-up at regular intervals. The decision to initiate or continue opioid therapy is based on clinical judgment; however, it is understood that opioid and other medication therapy represent one piece of the complete treatment plan for patients with CNCP.

Keywords: Chronic opioid therapy, Chronic noncancer pain, Pain management, Opioid risk management, Opioid induced respiratory depression.


a Pain Management, Minneapolis VA Health Care System, Minneapolis, MN, USA

b Pain Management, Harry S. Truman Memorial Veterans’ Hospital, Columbia, MO, USA

c Pain & Palliative Care, Stratton VA Medical Center, Albany, NY, USA

d Pain Management, PGY2 Pain & Palliative Care Pharmacy Residency, Stratton VA Medical Center, Albany, NY, USA

e Western New England University College of Pharmacy, Springfield, MA, USA

f Albany College of Pharmacy & Health Sciences, Albany, NY, USA

g University of Connecticut School of Pharmacy, Storrs, CT, USA

Corresponding author. PO Box 214, Delmar, NY 12054-0214.

Conflicts of Interest: This commentary is the sole opinion of the authors and does not reflect the opinion of employers, employee affiliates, and/or pharmaceutical companies mentioned or specific drugs discussed. It was not prepared as part of official government duties for authors Brooks, Kominek, Pham, or Fudin. Dr J. Fudin is an expert legal advisor and on the speakers’ bureau for Millennium Laboratories, Inc. He is on speakers’ bureaus for Kaléo Pharma and Astra Zeneca. He is a consultant to Zogenix, Astra Zeneca, Millennium Health LLC, and to Practical Pain Management in the development of the online Opioid Calculator. He is founder and owner of Remitigate LLC. Dr J. Fudin's participation does not reflect the opinion of employers, employee affiliates, and/or pharmaceutical companies listed.