Opioid therapy for chronic non-cancer pain: guidelines for Hong Kong

Opioids are increasingly used to control chronic non-cancer pain globally. International opioid guidelines have been issued in many different countries but a similar document is not generally available in Hong Kong. Chronic opioid therapy has a role in multidisciplinary management of chronic non-can...

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Bibliographic Details
Published in:	Hong Kong medical journal = Xianggang yi xue za zhi Vol. 22; no. 5; pp. 496 - 505
Main Authors:	Cheung, C W, Chan, T Cw, Chen, P P, Chu, M C, Chui, W Cm, Ho, P T, Lam, F, Law, S W, Lee, J Ly, Wong, S Hs, Wong, V Kc
Format:	Journal Article
Language:	English
Published:	China Hong Kong Academy of Medicine 01-10-2016
Subjects:	Addictions Adult Analgesics, Opioid - administration & dosage Analgesics, Opioid - adverse effects Cancer Chronic pain Chronic Pain - drug therapy Dose-Response Relationship, Drug Hong Kong Humans Informed Consent Mental health Morphine Narcotics Opioid-Related Disorders - prevention & control Pain management Patients Physicians Practice Guidelines as Topic Substance abuse treatment Surgery Hong Kong China China Chronic pain/drug therapy Practice guidelines as topic/standards Analgesics, opioid/therapeutic use
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Summary:	Opioids are increasingly used to control chronic non-cancer pain globally. International opioid guidelines have been issued in many different countries but a similar document is not generally available in Hong Kong. Chronic opioid therapy has a role in multidisciplinary management of chronic non-cancer pain despite insufficient evidence for its effectiveness and safety for long-term use. This document reviews the current literature to inform Hong Kong practitioners about the rational use of chronic opioid therapy in chronic non-cancer pain. It also aims to provide useful recommendations for the appropriate, effective, and safe use of such therapy in the management of chronic non-cancer pain in adults. Physicians should conduct a comprehensive biopsychosocial evaluation of patients prior to the commencement of opioid therapy. When opioid use is deemed appropriate, the patient should provide informed consent within an agreement that specifies treatment goals and expectations. A trial of opioid can be commenced and, provided there is progress towards treatment goals, then chronic therapy can be considered at a dose that minimises harm. Monitoring of effectiveness, safety, and drug misuse should be continued. Treatment should be stopped when opioids become ineffective, intolerable, or misused. The driving principles for opioid prescription in chronic pain management should be: start with a low dose, titrate slowly, and maintain within the shortest possible time.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	1024-2708 2226-8707
DOI:	10.12809/hkmj164920