Opioids for chronic non-cancer pain: a critical view from the other side of the pond

Opioid analgesics are important therapeutic options for chronic non-cancer pain (CNCP), recognized as a major public health issue with high social and economic burden. The increasing therapeutic opioid use for CNCP, misuse and abuse of prescription opioids have become matters of severe concern in USA. The recent position paper of the American Academy of Neurology (AAN) about the use of opioids in USA expresses growing alarms about opioid misuse/abuse, and has alerted physicians worldwide to rethink about their prescription practice. Current US practice in opioid prescription has been associated with morbidity and mortality of epidemic proportions: over 100,000 people directly or indirectly died from prescribed opioids in USA in the last twenty years, reaching 16,651 deaths in 2010. The actually alarming data from US have initiated pain physicians and researchers to re-evaluate their prescribing policies and attitudes for long-term treatment of non-cancer patients with opioids. In this position paper it is explained that any change in clinical behavior should not be based on an uncritical generalization of the US data that do not reflect the European situation. The primary objective of pain physicians remains to adequately treat chronic pain. Opioids are and will continue to remain an essential part of the "armamentarium against pain"; physicians should use them in the best way, i.e. after thorough diagnosis, assessment of alternative therapeutic options in the context of a multimodal treatment concept, and with repeated careful re-evaluations of the proper indication by a close long-term follow-up of any chronic opioid patient.