UI - 000209

AU - Portenoy RK

AU - Foley KM

TI - Chronic use of opioid analgesics in non-malignant pain: report of 38 cases

AB - AB - Thirty-eight patients maintained on opioid analgesics for non- malignant pain were

retrospectively evaluated to determine the indications, course, safety and efficacy of this therapy. Oxycodone

was used by 12 patients, methadone by 7, and levorphanol by 5; others were treated with propoxyphene,

meperidine, codeine, pentazocine, or some combination of these drugs. Nineteen patients were treated for

four or more years at the time of evaluation, while 6 were maintained for more than 7 years. Two-thirds

required less than 20 morphine equivalent mg/day and only 4 took more than 40 mg/day. Patients

occasionally required escalation of dose and/or hospitalization for exacerbation of pain; doses usually

returned to a stable baseline afterward. Twenty-four patients described partial but acceptable or fully

adequate relief of pain, while 14 reported inadequate relief. No patient underwent a surgical procedure for

pain management while receiving therapy. Few substantial gains in employment or social function could be

attributed to the institution of opioid therapy. No toxicity was reported and management became a problem

in only 2 patients, both with a history of prior drug abuse. A critical review of patient characteristics,

including data from the 16 Personality Factor Questionnaire in 24 patients, the Minnesota Multiphasic

Personality Inventory in 23, and detailed psychiatric evaluation in 6, failed to disclose psychological or social

variables capable of explaining the success of long-term management. We conclude that opioid maintenance

therapy can be a safe, salutary and more humane alternative to the options of surgery or no treatment in

those patients with intractable non-malignant pain and no history of drug abuse UI - 86258701

SO - Pain 1986;25:171-186