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European Journal of Physical and Rehabilitation Medicine 2013 February;49(1):93-6


lingua: Inglese

The utilization of opiates in pain management: use or abuse?

Mitra R.

Department of Rehabilitation Medicine, Kansas University School of Medicine, Kansas City, KS, USA


Background: Despite governmental regulations, opiate medications continue to be abused in some populations. Some clinicians have advocated non-opioid therapy for pain patients that suffer from non-malignant conditions; while others have suggested that chronic benign pain conditions may successfully be managed with opiates in non-escalating dosages.
Aim: The aim of this paper was to review the literature regarding opiate utilization in the acute and chronic pain population.
Design: Review.
Setting: Europe and United States.
Population: Acute and chronic adult pain patients.
Methods: A computer-aided search of several databases—MEDLINE (1966 to July 2012); EMBASE (Elsevier BV, Amsterdam, the Netherlands), 1982 to present; CINAHL (Cumulative Index to Nursing and Allied Health Literature, EBSCO Industries, Glendale, CA), 1982 to July 2012; and all EBM (Evidence-Based Medicine) reviews was performed. The search terms were pain, opioid, opiate and narcotic.
Results: It is generally accepted that WHO step III opioids are indicated and appropriate in malignant conditions, however the utilization of opiates in non-malignant chronic conditions remains controversial.
Conclusion: Limited data does support the utilization of non-escalating dosages of opiates in patients that are closely monitored in non-malignant conditions. Education in opiate utilization and pain management is insufficient in its current form.
Clinical Rehabilitation Impact: Studies demonstrating functional improvements with the utilization of opiate medications are also lacking. Physical Medicine and Rehabilitation researchers therefore have an ideal opportunity to positively influence education, regulation and patient care in this field.

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