Evidence-Based Guidelines on the Use of Opioids in Chronic Non-Cancer Pain—A Consensus Statement by the Pain Association of Singapore Task Force

Abstract

Introduction: While opioids are effective in carefully selected patients with chronic non-cancer pain (CNCP), they are associated with potential risks. Therefore, treatment recommendations for the safe and effective use of opioids in this patient population are needed. Materials and Methods: A multidisciplinary expert panel was convened by the Pain Association of Singapore to develop practical evidence-based recommendations on the use of opioids in the management of CNCP in the local population. This article discusses specific recommendations for various common CNCP conditions. Results: Available data demonstrate weak evidence for the long-term use of opioids. There is moderate evidence for the short-term benefit of opioids in certain CNCP conditions. Patients should be carefully screened and assessed prior to starting opioids. An opioid treatment agreement must be established, and urine drug testing may form part of this agreement. A trial duration of up to 2 months is necessary to determine efficacy, not only in terms of pain relief, but also to document improvement in function and quality of life. Regular reviews are essential with appropriate dose adjustments, if necessary, and routine assessment of analgesic efficacy, aberrant behaviour and adverse effects. The reasons for discontinuation of opioid therapy include side effects, lack of efficacy and aberrant drug behaviour. Conclusion: Due to insufficient evidence, the task force does not recommend the use of opioids as first-line treatment for various CNCP. They can be used as second- or third-line treatment, preferably as part of a multimodal approach. Additional studies conducted over extended periods are required. Key words: Chronic pain, Consensus statement, Guidelines, Non-cancer pain, Opioids

Misuse of prescription medicines is as prevalent as the use of recreational drugs and novel psychoactive substances in Singapore: an unrecognised public health issue?

“…Prescription opioids are commonly prescribed both in primary care as well as in the emergency department for pain relief; and, although opioids are not as widely prescribed for non-cancer pain in Singapore, recent studies have shown an increase in opioid use in the country. [ 17 21 22 ] Benzodiazepines are also commonly administered to patients with anxiety or sleep disorders. Studies are required to further characterise the misuse of these drugs in Singapore, including determining the demographics of misusers, doses misused, frequency of misuse and the association of misuse with chronic pain, to further understand the potential risk of opioid and benzodiazepine dependence among high-risk groups of individuals.…”

“…[ 16 ] There have been concerns about increasing use of opioid analgesia in Singapore related to the potential for misuse and addiction; as a result, the Pain Association of Singapore convened a multidisciplinary expert panel in September 2011 to develop practical evidence-based recommendations on the use of opioids for the management of chronic non-cancer pain in Singapore. [ 17 ]…”

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“…Opioids that are commonly prescribed for pain relief include morphine, pethidine, oxycodone, fentanyl, hydromorphone, methadone, tapentadol, and tramadol. 17 There was limited evidence on the use of opioids as first-line treatment of chronic noncancer pain. Instead, opioids are used as a multimodal approach, preferably as second or third line of pain management.…”

“…The aim of the association was to implement evidence-based recommendations on the use of opioids for managing chronic noncancer pain. Opioids that are commonly prescribed for pain relief include morphine, pethidine, oxycodone, fentanyl, hydromorphone, methadone, tapentadol, and tramadol 17. There was limited evidence on the use of opioids as first-line treatment of chronic noncancer pain.…”

“…There was limited evidence on the use of opioids as first-line treatment of chronic noncancer pain. Instead, opioids are used as a multimodal approach, preferably as second or third line of pain management 17…”