Volume 195 - Issue 9
Should opioids be used for chronic non-cancer pain?
Authors: Dilip Kapur, Phillip B Cornish, Carol A Snellgrove and David A Cherry
Med J Aust 2011; 195 (9): 513-514. || doi: 10.5694/mja11.11127
Published online: 7 November 2011
Published online: 7 November 2011
To the Editor: We write in response to the letter by Awerbuch1 and agree with many of his points. He has raised an interesting issue regarding the assertion that chronic pain is itself a disease,2 suggesting it would then logically follow that the patient becomes the final arbiter of whether he or she has the “disease” and hence which treatment may or may not be appropriate.
A disquieting development in this regard is the recent Declaration of Montréal, produced at the International Pain Summit of the International Association for the Study of Pain in September 2010.3 This declaration states that access to pain management should be considered a fundamental human right. The position of diagnosis is uncertain, and the only specific treatment modality mentioned is opioid therapy.
While we are sure that the Declaration is noble in intent, where does it place a clinician who has concerns about prescribing opioids to a patient who demands them? It adds the legal threat of a breach of human rights if the patient is disaffected with a doctor’s decision on opioid prescribing.
As Awerbuch and others4,5 have stated, the public health consequences of prescribed opioids are not trivial. Assessing the appropriate circumstances for their use requires an understanding of clinical evidence and due care, not dogma, moral coercion or forays into jurisprudence.
Competing interests
No relevant disclosures.
References
- Awerbuch MS. Should opioids be used for chronic non-cancer pain [letter]? Med J Aust 2011; 195: 264-265. 0_i1142867
- Siddall PJ, Cousins MJ. Persistent pain as a disease entity: implications for clinical management. Anesth Analg 2004; 99: 510-520. 0_i1142869
- International Association for the Study of Pain. Declaration of Montréal. Declaration that access to pain management is a fundamental human right. Approved October 2010. http://www.iasp-pain.org/Content/NavigationMenu/Advocacy/DeclarationofMontr233al/default.htm (accessed Sep 2011).
- Hall WD, Farrell MP. Minimising the misuse of oxycodone and other pharmaceutical opioids in Australia [editorial]. Med J Aust 2011; 195: 248-249. 0_i1142873
- Okie S. A flood of opioids, a rising tide of deaths. N Engl J Med 2010; 363: 1981-1985. 0_i1142876