Pain Management

Physicians and Opioids

There are several factors that contributed to the initial reluctance of the medical community in prescribing opioids for chronic pain. Up until the 1940s, the use of opioids was not considered illegal. However, due to the growing number of street users and the increased dangers of using opioids such as morphine and heroin, restrictions were put on the use of opioids for the general population. Opioid use was only considered legal if it was prescribed by a physician. However, the risk of losing one's medical license if opioids were misused decreased the probability that opioids would be prescribed. The additional risk was facing possible legal and criminal repercussions for inappropriate use. Another factor contributing to physician reluctance to prescribe opioids for pain relates to the limited information that was available on the efficacy of opioids. Physician perceptions of opioid use were largely based on the experience of treating street users, where addiction and the manifestations of addiction were the norm. The belief that anyone using opioids would manifest this stereotype prevented the prescription of these substances. Unfortunately, at the time, the combination of these factors led to the undertreatment of pain.

Current Use of Opioids

Research on opioid use has significantly increased in the past 20 years. As a result, new information provides evidence that opioids can be effective in treating chronic pain. The general consensus of clinical studies indicates that opioid use in low and stable dosages can provide effective relief from chronic pain and improve overall functioning. As a result, the medical community is becoming more accepting of the use of opioids to provide relief if the dosage and effects of these substances are being monitored. Although limited research is currently available for the efficacy of long-term, high dose use of opioids, it appears that monitored and regulated increases by a physician have the best outcomes. Some studies indicate that increasing [Page 678]the dosage of opioids too much, too soon can have an adverse effect on patients, including a reduction of pain relief and functioning.

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