Chronic opioid therapy for chronic noncancer pain in the United States: Long Day's Journey into Night?

Abstract

Since 1980, use of chronic opioid therapy (COT) for chronic noncancer pain (CNCP) has approximately doubled every 10 years. This increase is a result of at least two factors. First, in the 1980s, efforts were made to liberalize use of opioids for CNCP, with much of the impetus for these liberalization efforts coming from prior successful opioid initiatives for patients with cancer pain. Unfortunately, these efforts to liberalize opioids for CNCP were based primarily on clinical consensus, not evidence. Second, in the 1990s, and continuing to the present, there has been a push to formally include pain as the “fifth vital sign.” Today, many healthcare organizations, including the VA, the nation's largest healthcare provider, have adopted the practice of pain as the “fifth vital sign,” resulting in increased recognition of CNCP. This increased recognition of pain, which is good, has inevitably also led to increases in COT, which may or may not be good.