[Oral opioids for long-term treatment of chronic non-cancer pain].

The treatment of cancer pain with opioids is well accepted. However, the use of opioids for the treatment of non-cancer pain is still a matter of controversy. The main matters of concern are physical dependence and opioid abuse. Another argument against opioids is the lack of efficacy. Experiences with opioids in non-cancer pain have been published on about 850 patients, the longest therapy lasting almost 14 years. 85% of the patients treated with opioids had beneficial effects. In a number of investigations evaluating the opioid sensibility of pain by PCA and intravenous infusions, 67-80% of the patients with neuropathic pain responded to opioids. The efficacy of opioids in the treatment of non-cancer pain was proven in 3 placebo controlled studies. In 2 studies pain reduction in neuropathic pain was similar to that in nociceptive pain. When opioids are used, the administration has to be performed according to well defined standards. The indication for opioids must be made by a specialist in pain management. The diagnosis must clearly reveal an organic origin of the pain. Before the start of therapy the duration as well as the criteria for discontinuation must be set up. The treatment must be controlled by a specialist team and frequent regular follow up investigations must be performed. These must include proper documentation of the pain level, changes in patients' function and in social activities. The reliable intake of prescribed medication must be assured if necessary by laboratory screening. The treatment of non-cancer pain with opioids may be an alternative for those patients, who didn't gain sufficient reduction of pain by other therapies. Standards for this therapy are an absolute necessity and are to be followed closely.