This recommendation is based on a review of the literature on substance abuse and chronic pain. Careful patient evaluation before and during treatment of nonmalignant pain with opioids is highly recommended.
Many clinicians think that opioids are inappropriate therapy for chronic nonmalignant pain.
Physical dependence is not the same as addiction. The definition for addiction needs to include loss of control, compulsive use, and continued use in spite of harm. Epidemiologic studies show a low risk of addiction to opioids taken by patients with no history of substance abuse. This survey included patients given an opioid for at least four months in a hospital setting. The Perry and Heidrich survey on 10,000 burn center patients, treated with opioids, failed to identify any patients as substance abusers.