Acute pain is the body’s response to environmental dangers, and it helps protect people from harm. Chronic pain, which is pain that persists beyond normal tissue healing time and serves no physiologic purpose.  Chronic pain negatively affects a patient’s quality of life.  There has been an increased use of opioids for treating conditions like chronic back pain.  However, evidence does not show that long-term opioid use improves functioning in patients with chronic back pain.

Treatment regimens for chronic pain often include both a long-acting and short-acting opioids. The longacting component is used to achieve a baseline level of adequate pain control, while the short-acting component is used on an as needed basis for breakthrough pain or acute worsening of the chronic pain condition.  However, if the SAO is being utilized disproportionately to the LAO, then a regimen adjustment should be considered after determining the cause for the increased utilization. It may be due to an acute event or because the LAO is not achieving an adequate level of baseline pain control.

Opioid therapy should always be individualized to the specific patient.  Currently, there is insufficient evidence to indicate superiority of any particular opioid agent, or to recommend short-acting versus longacting opioids or even around-the-clock dosing versus as needed dosing in all situations. These decisions should be tailored to the patient’s pain severity, medical and social history, previous opioid experiences and other individual factors.