Cited by 284Opioid Use Disorder TreatmentPain Management and Opioid UseAnesthesia and Pain Management

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Use and Misuse of Opioids in Chronic Pain

Volkow, Nora, Benveniste, Helene, McLellan, A. Thomas·2018·Annual Review of Medicine

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Abstract

The prescribing of opioid analgesics for pain management-particularly for management of chronic noncancer pain (CNCP)-has increased more than fourfold in the United States since the mid-1990s. Yet there is mounting evidence that opioids have only limited effectiveness in the management of CNCP, and the increased availability of prescribed opioids has contributed to upsurges in opioid-related addiction cases and overdose deaths. These concerns have led to critical revisiting and modification of prior pain management practices (e.g., guidelines from the Centers for Disease Control and Prevention), but the much-needed changes in clinical practice will be facilitated by a better understanding of the pharmacology and behavioral effects of opioids that underlie both their therapeutic effects (analgesia) and their adverse effects (addiction and overdose). With these goals in mind, this review first presents an overview of the contemporary problems associated with opioid management of CNCP and the related public health issues of opioid diversion, overdose, and addiction. It then discusses the pharmacology underlying the therapeutic and main adverse effects of opioids and its implications for clinical management of CNCP within the framework of recent clinical guidelines for prescribing opioids in the management of CNCP.

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Crossref · 10.1146/annurev-med-011817-044739

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Authors: Volkow, N., Benveniste, H., & McLellan, A. T.
Affiliations: National Institute on Drug Abuse (US)
Yale University (US)
Treatment Research Institute (US)
ORCID: Volkow, Nora
Benveniste, Helene
Venue: Annual Review of Medicine
Publisher: Annual Reviews
Published: 2018-01-29
Volume: 69
Issue: 1
Pages: 451-465
ISSN: 0066-4219 (ISSN-L)
1545-326X
DOI: 10.1146/annurev-med-011817-044739
OpenAlex: W2587222353
Cited by: 279
References: 84
Citations by year: 2026: 14 · 2025: 28 · 2024: 40 · 2023: 30 · 2022: 38 · 2021: 44 · 2020: 27 · 2019: 40 · 2018: 17
FWCI: 3.73
Type: journal article
Language: en
Open access: closed
Locations: Annual Review of Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
Keywords: opioids, chronic non-cancer pain, opioid prescribing, opioid use disorder, opioid overdose, opioid diversion, opioid pharmacology, opioid side effects, opioid analgesia, pain management
MeSH terms: Analgesics, Opioid, Humans, Opioid-Related Disorders, Chronic Pain, Pain Management, Drug Overdose, Prescription Drug Misuse, Prescription Drug Diversion

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Use and Misuse of Opioids in Chronic Pain

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