Narcotics for chronic nonmalignant pain

In an article in CMAJ's rheumatology series, Simon Huang states that “narcotic analgesics should be avoided in patients with chronic musculoskeletal pain.”1 Nothing could be further from the truth.

The general consensus as stated in guidelines on the use of narcotics2 as well as among physicians dealing with chronic pain disorders is that narcotics are almost certainly underutilized in the treatment of chronic musculoskeletal pain. Several studies have confirmed the relatively low risk of the development of drug dependence among these patients, provided they are adequately screened for addiction risk.3^,4 The use of narcotics has improved the level of function and quality of life for many patients with chronic musculoskeletal pain, and elderly patients with arthritis are among the most satisfied clients.

Statements such as this are all too common and result in undertreatment of many chronic pain disorders by primary care physicians. We are now in the same position with respect to chronic nonmalignant pain as were our colleagues 15 years ago when patients with malignancies were often undertreated because of fears of creating drug addicts. Thankfully that situation has changed, and I am confident that in time so will the use of narcotics in the management of chronic musculoskeletal pain.