Editing Opioid (section)

====Chronic non-cancer pain====
Guidelines have suggested that the risk of opioids is likely greater than their benefits when used for most non-cancer chronic conditions including [[headaches]], [[back pain]], and [[fibromyalgia]].<ref>{{cite journal | vauthors = Franklin GM | title = Opioids for chronic noncancer pain: a position paper of the American Academy of Neurology | journal = Neurology | volume = 83 | issue = 14 | pages = 1277–84 | date = September 2014 | pmid = 25267983 | doi = 10.1212/WNL.0000000000000839 | doi-access = free }}</ref> Thus they should be used cautiously in chronic non-cancer pain.<ref name="Okie S (2010)">{{cite journal | vauthors = Okie S | title = A flood of opioids, a rising tide of deaths | journal = The New England Journal of Medicine | volume = 363 | issue = 21 | pages = 1981–5 | date = November 2010 | pmid = 21083382 | doi = 10.1056/NEJMp1011512 | s2cid = 7092234 | doi-access = free }}<br />Responses to Okie's perspective: {{cite journal | vauthors = Rich JD, Green TC, McKenzie MS | title = Opioids and deaths | journal = The New England Journal of Medicine | volume = 364 | issue = 7 | pages = 686–687 | date = February 2011 | pmid = 21323559 | doi = 10.1056/NEJMc1014490 | pmc = 10347760 }}</ref> If used the benefits and harms should be reassessed at least every three months.<ref name="auto">{{cite journal | vauthors = Dowell D, Haegerich TM, Chou R | title = CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016 | journal = JAMA | volume = 315 | issue = 15 | pages = 1624–45 | date = April 2016 | pmid = 26977696 | pmc = 6390846 | doi = 10.1001/jama.2016.1464 }}</ref>

In treating chronic pain, opioids are an option to be tried after other less risky pain relievers have been considered, including [[paracetamol]] or NSAIDs like [[ibuprofen]] or [[naproxen]].<ref name="pmid32110089">{{Cite journal |last1=Yang |first1=Juan |last2=Bauer |first2=Brent A |last3=Wahner-Roedler |first3=Dietlind L |last4=Chon |first4=Tony Y |last5=Xiao |first5=Lizu |date=17 February 2020 |title=The Modified WHO Analgesic Ladder: Is It Appropriate for Chronic Non-Cancer Pain? |journal=[[Journal of Pain Research]] |volume=13 |pages=411–417 |doi=10.2147/JPR.S244173 |pmc=7038776 |pmid=32110089 |doi-access=free }}</ref> Some types of chronic pain, including the pain caused by [[fibromyalgia]] or [[migraine]], are preferentially treated with drugs other than opioids.<ref name="AANfive">For information on the use and overuse of opioids to treat migraines, see {{Citation |author1 = American Academy of Neurology |author1-link = American Academy of Neurology |date = February 2013 |title = Five Things Physicians and Patients Should Question |publisher = American Academy of Neurology |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-neurology/ |access-date = 1 August 2013 |archive-date = 1 September 2013 |archive-url = https://web.archive.org/web/20130901115555/http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-neurology/ |url-status = live }}, which cites
* {{cite journal | vauthors = Silberstein SD | title = Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology | journal = Neurology | volume = 55 | issue = 6 | pages = 754–62 | date = September 2000 | pmid = 10993991 | doi = 10.1212/WNL.55.6.754 | doi-access = free }}
* {{cite journal | vauthors = Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, Sándor PS | title = EFNS guideline on the drug treatment of migraine--revised report of an EFNS task force | journal = European Journal of Neurology | volume = 16 | issue = 9 | pages = 968–81 | date = September 2009 | pmid = 19708964 | doi = 10.1111/j.1468-1331.2009.02748.x | author8 = European Federation of Neurological Societies | s2cid = 9204782 | doi-access = free }}
* {{Citation |author=Institute for Clinical Systems Improvement |year=2011 |title=Headache, Diagnosis and Treatment of |publisher=Institute for Clinical Systems Improvement |url=https://www.icsi.org/guidelines__more/catalog_guidelines_and_more/catalog_guidelines/catalog_neurological_guidelines/headache/ |ref=none |access-date=18 December 2013 |archive-url=https://web.archive.org/web/20131029201313/https://www.icsi.org/guidelines__more/catalog_guidelines_and_more/catalog_guidelines/catalog_neurological_guidelines/headache/ |archive-date=29 October 2013 |url-status=dead }}</ref><ref>{{cite journal | vauthors = Painter JT, Crofford LJ | title = Chronic opioid use in fibromyalgia syndrome: a clinical review | journal = Journal of Clinical Rheumatology | volume = 19 | issue = 2 | pages = 72–7 | date = March 2013 | pmid = 23364665 | doi = 10.1097/RHU.0b013e3182863447 }}</ref> The efficacy of using opioids to lessen chronic [[neuropathic pain]] is uncertain.<ref name="pmid23986501">{{cite journal | vauthors = McNicol ED, Midbari A, Eisenberg E | title = Opioids for neuropathic pain | journal = The Cochrane Database of Systematic Reviews | volume = 8 | issue = 8 | pages = CD006146 | date = August 2013 | pmid = 23986501 | pmc = 6353125 | doi = 10.1002/14651858.CD006146.pub2 }}</ref>

Opioids are contraindicated as a first-line treatment for headache because they impair alertness, bring risk of dependence, and increase the risk that episodic headaches will become chronic.<ref name="AHSfive">{{Citation |author1 = American Headache Society |author1-link = American Academy of Dermatology |date = September 2013 |title = Five Things Physicians and Patients Should Question |publisher = [[American Headache Society]] |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url = http://www.choosingwisely.org/doctor-patient-lists/american-headache-society/ |access-date = 10 December 2013 |url-status = dead |archive-url = https://web.archive.org/web/20131203001051/http://www.choosingwisely.org/doctor-patient-lists/american-headache-society/ |archive-date = 3 December 2013 |df = dmy-all }}, which cites
* {{cite journal | vauthors = Bigal ME, Lipton RB | title = Excessive opioid use and the development of chronic migraine | journal = Pain | volume = 142 | issue = 3 | pages = 179–82 | date = April 2009 | pmid = 19232469 | doi = 10.1016/j.pain.2009.01.013 | s2cid = 27949021 }}
* {{cite journal | vauthors = Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton RB | title = Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study | journal = Headache | volume = 48 | issue = 8 | pages = 1157–68 | date = September 2008 | pmid = 18808500 | doi = 10.1111/j.1526-4610.2008.01217.x | doi-access = free }}
* {{cite journal | vauthors = Scher AI, Stewart WF, Ricci JA, Lipton RB | title = Factors associated with the onset and remission of chronic daily headache in a population-based study | journal = Pain | volume = 106 | issue = 1–2 | pages = 81–9 | date = November 2003 | pmid = 14581114 | doi = 10.1016/S0304-3959(03)00293-8 | s2cid = 29000302 | url = https://zenodo.org/record/1260009 }}<!--https://zenodo.org/record/1260009-->
* {{cite journal | vauthors = Katsarava Z, Schneeweiss S, Kurth T, Kroener U, Fritsche G, Eikermann A, Diener HC, Limmroth V | title = Incidence and predictors for chronicity of headache in patients with episodic migraine | journal = Neurology | volume = 62 | issue = 5 | pages = 788–90 | date = March 2004 | pmid = 15007133 | doi = 10.1212/01.WNL.0000113747.18760.D2 | s2cid = 20759425 }}</ref> Opioids can also cause heightened sensitivity to headache pain.<ref name="AHSfive"/> When other treatments fail or are unavailable, opioids may be appropriate for treating headache if the patient can be monitored to prevent the development of chronic headache.<ref name="AHSfive"/>

Opioids are being used more frequently in the management of non-malignant [[chronic pain]].<ref>{{cite journal | vauthors = Manchikanti L, Helm S, Fellows B, Janata JW, Pampati V, Grider JS, Boswell MV | title = Opioid epidemic in the United States | journal = Pain Physician | volume = 15 | issue = 3 Suppl | pages = ES9-38 | date = July 2012 | doi = 10.36076/ppj.2012/15/ES9 | pmid = 22786464 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Chou R, Ballantyne JC, Fanciullo GJ, Fine PG, Miaskowski C | title = Research gaps on use of opioids for chronic noncancer pain: findings from a review of the evidence for an American Pain Society and American Academy of Pain Medicine clinical practice guideline | journal = The Journal of Pain | volume = 10 | issue = 2 | pages = 147–59 | date = February 2009 | pmid = 19187891 | doi = 10.1016/j.jpain.2008.10.007 | doi-access = free }}</ref><ref>{{cite web |url=http://www.painjournalonline.com/article/S0304-3959(06)00316-2/abstract |title=PAIN |publisher=Painjournalonline.com |date=1 September 2015 |access-date=7 January 2016 |archive-date=6 August 2020 |archive-url=https://web.archive.org/web/20200806025801/http://journals.lww.com/pain/pages/default.aspx |url-status=live }}</ref> This practice has now led to a new and growing problem with addiction and misuse of opioids.<ref name="Okie S (2010)"/><ref>{{cite journal | vauthors = Kissin I | title = Long-term opioid treatment of chronic nonmalignant pain: unproven efficacy and neglected safety? | journal = Journal of Pain Research | volume = 6 | pages = 513–29 | date = 28 September 2015 | pmid = 23874119 | pmc = 3712997 | doi = 10.2147/JPR.S47182 | doi-access = free }}</ref> Because of various negative effects the use of opioids for long-term management of chronic pain is not indicated unless other less risky pain relievers have been found ineffective. Chronic pain which occurs only periodically, such as that from [[nerve pain]], [[migraines]], and [[fibromyalgia]], frequently is better treated with medications other than opioids.<ref name="AANfive" /> [[Paracetamol]] and [[nonsteroidal anti-inflammatory drug]]s including [[ibuprofen]] and [[naproxen]] are considered safer alternatives.<ref>{{cite journal | vauthors = Dhalla IA, Gomes T, Mamdani MM, Juurlink DN | title = Opioids versus nonsteroidal anti-inflammatory drugs in noncancer pain | journal = Canadian Family Physician | volume = 58 | issue = 1 | pages = 30 | date = January 2012 | pmid = 22267615 | pmc = 3264005 }}</ref> They are frequently used combined with opioids, such as paracetamol combined with [[oxycodone]] ([[Oxycodone/paracetamol|Percocet]]) and ibuprofen combined with [[hydrocodone]] ([[Hydrocodone/ibuprofen|Vicoprofen]]), which [[Synergy|boosts the pain relief]] but is also intended to deter recreational use.<ref>{{cite journal | vauthors = Marret E, Beloeil H, Lejus C | title = [What are the benefits and risk of non-opioid analgesics combined with postoperative opioids?] | journal = Annales Françaises d'Anesthésie et de Réanimation | volume = 28 | issue = 3 | pages = e135-51 | date = March 2009 | pmid = 19304445 | doi = 10.1016/j.annfar.2009.01.006 }}</ref><ref>{{cite journal | vauthors = Franceschi F, Iacomini P, Marsiliani D, Cordischi C, Antonini EF, Alesi A, Giacobelli D, Zuccalà G | title = Safety and efficacy of the combination acetaminophen-codeine in the treatment of pain of different origin | journal = European Review for Medical and Pharmacological Sciences | volume = 17 | issue = 16 | pages = 2129–35 | date = August 2013 | pmid = 23893177 | url = http://www.europeanreview.org/wp/wp-content/uploads/2129-2135.pdf | access-date = 26 February 2016 | archive-date = 26 October 2020 | archive-url = https://web.archive.org/web/20201026093553/http://www.europeanreview.org/wp/wp-content/uploads/2129-2135.pdf | url-status = live }}</ref>