Opioid Therapy for Chronic Pain Management

Introduction to Opioid Therapy

The National Comprehensive Cancer Network recommends that long-acting opioids should be used for around-the-clock pain relief, not on an as-needed basis, for patients with continuous chronic pain requiring daily, long-term opioid therapy 1
The National Comprehensive Cancer Network guidelines state that extended-release formulations are designed to provide baseline analgesia on a fixed schedule, and long-acting dosing should be used for continuous pain relief 1, 2

The American College of Physicians and other organizations imply that extended-release opioids, like OxyContin ER, are reserved for continuous, around-the-clock pain control in patients requiring daily, long-term opioid treatment when alternative options are inadequate 3
Immediate-release opioids are appropriate for intermittent pain with pain-free intervals, administered on an as-needed basis, as recommended by the National Comprehensive Cancer Network 1, 4
Long-acting and extended-release opioids are for use in opioid-tolerant patients only and are not intended for use as an "as-needed" analgesic, according to the American College of Emergency Physicians 5

The National Comprehensive Cancer Network recommends that extended-release opioids should be dosed every 12 hours, never more frequently, to maintain appropriate total daily opioid exposure 1
Increasing the dose amount, rather than the frequency, is recommended if pain control is inadequate, as stated by the CDC and other organizations 6

For breakthrough pain on a 12-hourly ER regimen, the National Comprehensive Cancer Network recommends providing immediate-release oxycodone as rescue medication at 10-20% of the total daily dose, available every 1-2 hours as needed 6, 7
Incident pain, end-of-dose failure pain, and persistent pain should be managed with rescue doses of short-acting opioid, dose adjustments, or increases in dose amount, as recommended by the National Comprehensive Cancer Network 1, 6, 7

The CDC recommends that extended-release/long-acting opioids should be reserved for management of pain severe enough to require daily, around-the-clock, long-term opioid treatment when alternative options are inadequate 3
Clinicians should prescribe immediate-release opioids instead of extended-release/long-acting opioids when starting opioid therapy for chronic pain, according to the CDC and other organizations 3

Time-scheduled opioid use is associated with greater total average daily opioid dosage compared with intermittent, as-needed use, as reported by the Praxis Medical Insights 3