The Right Dose of Opioid Analgesics for Chronic Pain

Doctors often hesitate to prescribe morphine-based painkillers for patients with chronic pain. In this review article, Dr. J. Schneider, a pain specialist, offers suggestions on when and how to use opioid analgesics.

Dr. Schneider offers physicians the following tips:

  • Give the patient a low dose to start and gradually increase dosage until pain relief occurs.
  • To help the patient avoid constipation, advise activity and fluids and prescribe a stool softener.
  • Check testosterone levels in men taking moderate to high doses of these drugs. Testosterone replacement may be needed to avoid osteoporosis, loss of muscle strength, and decreased sex drive.
  • Remind patients to avoid taking these drugs and drinking or driving at the same time.
  • Patients who have taken opioid analgesics for more than a few days develop a physical dependency on the drug. Dependency is not the same as addiction. Dependency means that without it, withdrawal symptoms occur. Stopping use of the medicine must be done slowly.
  • The physician must be aware that drug seeking behavior may be a sign that the patient's pain is not being managed properly. The patient may need a higher dose or a different pain reliever.
  • Close supervision is a good idea. The physician should assess pain control and look for adverse side effects including signs of drug addiction.

    There is no one right dose of opioid analgesics. Each patient has his or her own best dosage for pain relief. Starting out low and building up to the needed amount is the best way to avoid sedation or tolerance. The right dose gives pain relief without unacceptable side effects.

    Jennifer P. Schneider, MD, PhD. Rational Use of Opioid Analgesics in Chronic Musculoskeletal Pain. In The Journal of Musculoskeletal Medicine. March 2006. Vol. 23. No. 3. Pp. 145-153.

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