Skip to Main Content




Over the last decade, chronic opioid use has garnered support for the treatment of terminal cancer pain. It also has been prescribed for noncancer pain. However, chronic opioid therapy (COT) is not without risk, or as one might expect, without controversy. Numerous potential ramifications exist, including maintaining nontoxic therapeutic levels that enhance livelihood, minimizing adverse effects, avoiding illicit diversion and abuse, and prescribing within the legal boundaries. Should aberrant use become a problem or if treatment endpoints are not met, alternatives to COT need to be sought for pain management.




The end goal of COT is to improve the functionality of the patient by allowing better daily control of the chronic pain. There are multiple routes of administration of COT that make this possible, including oral, sublingual, buccal, intranasal, transdermal, intramuscular, intrathecal, and, rarely, intravenous. The route selected should best suit the patient’s comorbidities. For example, a patient with oral cancer would likely be a better candidate for the transdermal rather than oral route. There are a multitude of therapeutic options for chronic opioid therapy (Table 30-1).

Table Graphic Jump Location
TABLE 30-1Therapeutic Options for Chronic Opioid Therapy

Physicians should consider using COT with the aim of providing safe, steady levels of analgesic and minimizing the peaks and troughs that can be associated with worsening pain or side effects. Common adverse effects of opioids include nausea, constipation, sedation, pruritus, and respiratory depression. Notably, constipation is often resistant to tolerance. Other side effects of opioids include urinary retention, decreased lower esophageal sphincter tone, increased tone at the sphincter of Oddi, decreased gastric motility, and decreased pancreatic and gastric secretions.


While side effects may limit successful COT, another feared adverse ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


Create a Free MyAccess Profile

* Required Fields

Note: If you have registered for a MyAccess profile on any of the Access sites, you can use the same MyAccess login credentials across all sites.

Passwords must be between 6 and 40 characters long (no whitespace), cannot contain characters #, &, and must contain:
  • at least one lowercase letter
  • at least one uppercase letter
  • at least one digit

Benefits of a MyAccess Profile:

  • Remote access to the site off-campus on any device
  • Notification of new content via custom alerts
  • Bookmark your favorite content such as chapters, figures, tables, videos, cases and more
  • Save and download images to PowerPoint
  • Self-Assessment quizzes saved for quick review
  • Custom Curriculum access for both instructors and learners

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.