Strategies to optimize pain management with opioids while minimizing risk of abuse.

More than 75 million Americans have chronic or recurring pain [1]. Such pain negatively impacts emotional and mental health, quality of life, and productivity and increases the use of health care resources [1-5]. Prescription opioids are widely used and may be effective analgesics for chronic, moderate-to-severe pain in appropriately selected patients, particularly when used as part of comprehensive pain management plans [4,6]. The increased use of prescription opioids over the last decade has been mirrored in an increase in the reported misuse, abuse, and diversion of these agents. Physician reluctance to initiate opioid therapy may lead to undertreatment of pain [7,8]. Clinicians can implement procedures such as careful patient screening and ongoing monitoring to ensure that risk of opioid abuse is minimized without interfering with the appropriate use for patients with legitimate chronic noncancer pain. Efforts are being made nationally, statewide, and locally to inform and educate medical professionals, policymakers, the public health community, and patients concerning the benefits and risks of opioid therapy for chronic pain. Monitoring programs are currently being adopted to document and discourage misuse, abuse, and diversion of prescription opioids. The US Food and Drug Administration recently initiated hearings to examine a potential change in the government's risk management plan, Risk Evaluation and Mitigation Strategies [9], which could dramatically change the development, release, marketing, and prescription of extended-release opioids. Pharmaceutical companies have remained active in developing products that are potentially less attractive for abuse. The challenge of balancing the availability of prescription opioids to treat patients who have pain while discouraging illicit use is complex, requiring effective efforts on many levels.