• Bob Kwok Bun Chan, Lee Ka Tam, Chun Yin Wat, Yu Fai Chung, Siu Lun Tsui, and Chi Wai Cheung.
• The University of Hong Kong, Queen Mary Hospital, Department of Anaesthesiology, Room 424, Block K, 102 Pokfulam Road, Hong Kong, China.
• Expert Opin Pharmacother. 2011 Apr 1;12(5):705-20.

IntroductionThe use of chronic opioid therapy for chronic non-cancer pain is growing and is now accepted as an effective treatment modality.Areas CoveredAlthough there are guidelines and reviews for chronic opioid therapy for chronic non-cancer pain patients, physicians may still have concerns and be reluctant to prescribe strong opioids for chronic non-cancer pain. Common issues and concerns when prescribing opioid for chronic pain management are reviewed and discussed. The literature search was done using Medline with key words 'chronic non-cancer pain', 'chronic opioid therapy', 'effectiveness', 'opioid tolerance', 'opioid-induced hyperalgesia', 'adverse effect', 'opioid dependency', 'addiction', 'monitoring', 'opioid contract' and various combinations with these key words. Studies from 1990 - 2010 have been included. This article helps readers to update, clarify and understand the common concerns when using opioid for chronic non-cancer pain. Clinical effectiveness and adverse effects with chronic opioid therapy, opioid tolerance and opioid-induced hyperalgesia, opioid dependency and addiction, monitoring during chronic opioid use, and opioid contact are discussed in detailed.Expert OpinionNot much strongly positive data supports the long-term use of opioids for pain relief, and the evidence for an improvement in functional activity is inconclusive. With careful selection of patients, meticulous prescription and monitoring protocol, chronic non-cancer pain patients who are likely to benefit from potent opioids should not be prevented from obtaining this treatment.

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