Opioids in the management of persistent non-cancer pain

Opioids can be a useful part of an integrated pain management strategy for selected patients with persistent non-cancer pain, but their use must be carefully considered and appropriate. Recommendations for clinical practice have been produced by several countries, and key themes emerge which encourage responsible prescribing and monitoring. Areas for future research include finding drugs or drug combinations that give maximum efficacy and minimize side effects, such as opioid-induced bowel dysfunction, tolerance and dependence. A balance needs to be achieved, where opioids are not withheld because of fears about problem drugs use, but indiscriminate prescribing is not encouraged.