International Journal of Nursing Studies 39 (2002) 59–69 A pilot study into the problematic use of opioid analgesics in chronic non-cancer pain patients David T. Cowan a, *, Laurie Allan a , Peter Griffiths b a Anaesthetic and Pain Research, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK b Florence Nightingale School of Nursing and Midwifery, Kings College London, Waterloo Road, London SE1 8WA, UK Received 11 July 2000; received in revised form 16 November 2000; accepted 15 December 2000 Abstract Controversy surrounds the use of strong opioid analgesic drugs for chronic non-cancer pain. Specialists have concludedthatfearsofproblematicdruguseareoftenunfounded.Incontrast,othersclaimtheexistenceofsignificant problems.‘Problematic drug use’ includes the following definitions; addiction, abuse, physiological dependence and tolerance.Wepresentacasestudyandtheresultsofapilot,longitudinal,cohortstudy,viaapilotquestionnaire,of22 chronic pain clinic patients following a trial of opioid drugs.The results suggest that chronic non-cancer pain patients canbemaintainedonopioidswithfewproblems,andlikewisecanwithdrawwithminimaladverseeffects,otherthana return of pain. # 2001 Elsevier Science Ltd. All rights reserved. Keywords: Opioid analgesic therapy; Chronic non-cancer pain; Problematic drug use 1. Introduction Thecontroversysurroundingtheuseofstrongopioid analgesic drugs for chronic non-cancer pain has been reiterated by several writers (Halpern and Robinson, 1985,1986,1988;BrenaandSanders,1991;Glynnetal., 1991; Gourlay and Cherry, 1991; Fishbain et al., 1992; Butler, 1994; Hill, 1996; Turk, 1996; Haythornthwaite etal., 1998; Collett, 1998). Opinions fuelling the controversy are largely depen- dent on the perceptions that have evolved within different medical specialities (Savage, 1993; Brena and Sanders, 1991; Gourlay and Cherry, 1991). One side is concerned with the prevention of needless pain, while the other is concerned with the prevention of needless problematic drug use. 1.1. Definitions It is important to point out that there is incomplete agreement and some perceived ‘chaos’ surrounding the terminology used to describe phenomena associated with opioid drug use (American Society of Addiction Medicine (ASAM), 1998; Shaffer, 1997). Thuswewillbrieflydiscustheterminologyusedhere. For the purpose of this study, the term ‘problematic drug use’ is used to describe undesirable behavioural patterns and other unwanted adverse effects associated with strong opioid analgesic drugs. In this context, problematic opioid drug use encompasses the following definitions; physiological dependence, addiction, abuse, tolerance, and other opioid-related side effects. The term ‘problematic drug use’ includes common opioid-related side effects. These comprise of: respira- tory depression, constipation, nausea, vomiting, xeros- toma, headache, and itching skin. Other side effects include dysphoria, somnolence and other mind-altering effects. However, these expected side effects should not be confused with the adverse consequences associated with the definition of addiction. For example mild *Corresponding author. Tel.: +44-20-8869-3410; fax: +44- 20-8869-3415. E-mail address: david.t.cowan@kcl.uk (D.T. Cowan). 0020-7489/01/$-see front matter # 2001 Elsevier Science Ltd. All rights reserved. PII:S0020-7489(01)00003-7