The fact that you are worried about potential abuse and addiction is a good sign. Physicians are also concerned about potential serious adverse effects of narcotic (opioid) medications. That's why they rely on guidelines for the long-term use of opioid therapy. The target patients are those like yourself who have chronic noncancer pain (CNCP).
Recent studies have shown that although concerns about opioid use are important, it's also true that most patients are able to take these medications without problems. This information has helped open up the use of opioids for chronic pain patients who might otherwise suffer needlessly.
There are several tools doctors use in assessing and monitoring patients taking these potentially addictive medications. The first is the Screener and Opioid Assessment for Patients with Pain (SOAPP). This brief questionnaire helps physicians determine how much monitoring a patient might need who is on long-term opioid therapy.
The second is the Opioid Risk Tool (ORT). Five measures are used to determine a low, moderate, or high risk of problems using opioids. Factors such as personal and family history of substance use, age, history of sexual abuse, and psychological disease contribute to the risk of opioid abuse or misuse.
Once it looks like you are a good candidate for opioid therapy, then it's important for the physician to monitor pain management. There are several monitoring tools available to help with this. These tools help the physician determine the risk-to-benefit ratio for each patient. In other words, do the benefits outweigh the risks enough to continue with the drug?
The Pain Assessment and Documentation Tool (PADT) keeps track of pain relief, activity level, and adverse effects of the medications. This checklist also helps the physician (or other health care professional) observe and make note of any potential drug-related behavior.
Another similar monitoring tool is the Current Opioid Misuse Measure (COMM). The COMM is a quick and easy patient self-assessment tool. Patients can still fudge their answers on this survey if they choose to do so. It is designed to be used to see if changes in the treatment plan are needed but it does require the patient's honesty.
Pain management with chronic opioid therapy (COT) requires patient participation and responsibility. Patients must understand that COT rarely provides total pain relief. And it's only one part of a total pain management plan that also includes diet, exercise, behavioral counseling, and stress management.
If you follow your doctor's recommendations, notify him or her of any side effects, and keep all of your follow-up appointments, you are likely to be one of the many patients who have a safe and effective experience with these medications.
Roger Chou, et al. Opioid Treatment Guidelines. In The Journal of Pain. February 2009. Vol. 10. No. 2. Pp. 113-130.'