The document discusses issues around balancing the risks and benefits of opioid use for pain management. It notes that while opioids carry risks like addiction and side effects, untreated pain also has physiological, psychological and immunological impacts that can impair quality of life. The document reviews guidelines from organizations that advocate for the safe and effective use of opioids to treat acute, cancer and chronic pain when non-opioid options are insufficient.

1. Opioid Risk:Benefit Issues U.S. Food and Drug Administration Anesthetic and Life Support Drugs Advisory Committee Bethesda MD September 9. 2003 Arthur G. Lipman, PharmD Professor of Pharmacotherapy, College of Pharmacy Director of Clinical Pharmacology, Pain Management Center Pain Medicine & Palliative Care Advisory Group, Huntsman Cancer Institute Investigator, Pharmacotherapy Outcomes Research and Pain Research Centers University of Utah Health Sciences Center Editor, Journal of Pharmaceutical Care in Pain & Symptom Control Salt Lake City, Utah

3. U.S. News & World Report March 17, 1997 Old Thinking New Science

4. AHCPR Clinical Practice Guideline Full Guideline Available in searchable format on the WWW at www.ahrq.gov 1992

5. AHCPR Clinical Practice Guideline Full Guideline Available in searchable format on the WWW at www.ahrq.gov 1994

6. Released March 15, 2002 American Pain Society Clinical Practice Guideline Available through the American Pain Society Website www.ampainsoc.org

7. Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain Fifth Edition, 2003 Available from American Pain Society 4700 West Lake Avenue Glenview IL 60025-1485 Phone: 847 375-4715 Fax: 847 375-6315 E-mail: info@ampainsoc.org Web Site:www.ampainsoc.org

11. Correlation of of Pain Intensity and Impact Activities Impaired by Increasing Pain on a Pain intensity Scale of 1-10 Relate Walk Walk Sleep Sleep Sleep Active Active Active Active Mood Mood Mood Mood Work Work Work Work Work Enjoy Enjoy Enjoy Enjoy Enjoy Enjoy 3 4 5 6 7 8 >>>>> >>>>> >>> Worst Pain Rating >>> >>>>> >>>>> Cleeland CS, Ryan KM. Ann Acad Med Singapore. 1994;23:129-138.

22. Diamorphine Use: 62 YO Man with Lung Cancer Twycross, RG. Int J Clin Pharmacol 9:184-98

29. Methadone Biphasic Elimination Lipman AG. Oncology. 1999;13:(9):1275-82 Therapeutic window Therapeutic window Analgesic onset ~ 1 h Analgesic offset ~ 8 h

30. Plot of Methadone Accumulation (dosed q 8 h over 6 days) Lipman AG. Oncology. 1999;13:(9):1275-82

35. All this needless pain and suffering impoverishes the quality of life of those afflicted and their families; it may even shorten life by impairing recovery from surgery or disease. People suffering severe or unrelenting pain become depressed. They may lose their will to live and fail to take normal health preserving measures; some commit suicide. Liebeskind J, Melzack R. Pain 1987;30:1