Need for a new approach to initiation and reevaluation of LTOT
Conceptualization of LTOT as a long-term analgesic therapy is not
compatible with the recognition of the complexity of opioid relief and
the potential for OICP. Therefore, we offer an alternate perspective and
suggest clinical principles to guide the initiation, continuation,
reevaluation, and discontinuation of LTOT in chronic pain.
Since opioid dependence is unavoidable with LTOT and analgesia is
unlikely to be the primary mechanism of opioid benefit among people with
pain, it is more sensible to approach LTOT as therapeutic induction and
maintenance of adaptive physiological opioid dependence with the goal of
improved function regardless of whether sustained pain
relief is achieved . The basic principles of LTOT initiation,
reevaluation, and treatment of LTOT ineffectiveness based on the above
perspective on LTOT are enumerated in Box 3 and a broader discussion of
the topic is provided below.
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