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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