Introduction
Opioid analgesics are commonly prescribed to relieve pain. They range in strength from weak opioids, for example codeine, which is found in the most commonly prescribed opioid preparation co-codamol (a combination of paracetamol and codeine) to strong opioids such as morphine, fentanyl, and oxycodone. Their important role in the management of acute and terminal cancer pain is well established but their benefits have been increasingly challenged in other conditions. In particular, concerns have emerged about their use in chronic non-cancer pain, such as lower back pain, which is estimated to affect 35-51% of adults in the UK1.
Opioid analgesic prescribing in recent decades in England and many other developed countries has increased and has been described as an ‘opioid epidemic’ 2. Concerns about the use of opioid analgesics in chronic pain relate to the lack of evidence of effectiveness 3 and the risk of tolerance, dependence, addiction and side effects, leading to reduced quality of life and increased use of healthcare resources 1,3. Here we report the case of a young man who developed chronic pain after a relatively minor injury, we highlight the problematic aspects of his opioid use and we discuss the best available evidence to guide doctors in treating similar cases.