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.