DEBATE: Do the benefits of opioids outweigh the risks for the treatment of chronic pain?

Affirmative:

Rollin Gallagher,
Professor of Psychiatry, Anesthesiology, and Public Health and Director of Pain Medicine at MCP/Hahnemann University,
Editor-in-chief of Pain Medicine

Joel Hochman
Executive Director,
National Foundation for the Treatment of pain

Negative:

R. Norman Harden
Associate Professor in Physical Medicine and Rehabilitation
Northwestern University
Chicago, IL
Editor in Chief, Journal of Back and Musculoskeletal Rehabilitation

Jon Streltzer
Professor of Psychiatry, John A. Burns School of Medicine, University of Hawaii
Chair, Chronic Pain Task Force, American Academy of Addiction Psychiatry

Chronic nonmalignant pain has many initiating causes including injury to tissue and nerves, diseases causing chronic inflammation, and diseases and treatments causing neuropathies. However, several chronic pain conditions remain enigmatic and subject to various interpretations and theories with respect to etiology and persistence. Serious controversies have arisen with regard to certain diagnoses, the role of psychological factors in inititiating and perpetuating pain, and the effectiveness of chronic opioid treatment. Management of the chronic pain patient with prescription opioids is one of the more difficult and controversial area s of pain management , reflecting both a lack of science and the paucity of interaction between the addiction medicine and pain medicine communities. By presenting opposing viewpoints, this debate will elucidate the science and the art of the use (or misuse) of opioids for chronic pain.