This issue was debated at the 2015 Annual Meeting of the American Academy of Neurology. Clearly, it is an important issue. Chronic painaffects 100 million adults in the United States; overdose deaths from prescription painkillers increased 4 times over 10 years; there are more than 140,000 deaths, hundreds of thousands of overdose admissions; and there are millions of people addicted and / or dependent upon opioids. So-called “opioid use disorder” is seen in about 30% of people on chronic opioids.

These are frightening statistics. What should neurologists do when faced with patients who suffer from intractable pain? There is no consensus, but my personal view is that a case can be made for using opioids to treat “neuropathic pain” such as from painful diabetic neuropathy or lumbar radiculopathies (sciatica) but not for headaches.

Jack Florin, MD

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