Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Initiating Chronic Opioid Therapy

J Pain; ePub 2016 Dec 2; Callinan, Neuman, et al

Chronic opioid therapy (>90 days) was prescribed for patients most often following surgery, for pain, and by primary physicians, although many patients initiated opioids without a clear treatment plan or opioid agreement, a recent study found. The study included 115 patients receiving chronic opioid therapy and examined how the therapy was started. Researchers found:

  • Chronic opioids were started following surgery (27%), or for the treatment of acute injury-related pain (27%).
  • 58.1% of patients with injury-related pain reported follow-up corrective surgery, which led to a continuation of opioids.
  • Surgeons (30%), pain (29%), and primary care physicians (21%) were the prescribers.
  • 24% of patients were taking opioids for a different indication than the initiating reason.


Callinan CE, Neuman MD, Lacy KE, Gabison C, Ashburn MA. The initiation of chronic opioids: a survey of chronic pain patients characterizing chronic opioid use. [Published online ahead of print December 2, 2016]. J Pain. doi:10.1016/j.jpain.2016.11.001.


It is not surprising that most patients who are on chronic opioid therapy had started for some acute reason, most commonly after an acute injury or after surgery. The challenge occurs when trying to stop opioids for the sub-group of patients who continue to have pain that persists beyond the acute period. In that group it is challenging but important to try to distinguish ongoing pain from early physical addiction. This study reminds us that chronic use starts somewhere, often with well-intentioned prescriptions by primary care physicians, and that limiting the duration of use after an acute injury is well advised. Neil Skolnik, MD