How can we best manage chronic pain for patients taking long-term narcotic analgesics?
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Tramadol has proven efficacy up to 6 months and less abuse potential than hydrocodone over 1 year. (SOR B, based on randomized controlled trials [RCTs].) Transdermal fentanyl and sustained-release morphine have been proven effective for longer-term use, although constipation is more common with morphine. (SOR A, based on consistent RCTs.) Tricyclic and tetracyclic antidepressants appear to be moderately effective for reduction of chronic back pain. (SOR B, based on a systematic review with heterogeneity.)
Evidence Based Practice 12(7): 09-10.