Chronic non-cancer pain and the long-term efficacy and safety of opioids: Some blind men and an elephant?

JB: this patient has been able to enjoy a good quality of life by suppressing phantom limb pain with opioids for 8 years.

NS: this patient is now able to maintain her weight by the relief of visceral pain provoked by eating by taking morphine before each of six daily meals. She has been on this regimen for 11 years.

WG: this patient developed trigeminal anesthesia dolorosa after a radiofrequency lesion for right sided chronic cluster headache. Area of sensory loss – all of the right trigeminal nerve area (interrupted line). Area of steady pain in maxillary ramus of the right trigeminal nerve (dotted line). Shock-like pain from upper lip area (jagged line). He has been on opioids for 10 years.

RL: this woman has a complex pain condition after a major accident in which her car was hit by a train. She had a history of alcohol and drug abuse, bipolar disorder and was seriously suicidal. In spite of these red flags she was successfully maintained on oxycodone and a fentanyl patch for 18 years.

LB: this woman had extreme dynamic mechanical allodynia after a sternotomy incision for aorto-coronary bypass surgery. Touch of clothing or air blowing on the skin caused severe pain. Note cage protecting her from clothes touching the allodynic skin area. She has been successfully relieved by opioids for 7 years.

AC: this man has been on opioids for 20 years, successfully suppressing severe allodynia in an area of sensory loss at the graft harvest site for aorto-coronary bypass surgery. The area of sensory loss is indicated by the black interrupted line. The area of allodynia is indicated by the red interrupted line.

LE: this patient had a combination of severe migraine treated with a triptan, severe glossopharyngeal neuralgia treated with carbamazepine and microvascular decompression and severe steady neuropathic pain in the maxillary division of the left trigeminal nerve relieved by opioid for 7 years.