Adverse Events of the Long-Term Use of Opioids for Chronic Non-cancer Pain: A Narrative Review.

BACKGROUND: The long-term use of opioids for chronic non-cancer pain (CNCP) has drawn more attention and debate. Although opioids are frequently used to treat chronic pain, their effectiveness and safety over extended periods are still unknown. OBJECTIVES: The purpose of this review is to provide an overview of what is currently known about the adverse events of long-term use of opioids in CNCP. It also delivers patient-centered strategies designed to mitigate these risks. METHODS: We conducted a literature search in PubMed, MEDLINE, EMBASE, and Web of Science databases. Search terms included CNCP, pain pathophysiology, opioid pharmacodynamics, opioid prescribing trends, guidelines for opioid use, and opioid side effects.  Results: Our review highlights that while opioids may provide short-term relief from CNCP, their effectiveness diminishes over time due to the development of opioid tolerance. This tolerance often leads to increased dosages, which can subsequently result in opioid dependence. Additionally, long-term opioid therapy is associated with a spectrum of adverse effects, including constipation, drowsiness, respiratory depression, and potential for drug interactions. Furthermore, our review indicates that alternative pain management strategies play a crucial role in controlling CNCP. They offer significant benefits with fewer adverse events. These strategies include non-opioid medications, physical therapy, cognitive-behavioral therapy (CBT), various interventional procedures, injection therapy, and acupuncture. CONCLUSION: Using opioids to manage CNCP presents several challenges. Given these challenges, alternative treatments are being considered as viable options. Moreover, it is crucial to customize treatment plans to align with the patients' specific health requirements, existing conditions, and potential risks to ensure the best possible outcomes.

Retraction: Giant Unruptured Internal Carotid Artery Aneurysm.

[This retracts the article DOI: 10.7759/cureus.20423.].

Giant Unruptured Internal Carotid Artery Aneurysm.

Headache is among the most frequent symptoms to seek medical care. Careful evaluation by history-taking and appropriate physical examination is needed to exclude the potential secondary causes of headaches. In the elderly population, secondary headaches are more prevalent compared with the younger adult population. We present the case of a 70-year-old man who presented with a three-month history of headache with visual disturbances. He reported that this was the first time he experienced such a headache. The patient had a longstanding history of hypertension, diabetes mellitus, dyslipidemia, and ischemic heart disease. He was a heavy smoker with a 35 pack-years smoking history. In view of the clinical signs and symptoms, the patient underwent a computed tomography scan that revealed a right internal carotid artery aneurysm. For better evaluation, magnetic resonance imaging of the brain was performed and re-demonstrated the saccular aneurysm of the terminal part of the right internal carotid artery aneurysm, measuring 48 x 37 x 31 mm and partially thrombosed with a surrounding mural hematoma. The neck of the aneurysm measured 4 mm. The decision for surgical management was planned. The patient underwent craniotomy with surgical clipping of the aneurysm. No complications occurred during the operation. The patient had an uneventful recovery. Elderly patients with chronic headaches should be carefully evaluated for secondary headaches. A giant cerebral artery aneurysm is an uncommon etiology of secondary headache that needs prompt diagnosis and management.