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Opioids for Pain Management



The 2024 Global Year will examine what is known about sex and gender differences in pain perception and modulation and address sex-and gender-related disparities in both the research and treatment of pain.

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February 2018

Opioids are indispensable for the treatment of severe short-lived pain during acute painful events and at the end of life (e.g., pain associated with cancer). Currently, no other oral medication offers immediate and effective relief of severe pain. Although opioids can be highly addictive, opioid addiction rarely emerges when opioids are used for short-term treatment of pain, except among a few highly susceptible individuals. For these reasons, IASP supports the use and availability of opioids at all ages for the relief of severe pain during short-lived painful events and at the end of life. IASP’s 2010 Declaration of Montreal states that access to pain management is a fundamental human right. In some cases, there is no substitute for opioids in achieving satisfactory pain relief.

Despite this stated value of opioids, the role of opioids in the treatment of chronic pain has come into question. Recent open-ended and indiscriminate long-term prescribing of opioids in the United States and Canada has led to high rates of prescription opioid abuse, unacceptable death rates, and an enormous burden to the affected societies. This burden has been a consequence largely of opioid prescribing for the treatment of chronic pain, where long-term effectiveness is uncertain and where harms, especially for high doses, are clear and strongly supported by cautionary data from the affected countries. Such harms include, but are not limited to, addiction and death. Increased prescribing for chronic pain is occurring in some other developed nations, while the developing world continues to struggle with lack of opioid availability for appropriate indications.

IASP strongly advocates for access to opioids for the humane treatment of severe short-lived pain, using reasonable precautions to avoid misuse, diversion, and other adverse outcomes. At the same time, IASP recommends caution when prescribing opioids for chronic pain. There may be a role for medium-term, low-dose opioid therapy in carefully selected patients with chronic pain who can be managed in a monitored setting. However, with continuous longer-term use, tolerance, dependence, and other neuroadaptations compromise both efficacy and safety. Chronic pain treatment strategies that focus on improving the quality of life, especially those integrating behavioral and physical treatments, are preferred. IASP also strongly advocates for continued research to identify ways to minimize opioid risk and find effective alternatives to opioids for the treatment of various pain problems.


  1. This statement is based on best available evidence and expert opinion. See References below.
  2. IASP recommends adherence to and promotion of local opioid prescribing guidelines, with special attention to assessing the supportive evidence with appropriate scientific rigor.
  3. IASP recognizes the importance of comprehensive educational efforts to teach safe and appropriate opioid use.


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IASP Presidential Task Force on Opioids

Jane C. Ballantyne, MD, FRCA (United States)
Task Force Chair
Professor, Anesthesiology and Pain Medicine
University of Washington School of Medicine
Seattle, Washington, USA

Sushma Bhatnagar, MD, MSc (India)*
Professor and Head, Department of Onco-Anaesthesia and Palliative Medicine
All India Institute of Medical Sciences
New Delhi, India

Fiona Blyth, PhD, MBBS (Australia)
Professor of Public Health and Pain Medicine
University of Sydney Medical School
Sydney, Australia

Mary Cardosa, MBBS (Malaysia)*
Consultant Anesthesiologist and Pain Specialist
Hospital Selayang, Selangor, Malaysia
Head, Pain Management Subspecialty, Anesthesiology Program
Ministry of Health, Malaysia

Allen Finley, MD, FRCPC (Canada)*
Professor of Anesthesia & Psychology, Dalhousie University
Dr. Stewart Wenning Chair in Pediatric Pain Management and Director, Centre for Pediatric Pain Research
IWK Health Centre, Halifax, NS, Canada

Andrea Furlan, PhD (Canada)
Associate Professor, Department of Medicine
University of Toronto
Staff Physician and Senior Scientist at the Toronto Rehabilitation Institute
Toronto, Canada

João Batista Garcia, MD, PhD (Brazil)*
Anesthesiologist & Professor, Federal University of Maranhão (UFMA)
São Luís, Brazil

Cynthia R. Goh, MBBS, PhD (Singapore)
Associate Professor, Division of Palliative Medicine
National Cancer Centre Singapore

Eija Kalso, MD, DMedSci (Finland)
Professor of Pain Research and Management, University of Helsinki
Director of the Multidisciplinary Pain Clinic, Department of Anaesthesia and Intensive Care Medicine
Helsinki University Central Hospital
Helsinki, Finland

Claudia Sommer, MD (Germany)*
Professor of Neurology, Department of Neurology, University of Würzburg, Germany

Cathy Stannard, MD (United Kingdom)
Consultant in Pain Medicine at Southmead Hospital, Bristol, UK

* Denotes IASP Councilor

The name of each task force member links to his or her personal disclosure statement. For information about IASP’s policies and procedures for working with industry, visit the Disclosures page.

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