The Opioid Paradox: Balancing Analgesia, Risk, and the Future of Clinical Practice

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Published Jul 30, 2026
DOI: https://doi.org/10.18103/mra.v14i7.7675

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Main Article Content

Dr. Grisell Vargas Schaffer
Centre de Gestion de la Douleur. Centre Hospitalier Universitaire de Montréal CHUM. Quebec, Canada
Jennifer Cogan
Centre de Gestion de la Douleur. Centre Hospitalier Universitaire de Montréal CHUM. Quebec, Canada
Marzieh Eghtesadi
Centre de Gestion de la Douleur. Centre Hospitalier Universitaire de Montréal CHUM. Quebec, Canada
Allen Steverman
Centre de Gestion de la Douleur. Centre Hospitalier Universitaire de Montréal CHUM. Quebec, Canada

Abstract

Opioids occupy a paradoxical position in contemporary medicine: they remain among the most effective analgesics for acute and cancer‑related pain, yet their long‑term use in chronic non‑cancer pain is associated with substantial risks, including misuse, dependence, overdose, opioid‑induced hyperalgesia, and endocrine dysfunction.1-3 Opioid‑related morbidity and mortality have risen exponentially in North America, and although the increase in Europe has been less pronounced,4-6 it has nonetheless placed internal medicine, family medicine, and pain physicians—those most involved in chronic pain care—in an increasingly difficult position. Patients with chronic pain frequently present with multimorbidity, psychological vulnerability, and social instability, further complicating opioid prescribing decisions. 1,2


This narrative review synthesizes current evidence on the limitations of traditional prescribing models, the importance of mechanism‑based pain assessment, and the influence of patient beliefs, expectations, and psychological factors on opioid outcomes.7-9 It examines epidemiological trends, the evolving understanding of opioid‑induced hyperalgesia, and the role of structured monitoring, opioid stewardship, and harm‑reduction strategies in mitigating risk.2,6 The review also outlines practical clinical recommendations for patient selection, risk stratification, informed consent, initiation, monitoring, and discontinuation.10,11


Navigating the opioid paradox requires individualized, biopsychosocial, and safety‑focused approaches that balance analgesic benefit with the potential for harm. A shift toward shared decision‑making, functional goal‑setting, and consistent monitoring is essential for safer opioid use and for the future of clinical practice in chronic pain management.


 

Keywords: opioids, chronic pain, opioid‑induced hyperalgesia, nociplastic pain, stewardship, prescribing practices

Article Details

How to Cite
SCHAFFER, Dr. Grisell Vargas et al. The Opioid Paradox: Balancing Analgesia, Risk, and the Future of Clinical Practice. Medical Research Archives, [S.l.], v. 14, n. 7, july 2026. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/7675>. Date accessed: 06 aug. 2026. doi: https://doi.org/10.18103/mra.v14i7.7675.
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Issue
Vol 14 No 7 (2026): Vol.14 Issue 7 July 2026
Section
Research Articles

The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.

 

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