Application of Opioid Tolerance Mechanisms, Withdrawal Strategies, and Multimodal Non-opioid Alternative Therapies Based on the Management of Chronic Neuropathic Pain

Currently, the clinical management of chronic non-cancer pain(CNCP), particularly chronic neuropathic pain, is at a critical juncture in terms of conceptual restructuring. For a long time, influenced by the analgesic ladder for cancer pain management, strong opioids had been widely employed for the maintenance treatment of chronic neuropathic pain. This review aims to elucidate that in the context of chronic neuropathic pain, the long-term maintenance use of strong opioids should be strictly restricted. These drugs should be positioned solely as low-frequency, emergency rescue measures for breakthrough pain, and ultimately, deprescribing should be achieved through the combination usage and substitution of non-opioid therapies.