Which client is most likely to receive opioids for extended periods of time?

• A. A client with fibromyalgia
• B. A client with phantom limb pain in the leg
• C. A client with progressive pancreatic cancer
• D. A client with trigeminal neuralgia

Answer: (C)

The main concept here is that long-term, steady opioid therapy is most appropriate when pain is persistent and tied to a progressive, life-limiting illness. In the case of progressive pancreatic cancer, pain tends to be continuous and worsening as the disease advances, often involving tumor invasion, nerve involvement, and treatment-related factors. This creates a scenario where around-the-clock analgesia is needed to maintain continuous relief and to prevent breakthrough pain, with a plan that includes a long-acting opioid for baseline control and short-acting doses for spikes in pain.

Other pain conditions in the options can be challenging and may respond to non-opioid therapies or adjuvants, and opioids are not typically the mainstay for long-term use. Fibromyalgia pain is widespread but is generally managed with non-opioid medications, antidepressants, anticonvulsants, exercise, and cognitive-behavioral approaches due to risks and limited long-term benefit from opioids. Phantom limb pain is neuropathic and often treated with adjuvants like gabapentinoids and nonpharmacologic strategies, with opioids not chosen as the primary long-term solution. Trigeminal neuralgia is usually treated with anticonvulsants such as carbamazepine, which can control the sharp, severe pain without needing prolonged opioid therapy. Therefore, the patient with progressive pancreatic cancer stands out as the one most likely to require opioids for an extended period to manage ongoing cancer-related pain.