Opioid analgesics are currently the most effective pharmacologic option for the management of both acute and chronic forms of moderate-to-severe
pain. Although the "as-needed" use of immediate-release formulations is considered optimum for treating acute, painful episodes of limited duration, the scheduled dosing of
extended-release formulations with immediate-release supplementation for
breakthrough pain is regarded to be most effective for managing
chronic conditions requiring around-the-clock treatment. The recent introduction of
extended-release formulations of the
opioid analgesic hydrocodone potentially broadened the possibility of providing
pain relief for individuals for whom current formulations are either ineffective or not tolerated. However, reaction to the approval of the new formulations has fueled controversy over the general safety and need for
opioid medications, in light of their potential for misuse, abuse, diversion, and addiction. Here, we discuss how the approval of
extended-release formulations of
hydrocodone and the emotionally charged controversy over their release may affect physician prescribing and the care available to patients in need of chronic
opioid therapy for the management of
pain.