In summary, opioid use for chronic non-malignant pain is justified in a select group of patients who do not respond to a variety of other pain treatment modalities. Proper trials of the analgesics given "by the clock" in appropriate dosages with attention to potential side effects and proper documentation is important. Efficacy should be monitored by improvement in function and symptomatology. Undertreatment for fear of addiction or legal consequences should be avoided. Specialized pain clinics may be utilized for consultation regarding the long-term use of opioids or for more advanced pain management strategies, possibly including the use of intraspinal opioid delivery systems.