As a physician, I find comments like this disturbing. Barring special circumstances (cancer related pain), there is almost no need for chronic opiates. In fact,

As a physician, I find comments like this disturbing. Barring special circumstances (cancer related pain), there is almost no need for chronic opiates. In fact, the body rapidly becomes accustomed to opiates and will require higher and higher doses that can become dangerous. The united states uses orders of magnitude more opiates than all other countries, and that often comes from potentially a cultural aversion to pain, but also many patients specifically seek out and ask for pain meds. In fact, the scenarios you mention, of post herpetic neuralgia, trigeminal neuralgia, and neuropathy should NEVER be treated with opiates. There are highly effective neuroleptics and medications like carbamazepine, gabapentin, and TCAs that are first line and highly effective for these syndromes. While painful, given that it is neuropathic pain, often with rapid onset and offset, opiates, even PRN medication, is not appropriate management and does not help with its treatment. Adjuvant therapy including topical creams like capsaicin as well as minor procedures like nerve blocks and injections are pursued if first line treatments do not work. Often I see people in clinic who were aggressive about opiates and got opiates for these syndromes and spiral into addiction and problems while the underlying problem is untreated. Opiates are not a panacea for all pain, and its troubling with patients see it that way, and often insist on opiate medications.