Opioids: Current Science

2021 ◽  
Vol 26 (5) ◽  
pp. 3-12
Author(s):  
James B. Talmage ◽  
Robert B. Snyder
Keyword(s):  
Surgical Outcomes ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy ◽  
Opioid Induced Hyperalgesia ◽  
Current Science ◽  
Chronic Use

Abstract Evidence shows that chronic opioid therapy is usually not beneficial; weaning patients off opioids many times results in less pain and better function, and opioid-induced hyperalgesia is real and frequent. Further evidence suggests that surgical outcomes are better if patients are weaned off opioids before surgery, and that the chronic use of opioids may adversely alter the assessment of maximum medical improvement (MMI).

Acute Pain in the Opioid-Tolerant Patient

2018 ◽  
Author(s):  
Ignacio Badiola ◽  
Tulsi Singh ◽  
Jiabin Liu ◽  
Nabil Elkassabany
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Opioid Therapy ◽  
Opioid Tolerance ◽  
Evidence Based ◽  
Chronic Opioid Therapy ◽  
Number Of Patients ◽  
Opioid Induced Hyperalgesia ◽  
Pain Center ◽  
Based Medicine

The number of people addicted to prescription and illicit opioids continues to increase, and many of these patients present to the hospital or pain center with acute pain issues. The matter is further complicated by the increasing number of patients with legitimately painful conditions treated with chronic opioid therapy. Typically, these patients are difficult to manage during any acute pain episode due to their opioid tolerance and opioid-induced hyperalgesia. This difficulty often leads to inadequate pain management, increased suffering, and delayed hospital discharge. Increased awareness is needed among pain management physicians and other clinicians who care for opioid-tolerant patients, yet there is a lack of evidence-based medicine regarding the optimal treatment of this population.

scholarly journals Predictors of Chronic Opioid Use: A Population-level Analysis of North Carolina Cancer Survivors Using Multi-Payer Claims

2021 ◽  
Author(s):  
Devon K Check ◽  
Christopher D Bagett ◽  
KyungSu Kim ◽  
Andrew W Roberts ◽  
Megan C Roberts ◽  
...  
Keyword(s):  
North Carolina ◽  
Substance Use ◽  
Cancer Survivors ◽  
Low Income ◽  
Opioid Therapy ◽  
Adjusted Relative Risk ◽  
Opioid Use ◽  
Chronic Opioid Therapy ◽  
Increased Risk ◽  
Chronic Opioid Use

Abstract Background No population-based studies have examined chronic opioid use among cancer survivors who are diverse with respect to diagnosis, age group, and insurance status. Methods We conducted a retrospective cohort study using North Carolina (NC) cancer registry data linked with claims from public and private insurance (2006–2016). We included adults with non-metastatic cancer who had no prior chronic opioid use (N = 38,366). We used modified Poisson regression to assess the adjusted relative risk of chronic opioid use in survivorship (>90-day continuous supply of opioids in the 13–24 months following diagnosis) associated with patient characteristics. Results Only 3.0% of cancer survivors in our cohort used opioids chronically in survivorship. Predictors included younger age (adjusted risk ratio [aRR], 50–59 vs 60–69 = 1.23, 95% confidence interval [CI] = 1.05–1.43), baseline depression (aRR = 1.22, 95% CI = 1.06–1.41) or substance use (aRR = 1.43, 95% CI = 1.15–1.78) and Medicaid (aRR vs Private = 1.93, 95% CI = 1.56–2.40). Survivors who used opioids intermittently (vs not at all) before diagnosis were twice as likely to use opioids chronically in early survivorship (aRR = 2.62, 95% CI = 2.28–3.02). Those who used opioids chronically (vs intermittently or not at all) during active treatment had a nearly 17-fold increased likelihood of chronic use in survivorship (aRR = 16.65, 95 CI = 14.30–19.40). Conclusions Younger and low-income survivors, those with baseline depression or substance use, and those who require chronic opioid therapy during treatment are at increased risk for chronic opioid use in survivorship. Our findings point to opportunities improve assessment of psychosocial histories and to engage patients in shared decision-making around long-term pain management, when chronic opioid therapy is required during treatment.

scholarly journals Predictors of chronic opioid therapy in Medicaid beneficiaries with HIV who initiated antiretroviral therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
GYeon Oh ◽  
Emily S. Brouwer ◽  
Erin L. Abner ◽  
David W. Fardo ◽  
Patricia R. Freeman ◽  
...  
Keyword(s):  
Regression Models ◽  
Opioid Therapy ◽  
Chronic Obstructive ◽  
Chronic Opioid Therapy ◽  
Hepatitis C Infection ◽  
Antipsychotic Therapy ◽  
Obstructive Pulmonary Disease ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Medicaid Beneficiaries

AbstractThe factors associated with chronic opioid therapy (COT) in patients with HIV is understudied. Using Medicaid data (2002–2009), this retrospective cohort study examines COT in beneficiaries with HIV who initiated standard combination anti-retroviral therapy (cART). We used generalized estimating equations on logistic regression models with backward selection to identify significant predictors of COT initiation. COT was initiated among 1014 out of 9615 beneficiaries with HIV (male: 10.4%; female: 10.7%). Those with older age, any malignancy, Hepatitis C infection, back pain, arthritis, neuropathy pain, substance use disorder, polypharmacy, (use of) benzodiazepines, gabapentinoids, antidepressants, and prior opioid therapies were positively associated with COT. In sex-stratified analyses, multiple predictors were shared between male and female beneficiaries; however, chronic obstructive pulmonary disease, liver disease, any malignancy, and antipsychotic therapy were unique to female beneficiaries. Comorbidities and polypharmacy were important predictors of COT in Medicaid beneficiaries with HIV who initiated cART.

scholarly journals Problems and concerns of patients receiving chronic opioid therapy for chronic non-cancer pain

Pain ◽  
2010 ◽  
Vol 149 (2) ◽  
pp. 345-353 ◽  
Author(s):  
Mark D. Sullivan ◽  
Michael Von Korff ◽  
Caleb Banta-Green ◽  
Joseph O. Merrill ◽  
Kathleen Saunders
Keyword(s):  
Cancer Pain ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy

scholarly journals PS1-01: Alcohol and Drug Use Among Chronic Opioid Therapy Patients

2012 ◽  
Vol 10 (3) ◽  
pp. 143-144
Author(s):  
C. Campbell ◽  
A. Kline-Simon ◽  
M. Von Korff ◽  
G. T. Ray ◽  
C. Weisner
Keyword(s):  
Drug Use ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy ◽  
Alcohol And Drug Use

Opioid-Induced Muscle Activity: Implications for Managing Chronic Pain

1995 ◽  
Vol 29 (11) ◽  
pp. 1118-1121 ◽  
Author(s):  
Robert K Sylvester ◽  
Ralph Levitt ◽  
Preston D Steen
Keyword(s):  
Breakthrough Pain ◽  
Oral Morphine ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy ◽  
Transdermal Fentanyl ◽  
Management Options ◽  
Morphine Infusion ◽  
Involuntary Muscle ◽  
Metastatic Lung ◽  
Morphine Solution

Objective: To increase awareness of opioid-induced involuntary muscle hyperactivity and to present management options. Case Summary: A ventilator-dependent 71-year-old man presented with pain caused by metastatic lung cancer. Transdermal fentanyl therapy was titrated to 200 μg/h. Two days later a continuous morphine infusion was initiated because of frequent administration of oral morphine solution for breakthrough pain. The patient became progressively less responsive and began exhibiting involuntary muscle hyperactivity thought to represent breakthrough pain. Despite the inability to assess pain control effectively in this unresponsive patient, the morphine infusion rate was increased from 22 to 717 mg/h within 7 days. No change in muscle hyperactivity was observed. Discussion: Over the last decade involuntary muscle hyperactivity has been documented as an adverse effect of chronic opioid therapy. The literature describing the incidence of this toxicity, possible risk factors for its development, and recommendations for its management are discussed. Conclusions: The occurrence of muscle hyperactivity in an unresponsive patient receiving chronic opioid therapy may represent opioid toxicity. Recommendations for managing opioid-induced muscle hyperactivity include reduction of the opioid dosage and/or administration of clonazepam therapy.

142. Impact of preoperative chronic opioid therapy on long-term outcomes, reoperations, complications and resource utilization after lumbar arthrodesis

2019 ◽  
Vol 19 (9) ◽  
pp. S68-S69
Author(s):  
Joshua M. Eisenberg ◽  
Piyush Kalakoti ◽  
Nathan R. Hendrickson ◽  
Comron Saifi ◽  
Andrew J. Pugely
Keyword(s):  
Resource Utilization ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy ◽  
Long Term Outcomes ◽  
Lumbar Arthrodesis
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