scholarly journals Intraspinal opioid therapy for chronic nonmalignant pain: Current practice and clinical guidelines

1996 ◽  
Vol 11 (6) ◽  
pp. 333-352 ◽  
Author(s):  
Elliot S. Krames
Keyword(s):  
Clinical Guidelines ◽  
Current Practice ◽  
Opioid Therapy ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

Opioid Therapy for Chronic Nonmalignant Pain: Clinicians' Perspective

1996 ◽  
Vol 24 (4) ◽  
pp. 296-309 ◽  
Author(s):  
Russell K. Portenoy
Keyword(s):  
Psychosocial Functioning ◽  
Cumulative Risk ◽  
Opioid Therapy ◽  
Adverse Outcomes ◽  
The Public ◽  
The Past ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

During the past decade, debate has intensified about the role of long-term opioid therapy in the management of chronic nonmalignant pain. Specialists in pain management have discussed the issues extensively and now generally agree that a selected population of patients with chronic pain can attain sustained analgesia without significant adverse consequences. This perspective, however, is not uniformly accepted by pain specialists and has not been widely disseminated to other disciplines or the public. Rather, the more traditional perspective, which ascribes both transitory benefit and substantial cumulative risk to long-term opioid therapy, continues to predominate. According to this perspective, the inevitability of tolerance limits the possibility of sustained efficacy, and other pharmacological properties increase the likelihood of adverse outcomes, including persistent side-effects, impairment in physical and psychosocial functioning, and addiction. If accurate, these outcomes would indeed justify the withholding of opioid therapy for all but the most extreme cases of chronic nonmalignant pain.

Functional Outcomes in Patients with Chronic Nonmalignant Pain on Long-Term Opioid Therapy

Pain Practice ◽  
2008 ◽  
Vol 8 (5) ◽  
pp. 379-384 ◽  
Author(s):  
Amol Soin ◽  
Jianguo Cheng ◽  
Lora Brown ◽  
Sami Moufawad ◽  
Nagy Mekhail
Keyword(s):  
Functional Outcomes ◽  
Opioid Therapy ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

scholarly journals Chronic Use of Opioids for Nonmalignant pain: A Prospective Study

1997 ◽  
Vol 2 (2) ◽  
pp. 101-107 ◽  
Author(s):  
Perry N Fuchs ◽  
Ann Gamsa
Keyword(s):  
Substance Abuse ◽  
Side Effects ◽  
Pain Relief ◽  
Pain Intensity ◽  
Leisure Activities ◽  
Opioid Therapy ◽  
Social Activities ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

OBJECTIVE: To assess the effects of long term opioid therapy on pain, mood, and social and leisure activities in patients with chronic nonmalignant pain.METHODS: Fourteen patients (eight males and six females) were treated with opioid medications for chronic nonmalignant pain not improved by previous treatments. Baseline measures of pain intensity were obtained before introducing opioids. Patients were monitored throughout the study, with outcome measured four to 32 months after opioids were started. The final measures examined drug dose, side effects, pain level, pain relief, emotional status, and involvement in social and leisure activities.RESULTS: A total of 64.3% of patients reported good to excellent pain relief with opioid medication, and 64.3% reported reduced pain intensity, the decrease ranging from 25% to 100% (from baseline measures) on a scale rated from 0 to 10. As well, 64.3% scored their emotional state as 5 or better on the 0 to 10 scale (0 indicating greatest distress), and 64.3% reported at least moderate (at least 5 on the 0 to 10 scale) involvement in leisure and social activities. There was a significant negative correlation between pain intensity and amount of leisure and social activity; 88.9% of patients who reported moderate to full involvement in leisure and social activities also noted decreased pain on the 0 to 10 scale. Other than one patient who developed tolerance, there were no notable problems with dose escalation or with any other form of substance abuse.CONCLUSIONS: Some patients with chronic nonmalignant pain benefit from long term opioid therapy without developing unmanageable side effects, tolerance or substance abuse problems. These results, together with previous findings, show that opioids can be a safe and useful long term treatment for chronic nonmalignant pain.

Adverse effects and cognitive function among primary care patients taking opioids for chronic nonmalignant pain

2006 ◽  
Vol 2 (3) ◽  
pp. 137 ◽  
Author(s):  
Randall T. Brown, MD ◽  
Megan Zuelsdorff, BS ◽  
Michael Fleming, MD, MPH
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Chronic Pain ◽  
Cognitive Function ◽  
Adverse Effects ◽  
Primary Care Physicians ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

Chronic opioid therapy is commonly prescribed for chronic nonmalignant pain. Few published data describe the adverse effects experienced by patients with chronic nonmalignant pain being treated by primary care physicians. A prevalence study was conducted on a sample of 1,009 patients (889 receiving chronic opioids) being treated by 235 primary care physicians. Standardized questionnaires and medical record reviews were used to assess rates of addiction, pain diagnosis and severity, opioid adverse effects, and mental health. The mean daily dose of opioids was 92 mg using a morphine-equivalent conversion. Side effects included constipation (40 percent), sleeping problems (25 percent), loss of appetite (23 percent), and sexual dysfunction (18 percent), with patients on daily opioids experiencing more side effects than subjects on intermittent medication. The Medical Outcomes Study Mental Health Inventory (MOS-MHI) cognitive functioning scale indicated poorer cognitive function in the overall sample of chronic pain patients as compared to a general clinical sample (Δ x 95 percent CI = 9.28, 13.76). However, there were limited differences in MOS scores between chronic pain subjects on daily opioids vs. intermittent opioids vs. no prescription opioids. A regression model suggests that psychological measures and pain severity are more predictive of decrements in cognitive function than specific opioid preparations or daily opioid dose. Physicians should closely monitor patients for adverse effects and adequacy of pain control when using chronic opioid therapy for chronic pain treatment. Psychological health, an important predictor of cognitive dysfunction, is a particularly important measure to actively monitor and manage.

scholarly journals Opioid Therapy for Chronic Nonmalignant Pain

1996 ◽  
Vol 1 (1) ◽  
pp. 17-28 ◽  
Author(s):  
Russell K Portenoy
Keyword(s):  
Chronic Pain ◽  
Opioid Therapy ◽  
Minimal Risk ◽  
Addiction Medicine ◽  
Nonmalignant Pain ◽  
Term Administration ◽  
Chronic Nonmalignant Pain ◽  
Physician Prescribing ◽  
Structured Approach

Long term administration of an opioid drug for chronic nonmalignant pain continues to be controversial, but is no longer uniformly rejected by pain specialists. This is true despite concerns that the regulatory agencies that oversee physician prescribing of opioid drugs continue to stigmatize the practice. The changing clinical perspective has been driven, in part, by widespread acknowledgement of the remarkably favourable outcomes achieved during opioid treatment of cancer pain. These outcomes contrast starkly with popular teaching about chronic opioid therapy and affirm the potential for prolonged efficacy, tolerable side effects, enhanced function associated with improved comfort and minimal risk of aberrant drug-related behaviours consistent with addiction. A large anecdotal experience in populations with nonmalignant pain suggests that these patients are more heterogeneous and that opioid therapy will greatly benefit some and will contribute to negative outcomes for others. The few controlled clinical trials that have been performed support the safety and efficacy of opioid therapy, but have been too limited to ensure generalization to the clinical setting. A critical review of the medical literature pertaining to chronic pain, opioid pharmacology and addiction medicine can clarify misconceptions about opioid therapy and provide a foundation for patient selection and drug administration. The available data support the view that opioids are no panacea for chronic pain, but should be considered in carefully selected patients using clinically derived guidelines that stress a structured approach and ongoing monitoring of efficacy, adverse effects, functional outcomes and the occurrence of aberrant drug-related behaviours.

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