scholarly journals Endogenous theta stimulation during meditation predicts reduced opioid dosing following treatment with Mindfulness-Oriented Recovery Enhancement

2020 ◽  
Author(s):  
Justin Hudak ◽  
Adam W. Hanley ◽  
William R. Marchand ◽  
Yoshio Nakamura ◽  
Brandon Yabko ◽  
...  
Keyword(s):  
Dose Escalation ◽  
Mindfulness Meditation ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Supportive Psychotherapy ◽  
Opioid Dose ◽  
Theta Power ◽  
Study Results ◽  
Referential Processing ◽  
Before And After

AbstractVeterans experience chronic pain at greater rates than the rest of society and are more likely to receive long-term opioid therapy (LTOT), which, at high doses, is theorized to induce maladaptive neuroplastic changes that attenuate self-regulatory capacity and exacerbate opioid dose escalation. Mindfulness meditation has been shown to modulate frontal midline theta (FMT) and alpha oscillations that are linked with marked alterations in self-referential processing. These adaptive neural oscillatory changes may promote reduced opioid use and remediate the neural dysfunction occasioned by LTOT. In this study, we used electroencephalography (EEG) to assess the effects of a mindfulness-based, cognitive training intervention for opioid misuse, Mindfulness-Oriented Recovery Enhancement (MORE), on alpha and theta power and FMT coherence during meditation. We then examined whether these neural effects were associated with reduced opioid dosing and changes in self-referential processing. Before and after 8 weeks of MORE or a supportive psychotherapy control, veterans receiving LTOT (N = 62) practiced mindfulness meditation while EEG was recorded. Participants treated with MORE demonstrated significantly increased alpha and theta power (with larger theta power effect sizes) as well as increased FMT coherence relative to those in the control condition—neural changes that were associated with altered self-referential processing. Crucially, MORE significantly reduced opioid dose over time, and this dose reduction was partially statistically mediated by changes in frontal theta power. Study results suggest that mindfulness meditation practice may produce endogenous theta stimulation in the prefrontal cortex, thereby enhancing inhibitory control over opioid dose escalation behaviors.

Opioid utilization patterns among patients with cancer and noncancer pain.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 194-194
Author(s):  
Catherine J. Datto ◽  
Yiqun Hu ◽  
Eric Wittbrodt ◽  
Perry G. Fine
Keyword(s):  
Cancer Pain ◽  
Dose Escalation ◽  
Index Date ◽  
Opioid Therapy ◽  
Administrative Claims ◽  
Opioid Use ◽  
Medical Claim ◽  
Opioid Dose ◽  
Patients With Cancer ◽  
Utilization Patterns

194 Background: Opioids are used to manage moderate to severe pain in patients with cancer and non-cancer pain. Limited data exist comparing opioid utilization patterns between these two patient populations. Methods: This retrospective, commercial administrative claims database analysis (HealthCore Integrated Research Environment) investigated opioid use patterns, including opioid dose escalation, in adult patients with cancer-related (CP) and non-cancer-related pain (NCP). Adults (age ≥18 years) with at least one pharmacy claim for an opioid between July 1, 2006, and September 30, 2014, were identified (index date). Patients selected for analysis had to have continuous plan eligibility for 6 months pre- and 12 months post-index date and opioid use for at least 4 weeks. Patients with opioid use related to cancer pain were identified by a medical claim for a cancer diagnosis coded within 30 days prior to the index opioid date. Results: A total of 9,209 patients with CP and 409,703 patients with NCP were analyzed. Patients with CP were older than patients with NCP (mean [SD]: 62.6 [12.9] yrs vs. 49.3 [15.3] yrs); other demographics were similar between cohorts. The most common cancer diagnoses were breast, lung, and prostate. Hydrocodone was the most common opioid prescribed for both cohorts. Total mean (SD) days of opioid therapy were 167.1 (341.8) for CP and 196.6 (421.1) for NCP, with similar rates of opioid use for ≥1 year (10.6% for CP; 13.6% for NCP). Median index opioid doses were consistent between the cohorts (CP: 51.7 morphine-equivalent units (MEU); NCP: 45.0 MEU). Median post-index (after the first 30 days) opioid doses were also similar (CP: 55.8 MEU; NCP: 45.3 MEU). Post-index opioid dose reductions occurred in approximately one-third of both cohorts. Opioid dose escalations (up to dose doubling) occurred in 31.8% of CP and 28.3% of NCP patients. More patients died during the follow-up period in the CP cohort (24.1%) compared with the NCP cohort (0.02%). Conclusions: The use of opioids bears many similarities between patients with cancer pain and non-cancer pain, including clinically similar rates of chronic opioid utilization and dose escalation. This study was supported by AstraZeneca.

scholarly journals Mindfulness-Oriented Recovery Enhancement remediates anhedonia in chronic opioid use by enhancing neurophysiological responses during savoring of natural rewards

2021 ◽  
pp. 1-10
Author(s):  
Eric L. Garland ◽  
Spencer T. Fix ◽  
Justin P. Hudak ◽  
Edward M. Bernat ◽  
Yoshio Nakamura ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Skin Conductance Level ◽  
Opioid Therapy ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Natural Reward ◽  
Before And After ◽  
Natural Rewards ◽  
Chronic Opioid Use ◽  
Opioid Users

Abstract Background Neuropsychopharmacologic effects of long-term opioid therapy (LTOT) in the context of chronic pain may result in subjective anhedonia coupled with decreased attention to natural rewards. Yet, there are no known efficacious treatments for anhedonia and reward deficits associated with chronic opioid use. Mindfulness-Oriented Recovery Enhancement (MORE), a novel behavioral intervention combining training in mindfulness with savoring of natural rewards, may hold promise for treating anhedonia in LTOT. Methods Veterans receiving LTOT (N = 63) for chronic pain were randomized to 8 weeks of MORE or a supportive group (SG) psychotherapy control. Before and after the 8-week treatment groups, we assessed the effects of MORE on the late positive potential (LPP) of the electroencephalogram and skin conductance level (SCL) during viewing and up-regulating responses (i.e. savoring) to natural reward cues. We then examined whether these neurophysiological effects were associated with reductions in subjective anhedonia by 4-month follow-up. Results Patients treated with MORE demonstrated significantly increased LPP and SCL to natural reward cues and greater decreases in subjective anhedonia relative to those in the SG. The effect of MORE on reducing anhedonia was statistically mediated by increases in LPP response during savoring. Conclusions MORE enhances motivated attention to natural reward cues among chronic pain patients on LTOT, as evidenced by increased electrocortical and sympathetic nervous system responses. Given neurophysiological evidence of clinical target engagement, MORE may be an efficacious treatment for anhedonia among chronic opioid users, people with chronic pain, and those at risk for opioid use disorder.

scholarly journals Race and Gender Are Associated with Opioid Dose Reduction Among Patients on Chronic Opioid Therapy

Pain Medicine ◽  
2018 ◽  
Vol 20 (8) ◽  
pp. 1519-1527 ◽  
Author(s):  
Michele Buonora ◽  
Hector R Perez ◽  
Moonseong Heo ◽  
Chinazo O Cunningham ◽  
Joanna L Starrels
Keyword(s):  
Dose Reduction ◽  
Clinical Decision Making ◽  
Female Gender ◽  
Opioid Therapy ◽  
Clinical Factors ◽  
Opioid Use ◽  
Chronic Opioid Therapy ◽  
Race And Gender ◽  
Opioid Dose ◽  
And Gender

Abstract Objective Among patients with chronic pain, risk of opioid use is elevated with high opioid dose or concurrent benzodiazepine use. This study examined whether these clinical factors, or sociodemographic factors of race and gender, are associated with opioid dose reduction. Design and Setting A retrospective cohort study of outpatients prescribed chronic opioid therapy between 2007 and 2012 within a large, academic health care system in Bronx, New York, using electronic medical record data. Included patients were prescribed a stable dose of chronic opioid therapy over a one-year “baseline period” and did not have cancer. Methods The primary outcome was opioid dose reduction (≥30% reduction from baseline) within two years. Multivariable logistic regression tested the associations of two clinical variables (baseline daily opioid dose and concurrent benzodiazepine prescription) and two sociodemographic variables (race/ethnicity and gender) with opioid dose reduction. Results Of 1,097 patients, 463 (42.2%) had opioid dose reduction. High opioid dose (≥100 morphine-milligram equivalents [MME]) was associated with lower odds of opioid dose reduction compared with an opioid dose <100 MME (adjusted odds ratio [AOR] = 0.69, 95% confidence interval [CI] = 0.54–0.89). Concurrent benzodiazepine prescription was not associated with opioid dose reduction. Black (vs white) race and female (vs male) gender were associated with greater odds of opioid dose reduction (AOR = 1.82, 95% CI = 1.22–2.70; and AOR = 1.43, 95% CI = 1.11–1.83, respectively). Conclusions Black race and female gender were associated with greater odds of opioid dose reduction, whereas clinical factors of high opioid dose and concurrent benzodiazepine prescription were not. Efforts to reduce opioid dose should target patients based on clinical factors and address potential biases in clinical decision-making.

scholarly journals Impact of Spinal Cord Stimulation on Opioid Dose Reduction: A Nationwide Analysis

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 193-201
Author(s):  
Syed M Adil ◽  
Lefko T Charalambous ◽  
Charis A Spears ◽  
Musa Kiyani ◽  
Sarah E Hodges ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Dose Reduction ◽  
Spinal Cord Stimulation ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Patient Centered ◽  
Opioid Dose ◽  
The Impact

Abstract BACKGROUND Opioid misuse in the USA is an epidemic. Utilization of neuromodulation for refractory chronic pain may reduce opioid-related morbidity and mortality, and associated economic costs. OBJECTIVE To assess the impact of spinal cord stimulation (SCS) on opioid dose reduction. METHODS The IBM MarketScan® database was retrospectively queried for all US patients with a chronic pain diagnosis undergoing SCS between 2010 and 2015. Opioid usage before and after the procedure was quantified as morphine milligram equivalents (MME). RESULTS A total of 8497 adult patients undergoing SCS were included. Within 1 yr of the procedure, 60.4% had some reduction in their opioid use, 34.2% moved to a clinically important lower dosage group, and 17.0% weaned off opioids entirely. The proportion of patients who completely weaned off opioids increased with decreasing preprocedure dose, ranging from 5.1% in the &gt;90 MME group to 34.2% in the ≤20 MME group. The following variables were associated with reduced odds of weaning off opioids post procedure: long-term opioid use (odds ratio [OR]: 0.26; 95% CI: 0.21-0.30; P &lt; .001), use of other pain medications (OR: 0.75; 95% CI: 0.65-0.87; P &lt; .001), and obesity (OR: 0.75; 95% CI: 0.60-0.94; P = .01). CONCLUSION Patients undergoing SCS were able to reduce opioid usage. Given the potential to reduce the risks of long-term opioid therapy, this study lays the groundwork for efforts that may ultimately push stakeholders to reduce payment and policy barriers to SCS as part of an evidence-based, patient-centered approach to nonopioid solutions for chronic pain.

scholarly journals A pediatric cancer patient with suspected chemical coping following high-dose opioid therapy: a case report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Mototsugu Miura ◽  
Kenkichi Tsuruga ◽  
Yuji Morimoto
Keyword(s):  
Opioid Therapy ◽  
Lymphocytic Leukemia ◽  
High Dose ◽  
Care Providers ◽  
Opioid Use ◽  
Opioid Dose ◽  
Rescue Dose ◽  
Patients With Cancer ◽  
Old Japanese ◽  
Articular Pain

Abstract Background Chemical coping is an inappropriate method for dealing with stress through the use of opioids; it is considered the stage prior to abuse and dependence. In patients with cancer, it is important to evaluate the risk of chemical coping when using opioids. There are some pediatric opioid use-related tolerances and addictions; however, no mention of chemical coping has been found. Case presentation We present a case of an 11-year-old Japanese boy with acute lymphocytic leukemia. After transplantation, he complained of abdominal and articular pain, which are considered as symptoms of graft-versus-host disease; thus, opioid therapy was initiated, and the dose was gradually increased for pain management, resulting in a high dose of 2700 μg/day of fentanyl (4200–4700 μg/day including the rescue dose). After switching from fentanyl to oxycodone injections, he continued to experience pain, and there was no change in the frequency of oxycodone rescue doses. Physically, his pain was considered to have alleviated; thus, there was the possibility of mental anxiety resulting in the lowering of pain threshold and the possibility of chemical coping. Mental anxiety and stress with progress through schooling was believed to have resulted in chemical coping; thus, efforts were made to reduce the boy’s anxiety, and opioid education was provided. However, dose reduction was challenging. Ultimately, with guidance from medical care providers, the opioid dose was reduced, and the patient was successfully weaned off opioids. Conclusions When chemical coping is suspected in pediatric patients, after differentiating from pseudo-addiction, it might be necessary to restrict the prescription for appropriate use and to provide opioid education while taking into consideration the emotional background of the patient that led to chemical coping.

scholarly journals A Predictive Model for Intrathecal Opioid Dose Escalation for Chronic Non-Cancer Pain

2012 ◽  
Vol 5;15 (5;9) ◽  
pp. 363-369 ◽  
Author(s):  
Rui V. Duarte
Keyword(s):  
Chronic Pain ◽  
Cancer Pain ◽  
Predictive Model ◽  
Dose Escalation ◽  
Medical Records ◽  
Intrathecal Morphine ◽  
Opioid Therapy ◽  
Intrathecal Therapy ◽  
Morphine Dose ◽  
Opioid Dose

Background: Tolerance is defined as a phenomenon in which exposure to a drug results in a decrease of an effect or the requirement of a higher dose to maintain an effect. The fear of a patient developing opioid tolerance contributes regularly to the stigmatization and withholding of intrathecal opioid therapy for chronic pain of non-cancer origin. Objectives: The aim of this study was to describe the intrathecal opioid dose escalation throughout the years in chronic non-cancer pain patients. A secondary objective was the development of an intrathecal opioid dose predictive model. Study Design: Retrospective assessment of medical records. Setting: Department of Pain Management, Russells Hall Hospital, Dudley, United Kingdom. Methods: Medical records were reviewed and pump refill notes screened from the date of implant through November 2010 for 31 patients undertaking continuous intrathecal opioid therapy. All the patients included had undertaken a minimum of 6 years of intrathecal therapy when the data were collected. Results: Significant increases in the intrathecal morphine dose were verified between follow-up at one year and all subsequent observations, F (2.075, 62.238) = 13.858, 0 < 0.001, but ceased to be significant from year 3 onwards, indicating stability of the morphine dose, F (3, 90) = 2.516, P = 0.63. A model that accounts for 76% of the variability of morphine doses at year 6 based on year 2 assessment combined with duration of pain prior to initiation of intrathecal therapy was developed: year 6 dose = -0.509 + (1.296 x [year 2 dose]) + (0.061 x [duration of pain]). Limitations: Retrospective study. Conclusion: The opioid dose escalation observed throughout the years was modest and not significant following year 3 of therapy. The model developed has the potential to assist the physician in the identification of a need for alternative treatment strategies. Furthermore, since many of the pump replacements are performed prior to year 6, it can also assist in the informed decision of the benefits and risks of the maintenance of this therapy. Key words: Chronic pain, non-cancer pain, intrathecal opioid therapy, opioid dose escalation, predictive mode

scholarly journals Opioids and Chronic Pain: An Analytic Review of the Clinical Evidence

2021 ◽  
Vol 2 ◽  
Author(s):  
Stephen E. Nadeau ◽  
Jeffrey K. Wu ◽  
Richard A. Lawhern
Keyword(s):  
Chronic Pain ◽  
Scientific Evidence ◽  
The United States ◽  
Opioid Therapy ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Opioid Treatment ◽  
Opioid Dose ◽  
Risk Of Death ◽  
Analytic Review

We conducted an analytic review of the clinical scientific literature bearing on the use of opioids for treatment of chronic non-cancer pain in the United States. There is substantial, albeit not definitive, scientific evidence of the effectiveness of opioids in treating pain and of high variability in opioid dose requirements and side effects. The estimated risk of death from opioid treatment involving doses above 100 MMED is ~0.25%/year. Multiple large studies refute the concept that short-term use of opioids to treat acute pain predisposes to development of opioid use disorder. The prevalence of opioid use disorder associated with prescription opioids is likely &lt;3%. Morbidity, mortality, and financial costs of inadequate treatment of the 18 million Americans with moderate to severe chronic pain are high. Because of the absence of comparative effectiveness studies, there are no scientific grounds for considering alternative non-pharmacologic treatments as an adequate substitute for opioid therapy but these treatments might serve to augment opioid therapy, thereby reducing dosage. There are reasons to question the ostensible risks of co-prescription of opioids and benzodiazepines. As the causes of the opioid crisis have come into focus, it has become clear that the crisis resides predominantly in the streets and that efforts to curtail it by constraining opioid treatment in the clinic are unlikely to succeed.

scholarly journals Sex differences in high opioid dose escalation among Malaysian patients with long term opioid therapy

2019 ◽  
Vol Volume 12 ◽  
pp. 1251-1257 ◽  
Author(s):  
Che Suraya Zin ◽  
Nor Elina Alias ◽  
Nor Hidayah Taufek ◽  
Mazlila Meor Ahmad
Keyword(s):  
Sex Differences ◽  
Dose Escalation ◽  
Opioid Therapy ◽  
Opioid Dose

Clinical interpretation of opioid tolerance versus opioid-induced hyperalgesia

2014 ◽  
Vol 10 (6) ◽  
pp. 383 ◽  
Author(s):  
Lucy Chen, MD ◽  
Michael Sein, MD ◽  
Trang Vo, BA ◽  
Shihab Amhmed, MD ◽  
Yi Zhang, MD ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Dose Escalation ◽  
Dose Adjustment ◽  
Opioid Analgesics ◽  
The United States ◽  
Opioid Therapy ◽  
Opioid Tolerance ◽  
Clinical Interpretation ◽  
Opioid Dose ◽  
Opioid Induced Hyperalgesia

Opioid analgesics are commonly used to manage moderate to severe pain. However, the long-term use of opioids could lead to opioid tolerance (OT) and opioid-induced hyperalgesia (OIH). Distinguishing OIH from OT would impact the practice of opioid therapy because opioid dose adjustment may differentially influence OT and OIH. Currently, there are no standard criteria of OT versus OIH causing considerable ambiguity in clinical interpretation and management of these conditions. The authors designed a practitioner-based survey consisting of 20 targeted questions. Answering these questions would require responders' actual clinical experiences with opioid therapy. The survey was conducted between 2011 and 2012 through direct mails or e-mails to 1,408 physicians who are currently practicing in the United States. The authors find that certain clinical characteristics (eg, increased pain despite opioid dose escalation) are often used by practitioners to make differential diagnosis of OT and OIH despite some overlap in their clinical presentation. A key difference in clinical outcome is that OT and OIH could be improved and exacerbated by opioid dose escalation, respectively. Our survey results revealed a significant knowledge gap in some responders regarding differential diagnosis and management of OT and OIH. The results also identified several issues, such as opioid dose adjustment and clinical comorbidities related to OT and OIH, which require future patient-based studies.

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