Opioid use in chronic pain management in the Philippines

Objective: Exploring the potential role of clonidine as an alternative to the currently available neuraxial medication options for the management of chronic pain. Methods: A comprehensive literature search was conducted investigating the treatment of chronic pain using clonidine over the past 73 years. A stepwise filtering approach was used to obtain articles addressing neuraxial treatment of chronic pain in adults. Selected articles were assessed for their levels of evidence followed by a discussion of their contribution to the understanding of the role of clonidine in chronic pain management. Results: Out of 1,035 articles that described the administration of clonidine for chronic pain management, seven articles met all of the inclusion criteria. Their levels of evidence ranged from 1a to 4 (Oxford Centre CEBM). Neuraxial administration of clonidine was found to be effective in the treatment of chronic pain, often exhibiting a synergistic effect with other analgesics to provide pain reduction with reduced opioid use. The most common side effect was hypotension, in some cases reported to have been serious. Conclusion: The use of neuraxial clonidine, in either a primary or adjunctive role, appears promising as an effective treatment for chronic pain.

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European Pain Federation position paper on appropriate opioid use in chronic pain management

European Journal of Pain ◽

10.1002/ejp.970 ◽

2016 ◽

Vol 21 (1) ◽

pp. 3-19 ◽

Cited By ~ 78

Author(s):

T. O'Brien ◽

L.L. Christrup ◽

A.M. Drewes ◽

M.T. Fallon ◽

H.G. Kress ◽

...

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Position Paper ◽

Chronic Pain Management ◽

Opioid Use

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Assessment of Chronic Pain Management in the Treatment of Opioid Use Disorder: Gaps in Care and Implications for Treatment Outcomes

Journal of Pain ◽

10.1016/j.jpain.2020.10.005 ◽

2020 ◽

Author(s):

Matthew S. Ellis ◽

Zachary Kasper ◽

Theodore Cicero

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Treatment Outcomes ◽

Opioid Use Disorder ◽

Chronic Pain Management ◽

Opioid Use

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Framing of the opioid problem in cancer pain management in Canada

Current Oncology ◽

10.3747/co.26.4517 ◽

2019 ◽

Vol 26 (3) ◽

Cited By ~ 3

Author(s):

R. Asthana ◽

S. Goodall ◽

J. Lau ◽

C. Zimmermann ◽

P. L. Diaz ◽

...

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Cancer Pain ◽

Opioid Therapy ◽

Position Paper ◽

Chronic Pain Management ◽

Opioid Use ◽

Cancer Pain Management ◽

Canadian Guideline ◽

Patients With Cancer

Two guidelines about opioid use in chronic pain management were published in 2017: the Canadian Guideline for Opioids for Chronic Non-Cancer Pain and the European Pain Federation position paper on appropriate opioid use in chronic pain management. Though the target populations for the guidelines are the same, their recommendations differ depending on their purpose. The intent of the Canadian guideline is to reduce the incidence of serious adverse effects. Its goal was therefore to set limits on the use of opioids. In contrast, the European Pain Federation position paper is meant to promote safe and appropriate opioid use for chronic pain. The content of the two guidelines could have unintentional consequences on other populations that receive opioid therapy for symptom management, such as patients with cancer. In this article, we present expert opinion about those chronic pain management guidelines and their impact on patients with cancer diagnoses, especially those with histories of substance use disorder and psychiatric conditions. Though some principles of chronic pain management can be extrapolated, we recommend that guidelines for cancer pain management should be developed using empirical data primarily from patients with cancer who are receiving opioid therapy.

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