Opioid Pharmacotherapies for Chronic Pain (DRAFT)

2018 ◽  
Author(s):  
Thien C. Pham ◽  
Courtney Kominek ◽  
Abigail Brooks ◽  
Jeffrey Fudin
Keyword(s):  
Chronic Pain ◽  
Extended Release ◽  
Opioid Analgesics ◽  
Chronic Pain Management ◽  
Opioid Use ◽  
Daily Dose ◽  
Long Acting ◽  
Conversion Tool ◽  
Morphine Equivalent

Chronic pain management employing opioids is divided into subtopics, including: risk–benefit balance; a review of the mode of action of opioid analgesics (Chap. 8); the suitability of synthetic opioids for neuropathic pain; endocrinopathy proceeding from opioid use; the use of the morphine-equivalent daily dose as a conversion tool for managing multiple opioids; the place of extended-release and long-acting opioids; current technology in abuse deterrence; and an overview of the challenges entailed in prescribing. This last section details the complex components of a decision to prescribe opioids for chronic pain. A table is provided of the classification of common opioid analgesics and their duration of activity. A text box gives the table of contents of Appendix B, supportive tables and figures therein for this chapter; there is also a text box listing additional resources.

The Pharmacology of Opioids (DRAFT)

2018 ◽  
Author(s):  
Christopher Cavacuiti
Keyword(s):  
Adverse Effects ◽  
Opioid Receptor ◽  
Extended Release ◽  
Receptor Subtypes ◽  
Synthetic Method ◽  
Physiological Effects ◽  
Opioid Use ◽  
Receptor Affinity ◽  
Opioid Receptor Subtypes ◽  
Long Acting

This chapter focuses on the attributes of and component medications within the class of opioids, emphasizing kinetics, dynamics, and therapeutic and adverse effects. To help patients make informed decisions about opioid use, the clinicians prescribing these medications must be able to explain when opioids are likely to help and when they are likely to do harm. Subclasses of opioids include phenanthrenes, benzomorphans, phenylpiperidines, and diphenylheptanes; examples are given of each, with respective utilities and limitations. A discussion then follows of pharmacodynamics, pharmacokinetics, opioid receptor affinity, metabolism, and drug interactions. Tables and figures amplifying the text include: opioid class by synthetic method (Table 8.1); common physiological effects by opioid receptor subtypes (Table 8.2); opioid activity (Table 8.3); and a listing of figures and tables located in Appendix B (opioid receptor affinity, respiratory depression with opioids, adverse effects, metabolism, pharmacogenetics, extended release/long-acting opioids, abuse deterrent formulations). A text box provides supplemental resources.

scholarly journals Gaps in the Use of Long-Acting Opioids Within Intervals of Consecutive Days Among Cancer Outpatients Using Electronic Pill Caps

Pain Medicine ◽  
2020 ◽  
Author(s):  
Salimah H Meghani ◽  
Amelia L Persico ◽  
Jeffrey Fudin ◽  
George J Knafl
Keyword(s):  
Cancer Patients ◽  
Extended Release ◽  
Electronic Monitoring ◽  
Secondary Analysis ◽  
Study Participant ◽  
Current Analysis ◽  
Opioid Use ◽  
Event Monitoring ◽  
Atlantic Region ◽  
Long Acting

Abstract Objective This study describes individual cancer patients’ nonuse of extended-release or long-acting (ER/LA) opioids, including periods of gap between opioid doses taken. Design Secondary analysis of a three-month observational study of prescribed ER/LA opioids monitored using electronic pill caps. Setting Two outpatient oncology clinics of a large health system in the Mid-Atlantic region. Participants Inclusion was based on self-identified African Americans and whites, at least 18 years old, diagnosed with solid tumors or multiple myeloma. For the current analysis, the additional inclusion criterion was prescription of an oral ER/LA opioid for cancer pain to be taken around the clock. Methods The electronic monitoring period for each study participant was partitioned into intervals of days between days with one or more openings (using medication event monitoring systems) representing rates of ER/LA opioid nonuse over consecutive days and over time. Results Of the sample (N = 109), two-thirds of the cancer patients had some nonuse of prescribed ER/LA opioids, with one in four having nonuse during 31.5–87.5% of their electronic-monitoring periods. Nonuse over periods of five or more, six or more, and seven or more consecutive days occurred for 37.6%, 34.9%, and 30.3% of the participants, respectively. Conclusions About one in three ambulatory cancer patients in this study had substantial gaps between days of ER/LA opioid use, potentially resulting in risk of overdose depending upon the prescribed ER/LA opioid type, dose, and length of the time the opioid was stopped and resumed at the previous dose. This phenomenon has received little to no attention in the opioid safety discourse.

scholarly journals Subcutaneous Extended-Release Buprenorphine Use in Pregnancy

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Craig V. Towers ◽  
Heather Deisher
Keyword(s):  
Extended Release ◽  
Opioid Use Disorder ◽  
Adverse Outcomes ◽  
Extensive Literature ◽  
Opioid Use ◽  
Sublingual Buprenorphine ◽  
Medication Assisted Treatment ◽  
Urine Drug ◽  
Long Acting ◽  
In Pregnancy

Background. Opioid use disorder (OUD) in pregnancy is managed by medication-assisted treatment. Sublingual buprenorphine is one option, but subcutaneous extended-release buprenorphine (Sublocade®) is an alternate form administered in monthly injections. Through an extensive literature search, we did not find any prior publication on the use of Sublocade in pregnancy. Case. Two patients with OUD switched from sublingual buprenorphine to Sublocade. One patient received a total of eight injections and then discovered she was pregnant. Based on ultrasound dating, the last 5 administrations occurred during her pregnancy. The second patient received 6 injections with the last occurring at the time of her last menstrual period. Both declined further injections, as well as oral buprenorphine. Serial urine drug screens remained positive for buprenorphine through delivery in both cases. Neither the mothers nor the neonates experienced withdrawal symptoms or adverse outcomes. No birth anomalies were found. Discussion. Though further research is needed regarding the use of Sublocade in pregnancy, it is likely that other pregnancies will occur during this treatment modality. If this long-acting form of buprenorphine medication is found to be safe, it might play a role in managing some pregnant patients with OUD.

Oxymorphone and oxymorphone extended release: A pharmacotherapeutic review

2018 ◽  
Vol 4 (3) ◽  
pp. 131 ◽  
Author(s):  
Paul Alexander Sloan, MD ◽  
Robert L. Barkin, PharmD, MBA
Keyword(s):  
Chronic Pain ◽  
Extended Release ◽  
Analgesic Efficacy ◽  
Opioid Analgesics ◽  
Immediate Release ◽  
The United States ◽  
Efficacy And Safety ◽  
Open Label ◽  
Opioid Agonist ◽  
Noncancer Pain

The treatment of chronic pain remains an enormous challenge in the United States. Opioid analgesics are an important component of pharmacotherapy for chronic pain and have proven efficacy in the management of cancer and noncancer chronic pain. The newest addition to oral opioid pharmacotherapy is oral oxymorphone, a semisynthetic opioid agonist that is now available in oral immediate-release (IR) and extended-release (ER) formulations. This review discusses the pharmacology, pharmacokinetics, pharmacodynamics, pharmacotherapeutics, and clinical use of oral oxymorphone IR and ER formulations for the management of moderate to severe pain for different types of patients in a variety of settings. Two published studies evaluated the efficacy and safety of oxymorphone IR in patients with moderate to severe postoperative pain and demonstrated that it provides rapid and effective analgesia and is generally well tolerated. Six published randomized controlled trials and three published open-label studies evaluated the efficacy and safety of oxymorphone ER for chronic cancer or noncancer pain. These trials found analgesic efficacy and tolerability comparable to that provided by morphine controlled release (CR) or oxycodone CR; treatment effects with oxymorphone ER were durable for treatment periods of 12 weeks at the same dose or up to 1 year with little dose escalation. Titrated doses of oxymorphone ER were effective and generally well tolerated in both opioid-experienced and opioid-naïve patients. Aspects of oxymorphone metabolism and limited protein binding may simplify treatment in certain populations.

Is Neuraxial Clonidine a Safer Alternative to Opioids for Chronic Pain? An Alternative Worth Exploring

2020 ◽  
pp. 1-7
Author(s):  
Nagy Mekhail ◽  
Nagy Mekhail ◽  
Shrif Costandi ◽  
Alaa Abd-Elsayed ◽  
Gregory Fiore ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Potential Role ◽  
Common Side Effect ◽  
Chronic Pain Management ◽  
Inclusion Criteria ◽  
Opioid Use ◽  
Levels Of Evidence ◽  
The Past

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.

Daily home opioid use in adults with sickle cell disease: The PiSCES project

2015 ◽  
Vol 11 (3) ◽  
pp. 243 ◽  
Author(s):  
Wally R. Smith, MD ◽  
Donna K. McClish, PhD ◽  
Bassam A. Dahman, PhD ◽  
James L. Levenson, MD ◽  
Imoigele P. Aisiku, MD, MSCR ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Symptom Burden ◽  
Opioid Analgesics ◽  
Cell Disease ◽  
Opioid Use ◽  
Short Acting ◽  
Negative Coping ◽  
Long Acting ◽  
Opioid Users

Background: Although opioid prescribing in sickle cell disease (SCD) can be controversial, little is published about patterns of opioid use.Objective: To report on home opioid use among adults with SCD.Design: Cohort study.Participants: Adults with SCD (n = 219) who completed daily pain diaries for up to 6 months and had at least one home pain day.Main measures: Use of long-acting or short-acting opioids, other analgesics, or adjuvants; the proportion of home days, home pain days, and home crisis days with opioid use; these two outcomes according to patient characteristics.Key results: Patients used opioids on 12,311 (78 percent) of 15,778 home pain days. Eighty-five patients (38.8 percent) used long-acting opioids with or without short-acting opioids and 103 (47.0 percent) used only short-acting opioids. Twenty-one (9.6 percent) patients used only non-opioid analgesics and 10 (4.6 percent) used no analgesics. Both pain intensity and pain frequency were higher among opioid users (analysis of variance [ANOVA], p < 0.0001). Opioid users used hydroxyurea more often than nonusers, even when controlling for mean pain on pain days. Among all patients, significant relationships were found between any opioid use and somatic symptom burden, SCD stress, negative coping, and physical and mental quality of life (QOL); the relationship with SCD stress and physical QOL remained when controlled for mean pain. Among opioid users, similar associations were found between frequency of opioid use and some disease-related and psychosocial variables.Conclusions: In this adult SCD sample, opioids were used by the majority of patients. Pain was the overwhelming characteristic associated with use, but disease-related and psychosocial variables were also associated.

Opioid use in chronic pain management in the Philippines

2001 ◽  
Vol 5 (SA) ◽  
pp. 83-85 ◽  
Author(s):  
Francis O. Javier ◽  
Lyde A. Magpantay ◽  
E.L. Espinosa ◽  
S.M. Harder ◽  
M.A. Unite
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
The Philippines ◽  
Chronic Pain Management ◽  
Opioid Use
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