Conversion of Schedule II Opioids to Buprenorphine Buccal Film: A Retrospective Analysis

Pain Medicine ◽  
2020 ◽  
Author(s):  
Amanda Zimmerman ◽  
Rami Bikdash ◽  
Richard Rauck
Keyword(s):  
Chronic Pain ◽  
North Carolina ◽  
Chart Review ◽  
Rating Scale ◽  
Breakthrough Pain ◽  
Numerical Rating Scale ◽  
Inclusion Criteria ◽  
Pain Scores ◽  
Numerical Rating ◽  
Long Acting

Abstract Objective To provide clinical data for the conversion of Schedule II opioids to buprenorphine buccal film and to demonstrate sustained analgesia and a reduction in morphine milligram equivalents after conversion. Design Retrospective review of electronic medical records. Setting Group clinical practice providing outpatient chronic pain management care in Winston-Salem, North Carolina. Subjects Patients who received opioids for chronic pain between January 1, 2016, and June 30, 2019, were selected for chart review if they were converted to buprenorphine buccal film from a Schedule II opioid. Methods Patients who met inclusion criteria were stratified into subgroups on the basis of preconversion morphine milligram equivalents, whether they remained on opioids for breakthrough pain postconversion, and pre- and postconversion numerical rating scale pain scores. Outcomes of interest included the differences between pre- and postconversion numerical rating scale pain scores and daily morphine milligram equivalents for each subgroup. Results Of 157 patients reviewed, 87.9% were successfully converted to buprenorphine buccal film. Overall, numerical rating scale pain scores were stable after conversion. Statistically significant reductions were demonstrated in the <90 daily morphine milligram equivalent subgroup. Postconversion daily morphine milligram equivalents decreased by 85.4% from baseline. Change in daily morphine milligram equivalents is representative of patients who remained on breakthrough pain medication. Conclusions Results demonstrate continued analgesia after conversion to buprenorphine buccal film despite reductions in daily morphine milligram equivalents. Most patients were able to convert directly from their long-acting opioid to buprenorphine buccal film and stabilized without the use of concomitant opioids for breakthrough pain. Aggressive titration strategies were associated with greater success.

scholarly journals Analgesic Effects of Preincision Ketamine on Postspinal Caesarean Delivery in Uganda’s Tertiary Hospital: A Randomized Clinical Trial

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Richard Mwase ◽  
Tonny Stone Luggya ◽  
John Mark Kasumba ◽  
Humphrey Wanzira ◽  
Andrew Kintu ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Rating Scale ◽  
Breakthrough Pain ◽  
Numerical Rating Scale ◽  
Postoperative Pain Management ◽  
Mulago Hospital ◽  
Clinical Trial Registry ◽  
Analgesic Effects ◽  
Pain Scores ◽  
Intravenous Ketamine

Background. Good postoperative analgesic management improves maternal satisfaction and care of the neonate. Postoperative pain management is a challenge in Mulago Hospital, yet ketamine is accessible and has proven benefit. We determined ketamine’s postoperative analgesic effects.Materials and Methods. We did an RCT among consenting parturients that were randomized to receive either intravenous ketamine (0.25 mg/kg) or placebo after spinal anesthetic. Pain was assessed every 30 mins up to 24 hours postoperatively using the numerical rating scale. The first complaint of pain requiring treatment was noted as “time to first breakthrough pain.”Results. We screened 100 patients and recruited 88 that were randomized into two arms of 44 patients that received either ketamine or placebo. Ketamine group had 30-minute longer time to first breakthrough pain and lower 24-hour pain scores. Postoperative diclofenac consumption was lesser in the ketamine group compared to placebo and Kaplan-Meier graphs showed a higher probability of experiencing breakthrough pain earlier in the placebo group.Conclusion. Preincision intravenous ketamine (0.25 mg/kg) offered 30-minute prolongation to postoperative analgesia requirement with reduced 24-hour pain scores. We recommend larger studies to explore this benefit. This trial is registered with Pan African Clinical Trial Registry numberPACTR201404000807178.

scholarly journals Resting-state brain functional connectivity in patients with chronic pain who responded to subanesthetic-dose ketamine

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yasushi Motoyama ◽  
Yoshitetsu Oshiro ◽  
Yumiko Takao ◽  
Hitoaki Sato ◽  
Norihiko Obata ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Functional Connectivity ◽  
Resting State ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Predictive Marker ◽  
Significant Negative Correlation ◽  
Improvement Rate ◽  
Numerical Rating ◽  
Brain Functional Connectivity

Abstract Ketamine has been used to treat chronic pain; however, it is still unknown as to what types of chronic pain is ketamine effective against. To identify the effect of administration of subanesthetic-dose ketamine in patients with chronic pain and to clarify the mechanism of the effect, we retrospectively investigated brain functional connectivity using resting-state functional magnetic resonance imaging (rs-fMRI). Patients were divided into responders (Group R: ≥50% improvement on Numerical Rating Scale) and non-responders (Group NR). We compared the differences in terms of brain functional connectivity by seed-to-voxel correlation analysis. Two-sample t-test revealed significant lower connectivity between the medial prefrontal cortex (mPFC) and precuneus in Group R. We also found a significant negative correlation between the improvement rate and functional connectivity strength between the mPFC and precuneus. These findings suggest that subanesthetic-dose ketamine is effective in patients with chronic pain whose brain functional connectivity between the mPFC and precuneus is low. We believe that the current study explored for the first time the correlation between brain functional connectivity and the effect of subanesthetic-dose ketamine for chronic pain and indicated the possibility of use of the predictive marker in pharmacological treatment of chronic pain.

scholarly journals EUS-Guided Versus Percutaneous Celiac Neurolysis for the Management of Intractable Pain Due to Unresectable Pancreatic Cancer: A Randomized Clinical Trial

2020 ◽  
Vol 9 (6) ◽  
pp. 1666
Author(s):  
Won Jae Yoon ◽  
Yul Oh ◽  
Changhoon Yoo ◽  
Sunguk Jang ◽  
Seong-Sik Cho ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Abdominal Pain ◽  
Back Pain ◽  
Cancer Patients ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Intractable Pain ◽  
Point Reduction ◽  
Pain Scores ◽  
Numerical Rating

Although endoscopic ultrasound-guided celiac neurolysis (EUS-CN) and percutaneous celiac neurolysis (PCN) are utilized to manage intractable pain in pancreatic cancer patients, no direct comparison has been made between the two methods. We compared the efficacy and safety of EUS-CN and PCN in managing intractable pain in such patients. Sixty pancreatic cancer patients with intractable pain were randomly assigned to EUS-CN (n = 30) or PCN (n = 30). The primary outcomes were pain reduction in numerical rating scale (NRS) and opioid requirement reduction. Secondary outcomes were: successful pain response (NRS decrease ≥50% or ≥3-point reduction from baseline); quality of life; patient satisfaction; adverse events; and survival rate at 3 months postintervention. Both groups reported sustained decreases in pain scores up to 3 months postintervention (mean reductions in abdominal pain: 0.9 (95% confidence interval (CI): −0.8 to 4.2) and 1.7 (95% CI: −0.3 to 2.1); back pain: 1.3 (95% CI: −0.9 to 3.4) and 2.5 (95% CI: −0.2 to 5.2) in EUS-CN, and PCN groups, respectively). The differences in mean pain scores between the two groups at baseline and 3 months were −0.5 (p = 0.46) and −1.4 (p = 0.11) for abdominal pain and 0.1 (p = 0.85) and −0.9 (p = 0.31) for back pain in favor of PCN. No significant differences were noted in opioid requirement reduction and other outcomes. EUS-CN and PCN were similarly effective and safe in managing intractable pain in pancreatic cancer patients. Either methods may be used depending on the resources and expertise of each institution.

scholarly journals The Role of Testosterone Supplemental Therapy in Opioid-Induced Hypogonadism: A Retrospective Pilot Analysis

2016 ◽  
Vol 11 (4) ◽  
pp. 1208-1213 ◽  
Author(s):  
Omer A. Raheem ◽  
Sunil H. Patel ◽  
David Sisul ◽  
Tim J. Furnish ◽  
Tung-Chin Hsieh
Keyword(s):  
Chronic Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Opioid Therapy ◽  
Total Testosterone ◽  
Chronic Noncancer Pain ◽  
Numerical Rating ◽  
Noncancer Pain ◽  
Supplemental Therapy

Chronic opioid therapy for pain management is known to induce several endocrine changes. The authors examined the effect of testosterone supplemental therapy (TST) in patients with chronic, noncancer pain undergoing opioid therapy. It was hypothesized that treatment of opioid-induced hypogonadism (OIH) can reduce opioid requirements in patients suffering from chronic pain and approve their quality of life. Over 18 months period, patients with OIH were identified in a tertiary referral pain center, Numerical Rating Scale (NRS) pain scores and daily morphine equivalent dose (MED) were the primary outcomes measured. Data were collected and comparative analysis performed between men undergoing TST versus nontreatment group. Twenty-seven OIH patients (total testosterone <300 ng/dL) were identified during the study period. TST group consists of 11 patients, while non-TST group consists of 16 patients as control cohort. Mean patient age (55 and 54.4, p = .4) and basic metabolic index (28.5 and 31.9, p = .07) in TST and non-TST groups, respectively. Mean follow-up total testosterone (ng/dL) was significantly higher after TST compared with the non-TST group (497.5 vs. 242.4 ng/dL, p = .03). Median follow-up NRS was 0 and 2 in the TST and non-TST groups ( p = .02). Mean MED (mg) decreased by 21 mg in TST group and increased by 2.5 mg in non-TST group ( p < .05). This study reports that treatment of OIH with TST can reduce opioid requirements in men with chronic pain as quantified by MED. It also confirms previous reports on the potential effects of OIH and that TST is effective in correcting opioid-induced endocrine abnormalities.

What is the clinical relevance of the Numerical rating scale for pain?

2018 ◽  
Author(s):  
Felicia Cox
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Clinical Importance ◽  
Patient Global Impression ◽  
Numerical Rating ◽  
Group A ◽  
Clinically Significant ◽  
Global Impression Of Change

The landmark paper discussed in this chapter is ‘Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale’, published by Farrar et al. in 2001. The numerical rating scale is now the standard instrument used in chronic pain studies to measure pain intensity. Farrar et al. determined the changes in pain intensity that were clinically significant for studies of chronic pain while measuring the patient’s global impression of change. The paper used pooled data from ten recent studies of pregabalin in 2,724 subjects. The authors reported a consistent relationship between pain intensity and patient global impression of change, regardless of study, disease type, age, sex, study result, or treatment group. A reduction of approximately two points on the numerical rating scale, or of 30% in the global impression of change of pain intensity, represented a clinically important difference.

scholarly journals Clinical Evaluation of a Topical Patch for the Management of Acute and Chronic Osteoarticular Pain

2020 ◽  
pp. 1-4
Author(s):  
Gaetana Rizzi ◽  
◽  
Carlo Braga ◽  
Alessandro Corsi ◽  
◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Therapy ◽  
Rating Scale ◽  
Negative Impact ◽  
Numerical Rating Scale ◽  
Age Groups ◽  
The Elderly ◽  
Topical Product ◽  
Numerical Rating

Pain is a symptom common to many pathological conditions that can affect all age groups, with greater incidence among adults and the elderly. It is an important clinical, social and economic aspect of all ages and has a negative impact on the quality of life. Pain therapy, also called antalgic therapy or pain medicine, aims to identify, evaluate and treat acute and/or chronic pain. The objective of this observational study is to evaluate the effect of the ”Tecnologia DUKTOR ionoattiva” iPatchMed ZeroDol patch in reducing in the short-term painful symptoms in case of local acute and chronic inflammatory states. The patch is a topical product to be applied on the affected area in order to create a hydro-active environment. The mechanism of action consists in the generation of micro-currents and micro-electromagnetic fields that promote ion exchange and the passage of micro-currents in the cutaneous tissues, increasing the use of oxygen by the cells and the restoration of the cell membrane. This results in both cellular reinvigoration and a high antalgic effect.This single-arm monocentric investigation has 50 subjects with acute and chronic pain.The pain measurement was recorded through the Numerical Rating Scale (NRS) at selected time points: at baseline (T0) and after 2, 8 and 24 hours. The use of the ”Tecnologia DUKTOR ionoattiva” iPatchMed ZeroDol patch significantly promotes a decrease in acute and chronic pain; furthermore, no adverse effects were recorded, thus demonstrating that the medical device is optimally tolerated.

scholarly journals A Novel Exercise Facilitation Method in Combination with Cognitive Behavioral Therapy Using the Ikiiki Rehabilitation Notebook for Intractable Chronic Pain: Technical Report and 22 Cases

Healthcare ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1209
Author(s):  
Shinji Kimura ◽  
Masako Hosoi ◽  
Naofumi Otsuru ◽  
Madoka Iwasaki ◽  
Takako Matsubara ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cognitive Behavioral Therapy ◽  
Rating Scale ◽  
School Attendance ◽  
Numerical Rating Scale ◽  
Pain Catastrophizing ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Technical Report ◽  
Numerical Rating

Recent clinical practice guidelines for chronic pain indicate, with a high evidence level, that the combination of exercise and cognitive behavioral therapy (CBT) is effective. The purpose of this study was to evaluate the effectiveness of an exercise facilitation method in combination with CBT using the “Ikiiki Rehabilitation Notebook” for patients with intractable chronic pain. “Ikiiki” means active in Japanese. A total of 22 cases with chronic low back (n = 13), lower extremity (n = 8), or neck (n = 1) pain were treated using this notebook. Two cases dropped out, leaving 22 cases. Each case was evaluated in terms of the numerical rating scale (NRS) of the pain, activities of daily living (ADL), pain catastrophizing scale (PCS), and quality of life (QOL) at pretreatment and post-treatment. The endpoint of the method was to achieve the long-term goals set by the patients. The mean treatment period was 11.2 months. The outcomes were as follows: improvement of presenteeism: nine cases; enhanced participation in hobbies: seven cases; improved school attendance: two cases; return to work: one case; improvement of self-care and/or self-efficacy: three cases. The NRS, ADL, PCS, and QOL were significantly improved after the treatment. This method is possibly valuable for educating patients about the cause and treatment of chronic pain and actively facilitating exercise and social participation. Further studies are needed to investigate the effectiveness of using this notebook for the patient with intractable chronic pain.

scholarly journals Assessing Pain Intensity in Children with Chronic Pain: Convergent and Discriminant Validity of The 0 To 10 Numerical Rating Scale in Clinical Practice

2014 ◽  
Vol 19 (3) ◽  
pp. 141-148 ◽  
Author(s):  
Danielle Ruskin ◽  
Chitra Lalloo ◽  
Khushnuma Amaria ◽  
Jennifer N Stinson ◽  
Erika Kewley ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Clinical Practice ◽  
Pain Intensity ◽  
Discriminant Validity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Clinic ◽  
Small Range ◽  
Convergent And Discriminant Validity ◽  
Numerical Rating

BACKGROUND: In clinical practice, children are often asked to rate their pain intensity on a simple 0 to 10 numerical rating scale (NRS). Although the NRS is a well-established measure for adults, no study has yet evaluated its validity for children with chronic pain.OBJECTIVES: To examine the convergent and discriminant validity of the NRS as it is used within regular clinical practice to document pain intensity for children with chronic pain. Interchangeability between the NRS and an analogue pain measure was also assessed.METHODS: A cohort of 143 children (mean [± SD] age 14.1±2.4 years; 72% female) rated their pain intensity (current, usual, lowest and strongest levels) on a verbally administered 0 to 10 NRS during their first appointment at a specialized pain clinic. In a separate session that occurred either immediately before or after their appointment, children also rated their pain using the validated 0 to 10 coloured analogue scale (CAS).RESULTS: NRS ratings met a priori criteria for convergent validity (r>0.3 to 0.5), correlating with CAS ratings at all four pain levels (r=0.58 to 0.68; all P<0.001). NRS for usual pain intensity differed significantly from an affective pain rating, as hypothesized (Z=2.84; P=0.005), demonstrating discriminant validity. The absolute differences between NRS and CAS pain scores were small (range 0.98±1.4 to 1.75±1.9); however, the two scales were not interchangeable.CONCLUSIONS: The present study provides preliminary evidence that the NRS is a valid measure for assessing pain intensity in children with chronic pain.

Sign in / Sign up

Export Citation Format

Share Document