scholarly journals Changes in pain intensity after discontinuation of long-term opioid therapy for chronic noncancer pain

Pain ◽  
2018 ◽  
Vol 159 (10) ◽  
pp. 2097-2104 ◽  
Author(s):  
Sterling McPherson ◽  
Crystal Lederhos Smith ◽  
Steven K. Dobscha ◽  
Benjamin J. Morasco ◽  
Michael I. Demidenko ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Opioid Therapy ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain

scholarly journals Long-term opioid therapy for chronic noncancer pain: second update of the German guidelines

PAIN Reports ◽  
2020 ◽  
Vol 5 (5) ◽  
pp. e840
Author(s):  
Frank Petzke ◽  
Frietjof Bock ◽  
Michael Hüppe ◽  
Monika Nothacker ◽  
Heike Norda ◽  
...  
Keyword(s):  
Opioid Therapy ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain

Guideline-recommended vs high-dose long-term opioid therapy for chronic noncancer pain is associated with better health outcomes

Pain ◽  
2018 ◽  
Vol 159 (1) ◽  
pp. 85-91 ◽  
Author(s):  
Winfried Häuser ◽  
Tino Schubert ◽  
Norbert Scherbaum ◽  
Thomas Tölle
Keyword(s):  
Health Outcomes ◽  
Opioid Therapy ◽  
High Dose ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain

Opioid Misuse and Addiction Among Patients With Chronic Pain

2019 ◽  
pp. 339-354
Author(s):  
Marc O. Martel ◽  
Robert N. Jamison
Keyword(s):  
Chronic Pain ◽  
Opioid Therapy ◽  
Screening Tools ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Chronic Noncancer Pain ◽  
Medication Misuse ◽  
Opioid Medications ◽  
Noncancer Pain

Chapter 20 provides an introduction to understanding the prevalence and risk factors as well as screening tools for assessing opioid misuse and addiction in patients with chronic pain. In the era of the opioid epidemic in North America and beyond, the use of prescription opioid medications to help improve function in chronic noncancer pain is frequently debated. Out of fear of iatrogenic addiction, litigation, and/or potential medication misuse, some clinicians are refusing to prescribe opioids for chronic pain. Evidence indicates that rates of opioid misuse and addiction are fairly high among chronic pain patients prescribed long-term opioid therapy, but there is consensus that opioids can be safe and effective for carefully selected and monitored patients.

A Two-Year Prospective Multicenter Study of Opioid Therapy for Chronic Noncancer Pain: Prescription Trends and Predictors

Pain Medicine ◽  
2018 ◽  
Vol 20 (11) ◽  
pp. 2166-2178 ◽  
Author(s):  
Dalila R Veiga ◽  
Liliane Mendonça ◽  
Rute Sampaio ◽  
José M Castro-Lopes ◽  
Luís F Azevedo
Keyword(s):  
Chronic Pain ◽  
Clinical Outcomes ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain ◽  
Opioid Users

Abstract Objectives Opioid use in chronic pain has increased worldwide in recent years. The aims of this study were to describe the trends and patterns of opioid therapy over two years of follow-up in a cohort of chronic noncancer pain (CNCP) patients and to assess predictors of long-term opioid use and clinical outcomes. Methods A prospective cohort study with two years of follow-up was undertaken in four multidisciplinary chronic pain clinics. Demographic data, pain characteristics, and opioid prescriptions were recorded at baseline, three, six, 12, and 24 months. Results Six hundred seventy-four CNCP patients were recruited. The prevalence of opioid prescriptions at baseline was 59.6% (N = 402), and 13% (N = 86) were strong opioid prescriptions. At 24 months, opioid prescription prevalence was as high as 74.3% (N = 501), and strong opioid prescription was 31% (N = 207). Most opioid users (71%, N = 479) maintained their prescription during the two years of follow-up. Our opioid discontinuation was very low (1%, N = 5). Opioid users reported higher severity and interference pain scores, both at baseline and after two years of follow-up. Opioid use was independently associated with continuous pain, pain location in the lower limbs, and higher pain interference scores. Conclusions This study describes a pattern of increasing opioid prescription in chronic pain patients. Despite the limited improvement of clinical outcomes, most patients keep their long-term opioid prescriptions. Our results underscore the need for changes in clinical practice and further research into the effectiveness and safety of chronic opioid therapy for CNPC.

scholarly journals Tapering Long-term Opioid Therapy in Chronic Noncancer Pain

2015 ◽  
Vol 90 (6) ◽  
pp. 828-842 ◽  
Author(s):  
Chantal Berna ◽  
Ronald J. Kulich ◽  
James P. Rathmell
Keyword(s):  
Opioid Therapy ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain

How Effective Is Long-term Opioid Therapy for Chronic Noncancer Pain?

2007 ◽  
Vol 23 (4) ◽  
pp. 300-302 ◽  
Author(s):  
Michael C. Rowbotham ◽  
Calandra Diamond Lindsey
Keyword(s):  
Opioid Therapy ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain

scholarly journals Chronic Noncancer Pain and the Long Term Utility of Opioids

2004 ◽  
Vol 9 (1) ◽  
pp. 19-24 ◽  
Author(s):  
CPN Watson ◽  
JH Watt-Watson ◽  
ML Chipman
Keyword(s):  
Pain Relief ◽  
Adverse Events ◽  
Demographic Data ◽  
Chemical Dependency ◽  
Opioid Therapy ◽  
Chronic Noncancer Pain ◽  
History Of ◽  
One Year ◽  
Noncancer Pain

OBJECTIVE:To report on a long term experience in treating patients with chronic noncancer pain (CNCP).METHODS:One hundred two patients with CNCP were seen every three months and followed for one year or more (median eight years, range one to 22). Demographic data, diagnostic categories and response to therapies were recorded. The utility and safety of opioid therapy, adverse events, impact on disability and issues related to previous psychiatric or chemical dependency history were documented.RESULTS:Most patients reported a variety of neuropathic pain problems and most required chronic opioid therapy after the failure of other treatments. Although 44% reported being satisfied with pain relief despite adverse events, it is noteworthy that the remaining patients chose to continue therapy for the modest benefit of pain relief despite adverse events. Moreover, 54% were less disabled on opioid therapy.CONCLUSIONS:This is a large sample of CNCP patients, most taking opioids over a long period of time. CNCP can be treated by opioids safely and with a modest effect, with improvement in functioning in some patients who are refractory to other measures. If care is taken, opioids may even be used effectively for patients with a history of chemical dependency.

scholarly journals Self-Reported Practices in Opioid Management of Chronic Noncancer Pain: An Updated Survey of Canadian Family Physicians

2020 ◽  
Vol 9 (10) ◽  
pp. 3304
Author(s):  
Andrea D. Furlan ◽  
Santana Diaz ◽  
Angela Carol ◽  
Peter MacDougall ◽  
Michael Allen
Keyword(s):  
Online Survey ◽  
Family Physicians ◽  
Opioid Therapy ◽  
Chronic Noncancer Pain ◽  
Barriers And Enablers ◽  
Canadian Population ◽  
Noncancer Pain ◽  
Morphine Equivalent ◽  
Main Factor

Chronic pain affects one in five Canadians, and opioids continue to be prescribed to 12.3% of the Canadian population. A survey of family physicians was conducted in 2010 as a baseline prior to the release of the Canadian Opioid Guideline. We repeated the same survey with minor modifications to reflect the updated 2017 opioid prescribing guideline. The online survey was distributed in all provinces and territories in both English and French. There were 265 responses from May 2018 to October 2019, 55% of respondents were male, 16% had advanced training in pain management, 51% had more than 20 years in practice, 54% wrote five or fewer prescriptions of opioids per month, and 58% were confident in their skills in prescribing opioids. Of the 11 knowledge questions, only two were correctly selected by more than 80% of the respondents. Twenty-nine physicians (11%) do not prescribe opioids, and the main factor affecting their decisions were concerns about long-term adverse effects and lack of evidence for effectiveness of opioids in chronic noncancer pain. Of the 12 guideline-concordant practices, only two were performed regularly by 90% or more of the respondents: explain potential harms of long-term opioid therapy and beginning dose of less than 50 mg of morphine equivalent daily. This survey represents a small proportion of family physicians in Canada and its generalizability is limited. However, we identified a number of opioid-related and guideline-specific gaps, as well as barriers and enablers to prescribing opioids and adhering to the guideline.

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