Experience of Methadone Therapy in 100 Consecutive Chronic Pain Patients in a Multidisciplinary Pain Center

Abstract In the adversarial setting of an independent medical evaluation (IME), claimants may be incentivized to exaggerate the severity of their problems. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) describes a protocol for assessing impairment associated with chronic pain, including the Impairment Impact Inventory (I3) that consists of 26 items that assess the burden of illness in three domains: pain intensity, interference with activities of daily living, and emotional distress. A study was performed to establish preliminary norms for the I3 and to compare responses of claimants undergoing IMEs with those of treatment-seeking chronic pain patients: 183 patients completed the I3, including fibromyalgia syndrome patients (FMS group), 35 multidisciplinary pain center patients (PC group), and 72 claimants undergoing IMEs. Patients in the latter two groups had a variety of chronic pain problems (and hypothetically may be more likely to exaggerate their problems). The three groups had similar mean scores on the total I3 and for each of the FMS, PC, and IME groups. Results support the hypothesis that participants, in aggregate, do not exaggerate their pain when they undergo IMEs, although some quite possibly do. These results are a step toward establishing a scientific basis for the impairment rating system described in the AMA Guides from consensus-based rules to an evidence-based system for making decisions about impairment.

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Evaluation of Phenotypic and Genotypic Variations of Drug Metabolising Enzymes and Transporters in Chronic Pain Patients Facing Adverse Drug Reactions or Non-Response to Analgesics: A Retrospective Study

Journal of Personalized Medicine ◽

10.3390/jpm10040198 ◽

2020 ◽

Vol 10 (4) ◽

pp. 198

Author(s):

Victoria Rollason ◽

Célia Lloret-Linares ◽

Kuntheavy Ing Lorenzini ◽

Youssef Daali ◽

Marianne Gex-Fabry ◽

...

Keyword(s):

Chronic Pain ◽

Retrospective Study ◽

Cytochromes P450 ◽

Response To Treatment ◽

Glycoprotein P ◽

Chronic Pain Patients ◽

Comt Activity ◽

Pain Center ◽

Pain Patients ◽

Drug Metabolising Enzymes

This retrospective study evaluates the link between an adverse drug reaction (ADR) or a non-response to treatment and cytochromes P450 (CYP), P-glycoprotein (P-gp) or catechol-O-methyltransferase (COMT) activity in patients taking analgesic drugs for chronic pain. Patients referred to a pain center for an ADR or a non-response to an analgesic drug between January 2005 and November 2014 were included. The genotype and/or phenotype was obtained for assessment of the CYPs, P-gp or COMT activities. The relation between the event and the result of the genotype and/or phenotype was evaluated using a semi-quantitative scale. Our analysis included 243 individual genotypic and/or phenotypic explorations. Genotypes/phenotypes were mainly assessed because of an ADR (n = 145, 59.7%), and the majority of clinical situations were observed with prodrug opioids (n = 148, 60.9%). The probability of a link between an ADR or a non-response and the genotypic/phenotypic status of the patient was evaluated as intermediate to high in 40% and 28.2% of all cases, respectively. The drugs in which the probability of an association was the strongest were the prodrug opioids, with an intermediate to high link in 45.6% of the cases for occurrence of ADRs and 36.0% of the cases for non-response. This study shows that the genotypic and phenotypic approach is useful to understand ADRs or therapeutic resistance to a usual therapeutic dosage, and can be part of the evaluation of chronic pain patients.

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Age-Dependent Opioid Escalation in Chronic Pain Patients

Yearbook of Anesthesiology and Pain Management ◽

10.1016/s1073-5437(08)70477-7 ◽

2006 ◽

Vol 2006 ◽

pp. 233

Author(s):

S.E. Abram

Keyword(s):

Chronic Pain ◽

Chronic Pain Patients ◽

Age Dependent ◽

Pain Patients

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Pain Influences Several Levels of Attention

Zeitschrift für Neuropsychologie ◽

10.1024/1016-264x.16.4.235 ◽

2005 ◽

Vol 16 (4) ◽

pp. 235-242 ◽

Cited By ~ 4

Author(s):

Astrid von Bueren Jarchow ◽

Bogdan P. Radanov ◽

Lutz Jäncke

Keyword(s):

Chronic Pain ◽

Divided Attention ◽

Covert Attention ◽

Attention Task ◽

Attentional Deficits ◽

Control Subjects ◽

Chronic Pain Patients ◽

Divided Attention Task ◽

Pain Stimuli ◽

Pain Patients

Abstract: The aim of the present study was to examine to what extent chronic pain has an impact on various attentional processes. To measure these attention processes a set of experimental standard tests of the “Testbatterie zur Aufmerksamkeitsprüfung” (TAP), a neuropsychological battery testing different levels of attention, were used: alertness, divided attention, covert attention, vigilance, visual search, and Go-NoGo tasks. 24 chronic outpatients and 24 well-matched healthy control subjects were tested. The control subjects were matched for age, gender, and education. The group of chronic pain patients exhibited marked deficiencies in all attentional functions except for the divided attention task. Thus, the data supports the notion that chronic pain negatively influences attention because pain patients` attention is strongly captivated by the internal pain stimuli. Only the more demanding divided attention task has the capability to distract the focus of attention to the pain stimuli. Therefore, the pain patients are capable of performing within normal limits. Based on these findings chronic pain patients' attentional deficits should be appropriately evaluated and considered for insurance and work related matters. The effect of a successful distraction away from the pain in the divided attention task can also open new therapeutic aspects.

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