Perioperative and Intraoperative Pain and Anesthetic Care of the Chronic Pain and Cancer Pain Patient Receiving Chronic Opioid Therapy

Pain Practice ◽  
2005 ◽  
Vol 5 (1) ◽  
pp. 18-32 ◽  
Author(s):  
Dima Rozen ◽  
Gerald W. Grass
Keyword(s):  
Chronic Pain ◽  
Cancer Pain ◽  
Opioid Therapy ◽  
Pain Patient ◽  
Chronic Opioid Therapy ◽  
Anesthetic Care ◽  
Intraoperative Pain

scholarly journals Chronic Opioid Therapy for Chronic Non-Cancer Pain: A Review and Comparison of Treatment Guidelines

2014 ◽  
Vol 5;17 (5;9) ◽  
pp. 401-414
Author(s):  
Chi-Wai Cheung
Keyword(s):  
Chronic Pain ◽  
Adverse Effects ◽  
Cancer Pain ◽  
Practice Guidelines ◽  
Scientific Evidence ◽  
Opioid Therapy ◽  
Scientific Data ◽  
Drug Misuse ◽  
Opioid Use ◽  
Chronic Opioid Therapy

Background: Long-term opioid use for chronic non-cancer pain has increased substantially in recent years despite the paucity of strong supporting scientific data and concerns regarding adverse effects and potential misuse. Study Design: Review and summary of practice guidelines available on PubMed and Cochrane databases as well as on the Internet on chronic opioid therapy from June 2004 to June 2013. Objective: To review expert-developed practice guidelines on chronic opioid therapy, published in different countries over the past decade in order to reveal similar principles of therapy and to provide useful information and references for future development of opioid guidelines to identify adequately supported practice points and areas in need of further scientific evidence. Method: Seven guidelines were identified as pertaining specifically to the long-term use of opioids for general chronic non-cancer pain from an initial search of the PubMed/Medline and Cochrane databases using combinations of the search terms “opioid,” “chronic opioid therapy,” “chronic pain,” “chronic non-cancer pain,” “chronic non-malignant pain,” “guidelines,” “practice guidelines,” and “clinical practice guidelines,” filtered to include only articles on humans published in the English language over the past 10 years. Results: All guidelines espouse an individual approach to management, beginning with a comprehensive patient evaluation, with particular focus on eliciting factors that may indicate potential drug misuse and abuse, and a trial of therapy to determine the course of treatment. Goals of treatment should be adequately discussed with and consented to by the patient. Opioids are generally not recommended as first-line therapy but, when used, clinicians should closely monitor patients for loss of response, adverse effects or aberrant behavior, and revise the treatment plan accordingly. Urine drug testing (UDT) may be used as a tool to monitor for aberrant behavior or drug misuse; opioid rotation may be considered when loss of response or adverse effects are a concern, at a starting dose lower than the calculated equianalgesic dose. Limitations: Information on some African nations, countries in the Middle-East, and Pacific Islands is not available and therefore was not included in this review. Conclusion: There is a growing body of scientific evidence to support opioid use in chronic pain. Future work should focus on continuing to generate good-quality evidence on the longterm benefits of opioid therapy, as well as scientific data to guide drug choice and dosing for specific conditions, populations, and situations. Key words: Chronic pain, opioid, non-cancer pain, guidelines, opioid rotation, pain management, opioid therapy

scholarly journals Patient Engagement Survey Regarding Future Double-Blinded, Randomized Controlled Trial of Tapering of Chronic Opioid Therapy

2019 ◽  
Vol 10 ◽  
pp. 215013271989023
Author(s):  
Jared James ◽  
Benjamin Lai ◽  
Terrence Witt
Keyword(s):  
Chronic Pain ◽  
Patient Engagement ◽  
Opioid Therapy ◽  
Future Research ◽  
Pain Patient ◽  
Willingness To Participate ◽  
Chronic Opioid Therapy ◽  
Management Options ◽  
Chronic Noncancer Pain ◽  
Opioid Medications

Objective: There is a lack of evidence regarding tapering opioid medications in patients with chronic non-cancer pain. The purpose of this survey was to gather perspectives on future research into opioid tapering from utilizers of chronic opioid therapy (COT) or other people affected by chronic noncancer pain. Methods: The survey was distributed in paper form to patients on COT and via an online platform to patients self-enrolled in the chronic pain patient engagement group. The survey included a layman’s description of a possible tapering trial of opioid medications and elicited binary responses regarding willingness to participate and reasoning as well as qualitative freeform responses. Thematic analysis was performed to identify themes in narrative responses. Results: A total of 190 surveys were returned with 72.1% of all respondents answering positively regarding their willingness to participate in a proposed study. The most common reasons for participating in the study included concerns regarding opioid dependence, adding to society’s knowledge of opioid medications, and determining if the respondent would personally receive benefit from opioid medications. Patients recently on COT felt it was important to be able to withdraw from the study and return to usual care at any time (41.8% for recent COT and 15.5% for no recent COT, P < .05). The most common reason for unwillingness to participate was that respondents did not feel they had enough information to feel comfortable participating. The narrative responses showed a group of respondents felt COT was the only answer to their or their loved ones’ chronic pain and that a study would demonstrate the need to continue these medications long-term. There were also stories of side effects and dependence with decreasing effectiveness of opioids for pain control. When prompted to comment on study design, respondents indicated the study should include alternative pain management options. This was accompanied by responses with the assumption that pain will worsen as opioid medications are decreased. Conclusion: Patient concerns regarding opioid medications and discontinuation reflect the lack of evidence available to prescribers. There appears to be patient support for future research into the effects of tapering opioid medications.

scholarly journals Problems and concerns of patients receiving chronic opioid therapy for chronic non-cancer pain

Pain ◽  
2010 ◽  
Vol 149 (2) ◽  
pp. 345-353 ◽  
Author(s):  
Mark D. Sullivan ◽  
Michael Von Korff ◽  
Caleb Banta-Green ◽  
Joseph O. Merrill ◽  
Kathleen Saunders
Keyword(s):  
Cancer Pain ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy

scholarly journals A Systematic Review of Randomized Trials of Long-Term Opioid Management for Chronic Non-Cancer Pain

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. 91-121
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Cancer Pain ◽  
Systematic Reviews ◽  
Randomized Trials ◽  
Opioid Therapy ◽  
Functional Improvement ◽  
Controlled Trials ◽  
Chronic Opioid Therapy ◽  
Level Of Evidence

Background: Even though opioids have been used for pain for thousands of years, opioid therapy for chronic non-cancer pain is controversial due to concerns regarding the long-term effectiveness and safety, particularly the risk of tolerance, dependance, or abuse. While the debate continues, the use of chronic opioid therapy for chronic non-cancer pain has increased exponentially. Even though evidence is limited, multiple expert panels have concluded that chronic opioid therapy can be effective therapy for carefully selected and monitored patients with chronic non-cancer pain. Study Design: A systematic review of randomized trials of opioid management for chronic noncancer pain. Objective: The objective of this systematic review is to evaluate the clinical efficacy of opioids in the treatment of chronic non-cancer pain. Methods: A comprehensive evaluation of the literature relating to opioids in chronic non-cancer pain was performed. The literature was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs) and Jadad criteria. A literature search was conducted by using PubMed, EMBASE, Cochrane library, ECRI Institute Library, U.S. Food and Drug Administration (FDA) website, U.S. National Guideline Clearinghouse (NGC), Database of Abstracts of Reviews of Effectiveness (DARE), clinical trials, systematic reviews and cross references from systematic reviews. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF) and used by other systematic reviews and guidelines. Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, withdrawals, and adverse effects. Results: Based on the USPSTF criteria, the indicated level of evidence was fair for Tramadol in managing osteoarthritis. For all the drugs assessed, including Tramadol, for all other conditions, the evidence was poor based on either weak positive evidence, indeterminate evidence, or negative evidence. Limitations: A paucity of literature, specifically with follow-up beyond 12 weeks for all types of opioids with controlled trials for various chronic non-cancer pain conditions. Conclusions: This systematic review illustrated fair evidence for Tramadol in managing osteoarthritis with poor evidence for all other drugs and conditions. Thus, recommendations must be based on non-randomized studies. Key words: Chronic non-cancer pain, opioids, opioid efficacy, opioid effectiveness, significant pain relief, functional improvement, adverse effects, morphine, hydrocodone, hydromorphone, fentanyl, tramadol, buprenorphine, methadone, tapentadol, oxycodone, oxymorphone, systematic reviews, randomized trials

scholarly journals Chronic Opioid Therapy Modifies QST Changes After Ketamine Infusion in Chronic Pain Patients

2017 ◽  
Vol 18 (12) ◽  
pp. 1468-1475 ◽  
Author(s):  
Dermot P. Maher ◽  
Yi Zhang ◽  
Shihab Ahmed ◽  
Tina Doshi ◽  
Charlene Malarick ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy ◽  
Ketamine Infusion ◽  
Chronic Pain Patients ◽  
Pain Patients

scholarly journals Outcome of Chronic Opioid Therapy for Non-Cancer Pain

1998 ◽  
Vol 15 (3) ◽  
pp. 185-194 ◽  
Author(s):  
Jennifer A. Haythornthwaite ◽  
Lynette A. Menefee ◽  
Amy L. Quatrano-Piacentini ◽  
Marco Pappagallo
Keyword(s):  
Cancer Pain ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy

scholarly journals Monitoring Opioid Adherence in Chronic Pain Patients: Assessment of Risk of Substance Misuse

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. E119-E131
Author(s):  
Daneshvari R. Solanki
Keyword(s):  
Chronic Pain ◽  
Cancer Pain ◽  
Comparative Studies ◽  
Opioid Therapy ◽  
Screening Tools ◽  
Cochrane Library ◽  
Simultaneous Increase ◽  
The Many ◽  
Adherence Monitoring ◽  
Pain Patients

Background: Use of opioids for chronic non-cancer pain (CNCP) has increased in recent years because this pain had been undertreated. There was also a simultaneous increase in misuse and abuse of opioids. Deaths due to such abuse and misuse also have risen as seen in the many reports published every day in local papers as well as in the medical literature. So, it is imperative that patients who are prescribed these medications be monitored for adherence so misuse and abuse can be curtailed and opioids are available to those who genuinely need them for chronic pain control. There are various screening tools available to monitor such adherence, and there is an abundance of literature about it in addiction and psychiatric medicine. There is, though, a paucity of such literature as applied to pain medicine. Objectives: Our objectives for this review were twofold. We wanted to identify which screening tools are available to monitor opioid adherence and we wanted to see if there were prospective comparative studies of these tools to identify a single best tool that can be applied to all chronic non-cancer pain patients managed with opioids. Study Design: We did a review of the current literature about monitoring of opioid adherence. We also looked at their use, validity, and comparative studies. Methods: We performed a literature search using PubMed, EMBASE, and the Cochrane library. The search was conducted using the terms opioids, non-cancer pain, monitoring, and adherence. The databases from 1996 to November 2010 were reviewed. The search included prospective and retrospective studies, review articles, and FDA records. Bibliographies and cross references were reviewed when deemed appropriate. Conclusion: We found 52 publications, of which 22 met the criteria to be included in this manuscript. We found only one study that was prospective, and compared the various screening tools that are available to monitor opioid adherence. In the majority of the studies the number treated was small. There was not a single screening tool that can be applied universally to all patients who are on opioid therapy for chronic non-cancer pain. Key words: Opioids, chronic pain, chronic non-cancer pain, opioid adherence, monitoring of opioid adherence, controlled substances, prescription monitoring programs, screening tools

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