Opioids May be Appropriate for Chronic Pain

2020 ◽  
Vol 48 (2) ◽  
pp. 241-248 ◽  
Author(s):  
Paul J. Christo
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Cancer Pain ◽  
Treatment Option ◽  
Severe Pain ◽  
Opioid Therapy ◽  
Therapeutic Options ◽  
Opioid Epidemic ◽  
Pain Care

Patients living with chronic pain require appropriate access to opioid therapy along with improved access to pain care and additional therapeutic options. It's both medically reasonable and ethical to consider opioid therapy as a treatment option in the management of chronic, non-cancer pain for a subset of patients with severe pain that is unresponsive to other therapies (e.g., injections, other medications, integrative strategies), negatively impacts function or quality of life, and will likely outweigh the potential harms. This paper will examine opioid therapy in the setting of the opioid epidemic, why critics feel that the CDC guideline has resulted in harsh consequences for patients and their physicians, and the rationale for opioid therapy as a means of providing ethical and compassionate pain care.

scholarly journals IMPORTANCE trial: a provisional study-design of a single-center, phase II, double-blinded, placebo-controlled, randomized, 4-week study to compare the efficacy and safety of intranasal esketamine in chronic opioid refractory pain

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 42
Author(s):  
Mauricio Fernandes ◽  
Magdalena Schelotto ◽  
Philipp Maximilian Doldi ◽  
Giovanna Milani ◽  
Abul Andrés Ariza Manzano ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Cancer Pain ◽  
Functional Status ◽  
Phase Ii ◽  
Therapeutic Options ◽  
High Dose ◽  
Efficacy And Safety ◽  
Refractory Pain

Background:  Cancer is the second leading cause of death globally. Up to 86% of advanced cancer patients experience significant pain, while 10-20% live in chronic pain. Besides, increasing prescription of opioids resulted in 33,000 deaths in the US in 2015. Both reduce patients’ functional status and quality of life. While cancer survival rates are increasing, therapeutic options for chronic opioid refractory pain are still limited. Esketamine is the s-enantiomer of ketamine, with superior analgesic effect and less psychotomimetic side effects. Intranasal esketamine was approved by the FDA for treatment-resistant depression. However, its use in chronic cancer pain has never been tested. Therefore, we propose a phase II, randomized, placebo-controlled trial to evaluate the efficacy and safety of intranasal esketamine in chronic opioid refractory cancer pain. Methods and analysis: We will recruit 120 subjects with chronic opioid refractory pain, defined as pain lasting more than 3 months despite optimal therapy with high dose opioids (>60 mg morphine equivalent dose/day) and optimal adjuvant therapy. Subjects will be randomized into two groups: intranasal esketamine (56mg) and placebo. Treatment will be administered twice a week for four consecutive weeks. The primary outcome is defined as reduction in the Numeric Pain Rating Scale (NPRS) after first application. Secondary outcomes include NPRS reduction after four weeks, the number of daily morphine rescue doses, functional status and satisfaction, and depression. Conclusion: This study may extend therapeutic options in patients with chronic pain, thus improving their quality of life and reducing opioid use. Trial registration: Clinical Trials.gov, NCT04666623. Registered on 14 December 2020

scholarly journals The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain—A Pilot Study

Pharmacy ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 113
Author(s):  
Mo Chen ◽  
Tejal Patel ◽  
Feng Chang
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Chronic Pain ◽  
Cancer Pain ◽  
Family Health ◽  
Primary Care Settings ◽  
Pain Intervention ◽  
Family Health Team ◽  
The Impact

Background: Chronic pain is a prevalent condition, experienced by 15.3% to 55% of Canadians, that is difficult to manage. With their broad accessibility and expertise on drugs, primary care pharmacists can help patients optimize their pain management. Methods: The objective of this study is to examine the effectiveness of a primary care, pharmacist-driven chronic pain intervention on pain and quality of life in patients with chronic non-cancer pain. A three-month naturalistic prospective study was conducted in primary care settings (five community pharmacies and one Family Health Team) across Ontario, Canada with a total of six pharmacists and 19 study participants. The primary care, pharmacist-driven chronic pain intervention consisted of patient assessments, medication reviews, care plan recommendations, and patient education. In order to evaluate the effectiveness of the intervention, pain intensity, pain interference, and quality of life were evaluated at baseline and at follow up (week 2 and month 3). Results: Trends towards improvement in pain and quality of life were found, however, these improvements were not statistically significant at follow up (month 3). Conclusions: This study provides the foundational research required to better understand the impact of Ontario pharmacists’ extended role in pain management in non-cancer patients within multiple primary care settings (e.g., Family Health Team, etc.) and has illustrated the importance of modifying and customizing care plans in patients with chronic pain. A larger sample size with tailored outcome measures may be necessary to better highlight significant improvements in pain and quality of life in patients with chronic non-cancer pain using a primary care, pharmacist-driven intervention.

Pharmacologic Management for Cancer Pain

2020 ◽  
Author(s):  
Casey A. Murphy ◽  
Randolph Roig ◽  
John Faciane Jr. ◽  
Harry J. Gould, III
Keyword(s):  
Chronic Pain ◽  
Cancer Pain ◽  
Pain Treatment ◽  
Evidence Base ◽  
Evidence Based ◽  
Cancer Pharmacology ◽  
Pharmacologic Management ◽  
Keywords Cancer ◽  
Pain Care

Chronic pain is a major factor that impairs functionality and compromises quality of life.  Unfortunately, this type of pain is often under-treated due to lack of education about the use and range of effective non-pharmacologic modalities, about how to use and monitor pharmacologic modalities, and the fear about real and imagined adverse effects that are associated with its management.  Cancer is diagnosed in approximately 40% of the population with up to 89% experiencing some form of pain in the later stages of the disease. Unfortunately, a significant portion of this population receives inadequate treatment for their pain.  Here we provide a review of the evidence-base for determining the best approach for managing the pain of malignancy in the hope of providing a basic framework for the physician to better utilize the pharmacological options that comprise an important component of comprehensive pain care for the cancer patient.   This review contains 2 figures, 7 tables, and 106 references. Keywords: Cancer pain, malignant pain, opioids, chronic pain, analgesic options, adjuvant options, cancer pharmacology, evidence-based pain treatment

Pharmacologic Management for Cancer Pain

2020 ◽  
Author(s):  
Casey A. Murphy ◽  
Randolph Roig ◽  
John Faciane Jr. ◽  
Harry J. Gould, III
Keyword(s):  
Chronic Pain ◽  
Cancer Pain ◽  
Pain Treatment ◽  
Evidence Base ◽  
Evidence Based ◽  
Cancer Pharmacology ◽  
Pharmacologic Management ◽  
Keywords Cancer ◽  
Pain Care

Chronic pain is a major factor that impairs functionality and compromises quality of life.  Unfortunately, this type of pain is often under-treated due to lack of education about the use and range of effective non-pharmacologic modalities, about how to use and monitor pharmacologic modalities, and the fear about real and imagined adverse effects that are associated with its management.  Cancer is diagnosed in approximately 40% of the population with up to 89% experiencing some form of pain in the later stages of the disease. Unfortunately, a significant portion of this population receives inadequate treatment for their pain.  Here we provide a review of the evidence-base for determining the best approach for managing the pain of malignancy in the hope of providing a basic framework for the physician to better utilize the pharmacological options that comprise an important component of comprehensive pain care for the cancer patient.   This review contains 2 figures, 7 tables, and 106 references. Keywords: Cancer pain, malignant pain, opioids, chronic pain, analgesic options, adjuvant options, cancer pharmacology, evidence-based pain treatment

The use of oxycodone with naloxone in the cancer patients pain treatment - case reports

Ból ◽  
2017 ◽  
Vol 18 (4) ◽  
pp. 43-46
Author(s):  
Justyna Bochenek-Cibor
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Severe Pain ◽  
Pain Treatment ◽  
Case Reports ◽  
Gastrointestinal Disorders

Cancer pain treatment stays an important part of multidisciplinary oncologic care. Opioids remain the most effective and the most widely used analgesics for the treatment of moderate-to-severe pain. However, they may cause side effects, such as constipation that significantly decrease patients’ quality of life. The combination of oxycodone and naloxone is an innovation in preventing the gastrointestinal disorders. Authors describe two cases of cancer patients for whom oxycodone/naloxe prove effective analgesic.

scholarly journals Pharmacotherapy of cancer pain in dogs and cats suffering from cancer

2010 ◽  
Vol 64 (3-4) ◽  
pp. 265-275
Author(s):  
Mirjana Milovanovic ◽  
Milan Jovanovic ◽  
Sonja Vuckovic ◽  
Milica Prostran
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Cancer Pain ◽  
Tricyclic Antidepressants ◽  
Opioid Analgesics ◽  
Human Medicine ◽  
Nmda Antagonists ◽  
Cancer Disease ◽  
Important Symptom

Pain is an important symptom that accompanies cancer disease. Cancer pain is a chronic pain of medium to strong intensity, and it usually seriously impairs the quality of life of the cancer patients. In dogs and cats, the management of cancer pain includes drugs from different pharmacological groups. They are non-opioid and opioid analgesics, NMDA antagonists, anticonvulsant drugs, tricyclic antidepressants and steroids. Some of them are registered for use in veterinary medicine, and some are drugs for use in human medicine. .

scholarly journals YouTube viewers’ comments on the opioid epidemic offer solutions to help chronic pain patients

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Bacon ◽  
L Ivanitskaya ◽  
E Erzikova ◽  
T Veverka
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Pain Control ◽  
Alternative Therapies ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Chronic Pain Patients ◽  
Pain Patients

Abstract Background Approximately 34.3 million people used prescription opioids for non-medical reasons globally in 2016. In addition, many of the 1.5 billion people worldwide who suffer from chronic pain use opioids. According to the United Nations Office on Drugs and Crime, 76% of overdose deaths are caused by prescription and non-prescription opioids. Opioid use disorder and addiction encompass many aspects; such as, economic forces, cultural forces and individual genetic makeup. Because of this complexity, policymakers will have to address chronic pain and social determinants of health. Understanding the public's perspectives on the opioid epidemic is critical for policymakers to create awareness and treatment programs to decrease opioid related deaths while treating pain. Methods This inductive, iterative approach to content analysis of secondary data collected 8,761 comments posted by viewers on ten videos regarding the opioid epidemic on CNN's YouTube Channel and ten videos on Fox News' YouTube channel posted between January 1, 2017 and December 31, 2018. Results After analyzing 8,761 comments, from 20 videos, results indicated 618 (7%) were pain patients, 926 (10.6%) of the comments indicated stigma, (54.5% social stigma and 30% structural stigma). 5,453 (62.2%) of the comments posted claims regarding the opioid epidemic and 1,881 (21.5%) offered solutions. Three of the major solutions offered include legalizing cannabis (608, 7%), developing alternative therapies (174, 1.9%), and kratom (105, 1.2%). Conclusions Reducing access to opioids is harming legitimate pain patients. Policymakers need to take the public's opinions into consideration when developing policies and programs that help reduce opioid overdose. These policies must ensure that the 1.5 billion chronic pain patients worldwide receive adequate pain control in order to have a good quality of life that allows them to be contributing members of society. Key messages Worldwide, 1.5 billion people suffer from chronic pain, many without access to adequate pain control. Solutions posted by viewers include cannabis, alternative therapies and kratom. Understanding the public’s perspectives will help policymakers create programs that improve quality of life for chronic pain patients that minimize social, internalized and structural stigma.

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