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

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.

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Opioid Misuse and Addiction Among Patients With Chronic Pain

Pain Care Essentials ◽

10.1093/med/9780199768912.003.0021 ◽

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.

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Depression and Anxiety Among Patients on Chronic Opioid Therapy

Health Services Research and Managerial Epidemiology ◽

10.1177/2333392818771243 ◽

2018 ◽

Vol 5 ◽

pp. 233339281877124 ◽

Cited By ~ 2

Author(s):

Muhamad Y. Elrashidi ◽

Lindsey M. Philpot ◽

Priya Ramar ◽

William B. Leasure ◽

Jon O. Ebbert

Keyword(s):

Opioid Therapy ◽

Anxiety And Depression ◽

Future Research ◽

Care Practice ◽

Depression And Anxiety ◽

Chronic Opioid Therapy ◽

Chronic Noncancer Pain ◽

History Of ◽

History Of Depression ◽

Item Scale

Background: Chronic noncancer pain (CNCP) and chronic opioid therapy (COT) commonly coexist with comorbid depression and anxiety. We investigated the prevalence of depression and anxiety and their correlates at the time of controlled substance agreement (CSA) enrollment among patients with CNCP and a history of depression or anxiety on COT. Methods: Retrospective analysis of 1066 patients in a Midwest primary care practice enrolled in CSAs for COT between May 9, 2013, and August 15, 2016. Patients with self-reported symptoms or a clinical history of depression or anxiety were screened at CSA enrollment using the Patient Health Questionnaire–9 item scale and the Generalized Anxiety Disorder–7 item scale. Results: The percentage of patients screening positive for depression and anxiety at CSA enrollment was 15.4% and 14.4%, respectively. Patients screening positive for depression or anxiety were more likely to be younger, unmarried, unemployed, and live alone compared to patients not screening positive. Patients screening positive for depression or anxiety were more likely to smoke cigarettes and report concern from friends or relatives regarding alcohol consumption. Compared to patients screening negative, patients screening positive for depression had higher odds of receiving opioid doses of ≥50 morphine milligram equivalents per day (adjusted odds ratio: 1.62; 95% confidence interval: 1.01-2.58). Conclusion: Anxiety and depression are prevalent at enrollment in CSAs among patients receiving COT. Future research is needed to determine whether recognition of anxiety and depression leads to improved management and outcomes for this population.

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

Pain Practice ◽

10.1111/j.1533-2500.2005.05104.x ◽

2005 ◽

Vol 5 (1) ◽

pp. 18-32 ◽

Cited By ~ 21

Author(s):

Dima Rozen ◽

Gerald W. Grass

Keyword(s):

Chronic Pain ◽

Cancer Pain ◽

Opioid Therapy ◽

Pain Patient ◽

Chronic Opioid Therapy ◽

Anesthetic Care ◽

Intraoperative Pain

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Opioid-Induced Muscle Activity: Implications for Managing Chronic Pain

Annals of Pharmacotherapy ◽

10.1177/106002809502901109 ◽

1995 ◽

Vol 29 (11) ◽

pp. 1118-1121 ◽

Cited By ~ 7

Author(s):

Robert K Sylvester ◽

Ralph Levitt ◽

Preston D Steen

Keyword(s):

Breakthrough Pain ◽

Oral Morphine ◽

Opioid Therapy ◽

Chronic Opioid Therapy ◽

Transdermal Fentanyl ◽

Management Options ◽

Morphine Infusion ◽

Involuntary Muscle ◽

Metastatic Lung ◽

Morphine Solution

Objective: To increase awareness of opioid-induced involuntary muscle hyperactivity and to present management options. Case Summary: A ventilator-dependent 71-year-old man presented with pain caused by metastatic lung cancer. Transdermal fentanyl therapy was titrated to 200 μg/h. Two days later a continuous morphine infusion was initiated because of frequent administration of oral morphine solution for breakthrough pain. The patient became progressively less responsive and began exhibiting involuntary muscle hyperactivity thought to represent breakthrough pain. Despite the inability to assess pain control effectively in this unresponsive patient, the morphine infusion rate was increased from 22 to 717 mg/h within 7 days. No change in muscle hyperactivity was observed. Discussion: Over the last decade involuntary muscle hyperactivity has been documented as an adverse effect of chronic opioid therapy. The literature describing the incidence of this toxicity, possible risk factors for its development, and recommendations for its management are discussed. Conclusions: The occurrence of muscle hyperactivity in an unresponsive patient receiving chronic opioid therapy may represent opioid toxicity. Recommendations for managing opioid-induced muscle hyperactivity include reduction of the opioid dosage and/or administration of clonazepam therapy.

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

Journal of Pain ◽

10.1016/j.jpain.2017.07.008 ◽

2017 ◽

Vol 18 (12) ◽

pp. 1468-1475 ◽

Cited By ~ 2

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

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Opioid Therapy for Chronic Noncancer Pain: Safe, Effective, Appropriate?

10.2310/fm.15027 ◽

2016 ◽

Author(s):

Joseph V. Pergolizzi Jr ◽

Robert B. Raffa ◽

Robert Taylor ◽

Jo Ann LeQuang

Keyword(s):

Risk Factors ◽

Chronic Pain ◽

Elderly Patients ◽

The United States ◽

Opioid Therapy ◽

Abuse Liability ◽

Opioid Abuse ◽

Individual Risk ◽

Chronic Noncancer Pain ◽

Routes Of Administration

In determining the appropriate role of opioids, two public health crises must be balanced: the opioid abuse epidemic and the “silent” crisis of unrelieved chronic pain. Opioids can be used safely and effectively in selected patients; however, clinicians must be aware of their abuse liability and individual risk factors for opioid misuse. A number of opioids are approved for use in the United States, and although there are class effects, there can be great variability among patients with regard to opioid response. In addition to the medication, prescribers must also determine the most appropriate dose and route of administration. Considerations must be made for special population, such as the renally impaired, those with hepatic dysfunction, and pediatric and elderly patients. Another factor is abuse-deterrent properties. Of particular interest as an opioid agent is buprenorphine, which is available in various routes of administration and because of its unique pharmacokinetics may be administered to renally compromised and elderly patients without dosing restrictions. Buprenorphine is also associated with a lower abuse liability than other opioids. Patients suffering moderate to severe pain syndromes should not be denied access to effective pain control, which in some cases may appropriately include opioid therapy. Key words: Buprenorphine, Chronic Pain, Opioid, Opioid Abuse, Opioid Prescribing, Risk Factors for Opioid Abuse

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