scholarly journals Comparative Efficacy and Mechanisms of a Single Session Behavioral Medicine Class among Patients with Chronic Pain Taking Prescription Opioids: Study Protocol for a Randomized Controlled Trial

2020 ◽  
Author(s):  
Maisa Ziadni ◽  
Abby L. Chen ◽  
Tyler Winslow ◽  
Sean C. Mackey ◽  
Beth D. Darnall
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Health Education ◽  
Behavioral Medicine ◽  
Self Regulation ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Single Session ◽  
Comparative Efficacy ◽  
Treatment Needs

Abstract Background: Independent of pain intensity, pain-specific distress is highly predictive of pain treatment needs, including prescription opioids. Given the inherently distressing nature of chronic pain, there is a need to equip individuals with pain education and self-regulatory skills that are shown to improve adaptation and improve response to medical treatments. Brief, targeted behavioral medicine interventions may efficiently address the key individual factors, improve self-regulation in the context of pain, and reduce need for opioid therapy. This highlights the critical need for targeted, cost-effective interventions that efficiently address the key psychological factors that can amplify the need for opioids and increased risk for misuse. In this trial, the primary goal is to test the comparative efficacy of a single-session skills-based pain management class to a health education active control group among patients with chronic pain who are taking opioids. Methods: Our study is a randomized, double-blind clinical trial testing the superiority of our 2-hour single-session skills-based pain management class against a 2-hour health education class. We will enroll 136 adult patients with mixed etiology chronic pain who are taking opioid prescription medication and randomize 1:1 to one of the two treatment arms. We hypothesize superiority for the skills-based pain class for pain control, self-regulation of pain-specific distress, and reduced opioid use measured by daily morphine equivalent. Team researchers masked to treatment assignment will assess outcomes up to 12 months post-treatment. Discussion: This study aims to test the utility of a single-session, 2-hour skills-based pain management class to improve self-regulation of pain and reduce opioid use. Findings from our project have the potential to shift current research and clinical paradigms by testing a brief and scalable intervention that could reduce need for opioids and prevent misuse effectively, efficiently and economically. Further, elucidation of mechanisms of opioid use can facilitate refinement of more targeted future treatments.

scholarly journals Comparative efficacy of a single-session “Empowered Relief” videoconference-delivered group intervention for chronic pain: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Maisa S. Ziadni ◽  
Steven R. Anderson ◽  
Lluvia Gonzalez-Castro ◽  
Beth D. Darnall
Keyword(s):  
Chronic Pain ◽  
Psychological Treatment ◽  
Controlled Trial ◽  
Self Regulation ◽  
Single Session ◽  
Comparative Efficacy ◽  
Pain Education ◽  
Waitlist Control ◽  
Link Type ◽  
Education Class

Abstract Background Chronic pain is naturally aversive and often distressing for patients. Pain coping and self-regulatory skills have been shown to effectively reduce pain-related distress and other symptoms. In this trial, the primary goal is to pilot test the comparative efficacy of a single-session videoconference-delivered group pain education class to a waitlist control among patients with chronic pain. Methods Our study is a randomized clinical trial pilot testing the superiority of our 2-h single-session videoconference-delivered group pain education class against a waitlist control. We will enroll 120 adult patients with mixed etiology chronic pain and randomize 1:1 to one of the two study arms. We hypothesize superiority for the pain education class for bolstering pain and symptom management. Team researchers masked to treatment assignment will assess the outcomes up to 3 months post-treatment. Discussion This study aims to test the utility of a single-session videoconference-delivered group pain education class to improve self-regulation of pain and pain-related outcomes. Findings from our project have the potential to significantly reduce barriers to effective psychological treatment for pain, optimizing the delivery of increasingly vital online and remote-delivered intervention options. Trial registration ClinicalTrials.govNCT04546685. Registered on 04 September 2020.

scholarly journals Opioid-sparing effects of medical cannabis or cannabinoids for chronic pain: a systematic review and meta-analysis of randomised and observational studies

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047717
Author(s):  
Atefeh Noori ◽  
Anna Miroshnychenko ◽  
Yaadwinder Shergill ◽  
Vahid Ashoorion ◽  
Yasir Rehman ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Sleep Disturbance ◽  
Observational Studies ◽  
Prescription Opioids ◽  
Randomised Trials ◽  
Medical Cannabis ◽  
Opioid Use ◽  
Opioid Dose ◽  
Chronic Cancer Pain ◽  
Pain Patients

ObjectiveTo assess the efficacy and harms of adding medical cannabis to prescription opioids among people living with chronic pain.DesignSystematic review.Data sourcesCENTRAL, EMBASE and MEDLINE.Main outcomes and measuresOpioid dose reduction, pain relief, sleep disturbance, physical and emotional functioning and adverse events.Study selection criteria and methodsWe included studies that enrolled patients with chronic pain receiving prescription opioids and explored the impact of adding medical cannabis. We used Grading of Recommendations Assessment, Development and Evaluation to assess the certainty of evidence for each outcome.ResultsEligible studies included five randomised trials (all enrolling chronic cancer-pain patients) and 12 observational studies. All randomised trials instructed participants to maintain their opioid dose, which resulted in a very low certainty evidence that adding cannabis has little or no impact on opioid use (weighted mean difference (WMD) −3.4 milligram morphine equivalent (MME); 95% CI (CI) −12.7 to 5.8). Randomised trials provided high certainty evidence that cannabis addition had little or no effect on pain relief (WMD −0.18 cm; 95% CI −0.38 to 0.02; on a 10 cm Visual Analogue Scale (VAS) for pain) or sleep disturbance (WMD −0.22 cm; 95% CI −0.4 to −0.06; on a 10 cm VAS for sleep disturbance; minimally important difference is 1 cm) among chronic cancer pain patients. Addition of cannabis likely increases nausea (relative risk (RR) 1.43; 95% CI 1.04 to 1.96; risk difference (RD) 4%, 95% CI 0% to 7%) and vomiting (RR 1.5; 95% CI 1.01 to 2.24; RD 3%; 95% CI 0% to 6%) (both moderate certainty) and may have no effect on constipation (RR 0.85; 95% CI 0.54 to 1.35; RD −1%; 95% CI −4% to 2%) (low certainty). Eight observational studies provided very low certainty evidence that adding cannabis reduced opioid use (WMD −22.5 MME; 95% CI −43.06 to −1.97).ConclusionOpioid-sparing effects of medical cannabis for chronic pain remain uncertain due to very low certainty evidence.PROSPERO registration numberCRD42018091098.

Opioid use disorder and chronic pain: challenges for palliative care practice

2019 ◽  
Vol 25 (9) ◽  
pp. 453-457
Author(s):  
Brenda Peters-Watral
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Substance Use ◽  
Pain Management ◽  
Cancer Pain ◽  
Opioid Use Disorder ◽  
Care Practice ◽  
Care Providers ◽  
Opioid Use ◽  
Multiple Cancer

Along with a well-documented increase in opioid use disorder (OUD) and a rapidly escalating rate of fatal overdose in North America, inadequate management of chronic pain remains a pervasive problem. The increasing number of individuals living with OUD also experience multiple cancer risk factors, which are related to their substance use, while people with cancer diagnoses have similar risks of current or past addiction as the general population. Recent pain guidelines focus on chronic non-cancer pain and do not include recommendations for cancer pain management. Managing cancer pain at the end of life is more challenging in people with current or past substance use disorder (SUD), especially OUD. Addressing these challenges requires confronting stigmas and stereotypes, building knowledge among palliative care providers and assessing the risks and benefits of opioids for pain management on an individual basis in order to continue to provide the holistic care.

scholarly journals Clinical Characteristics and Health Care Utilization Patterns of Sickle Cell Disease Patients Using Marijuana

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3669-3669
Author(s):  
Hope Miodownik ◽  
Christopher Bradford ◽  
Joanna L. Starrels ◽  
Ugochi Olivia Ogu ◽  
Merin Thomas ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Marijuana Use ◽  
Medical Cannabis ◽  
Opioid Use ◽  
Advisory Committees ◽  
Post Marketing ◽  
Ed Visits ◽  
Smoking Marijuana ◽  
Daily Pain

Abstract Background: Opioid analgesics have served as the cornerstone of acute and chronic pain management in patients with sickle cell disease (SCD) in the United States. Despite significant opioid use, hospitalization for painful crises comprises the majority of healthcare costs for patients with SCD. Moreover, greater use of opioids may correlate with poorer response to treatment of acute painful crises. Insufficient pain management, the rise of opioid use disorder and opioid-related fatal overdose have opened the door for new strategies of pain management for these patients. Medical cannabis represents a potential new strategy for the management of chronic SCD pain. There is a substantial body of literature describing the analgesic properties of cannabis, but little research has explored its role in the management of SCD-related pain. We sought to evaluate the prevalence of marijuana use in an urban SCD patient population and to identify demographic and clinical characteristics that may predict marijuana use in this cohort. Methods: Adult patients with SCD seen at an urban outpatient SCD center completed an intake form with questions regarding individual demographics, cumulative disease complications, current or prior marijuana use, ED utilization, frequency of pain, and opioid use. Data from 78 patients seen between October 2017 and June 2018 were available for analysis. Additional data including information regarding disease genotype and race were collected from the electronic medical record. Data were analyzed using Microsoft Excel and Chi-Square analysis. Results: Among the 78 patients, mean age of the population was 35.7 years (range 20-69), and 50% were male. Genotype was 69% HbSS/SB0 and 31% HbSC/SB+. Twenty-three patients (29%) reported ever using marijuana, and 15 (19%) endorsed current use; most patients (80%) reported smoking. Marijuana users were more likely than non-users to be male (67% v 46%), to have HbSS/SB0 (80% v 67%), to have avascular necrosis (AVN) (47% v 17%, p=.025), to report daily pain (40% v 13%, p=.013), and to be prescribed opioids (93% v 65%, p=.031). Frequent ED visits (at least monthly) were more common in marijuana users (33% v 6% p=.002) compared to non-users. Age, leg ulcers, priapism, and hydroxyurea use were not different in users versus non-users. Discussion: In this cohort of patients with SCD seeking outpatient care, 19% reported current marijuana use for the management of SCD-related symptoms. Most patients reported smoking marijuana, and only one patient reported ingestion of edible marijuana. These rates are similar to marijuana use in other populations with chronic pain. SCD marijuana users were similar in age but not in sex distribution, as men more commonly reported marijuana use than women in our population. Marijuana users were enriched for the HbSS genotype, reported more daily pain, had more frequent ED visits and were more likely to be diagnosed with AVN of bones. There was a strong association between marijuana use and self-reported opioid use for pain control. These preliminary data suggest that patients with more severe manifestations of SCD, namely daily pain, frequent ED visits, AVN of bones, and significant utilization of opioids, are more likely to be using marijuana as adjunctive therapy for their chronic pain. As of July 2018, 31 US states and the District of Columbia have legalized the use of medical cannabis, with chronic pain an indication in most states and opioid replacement an indication in some. The expansion of access to medical cannabis highlights the need for careful evaluation of the potential benefits and harms of medical cannabis in the SCD population. These benefits might include better control of daily pain, reduced visits to the ED, and possibly decreased utilization of opioids. As medical cannabis is becoming a more available therapy, carefully controlled prospective studies are needed to assess its efficacy in the management of debilitating symptoms of SCD. Disclosures Starrels: Opioid Post-Marketing Requirement Consortium: Other: Research and travel support from the Opioid Post-Marketing Requirement Consortium for a FDA-mandated observational study of the risks of opioid medications. Minniti:Novartis: Membership on an entity's Board of Directors or advisory committees; Bluebird Bio: Other: Adjudicating Committee; Global Blood Therapeutics: Research Funding; Teutona: Membership on an entity's Board of Directors or advisory committees; Bayer: Research Funding.

Obstetric Pain

2017 ◽  
Author(s):  
Hans P. Sviggum ◽  
Adam K. Jacob
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Adverse Effects ◽  
Labor And Delivery ◽  
Opioid Use ◽  
Factors Influencing ◽  
Pain Transmission ◽  
Pain Pathways ◽  
Peripartum Period

This chapter on obstetric pain reviews the complex pathophysiologic processes of pain transmission and perception experienced by women throughout pregnancy, management of pain in the peripartum period, and how preexisting chronic pain or opioid use affects the care of parturients. It discusses mechanisms of pain; common pain pathways; and factors influencing the perception of pain during pregnancy, labor, and delivery. It compares the benefits and adverse effects of current strategies for managing maternal pain during labor and after delivery. Finally, it reviews maternal and fetal effects of peripartum pain management in opiate- and non-opiate-dependent mothers.

Is Neuraxial Clonidine a Safer Alternative to Opioids for Chronic Pain? An Alternative Worth Exploring

2020 ◽  
pp. 1-7
Author(s):  
Nagy Mekhail ◽  
Nagy Mekhail ◽  
Shrif Costandi ◽  
Alaa Abd-Elsayed ◽  
Gregory Fiore ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Potential Role ◽  
Common Side Effect ◽  
Chronic Pain Management ◽  
Inclusion Criteria ◽  
Opioid Use ◽  
Levels Of Evidence ◽  
The Past

Objective: Exploring the potential role of clonidine as an alternative to the currently available neuraxial medication options for the management of chronic pain. Methods: A comprehensive literature search was conducted investigating the treatment of chronic pain using clonidine over the past 73 years. A stepwise filtering approach was used to obtain articles addressing neuraxial treatment of chronic pain in adults. Selected articles were assessed for their levels of evidence followed by a discussion of their contribution to the understanding of the role of clonidine in chronic pain management. Results: Out of 1,035 articles that described the administration of clonidine for chronic pain management, seven articles met all of the inclusion criteria. Their levels of evidence ranged from 1a to 4 (Oxford Centre CEBM). Neuraxial administration of clonidine was found to be effective in the treatment of chronic pain, often exhibiting a synergistic effect with other analgesics to provide pain reduction with reduced opioid use. The most common side effect was hypotension, in some cases reported to have been serious. Conclusion: The use of neuraxial clonidine, in either a primary or adjunctive role, appears promising as an effective treatment for chronic pain.

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