Sublingual Buprenorphine/Naloxone and Multi-Modal Management for High-Risk Chronic Pain Patients

Patients with chronic pain managed with opioid medications are at high risk for opioid overuse or misuse. West Virginia University (WVU) established a High-Risk Pain Clinic to use sublingual buprenorphine/naloxone (bup/nal) plus a multimodal approach to help chronic pain patients with history of Substance Use Disorder (SUD) or aberrant drug-related behavior. The objective of this study was to report overall retention rates and indicators of efficacy in pain control from approximately six years of High-Risk Pain Clinic data. A retrospective chart review was conducted for a total of 78 patients who enrolled in the High-Risk Pain Clinic between 2014 and 2020. Data gathered include psychiatric diagnoses, prescribed medications, pain score, buprenorphine/naloxone dosing, time in clinic, and reason for dismissal. A linear mixed effects model was used to assess the pain score from the Defense and Veterans Pain Rating Scale (DVPRS) and daily bup/nal dose across time. The overall retention of the High-Risk Pain Clinic was 41%. The mean pain score demonstrated a significant downward trend across treatment time (p < 0.001), while the opposite trend was seen with buprenorphine dose (p < 0.001). With the benefit of six years of observation, this study supports buprenorphine/naloxone as a safe and efficacious component of comprehensive chronic pain treatment in patients with SUD or high-risk of opioid overuse or misuse.

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Pain, Stress and Anxiety of Chronic Pain Patients Prior to, During and After Political Turmoil in Thailand

Journal of Health Science and Medical Research ◽

10.31584/jhsmr.201827 ◽

2018 ◽

Vol 36 (4) ◽

pp. 291

Author(s):

Sasikaan Nimmaanrat

Keyword(s):

Chronic Pain ◽

Pain Score ◽

Pain Clinic ◽

P Value ◽

Military Dictatorship ◽

Chronic Pain Patients ◽

The Mean ◽

Stress Score ◽

Political Turmoil ◽

Pain Patients

Objective: Thailand was plagued with serious political turmoil for many years. We would like to know whether this turmoil has had an impact on our chronic pain patients in terms of intensity of pain, stress and anxiety, as well as daily living and sleep.Material and Methods: Patients with at least 3 months of pain prior to 31 October 2013 (the date that the demonstrations started) were enrolled in this study. The data were collected from the patients who attended our pain clinic from December 2014 to May 2015. The patients were asked to complete a questionnaire on their severity of pain, stress and anxiety for the 3 different stages: prior to the demonstrations (period 1), during the demonstrations (period 2) and under military dictatorship or after the demonstrations (period 3).Results: There were 120 patients, 49 males (40.8%) and 71 females (59.2%). The mean age was 56.3±15.8 years old (range 18-88). The majority were Buddhist (108 patients, 90.0%) while 11 patients (9.2%) were Muslim and 1 patient (0.8%) was Christian. The mean duration of pain prior to the beginning of the demonstrations was 62.8 months (range 3-324 months). Regarding the pain score, the mean maximum pain score was significantly different between periods 1 (8), 2 (7.7) and 3 (6.8) (p-value<0.001). Regarding the anxiety score, the mean maximum anxiety score was significantly different between periods 1 (3.8), 2 (4.8) and 3 (2.9) (p-value=0.03). Regarding the stress score, the mean maximum stress score was significantly different between periods 1 (3.8), 2 (4.4) and 3 (2.8) (p-value=0.02). Using multiple logistic regression analysis, no factors (gender, age, religious, duration of pain and levels of anxiety and stress) were found to have contributed to the reduction of pain intensity.Conclusion: The demonstrations during the political turmoil did not increase the severity of pain but led to higher levels of stress and anxiety. On the other hand, under the military dictatorship, lower pain scores as well as stress and anxiety levels in chronic pain patients attending our pain clinic have been found.

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CYP2D6 Basic Genotyping of Patients with Chronic Pain Receiving Tramadol or Codeine. A Study in a Greek Cohort

Pain Medicine ◽

10.1093/pm/pnaa122 ◽

2020 ◽

Vol 21 (11) ◽

pp. 3199-3204 ◽

Cited By ~ 1

Author(s):

Chrysanthi Batistaki ◽

Eleni Chrona ◽

Andreas Kostroglou ◽

Georgia Kostopanagiotou ◽

Maria Gazouli

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Adverse Effects ◽

Rating Scale ◽

Numeric Rating Scale ◽

Cyp2d6 Genotype ◽

Chronic Pain Patients ◽

Reduction Of Pain ◽

Pain Patients ◽

Numeric Rating

Abstract Objective To assess CYP2D6 genotype prevalence in chronic pain patients treated with tramadol or codeine. Design Prospective cohort study. Setting General hospital, pain management unit. Subjects Patients with chronic pain, treated with codeine or tramadol. Methods Patients’ pain was assessed at baseline (numeric rating scale [NRS]; 0–10). Prescription of codeine or tramadol was selected randomly. The assessment of patients’ response to the drug in terms of pain relief and adverse effects was performed after 24 hours. Reduction of pain intensity of >50% or an NRS <4 was considered a positive response. Patients’ blood samples were collected during the first visit. Genotyping for the common variants CYP2D6 *2, *3, *4, *5, *6, *9, *10, *14, and *17 was performed, and alleles not carrying any polymorphic allele were classified as CYP2D6*1 (wild-type [wt]). Results Seventy-six consecutive patients were studied (20 males, 56 females), aged 21–85 years. Thirty-four received tramadol and 42 codeine. The main genotypes of CYP2D6 identified were the wt/wt (35.5%), the *4/wt (17.1%), and the *6/wt (10.5%). Adverse effects were common, especially in carriers of *9/*9, *5/*5, *5/*4, and *10/*10, as well as in variants including the 4 allele (*4/*1 [38.4%] and *4/*4 [42.8%]). Conclusions Genotyping can facilitate personalized pain management with opioids, as specific alleles are related to decreased efficacy and adverse effects.

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Pain Characteristics and Demographics of Patients Attending a University-Affiliated Pain Clinic in Toronto, Ontario

Pain Research and Management ◽

10.1155/2007/658762 ◽

2007 ◽

Vol 12 (2) ◽

pp. 93-99 ◽

Cited By ~ 23

Author(s):

Angela Mailis-Gagnon ◽

Balaji Yegneswaran ◽

SF Lakha ◽

Keith Nicholson ◽

Amanda J Steiman ◽

...

Keyword(s):

Chronic Pain ◽

Tertiary Care ◽

Pain Clinic ◽

Pain Clinics ◽

Chronic Pain Patients ◽

Musculoskeletal Problems ◽

Pain Duration ◽

Study Population ◽

Age Range ◽

Pain Patients

BACKGROUND: Pain clinics tend to see more complex chronic pain patients than primary care settings, but the types of patients seen may differ among practices.OBJECTIVE: The aim of the present observational study was to describe the pain and demographic characteristics of patients attending a university-affiliated tertiary care pain clinic in Toronto, Ontario.METHODS: Data were collected on 1242 consecutive new patients seen over a three-year period at the Comprehensive Pain Program in central Toronto.RESULTS: Musculoskeletal problems affecting large joints and the spine were the predominant cause of pain (more prevalent in women), followed by neuropathic disorders (more prevalent in men) in patients with recognizable physical pathology. The most affected age group was in the 35- to 49-year age range, with a mean pain duration of 7.8 years before the consultation. While 77% of the Comprehensive Pain Program patients had relevant and detectable physical pathology for pain complaints, three-quarters of the overall study population also had significant associated psychological or psychiatric comorbidity. Women, in general, attended the pain clinic in greater numbers and had less apparent physical pathology than men. Finally, less than one in five patients was employed at the time of referral.CONCLUSIONS: The relevance of the data in relation to other pain clinics is discussed, as well as waiting lists and other barriers faced by chronic pain patients, pain practitioners and pain facilities in Ontario and Canada.

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Lack of Correlation Between Opioid Dose Adjustment and Pain Score Change in a Group of Chronic Pain Patients

Journal of Pain ◽

10.1016/j.jpain.2012.12.012 ◽

2013 ◽

Vol 14 (4) ◽

pp. 384-392 ◽

Cited By ~ 26

Author(s):

Lucy Chen ◽

Trang Vo ◽

Lindsey Seefeld ◽

Charlene Malarick ◽

Mary Houghton ◽

...

Keyword(s):

Chronic Pain ◽

Pain Score ◽

Dose Adjustment ◽

Score Change ◽

Opioid Dose ◽

Chronic Pain Patients ◽

Pain Patients

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Association Between Urine Drug Test Results and Treatment Outcome in High-Risk Chronic Pain Patients on Opioids

Journal of Addiction Medicine ◽

10.1097/adm.0b013e3181c379ed ◽

2010 ◽

Vol 4 (3) ◽

pp. 167-173 ◽

Cited By ~ 4

Author(s):

Kelly S. Barth ◽

William C. Becker ◽

Nancy L. Wiedemer ◽

Shahrzad Mavandadi ◽

David W. Oslin ◽

...

Keyword(s):

Chronic Pain ◽

Treatment Outcome ◽

High Risk ◽

Test Results ◽

Drug Test ◽

Chronic Pain Patients ◽

Urine Drug ◽

Urine Drug Test ◽

Pain Patients

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Codetron in Rehabilitation of Chronic Pain Patients

Acupuncture in Medicine ◽

10.1136/aim.6.2.54 ◽

1989 ◽

Vol 6 (2) ◽

pp. 54-56 ◽

Cited By ~ 1

Author(s):

Angelica Fargas-Babjak

Keyword(s):

Clinical Trial ◽

Chronic Pain ◽

Transcutaneous Electrical Nerve Stimulation ◽

Modern Medicine ◽

Pain Clinic ◽

The Novel ◽

Technological Changes ◽

Electrical Nerve Stimulation ◽

Chronic Pain Patients ◽

Pain Patients

Acupuncture is one of the oldest healing methods which is used in traditional medicine. in modern medicine we are witnessing a renaissance of this ancient treatment applied mainly in the management of chronic pain. A number of modern technological changes are being applied to replace, or modify, the classical needle treatment Among many of the modalities used at present are light, in the form of laser, and electrical stimulation. CODETRON TENS, the novel addition to Transcutaneous Electrical Nerve Stimulation (TENS), has been evaluated in a clinical trial, over a two year period, in a multidisciplinary pain clinic on patients who came for acupuncture therapy. Indications, effectiveness and experiences with this form of treatment are presented.

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The visual time analog scale: simple, novel measurement approach to assess pain in patients with chronic pain

Pain Management ◽

10.2217/pmt-2020-0036 ◽

2021 ◽

Vol 11 (4) ◽

pp. 357-368

Author(s):

Akiko Okifuji ◽

Reiko Mitsunaga ◽

Yuri Kida ◽

Gary W Donaldson

Keyword(s):

Chronic Pain ◽

Pain Intensity ◽

Rating Scale ◽

Chronic Back Pain ◽

Preliminary Evaluation ◽

Numerical Pain Rating Scale ◽

Chronic Pain Patients ◽

Pain Patients ◽

Pain Rating Scale ◽

Measurement Approach

Aim: We conducted a preliminary evaluation of a newly developed, time-based visual time analog (VITA) scale for measuring pain in chronic pain patients. Materials & methods: 40 patients with chronic back pain rated their pain over four visits using numerical (pain) rating scale (NRS) and VITA assessing pain intensity by distributing the amount of time spent on ‘not aware of pain’ (blue), ‘aware of nothing but pain’ (red) and time in between (yellow). Results: The NRS scores were correlated with the VITA Red but not with VITA Blue. The psychometric analyses revealed that VITA achieved greater reliability and sensitivity than did NRS. Conclusion: The results provide preliminary support for VITA scale for assessing pain intensity in patients with chronic pain.

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