scholarly journals Responsible Prescribing of Opioids for Chronic Non-Cancer Pain: A Scoping Review

Pharmacy ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 150
Author(s):  
Eleanor Black ◽  
Kok Eng Khor ◽  
Apo Demirkol
Keyword(s):  
Cancer Pain ◽  
Systematic Reviews ◽  
Scoping Review ◽  
Treatment Plan ◽  
Healthcare Delivery ◽  
Opioid Therapy ◽  
System Level ◽  
Controlled Trials ◽  
Related Factors ◽  
Pain Management Program

Chronic non-cancer pain is common and long-term opioid therapy is frequently used in its management. While opioids can be effective, they are also associated with significant harm and misuse, and clinicians must weigh any expected benefits with potential risks when making decisions around prescribing. This review aimed to summarise controlled trials and systematic reviews that evaluate patient-related, provider-related, and system-related factors supporting responsible opioid prescribing for chronic non-cancer pain. A scoping review methodology was employed, and six databases were searched. Thirteen systematic reviews and nine controlled trials were included for analysis, and clinical guidelines were reviewed to supplement gaps in the literature. The majority of included studies evaluated provider-related factors, including prescribing behaviours and monitoring for misuse. A smaller number of studies evaluated system-level factors such as regulatory measures and models of healthcare delivery. Studies and guidelines emphasise the importance of careful patient selection for opioid therapy, development of a treatment plan, and cautious initiation and dose escalation. Lower doses are associated with reduced risk of harm and can be efficacious, particularly when used in the context of a multimodal interdisciplinary pain management program. Further research is needed around many elements of responsible prescribing, including instruments to monitor for misuse, and the role of policies and programs.

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 Identifying alternative models of healthcare service delivery to inform health system improvement: scoping review of systematic reviews

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e036112 ◽  
Author(s):  
Rebecca Jessup ◽  
Polina Putrik ◽  
Rachelle Buchbinder ◽  
Janet Nezon ◽  
Kobi Rischin ◽  
...  
Keyword(s):  
Health System ◽  
Patient Outcomes ◽  
Systematic Reviews ◽  
Scoping Review ◽  
Resource Use ◽  
Healthcare Delivery ◽  
High Income ◽  
Economic Evaluations ◽  
Wide Range ◽  
System Improvement

ObjectiveTo describe available evidence from systematic reviews of alternative healthcare delivery arrangements relevant to high-income countries to inform decisions about healthcare system improvement.DesignScoping review of systematic reviews.Data sourcesSystematic reviews of interventions indexed in Pretty Darn Quick-Evidence.Eligibility criteriaAll English language systematic reviews evaluating the effects of alternative delivery arrangements relevant to high-income countries, published between 1 January 2012 and 20 September 2017. Eligible reviews had to summarise evidence on at least one of the following outcomes: patient outcomes, quality of care, access and/or use of healthcare services, resource use, impacts on equity and/or social outcomes, healthcare provider outcomes or adverse effects.Data extraction and synthesisJournal, publication year, number and design of primary studies, populations/health conditions represented and types of outcomes were extracted.ResultsOf 829 retrieved records, 531 reviews fulfilled our inclusion criteria. Almost all (93%) reviews reported on patient outcomes, while only about one-third included resource use as an outcome of interest. Just over a third (n=189, 36%) of reviews focused on alternative information and communications technology interventions (including 162 reviews on telehealth). About one-quarter (n=122, 23%) of reviews focused on alternative care coordination interventions. 15% (n=80) of reviews examined interventions involving changes to who provides care and how the healthcare workforce is managed. Few reviews investigated the effects of interventions involving changes to how and when care is delivered (n=47, 9%) or interventions addressing a goal-focused question (n=38, 7%).ConclusionA substantial body of evidence about the effects of a wide range of delivery arrangements is available to inform health system improvements. The lack of economic evaluations in the majority of systematic reviews of delivery arrangements means that the value of many of these models is unknown. This scoping review identifies evidence gaps that would be usefully addressed by future research.

scholarly journals Effectiveness of acupuncture for cancer pain: protocol for an umbrella review and meta-analyses of controlled trials

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018494 ◽  
Author(s):  
Yihan He ◽  
Yihong Liu ◽  
Brian H May ◽  
Anthony Lin Zhang ◽  
Haibo Zhang ◽  
...  
Keyword(s):  
Cancer Pain ◽  
Systematic Reviews ◽  
Clinical Studies ◽  
Meta Analysis ◽  
Grey Literature ◽  
Sensitivity Analyses ◽  
Controlled Trials ◽  
Statistical Heterogeneity ◽  
Meta Analyses

IntroductionThe National Comprehensive Cancer Network guidelines for adult cancer pain indicate that acupuncture and related therapies may be valuable additions to pharmacological interventions for pain management. Of the systematic reviews related to this topic, some concluded that acupuncture was promising for alleviating cancer pain, while others argued that the evidence was insufficient to support its effectiveness.Methods and analysisThis review will consist of three components: (1) synthesis of findings from existing systematic reviews; (2) updated meta-analyses of randomised clinical trials and (3) analyses of results of other types of clinical studies. We will search six English and four Chinese biomedical databases, dissertations and grey literature to identify systematic reviews and primary clinical studies. Two reviewers will screen results of the literature searches independently to identify included reviews and studies. Data from included articles will be abstracted for assessment, analysis and summary. Two assessors will appraise the quality of systematic reviews using Assessment of Multiple Systematic Reviews; assess the randomised controlled trials using the Cochrane Collaboration’s risk of bias tool and other types of studies according to the Newcastle-Ottawa Scale. We will use ‘summary of evidence’ tables to present evidence from existing systematic reviews and meta-analyses. Using the primary clinical studies, we will conduct meta-analysis for each outcome, by grouping studies based on the type of acupuncture, the comparator and the specific type of pain. Sensitivity analyses are planned according to clinical factors, acupuncture method, methodological characteristics and presence of statistical heterogeneity as applicable. For the non-randomised studies, we will tabulate the characteristics, outcome measures and the reported results of each study. Consistencies and inconsistencies in evidence will be investigated and discussed. Finally, we will use the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the quality of the overall evidence.Ethics and disseminationThere are no ethical considerations associated with this review. The findings will be disseminated in peer-reviewed journals or conference presentations.PROSPERO registration numberCRD42017064113.

scholarly journals Collaboration between adult patients and practitioners when making decisions about prescribing opioid medicines for chronic non-cancer pain in primary care: a scoping review

2021 ◽  
pp. 204946372110255
Author(s):  
Nirlas Shantilal Bathia ◽  
Robyn E McAskill ◽  
Jennie E Hancox ◽  
Roger D Knaggs
Keyword(s):  
Primary Care ◽  
Cancer Pain ◽  
Scoping Review ◽  
English Language ◽  
Good Clinical Practice ◽  
Opioid Therapy ◽  
Advisory Group ◽  
Video Recordings ◽  
And Function

Background: Long-term opioid therapy (>12 months) is not effective for improving chronic non-cancer pain and function. Where patients are not experiencing pain relief with long-term opioids, the opioid should be tapered and discontinuation considered. Practitioners may find it challenging to tell patients experiencing pain that they are better off reducing or not taking medicines that do not help. This review aims to ascertain what is published about: (1) the interaction and (2) the nature of the relationship between practitioners and patients when prescribing opioids for chronic non-cancer pain in primary care. Method: A scoping review of English-language qualitative, quantitative or mixed-method studies in databases including: MEDLINE, Embase, PsycINFO, AMED, BNI, CINALH EMCARE and HMIC. The identified papers were reviewed to provide a descriptive summary of the literature. Results: The review identified 20 studies. The studies used a range of methods including interviews, focus groups, audio and video recordings of clinical consultations, telephone survey and data from patient records. One study reported that researchers had engaged with a patient advisory group to guide their research. Patients expressed the importance of being treated as individuals, not being judged and being involved in prescribing decisions. Practitioners expressed difficulty in managing patient expectations and establishing trust. Opioid risk and practitioner suspicion shape opioid prescribing decisions. There is a paucity of literature about how precisely practitioners overcome interactional challenges and implement personalised care in practice. Conclusion: The studies in this review ascertain that practitioners and patients often find it challenging to achieve shared decisions in opioid review consultations. Effective communication is essential to achieve good clinical practice. Collaborative research with PPI partners should be aimed at identifying communication practices that support practitioners to achieve shared decisions with patients when reviewing opioids for chronic non-cancer pain.

scholarly journals Managing acromio-clavicular joint pain: a scoping review

2017 ◽  
Vol 10 (1) ◽  
pp. 4-14 ◽  
Author(s):  
Salma Chaudhury ◽  
Luckshman Bavan ◽  
Neal Rupani ◽  
Kyriacos Mouyis ◽  
Ro Kulkarni ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Scoping Review ◽  
Joint Pain ◽  
Randomised Controlled Trials ◽  
Acromioclavicular Joint ◽  
Treatment Modalities ◽  
Controlled Trials ◽  
Acromioclavicular Joint Dislocation ◽  
Patient Pathways ◽  
Randomised Controlled

Background Shoulder pain secondary to acromioclavicular joint pain is a common presentation in primary and secondary care but is often poorly managed as a result of uncertainty about optimal treatment strategies. Osteoarthritis is the commonest cause. Although acromioclavicular pain can be treated non-operatively and operatively, there appears to be no consensus on the best practice pathway of care for these patients, with variations in treatment being common place. The present study comprises a scoping review of the current published evidence for the management of isolated acromioclavicular pain (excluding acromioclavicular joint dislocation). Methods A comprehensive search strategy was utilized in multiple medical databases to identify level 1 and 2 randomised controlled trials, nonrandomised controlled trials and systematic reviews for appraisal. Results Four systematic reviews and two randomised controlled trials were identified. No direct studies have compared the benefits or risks of conservative versus surgical management in a controlled environment. Conclusions High-level studies on treatment modalities for acromioclavicular joint pain are limited. As such, there remains little evidence to support one intervention or treatment over another, making it difficult to develop any evidenced-based patient pathways of care for this condition. Level of evidence: 2A

scholarly journals Recent advances in understanding and managing cancer pain

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 945 ◽  
Author(s):  
Marcin Chwistek
Keyword(s):  
Cancer Pain ◽  
Clinical Problem ◽  
Opioid Therapy ◽  
Laboratory Research ◽  
Neural Systems ◽  
Related Factors ◽  
New Class ◽  
Non Invasive ◽  
Pain Syndromes

Cancer pain remains a significant clinical problem worldwide. Causes of cancer pain are multifactorial and complex and are likely to vary with an array of tumor-related and host-related factors and processes. Pathophysiology is poorly understood; however, new laboratory research points to cross-talk between cancer cells and host’s immune and neural systems as an important potential mechanism that may be broadly relevant to many cancer pain syndromes. Opioids remain the most effective pharmaceuticals used in the treatment of cancer pain. However, their role has been evolving due to emerging awareness of risks of chronic opioid therapy. Despite extensive research efforts, no new class of analgesics has been developed. However, many potential therapeutic targets that may lead to the establishment of new pharmaceuticals have been identified in recent years. It is also expected that the role of non-pharmacological modalities of treatment will grow in prominence. Specifically, neuromodulation, a rapidly expanding field, may play a major role in the treatment of neuropathic cancer pain provided that further technological progress permits the development of non-invasive and inexpensive neuromodulation techniques.

scholarly journals Contributo das terapias integrativas na sexualidade da mulher com neoplasia da mama: scoping review

2021 ◽  
Vol 4 (1) ◽  
pp. 99-110
Author(s):  
Filomena Paulo ◽  
Manuela Ferreira ◽  
Regilnaldo Filho
Keyword(s):  
Systematic Reviews ◽  
Scoping Review ◽  
Allied Health ◽  
Information Science ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Cochrane Database ◽  
Central Register

Enquadramento: o tratamento do cancro da mama traz consigo terapêuticas agressivas e invasivas, trazendo alterações a nível físico e psicológico que afetam a vida da mulher e a vivência da sua sexualidade. Objetivo: mapear o contributo das terapias integrativas na sexualidade da mulher com cancro da mama. Metodologia: a Scoping Review foi construída seguindo as recomendações da extensão PRISMA. A estratégia de pesquisa incluiu as bases de dados: CINAHL Complete; MEDLINE Complete; Nursing & Allied Health Collection: Comprehensive; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Cochrane Methodology Register; Library, Information Science & Technology Abstracts; MedicLatina, via EBSCOhost - Research Databases, Google Académico, PubMed, B-On, LILACS, MEDLINE e SCIELO. Foi definido como limite cronológico janeiro de 1999 a março de 2020. O corpus da revisão ficou constituído por cinco artigos científicos. Resultados: os estudos analisados são unânimes: demostrando que o recurso às terapias integrativas por parte das mulheres com cancro de mama, mastectomizadas, refletem em efeitos positivos na saúde das mesmas.  Conclusão: as terapias integrativas promovem nas mulheres, através da harmonia dos seus próprios recursos, trazendo efeitos positivos na vivência da sua sexualidade.

scholarly journals Implementation strategies in emergency management of children: A scoping review

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248826
Author(s):  
Alex Aregbesola ◽  
Ahmed M. Abou-Setta ◽  
George N. Okoli ◽  
Maya M. Jeyaraman ◽  
Otto Lam ◽  
...  
Keyword(s):  
Emergency Management ◽  
Randomized Controlled Trials ◽  
Capacity Building ◽  
Scoping Review ◽  
Research Evidence ◽  
Scale Up ◽  
Healthcare Delivery ◽  
Implementation Strategies ◽  
Controlled Trials ◽  
Randomized Controlled

Background Implementation strategies are vital for the uptake of evidence to improve health, healthcare delivery, and decision-making. Medical or mental emergencies may be life-threatening, especially in children, due to their unique physiological needs when presenting in the emergency departments (EDs). Thus, practice change in EDs attending to children requires evidence-informed considerations regarding the best approaches to implementing research evidence. We aimed to identify and map the characteristics of implementation strategies used in the emergency management of children. Methods We conducted a scoping review using Arksey and O’Malley’s framework. We searched four databases [Medline (Ovid), Embase (Ovid), Cochrane Central (Wiley) and CINAHL (Ebsco)] from inception to May 2019, for implementation studies in children (≤21 years) in emergency settings. Two pairs of reviewers independently selected studies for inclusion and extracted the data. We performed a descriptive analysis of the included studies. Results We included 87 studies from a total of 9,607 retrieved citations. Most of the studies were before and after study design (n = 68, 61%) conducted in North America (n = 63, 70%); less than one-tenth of the included studies (n = 7, 8%) were randomized controlled trials (RCTs). About one-third of the included studies used a single strategy to improve the uptake of research evidence. Dissemination strategies were more commonly utilized (n = 77, 89%) compared to other implementation strategies; process (n = 47, 54%), integration (n = 49, 56%), and capacity building and scale-up strategies (n = 13, 15%). Studies that adopted capacity building and scale-up as part of the strategies were most effective (100%) compared to dissemination (90%), process (88%) and integration (85%). Conclusions Studies on implementation strategies in emergency management of children have mostly been non-randomized studies. This review suggests that ‘dissemination’ is the most common strategy used, and ‘capacity building and scale-up’ are the most effective strategies. Higher-quality evidence from randomized-controlled trials is needed to accurately assess the effectiveness of implementation strategies in emergency management of children.

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