Faculty Opinions recommendation of Increased risk of depression recurrence after initiation of prescription opioids in noncancer 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.

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Efficacy and Practicality of Opioid Therapy in Japanese Chronic Noncancer Pain Patients

Pain Management Nursing ◽

10.1016/j.pmn.2018.09.010 ◽

2019 ◽

Vol 20 (3) ◽

pp. 222-231 ◽

Cited By ~ 1

Author(s):

Yukari Shindo ◽

Soushi Iwasaki ◽

Michiaki Yamakage

Keyword(s):

Opioid Therapy ◽

Chronic Noncancer Pain ◽

Noncancer Pain ◽

Pain Patients

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Health care resource use and cost differences by opioid therapy type among chronic noncancer pain patients

Journal of Pain Research ◽

10.2147/jpr.s130913 ◽

2017 ◽

Vol Volume 10 ◽

pp. 1713-1722 ◽

Cited By ~ 2

Author(s):

Pamela Landsman-Blumberg ◽

Nathaniel Katz ◽

Kavita Gajria ◽

Anna D’Souza ◽

Sham L Chaudhari ◽

...

Keyword(s):

Health Care ◽

Resource Use ◽

Opioid Therapy ◽

Health Care Resource ◽

Chronic Noncancer Pain ◽

Health Care Resource Use ◽

Noncancer Pain ◽

Pain Patients ◽

Cost Differences

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Assessing Cognitive and Psychomotor Performance Under Long-Term Treatment with Transdermal Buprenorphine in Chronic Noncancer Pain Patients

Anesthesia & Analgesia ◽

10.1213/01.ane.0000281078.65585.1e ◽

2007 ◽

Vol 105 (5) ◽

pp. 1442-1448 ◽

Cited By ~ 32

Author(s):

Oguzhan Dagtekin ◽

Hans J. Gerbershagen ◽

Werner Wagner ◽

Frank Petzke ◽

Lukas Radbruch ◽

...

Keyword(s):

Psychomotor Performance ◽

Term Treatment ◽

Chronic Noncancer Pain ◽

Long Term Treatment ◽

Noncancer Pain ◽

Pain Patients

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Accuracy of Patient Opioid Use Reporting at the Time of Medical Cannabis License Renewal

Pain Research and Management ◽

10.1155/2018/5704128 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Jacob M. Vigil ◽

Sarah S. Stith ◽

Anthony P. Reeve

Keyword(s):

Monitoring Program ◽

Prescription Opioid ◽

Prescription Opioids ◽

Medical Cannabis ◽

Opioid Use ◽

Opioid Prescription ◽

Health Functioning ◽

Patient Symptom ◽

License Renewal ◽

Pain Patients

The decision to authorize a patient for continued enrollment in a state-sanctioned medical cannabis program is difficult in part due to the uncertainty in the accuracy of patient symptom reporting and health functioning including any possible effects on other medication use. We conducted a pragmatic convenience study comparing patient reporting of previous and current prescription opioid usage to the opioid prescription records in the Prescription Monitoring Program (PMP) among 131 chronic pain patients (mean age = 54; 54% male) seeking the first annual renewal of their New Mexico Medical Cannabis Program (NMMCP) license. Seventy-six percent of the patients reported using prescription opioids prior to enrollment in the NMMCP, however, the PMP records showed that only 49% of the patients were actually prescribed opioids in the six months prior to enrollment. Of the 64 patients with verifiable opioid prescriptions prior to NMMCP enrollment, 35 (55%) patients reported having eliminated the use of prescription opioids by the time of license renewal. PMP records showed that 26 patients (63% of patients claiming to have eliminated the use of opioid prescriptions and 41% of all patients with verifiable preenrollment opioid use) showed no prescription opioid activity at their first annual NMMCP renewal visit.

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Monitoring outcomes during long-term opioid therapy for noncancer pain: Results with the Pain Assessment and Documentation Tool

Journal of Opioid Management ◽

10.5055/jom.2005.0055 ◽

2005 ◽

Vol 1 (5) ◽

pp. 257 ◽

Cited By ~ 53

Author(s):

Steven D. Passik, PhD ◽

Kenneth L. Kirsh, PhD ◽

Laurie Whitcomb, MA ◽

Jeffrey R. Schein, PhD, MPH ◽

Mitchell A. Kaplan, PhD ◽

...

Keyword(s):

Chronic Pain ◽

Side Effects ◽

Pain Assessment ◽

The United States ◽

Opioid Therapy ◽

Chronic Pain Patients ◽

Noncancer Pain ◽

Documentation Tool ◽

Pain Patients

The increasingly common practice of long-term opioid therapy for chronic noncancer pain must be guided by ongoing assessment of four types of outcomes: pain relief, function, side effects, and drug-related behaviors. Our objective was to gather initial pilot data on the clinical application of a specialized chart note, the Pain Assessment and Documentation Tool (PADT), which was developed and tested with 27 physicians. This pilot test provided the means to collect cross-sectional outcome data on a large sample of opioid-treated chronic pain patients. Each of the physician volunteers (located in a variety of settings across the United States) completed the PADT for a convenience sample of personally treated chronic pain patients who had received at least three months of opioid therapy. Completion of the PADT required a clinical interview, review of the medical chart, and direct clinical observation. Data from the PADTs were collated and analyzed. The results suggested that the majority of patients with chronic pain achieve relatively positive outcomes in the eyes of their prescribing physicians in all four relevant domains with opioid therapy. Analgesia was modest but meaningful, functionality was generally stabilized or improved, and side effects were tolerable. Potentially aberrant behaviors were common but viewed as an indicator of a problem (i.e., addiction or diversion) in only approximately 10 percent of cases. Using the PADT, physician ratings can be developed in four domains. In this sample, outcomes suggested that opioid therapy provided meaningful analgesia.

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The Biopsychosocial Model of the Assessment, Prevention, and Treatment of Chronic Pain

US Neurology ◽

10.17925/usn.2016.12.02.98 ◽

2016 ◽

Vol 12 (02) ◽

pp. 98 ◽

Cited By ~ 19

Author(s):

Kelley Bevers ◽

Lynette Watts ◽

Nancy D Kishino ◽

Robert J Gatchel ◽

◽

...

Keyword(s):

Chronic Pain ◽

Pain Management ◽

Biopsychosocial Model ◽

Emotional Reactivity ◽

Functional Restoration ◽

Interdisciplinary Treatment ◽

Specific Patient ◽

Increased Risk ◽

Prevention And Treatment ◽

Pain Patients

The biopsychosocial model has been demonstrated to be the most heuristic approach to chronic pain assessment, prevention, and treatment. Currently, this model also provides the best foundation for tailoring the most comprehensive pain management program for each specific patient. Chronic pain patients have an increased risk for developing deficits in physical functioning, emotional reactivity, and cognition. Interdisciplinary treatment, based on the biopsychosocial model, is vital to address these multifaceted issues facing chronic pain sufferers. These interdisciplinary pain management strategies have progressed with advancements in science and technology in an attempt to provide the best possible outcomes for pain patients. However, while research has made enormous advances, there are still some clinical research gaps to be addressed. This article will begin with a historical overview of pain management in order to demonstrate the evolution in theory from ancient practices to the modern biopsychosocial model. Additionally, functional restoration and other early interdisciplinary intervention programs will be highlighted for their importance and effectiveness in chronic pain management, assessment, and prevention.

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