scholarly journals Monitoring Opioid Adherence in Chronic Pain Patients: Assessment of Risk of Substance Misuse

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. E119-E131
Author(s):  
Daneshvari R. Solanki
Keyword(s):  
Chronic Pain ◽  
Cancer Pain ◽  
Comparative Studies ◽  
Opioid Therapy ◽  
Screening Tools ◽  
Cochrane Library ◽  
Simultaneous Increase ◽  
The Many ◽  
Adherence Monitoring ◽  
Pain Patients

Background: Use of opioids for chronic non-cancer pain (CNCP) has increased in recent years because this pain had been undertreated. There was also a simultaneous increase in misuse and abuse of opioids. Deaths due to such abuse and misuse also have risen as seen in the many reports published every day in local papers as well as in the medical literature. So, it is imperative that patients who are prescribed these medications be monitored for adherence so misuse and abuse can be curtailed and opioids are available to those who genuinely need them for chronic pain control. There are various screening tools available to monitor such adherence, and there is an abundance of literature about it in addiction and psychiatric medicine. There is, though, a paucity of such literature as applied to pain medicine. Objectives: Our objectives for this review were twofold. We wanted to identify which screening tools are available to monitor opioid adherence and we wanted to see if there were prospective comparative studies of these tools to identify a single best tool that can be applied to all chronic non-cancer pain patients managed with opioids. Study Design: We did a review of the current literature about monitoring of opioid adherence. We also looked at their use, validity, and comparative studies. Methods: We performed a literature search using PubMed, EMBASE, and the Cochrane library. The search was conducted using the terms opioids, non-cancer pain, monitoring, and adherence. The databases from 1996 to November 2010 were reviewed. The search included prospective and retrospective studies, review articles, and FDA records. Bibliographies and cross references were reviewed when deemed appropriate. Conclusion: We found 52 publications, of which 22 met the criteria to be included in this manuscript. We found only one study that was prospective, and compared the various screening tools that are available to monitor opioid adherence. In the majority of the studies the number treated was small. There was not a single screening tool that can be applied universally to all patients who are on opioid therapy for chronic non-cancer pain. Key words: Opioids, chronic pain, chronic non-cancer pain, opioid adherence, monitoring of opioid adherence, controlled substances, prescription monitoring programs, screening tools

scholarly journals Prescription Opioid Abuse in Chronic Pain: An Updated Review of Opioid Abuse Predictors and Strategies to Curb Opioid Abuse: Part 1

2017 ◽  
Vol 2 (20;2) ◽  
pp. s93-s111 ◽  
Author(s):  
Alan D. Kaye
Keyword(s):  
Chronic Pain ◽  
Cancer Pain ◽  
Drug Testing ◽  
The United States ◽  
Opioid Therapy ◽  
Opioid Abuse ◽  
Screening Tools ◽  
Prescription Opioid ◽  
Self Medication ◽  
Prescription Opioid Abuse

Chronic pain and prescription opioid abuse are extremely prevalent in the United States and worldwide. The consequences of opioid misuse can be life-threatening with significant morbidity and mortality, exacting a heavy toll on patients, physicians, and society. The risk for misuse of prescribed opioids is much higher in patients with chronic pain, especially those with concurrent substance use and /or mental health disorders. Several reasons can account for the occurrence of opioid abuse and misuse, including self-medication, use for reward, compulsive use related to addiction, and diversion for profit. There is a need, therefore, for therapeutic approaches that balance treating chronic pain, while minimizing risks for opioid abuse, misuse, and diversion. Chronic opioid therapy for chronic non-cancer pain has seen a dramatic increase throughout the past 2 decades in conjunction with associated increases in the abuse of prescribed opioids and accidental opioid overdoses. Consequently, a validated screening instrument that provides an effective and rational method for selecting patients for opioid therapy, predicting risk, and identifying problems once they have arisen, could be of enormous benefit in clinical practice. An instrument as such has the potential to attenuate the risk of iatrogenic addiction. Despite the recent introduction of various screening strategies and instruments, no single test or instrument can reliably and accurately predict those patients unsuitable for opioid therapy or pinpoint those requiring heightened degrees of surveillance and monitoring throughout their therapy. Current opioid abuse screening tactics include assessing premorbid and comorbid substance abuse; assessing aberrant drug-related behaviors; stratification of risk factors; and utilizing opioid assessment screening tools. Several authors have contributed numerous screening tools and instruments to aid the assessment of appropriate opioid therapy. Additional essential measures include urine drug testing, prescription practice monitoring programs, opioid treatment agreements, and implementing universal precautions. Presently accepted recommendations consist of a combination of strategies designed to stratify risk, to identify and to understand aberrant drug-related behaviors, and to tailor treatments accordingly. This manuscript, Part 2 of a 2 part update, builds on the 2012 opioid guidelines published in Pain Physician, and the 2016 guidelines released by the Centers for Disease Control and Prevention. It reviews screening, monitoring, and addressing opioid abuse and misuse in patients with chronic non-cancer pain. Key words: Opioids, misuse, abuse, chronic pain, prevalence, risk assessment, risk management, drug monitoring, aberrant drug-related behavior

679 Prevalence of Sleep Disturbances in Patients with Chronic Non-cancer Pain: A Systematic Review and Meta-Analysis

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A265-A266
Author(s):  
Yishi Sun ◽  
Isabelle Laksono ◽  
Janannii Selvanathan ◽  
Aparna Saripella ◽  
Mahesh Nagappa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Sleep Quality ◽  
Cancer Pain ◽  
Sleep Disturbances ◽  
Meta Analysis ◽  
Pain Group ◽  
Pooled Prevalence ◽  
Chronic Pain Patients ◽  
Pain Patients

Abstract Introduction In individuals with chronic pain, sleep disturbances have been suggested to increase suffering, perception of pain, and to negatively affect long-term prognosis. This systematic review and meta-analysis aims to determine the pooled prevalence of sleep disturbances in chronic non-cancer pain patients with no other sleep disorders, using the patient-rated questionnaires Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Methods Multiple databases were searched for studies reporting the prevalence of sleep disturbances in chronic pain patients. Chronic pain was defined as pain >3 months. Comorbid sleep disorders such as sleep disordered breathing and restless leg syndrome were excluded. Sleep disturbances were defined using the PSQI cutoff of > 5 (poor sleep quality) and ISI ≥ 8 (subthreshold to clinical insomnia). The meta-analysis was conducted to examine the pooled prevalence of PSQI and ISI data using the inverse-variance random-effects model and to examine mean differences in PSQI scores. Results The systematic search resulted in 25,486 articles and 20 were included for analysis. In 12 studies using PSQI, the pooled prevalence of sleep disturbance was 75.3% among 3,597 chronic pain patients (mean age 53 ± 12 years; 74% female). In eight studies using ISI, the pooled prevalence was 72.9% among 2,578 chronic pain patients (mean age 63 ± 12 years; 57% female). The meta-analysis showed a significant mean difference of 2.75 (p < 0.001) in the global PSQI score between the chronic pain group versus the non-chronic pain group. The meta-analysis also showed a significant mean difference in the scores of four of seven PSQI components: sleep latency, sleep efficiency, sleep duration, and sleep disturbances (p < 0.05). Conclusion In chronic pain patients, the pooled prevalence of sleep disturbances as measured by PSQI (75.3%) and ISI (72.9%) studies was much higher than those reported for the general population. The relatively high prevalence of sleep disturbances in chronic pain patients emphasizes the importance of further characterizing the relationship between sleep and chronic pain. Support (if any):

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

2017 ◽  
Vol 18 (12) ◽  
pp. 1468-1475 ◽  
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

Efficacy of the Opioid Compliance Checklist to Monitor Chronic Pain Patients Receiving Opioid Therapy in Primary Care

2016 ◽  
Vol 17 (4) ◽  
pp. 414-423 ◽  
Author(s):  
Robert N. Jamison ◽  
Marc O. Martel ◽  
Chuan-Chin Huang ◽  
Dylan Jurcik ◽  
Robert R. Edwards
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Opioid Therapy ◽  
Chronic Pain Patients ◽  
Pain Patients

scholarly journals Cross Validation of the Current Opioid Misuse Measure to Monitor Chronic Pain Patients on Opioid Therapy

2010 ◽  
Vol 26 (9) ◽  
pp. 770-776 ◽  
Author(s):  
Stephen F. Butler ◽  
Simon H. Budman ◽  
Gilbert J. Fanciullo ◽  
Robert N. Jamison
Keyword(s):  
Chronic Pain ◽  
Cross Validation ◽  
Opioid Therapy ◽  
Opioid Misuse ◽  
Chronic Pain Patients ◽  
Pain Patients

Opioid induced hyperalgesia: A focus on opioid use in chronic pain

2013 ◽  
Vol 2 (12) ◽  
pp. 395-397
Author(s):  
Julie L. Cunningham
Keyword(s):  
Chronic Pain ◽  
Side Effects ◽  
Treatment Option ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Chronic Pain Patients ◽  
Opioid Induced Hyperalgesia ◽  
Pain Patients ◽  
Established Treatment

Opioids are a well-established treatment option for chronic pain. However, opioid therapy is associated with many side effects, including opioid induced hyperalgesia (OIH). This article reviews studies which have evaluated OIH in chronic pain patients on opioids.

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

2005 ◽  
Vol 1 (5) ◽  
pp. 257 ◽  
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.

scholarly journals Monitoring of opioid therapy in advanced cancer pain patients

1997 ◽  
Vol 13 (4) ◽  
pp. 204-212 ◽  
Author(s):  
Sebastiano Mercadante ◽  
Gabriella Dardanoni ◽  
Leonardo Salvaggio ◽  
Maria Gabriella Armata ◽  
Antonio Agnello
Keyword(s):  
Cancer Pain ◽  
Advanced Cancer ◽  
Opioid Therapy ◽  
Pain Patients

scholarly journals Chronic Opioid Therapy for Chronic Non-Cancer Pain: A Review and Comparison of Treatment Guidelines

2014 ◽  
Vol 5;17 (5;9) ◽  
pp. 401-414
Author(s):  
Chi-Wai Cheung
Keyword(s):  
Chronic Pain ◽  
Adverse Effects ◽  
Cancer Pain ◽  
Practice Guidelines ◽  
Scientific Evidence ◽  
Opioid Therapy ◽  
Scientific Data ◽  
Drug Misuse ◽  
Opioid Use ◽  
Chronic Opioid Therapy

Background: Long-term opioid use for chronic non-cancer pain has increased substantially in recent years despite the paucity of strong supporting scientific data and concerns regarding adverse effects and potential misuse. Study Design: Review and summary of practice guidelines available on PubMed and Cochrane databases as well as on the Internet on chronic opioid therapy from June 2004 to June 2013. Objective: To review expert-developed practice guidelines on chronic opioid therapy, published in different countries over the past decade in order to reveal similar principles of therapy and to provide useful information and references for future development of opioid guidelines to identify adequately supported practice points and areas in need of further scientific evidence. Method: Seven guidelines were identified as pertaining specifically to the long-term use of opioids for general chronic non-cancer pain from an initial search of the PubMed/Medline and Cochrane databases using combinations of the search terms “opioid,” “chronic opioid therapy,” “chronic pain,” “chronic non-cancer pain,” “chronic non-malignant pain,” “guidelines,” “practice guidelines,” and “clinical practice guidelines,” filtered to include only articles on humans published in the English language over the past 10 years. Results: All guidelines espouse an individual approach to management, beginning with a comprehensive patient evaluation, with particular focus on eliciting factors that may indicate potential drug misuse and abuse, and a trial of therapy to determine the course of treatment. Goals of treatment should be adequately discussed with and consented to by the patient. Opioids are generally not recommended as first-line therapy but, when used, clinicians should closely monitor patients for loss of response, adverse effects or aberrant behavior, and revise the treatment plan accordingly. Urine drug testing (UDT) may be used as a tool to monitor for aberrant behavior or drug misuse; opioid rotation may be considered when loss of response or adverse effects are a concern, at a starting dose lower than the calculated equianalgesic dose. Limitations: Information on some African nations, countries in the Middle-East, and Pacific Islands is not available and therefore was not included in this review. Conclusion: There is a growing body of scientific evidence to support opioid use in chronic pain. Future work should focus on continuing to generate good-quality evidence on the longterm benefits of opioid therapy, as well as scientific data to guide drug choice and dosing for specific conditions, populations, and situations. Key words: Chronic pain, opioid, non-cancer pain, guidelines, opioid rotation, pain management, opioid therapy

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