scholarly journals Exploring the Role of Chronic Pain Clinics: Potential for Opioid Reduction

2018 ◽  
Vol 1 (21;1) ◽  
pp. E603-E610
Author(s):  
Mohab Ibrahim
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Pain Clinic ◽  
High Dose ◽  
Opioid Use ◽  
Pain Clinics ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain ◽  
And Function

Background: The management of chronic nonmalignant pain with high-dose opioids has partially contributed to the current opioid epidemic, with some responsibility shared by chronic pain clinics. Traditionally, both primary care providers and patients used chronic pain clinics as a source for continued medical management of patients on high-dose opioids, often resulting in tolerance and escalating doses. Although opioids continue to be an important component of the management of some chronic pain conditions, improvement in function and comfort must be documented. Pain clinics are ideally suited for reducing opioid usage while improving pain and function with the use of a multimodal approach to pain management. We assessed whether the application of multimodal treatment directed by pain specialists in a pain clinic provides for improved function and reduced dosages of opioid analgesics. Objective: We evaluated the role of a pain clinic staffed by fellowship-trained pain physicians in reducing pain and opioid use in chronic nonmalignant pain patients. Study Design: This study used a retrospective design. Setting: The research took place in an outpatient pain clinic in a tertiary referral center/teaching hospital. Methods: Of 1268 charts reviewed, 296 patients were on chronic opioids at the time of first evaluation. After a thorough evaluation, the patients were treated with nonopioid pharmacotherapy and interventional pain procedures as necessary. The data utilized from patients’ latest follow-up visit included current pain level using the Numerical Rating Scale (NRS-11), opioid usage, and various functional parameters. Results: NRS-11 scores decreased by 33.8% from 6.8 (± 0.1)/10 to 4.5 (± 0.2)/10. The pain frequency and number of pain episodes improved by 36.8 ± 2 and 36.2 ± 2.1, respectively. Additionally, the ability to sleep, work, and perform chores significantly improved. Total opioid use decreased by about 55.4% from 53.8 ± 4 to about 24 ± 2.8 MME/patient/day. Limitation: This study is not a randomized prospective controlled study. The patients analyzed are still getting therapy and their pain status may change. Some opioids are underrepresented in the analyzed cohort. Finally, this study lacks in-depth stratification by type of pain, age, gender, and duration of opioid use. Conclusion: Chronic pain clinics can play a pivotal role in reducing opioid usage while improving pain and function in patients on chronic opioids. We wish to emphasize the importance of allocating resources toward nonopioid treatments that may improve the function and well-being of patients. Key words: Pain clinic, pain management, multimodal pain management, chronic pain, opioid reduction, improved pain, improved functional capacity

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.

Chronic Pain Management: The Occupational Therapist's Role

1987 ◽  
Vol 50 (8) ◽  
pp. 262-263 ◽  
Author(s):  
Jenny Strong
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Occupational Therapists ◽  
Occupational Therapist ◽  
Pain Patient ◽  
Chronic Pain Management ◽  
Medical Specialists ◽  
Pain Clinics

This paper describes the contribution the occupational therapist makes in improving the quality of life of the patient with chronic benign pain. Working closely with medical specialists, the occupational therapist is able to contribute much towards the rehabilitation of the patient. Occupational therapists are currently providing pain patient services from specialist pain clinics, community centres, general hospitals and private practice settings. The role of the occupational therapist in chronic pain management is highlighted by a case history.

Management of Chronic Nonmalignant Pain

1998 ◽  
Vol 11 (5) ◽  
pp. 374-381 ◽  
Author(s):  
James T. O'Donnell ◽  
Moriah B. Richie ◽  
Lori A. Nesbitt
Keyword(s):  
Chronic Pain ◽  
Clinical Research ◽  
Interpersonal Relationships ◽  
State Level ◽  
Social Consequences ◽  
High Quality ◽  
Level Of Functioning ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

Although advances in knowledge about the pathophysiology of pain have been impressive in recent years, high-quality clinical research in patients with chronic pain has not been abundant. Because chronic pain often leads to profound changes in psychologic state, level of functioning, and interpersonal relationships, treatment requires attention not only to the pathophysiologic cause of the pain (if one can be found) but also to the psychologic and social consequences (and antecedents).

Problematic Prescription Opioid Use in a Chronic Pain Treatment Facility: The Role of Emotional Processes

2018 ◽  
Vol 54 (3) ◽  
pp. 495-505 ◽  
Author(s):  
Lindsay M. S. Oberleitner ◽  
Mark A. Lumley ◽  
Emily R. Grekin ◽  
Kathryn M. Z. Smith ◽  
Amy M. Loree ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Treatment ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Treatment Facility ◽  
Emotional Processes ◽  
Chronic Pain Treatment ◽  
Prescription Opioid Use

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

2007 ◽  
Vol 12 (2) ◽  
pp. 93-99 ◽  
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.

Sign in / Sign up

Export Citation Format

Share Document