scholarly journals Framing of the opioid problem in cancer pain management in Canada

2019 ◽  
Vol 26 (3) ◽  
Author(s):  
R. Asthana ◽  
S. Goodall ◽  
J. Lau ◽  
C. Zimmermann ◽  
P. L. Diaz ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Cancer Pain ◽  
Opioid Therapy ◽  
Position Paper ◽  
Chronic Pain Management ◽  
Opioid Use ◽  
Cancer Pain Management ◽  
Canadian Guideline ◽  
Patients With Cancer

Two guidelines about opioid use in chronic pain management were published in 2017: the Canadian Guideline for Opioids for Chronic Non-Cancer Pain and the European Pain Federation position paper on appropriate opioid use in chronic pain management. Though the target populations for the guidelines are the same, their recommendations differ depending on their purpose. The intent of the Canadian guideline is to reduce the incidence of serious adverse effects. Its goal was therefore to set limits on the use of opioids. In contrast, the European Pain Federation position paper is meant to promote safe and appropriate opioid use for chronic pain.     The content of the two guidelines could have unintentional consequences on other populations that receive opioid therapy for symptom management, such as patients with cancer. In this article, we present expert opinion about those chronic pain management guidelines and their impact on patients with cancer diagnoses, especially those with histories of substance use disorder and psychiatric conditions. Though some principles of chronic pain management can be extrapolated, we recommend that guidelines for cancer pain management should be developed using empirical data primarily from patients with cancer who are receiving opioid therapy.

Understanding transdermal buprenorphine and a practical guide to its use for chronic cancer and non-cancer pain management

2019 ◽  
Vol 15 (2) ◽  
pp. 147-158 ◽  
Author(s):  
Tony O’Brien, MB, FRCPI ◽  
Jin Seok Ahn, MD ◽  
Richard Chye, MBBS, FRACP, FFPMANZCA, FAChPM ◽  
Brian Le, MBBS (Hons), MPH, FRACP, FAChPM ◽  
Henry Lu, MD, DABPN, DPBPM ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Pain Management ◽  
Cancer Pain ◽  
Chronic Pain Management ◽  
Cancer Pain Management ◽  
Appropriate Use ◽  
Chronic Pain Conditions ◽  
Favorable Safety ◽  
Practical Recommendations

Transdermal buprenorphine (TDB) has demonstrated effectiveness in treating a range of chronic pain conditions, including cancer pain, nociceptive pain, and neuropathic pain and has a favorable safety profile. Worldwide, clinical experience of its use is relatively limited. There is considerable misunderstanding about the pharmacology, mechanism of action, and safety of buprenorphine. There is also limited guidance on the appropriate use of TDB for chronic pain management. This article presents an overview of TDB and also provides practical recommendations for its use as part of a multifaceted strategy in chronic cancer and non-cancer pain.

scholarly journals European Pain Federation position paper on appropriate opioid use in chronic pain management

2016 ◽  
Vol 21 (1) ◽  
pp. 3-19 ◽  
Author(s):  
T. O'Brien ◽  
L.L. Christrup ◽  
A.M. Drewes ◽  
M.T. Fallon ◽  
H.G. Kress ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Position Paper ◽  
Chronic Pain Management ◽  
Opioid Use

scholarly journals Chronic pain management and the development of opioid use disorder

2018 ◽  
Vol 87 (1) ◽  
pp. 55-57
Author(s):  
Lily Robinson ◽  
Richard Yu ◽  
Salonee Patel
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Cancer Pain ◽  
Medical Management ◽  
Opioid Therapy ◽  
Opioid Use Disorder ◽  
Medical Attention ◽  
Prescription Opioid ◽  
Evidence Based ◽  
Opioid Use

Chronic pain is a common condition that impacts quality of life and often precipitates the need for medical attention. Despite evidence that long-term opioid use provides limited relief, prescription opioid therapy remains a cornerstone in the medical management of chronic non-cancer pain. Presently, 13% of Canadians are prescribed opioids for pain management, and physicians play a crucial role in preventing the development of opioid use disorders. However, Canadian physicians lack knowledge of and comfort with evidence-based principles of opioid stewardship. In this article, we aim to highlight ongoing Canadian efforts to address physician discomfort and improve clinical practice. We focus on 2017 Canadian guidelines that provide clinicians with evidence-based recommendations for opioid use in chronic non-cancer pain management. In addition, we call attention to provincial efforts to implement physician accountability measures. In reviewing the existing literature, we uncovered inadequacies in pain management curricula within the Canadian undergraduate and continuing medical education (CME) systems. We consulted the educational practices of the European Pain Federation and the Centers for Disease Control and Prevention to make recommendations for improvement to current Canadian pain curricula. Based on our findings, we recommend that (1) Canadian medical institutions expand upon current core pain curricula, (2) pain management education be made compulsory, (3) academic detailing be emphasized as a means of CME, and (4) multidisciplinary non-medical management of chronic pain be featured more extensively.

scholarly journals Provider confidence in opioid prescribing and chronic pain management: results of the Opioid Therapy Provider Survey

2017 ◽  
Vol Volume 10 ◽  
pp. 1395-1400 ◽  
Author(s):  
Amy Pearson ◽  
Rajat Moman ◽  
Susan Moeschler ◽  
Jason Eldrige ◽  
W. Michael Hooten
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Opioid Therapy ◽  
Chronic Pain Management ◽  
Opioid Prescribing ◽  
Provider Survey

Opioid Rotation for Toxicity Reduction (DRAFT)

2018 ◽  
Author(s):  
Anna Cecilia Tenorio ◽  
Akhila Reddy
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Clinical Case ◽  
Cancer Pain Management ◽  
Opioid Rotation ◽  
Patients With Cancer ◽  
Daily Dose ◽  
Study Intervention ◽  
Morphine Equivalent

This chapter discusses the de Stoutz et al. retrospective review of patients with cancer pain who developed dose-limiting toxicities and underwent opioid rotation that resulted in improvement of symptoms related to opioid induced neurotoxicity, uncontrolled pain, and reduction in morphine equivalent daily dose. This study is the first to establish that opioid rotation, which is substituting one opioid with another using established equianalgesic conversion ratios, is a valuable tool in cancer pain management. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.

Pain in Europe

2018 ◽  
Author(s):  
Christopher Eccleston ◽  
Bart Morlion ◽  
Christopher Wells
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Pain Management ◽  
Cancer Pain ◽  
Final Section ◽  
International Association ◽  
Main Section ◽  
Cancer Pain Management ◽  
The World

There are over 740 million people living in the 37 countries who are members of the European Pain Federation of chapters of the International Association for the Study of Pain. The editors introduce the field of pain management, in particular the work of over 20,000 people in acute (largely injury related) pain, chronic pain including cancer pain management, and palliative care. We then describe how the book European Pain Management is structured. There are three sections: an introduction to the world of pain and the epidemiology of pain. The main section, which is 37 chapters long, reports describing the practice of pain management in each country, the challenges and innovations. And a final section looks at specific issues that cut across all nations, and ends with a concluding analysis of the statue of European Pain Management.

Opioid use disorder and chronic pain: challenges for palliative care practice

2019 ◽  
Vol 25 (9) ◽  
pp. 453-457
Author(s):  
Brenda Peters-Watral
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Substance Use ◽  
Pain Management ◽  
Cancer Pain ◽  
Opioid Use Disorder ◽  
Care Practice ◽  
Care Providers ◽  
Opioid Use ◽  
Multiple Cancer

Along with a well-documented increase in opioid use disorder (OUD) and a rapidly escalating rate of fatal overdose in North America, inadequate management of chronic pain remains a pervasive problem. The increasing number of individuals living with OUD also experience multiple cancer risk factors, which are related to their substance use, while people with cancer diagnoses have similar risks of current or past addiction as the general population. Recent pain guidelines focus on chronic non-cancer pain and do not include recommendations for cancer pain management. Managing cancer pain at the end of life is more challenging in people with current or past substance use disorder (SUD), especially OUD. Addressing these challenges requires confronting stigmas and stereotypes, building knowledge among palliative care providers and assessing the risks and benefits of opioids for pain management on an individual basis in order to continue to provide the holistic care.

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