Significant pain reduction in chronic pain patients after detoxification from high-dose opioids

2006 ◽  
Vol 2 (5) ◽  
pp. 277 ◽  
Author(s):  
Michael J. Baron, MD, MPH ◽  
Paul W. McDonald, PhD
Keyword(s):  
Chronic Pain ◽  
High Dose ◽  
Pain Condition ◽  
Opioid Dose ◽  
Pain Scores ◽  
Patient Pain ◽  
Opioid Induced Hyperalgesia ◽  
Pain Sensitization ◽  
Pain Patients

Opioid tolerance is a well-established phenomenon that often occurs in patients taking opioids for the treatment of chronic pain. Typically, doctors need to periodically elevate patients’ opioid doses in an attempt to manage their underlying pain conditions, resulting in escalating opioid levels with only moderate to negligible improvement in pain relief. Recently, opioid-induced hyperalgesia has been recognized as a potential form of central sensitization in which a patient’s pain level increases in parallel with elevation of his or her opioid dose. Here, we report a retrospective study of patients undergoing detoxification from high-dose opioids prescribed to treat an underlying chronic pain condition which had not resolved in the year prior. All patients were converted to ibuprofen to manage pain, with a subgroup treated with buprenorphine during detoxification. Selfreports for pain scores were taken at first evaluation, follow-up visits, and termination. Twenty-one of 23 patients reported a significant decrease in pain after detoxification, suggesting that high-dose opioids may contribute to pain sensitization via opioid-induced hyperalgesia, decreasing patient pain threshold and potentially masking resolution of the preexisting pain condition.

scholarly journals Conversion of Chronic Pain Patients from FullOpioid Agonists to Sublingual Buprenorphine

2012 ◽  
Vol 3S;15 (3S;7) ◽  
pp. ES59-ES66
Author(s):  
Jonathan Daitch
Keyword(s):  
Chronic Pain ◽  
Opioid Medication ◽  
Sublingual Buprenorphine ◽  
Pain Scores ◽  
Chronic Pain Patients ◽  
Opioid Induced Hyperalgesia ◽  
Patient Groups ◽  
Pain Patients ◽  
Morphine Equivalent

Background: Sublingual buprenorphine-naloxone (buprenorphine SL) is a preparation that is used to treat opioid dependence. In addition, the Drug Enforcement Administration (DEA) has acknowledged the legality of an off-label use to treat pain with a sublingual buprenorphine preparation. Buprenorphine SL is unique among the opioid class of analgesics; this compound has a high affinity for the mu-receptor, yet only partially activates it. Thus, buprenorphine SL can provide analgesia, yet minimize opioid side effects. Many patients on high doses of traditional opioid medication develop tolerance. Despite escalating medication dosage, a subset of patients had a paradoxical increase in pain, which has been characterized as opioid-induced hyperalgesia (OIH). Buprenorphine SL, on the other hand, may even be anti-hyperalgesic and may have utility in treating these challenging patients. Objective: To determine the effectiveness of converting patients from traditional full agonist opioid medication to sublingual buprenorphine, as well as to identify patient groups that are most likely to benefit from this therapy. Patients who underwent conversion either had developed tolerance with diminished analgesia or were experiencing side effects on their opioid medications. Study Design: An observational report of outcomes assessment. Setting: An interventional pain management practice setting in the United States. Methods: Retrospective data from clinical records was compiled on 104 de-identified chronic pain patients whose personal information had been redacted (60 men and 44 women, aged 21-78) and who had previously been treated with opioid-agonist drugs; they were converted to buprenorphine SL in tablet form during the study. Chronic pain was defined as persistent pain for at least 6 months. Data collected from patient profiles included age, sex, diagnosis, medication history, pre-induction opioid intake, reason for detoxification, preinduction Clinical Opiate Withdrawal Score (COWS), and if applicable, cause of buprenorphine SL cessation. Pain levels and Quality of Life scores were recorded before and after conversion to buprenorphine SL. Outcome Measures: Level of analgesia for patients who continued conversion to sublingual buprenorphine for more than 2 months. Results: After initiation of buprenorphine SL therapy for more than 2 months, the mean pain scores on a scale from 0-10 decreased by 2.3 points (P < 0.001). Patient Quality of Life (QoL scale) was not significantly affected by buprenorphine SL therapy (P = 0.14). The success rate was highest for patients using morphine, oxycodone, and fentanyl before buprenorphine SL induction. These patient groups had a 3.7 point decrease in pain for those taking morphine, a 2.5 point decrease in pain for those taking oxycodone, and a 2.2 point decrease for those taking fentanyl. The smallest pain reduction was seen in the patient group using oxymorphone before conversion with a 1.1 point decrease in pain. Patients taking between 100-199 mg morphine equivalent per day experienced the greatest reduction (2.7 points) in pain scores. Patients taking between 200 and 299 mg morphine equivalent before buprenorphine SL induction exhibited a decrease of over 2 points on average. Patients taking > 400mg morphine equivalent reported the smallest reduction in pain scores, on average a 1.1 point decrease. Limitations: This study is limited by its observational nature. Conclusions: Patients continuing buprenorphine SL therapy for more than 60 days reported significant decreases in pain (2.3 points). Patients on doses of opioid medication between 100-199 mg morphine equivalents seemed to fare better with conversion to buprenorphine SL than patients on the highest doses (> 400 mg morphine equivalents). The opioid drug used by the patient before buprenorphine SL induction appears to have some effect on buprenorphine SL conversion success. Patients previously taking morphine, oxycodone, and fentanyl had the greatest decrease in pain after conversion to buprenorphine SL. Key Words: Sublingual buprenorphine-naloxone, buprenorphine, buprenorphine SL, opioid dependence, opioid conversion, opioid-induced hyperalgesia, analgesia, full agonist opioids, opioid tolerance.

scholarly journals Conversion from High-Dose Full-Opioid Agonists to Sublingual Buprenorphine Reduces Pain Scores and Improves Quality of Life for Chronic Pain Patients

Pain Medicine ◽  
2014 ◽  
Vol 15 (12) ◽  
pp. 2087-2094 ◽  
Author(s):  
Danielle Daitch ◽  
Jonathan Daitch ◽  
Daniel Novinson ◽  
Michael Frey ◽  
Carol Mitnick ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
High Dose ◽  
Sublingual Buprenorphine ◽  
Pain Scores ◽  
Opioid Agonists ◽  
Chronic Pain Patients ◽  
Pain Patients

scholarly journals Opioid-sparing effects of medical cannabis or cannabinoids for chronic pain: a systematic review and meta-analysis of randomised and observational studies

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047717
Author(s):  
Atefeh Noori ◽  
Anna Miroshnychenko ◽  
Yaadwinder Shergill ◽  
Vahid Ashoorion ◽  
Yasir Rehman ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Sleep Disturbance ◽  
Observational Studies ◽  
Prescription Opioids ◽  
Randomised Trials ◽  
Medical Cannabis ◽  
Opioid Use ◽  
Opioid Dose ◽  
Chronic Cancer Pain ◽  
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.

Multidisciplinary treatment of chronic pain: long-term follow-up of low-back pain patients ★

Pain ◽  
1977 ◽  
Vol 4 (Supp C) ◽  
pp. 283-292 ◽  
Author(s):  
Richard I. Newman ◽  
Joel L. Seres ◽  
Leonard P. Yospe ◽  
Bonnie Garlington
Keyword(s):  
Chronic Pain ◽  
Low Back Pain ◽  
Back Pain ◽  
Multidisciplinary Treatment ◽  
Low Back ◽  
Long Term Follow Up ◽  
Pain Patients

scholarly journals Lack of Correlation Between Opioid Dose Adjustment and Pain Score Change in a Group of Chronic Pain Patients

2013 ◽  
Vol 14 (4) ◽  
pp. 384-392 ◽  
Author(s):  
Lucy Chen ◽  
Trang Vo ◽  
Lindsey Seefeld ◽  
Charlene Malarick ◽  
Mary Houghton ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Score ◽  
Dose Adjustment ◽  
Score Change ◽  
Opioid Dose ◽  
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.

Review of the Performance of Quantitative Sensory Testing Methods to Detect Hyperalgesia in Chronic Pain Patients on Long-term Opioids

2015 ◽  
Vol 122 (3) ◽  
pp. 677-685 ◽  
Author(s):  
Nathaniel P. Katz ◽  
Florence C. Paillard ◽  
Robert R. Edwards
Keyword(s):  
Chronic Pain ◽  
Controlled Trial ◽  
Controlled Study ◽  
Injection Pain ◽  
Heat Pain ◽  
Cold Pain ◽  
Chronic Pain Patients ◽  
Opioid Induced Hyperalgesia ◽  
Pain Patients

Abstract Background: Opioid-induced hyperalgesia is a clinical syndrome whereby patients on long-term opioids become more sensitive to pain while taking opioids. Opioid-induced hyperalgesia is characterized by increased pain intensity over time, spreading of pain to other locations, and increased pain sensation to external stimuli. To characterize opioid-induced hyperalgesia, laboratory methods to measure hyperalgesia have been developed. To determine the performance of these methods, the authors conducted a systematic review of clinical studies that incorporate measures of hyperalgesia in chronic pain patients on long-term opioids. Methods: PubMed and Cochrane databases were searched (terms: opioid induced hyperalgesia, study or trial, and long-term or chronic). Studies published in English were selected if they were conducted in chronic pain patients on long-term opioids and incorporated measures of hyperalgesia; acute/single-dose studies and/or conducted in healthy volunteers were excluded. Results: Fourteen articles made the final selection (11 were selected from the search and 3 others were found from additional sources); there was one randomized controlled trial, one prospective controlled study, three prospective uncontrolled studies, and nine cross-sectional observation studies. Hyperalgesia measurement paradigms used included cold pain, heat pain, pressure pain, electrical pain, ischemic pain, and injection pain. Although none of the stimuli were capable of detecting patients’ hyperalgesia, heat pain sensitivity showed some promising results. Conclusions: None of the measures reviewed herein met the criteria of a definitive standard for the measurement of hyperalgesia. Additional studies that use improved study design should be conducted.

Cost–benefit of a 13-week multidiciplinary rehabilitation course for chronic non-malignant pain patients

2010 ◽  
Vol 1 (3) ◽  
pp. 173-173
Author(s):  
Villy Meineche-Schmidt
Keyword(s):  
Chronic Pain ◽  
Sick Leave ◽  
Cost Benefit ◽  
Cost Effective ◽  
Social Benefit ◽  
Rehabilitation Program ◽  
Transfer Income ◽  
Pain Patients ◽  
Observation Period

Abstract Background Economy is an important part of chronic pain. Aim To describe the economy in chronic non-malignant pain patients attending a 13-week Rehabilitation Program (RP). Methods All patients participating in the RP 2006–2008 were evaluated at baseline (BL) and at follow-up (FU) after an observation period of mean … month in relation to: (1) work-income (WI) or (2) transfer income (TI), comprised by: (a) sick-leave (SL), (b) sick pension (SP), (c) social benefit (SB) and (d) rehabilitation benefit (RB). The economic impact on state and county and the time to age pension was calculated. Results 117 patients attended the RP. At BL 23 patients had WI and 19 maintained this at FU (3 were on SP and 1 on RB). 90 patients were on TI at BL: 58 on SL at BL changed to 20 on SP + 23 on WI + 6 on SB + 1 on RB + 6 maintained SL, 12 on SB at BL changed to 6 on WI+ 1 on SP + 5 still on SB. 7 on RB at BL changed to 6 on WI + 1 on RB. The economic situation was concluded for 97 patients (83%). State expenses were increased by 540,000 Euro and county savings was 698,000 Euro. The societal savings were 158,000 Euro. The total costs for the RP was 421,000 Euro. Costs balanced savings after 2.7 years. The average time to age pension for the participating patients was 25 years. The potential accumulated savings thus amounted to 3.5 million Euros. Conclusions The 13-week Rehabilitation Program was highly cost effective: expenses for the program balanced savings after 3 years and the time to age pension for the participating patients was 25 years. The potential accumulated saving per patient was 30,000 Euro.

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