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 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.

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.

Neuropathic pain in patients with haemophilia, that is the question

2015 ◽  
Vol 35 (S 01) ◽  
pp. S5-S9 ◽  
Author(s):  
S. Krüger ◽  
T. Hilberg
Keyword(s):  
Rheumatoid Arthritis ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Differential Diagnosis ◽  
Pain Management ◽  
Pain Mechanisms ◽  
Number Of Patients ◽  
Paindetect Questionnaire ◽  
Chronic Disorders ◽  
Chronic Pain Conditions

SummaryChronic pain caused by recurrent joint bleedings affects a large number of patients with haemophilia (PwH). The basis of this pain, nociceptive or neuropathic, has not been investigated so far. In other pain-related chronic disorders such as osteoarthritis or rheumatoid arthritis, initial studies showed nociceptive but also neuropathic pain features. 137 PwH and 33 controls (C) completed the painDETECT-questionnaire (pDq), which identifies neuropathic components in a person´s pain profile. Based on the pDq results, a neuropathic pain component is classified as positive, negative or unclear. A positive neuropathic pain component was found in nine PwH, but not in C. In 20 PwH an unclear pDq result was observed. In comparison to C the allocation of pDq results is statistically significant (p≤0.001). Despite various pDq results in PwH and C a similar appraisal pain quality, but on a different level, was determined. Summarising the results, there is a potential risk to misunderstand underlying pain mechanisms in PwH. In chronic pain conditions based on haemophilic arthopathy, a differential diagnosis seems to be unalterable for comprehensive and individualised pain management in PwH.

scholarly journals Gabapentinoids for treatment of neuropathic pain: a medicines usage evaluation at the Groote Schuur Hospital Chronic Pain Management Clinic

2019 ◽  
pp. 21-28 ◽  
Author(s):  
MLA Moabelo ◽  
R Parker
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Pain Management ◽  
Somatosensory System ◽  
Tricyclic Antidepressant ◽  
Screening Tools ◽  
Chronic Pain Management ◽  
Cross Sectional ◽  
Chronic Postsurgical Pain ◽  
Usage Evaluation

Background: Neuropathic pain (NP), defined as pain caused by a lesion or disease of the somatosensory system, affects 6.9–10% of people worldwide. Pregabalin is currently recommended as a first line drug for NP in South Africa. Methods: A cross-sectional, retrospective, descriptive medicines usage evaluation (MUE) of pregabalin at Groote Schuur Hospital (GSH) Chronic Pain Management Clinic for the year 2017 was conducted. A MUE using a standardised data collection form was performed on 100 randomly selected patient folders. Data was summarised using descriptive statistics. Results: The majority of cases were women (76) with a mean age of 55.9 years (SD12.49). A diagnosis of NP was recorded in 58 folders and a “possible” diagnosis recorded in 7 folders. In 79 cases there was no mention of a tool/method used to diagnose NP. The most common condition diagnosed was chronic postsurgical pain with a neuropathic component (n = 16), followed by NP (n = 15). The most common initiating and current dose of pregabalin was 75 mg twice daily. In 56 patients, pregabalin was prescribed in conjunction with a tricyclic antidepressant (TCA) or selective noradrenaline reuptake inhibitor (SNRI). Patient education was documented as having taken place in 76 of cases. Conclusions: Based on this MUE we recommend the use of screening tools for the diagnosis of neuropathic pain, and a focus on the initiating dose of pregabalin. The use of a standardised assessment document and the interdisciplinary team input at this clinic appears to optimise prescribing of pregabalin in line with practice guidelines.

Mexiletine Usage in a Chronic Pain Clinic: Indications, Tolerability, and Side Effects

2018 ◽  
Vol 1 (21;1) ◽  
pp. E573-E579 ◽  
Author(s):  
Adam Romman
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Cohort Study ◽  
Pain Management ◽  
Side Effects ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Diagnosis ◽  
Pain Clinic ◽  
Chronic Pain Management

Background: Background: Intravenous lidocaine has multiple applications in the management of acute and chronic pain. Mexiletine, an oral lidocaine analogue, has been used in a number of chronic pain conditions although its use is not well characterized. Objectives: To report our experience using mexiletine in a chronic pain population, specifically looking at tolerability, side effects, and EKG changes. Study Design: Retrospective, cohort study. Setting: Multiple pain clinic locations in an integrated multispecialty health system. Methods: All patients who had a mexiletine prescription between August 2015 and August 2016 were queried via the electronic medical record. Each chart was examined for demographics, QTc changes on EKG, length of use, and reasons for stoppage. Results:There were 74 total patients identified in the chronic pain management clinics as receiving at least 1 mexiletine prescription over the 1-year time period. Twice as many women as men received mexiletine prescriptions. Neuropathic pain was the most common primary diagnosis (64%) which included diabetic neuropathy, radiculopathy, and others. Fibromyalgia was the next most common primary diagnosis (28%). A QTc change on the EKG showed a mean decrease of 0.1 ms and median increase of 1.5 ms. At 6 months (180 days), approximately 30% of the patients remained on mexiletine therapy, and 28% remained on the therapy at 1 year (360 days). Median duration of use was 60 days and the mean was 288 days. Neurologic and gastrointestinal side effects were the most commons reason for stoppage. All side effects were mild and resolved with stoppage. After side effects, lack of response, or loss of efficacy, were the next most common reasons for stoppage. Limitations: Pain relief and outcomes were not specifically examined due to confounding factors including interventional treatments and multiple treatment modalities. This was a retrospective, cohort study limited to our specific clinic population with a relatively high loss to follow-up rate. Conclusion:Mexiletine is rarely a first line option for chronic pain management and is often used when multiple other modalities have failed. By reporting our experience, we hope other clinicians may have more familiarity with the drug’s use in a chronic pain practice. It appears reasonably tolerable, may not require frequent EKG monitoring, and can be an appropriate adjunct in the chronic pain population. More research is needed regarding efficacy and dose titration for mexiletine in chronic pain. Key Words: Chronic pain, mexiletine, IV lidocaine, pain, neuropathic pain, neuropathy, fibromyalgia, QTc, tolerability

scholarly journals Support for osteopathic manipulative treatment inclusion in chronic pain management guidelines: a narrative review

2021 ◽  
Vol 121 (3) ◽  
pp. 307-317
Author(s):  
Megan Franzetti ◽  
Emily Dries ◽  
Brady Stevens ◽  
Lisa Berkowitz ◽  
Sheldon C. Yao
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Functional Status ◽  
Secondary Outcome ◽  
Osteopathic Manipulative Treatment ◽  
Chronic Pain Management ◽  
Medication Usage ◽  
Management Guidelines ◽  
Comparator Group ◽  
Chronic Pain Conditions

Abstract Context Osteopathic manipulative treatment (OMT) is used to treat chronic pain conditions. However, few guidelines focusing on chronic pain management include recommendations for OMT. Objectives To evaluate previous literature on the use of OMT for improving chronic pain. Methods A literature search was conducted on MEDLINE/PubMed and ScienceDirect on August 26–27, 2019, using the terms “osteopathic,” “chronic,” and “pain,” yielding a total of 312 MEDLINE/PubMed articles and 515 ScienceDirect articles. Eligibility criteria required that studies investigate pain, functional status, or medication usage through an experimental design, focusing on human subjects with chronic pain who had various forms of OMT administered by osteopathically trained individuals in which the comparator group received no intervention, a sham or placebo, or conventional care. Three authors independently performed literature searches and methodically settled disagreements over article selection. Results In the 22 articles included in our study that examined OMT use in chronic pain conditions, we evaluated primary outcomes of pain (22; 100%) and functional status (20; 90.9%), and the secondary outcome of medication usage (3; 13.6%). The majority of articles showed that OMT resulted in a significant decrease in pain levels as compared to baseline pain levels or the control group (20; 90.9%) and that OMT resulted in an improvement in functional status (17; 77.3%). In articles that did not find a significant difference in pain (2; 9.1%) or functional status (3; 13.6%), there were overall outcomes improvements noted. All articles that investigated medication usage (3; 13.6%) showed that OMT was effective in decreasing patients’ medication usage. Our study was limited by its small sample size and multimodal comparator group exclusion. Conclusions OMT provides an evidence-based management option to reduce pain levels, improve functional status, and decrease medication usage in chronic pain conditions, especially low back pain (LBP). Pain management guidelines should include OMT as a resource to alleviate chronic pain.

scholarly journals P.153 Profiles and Outcomes of Workers’ Compensation Patients Undergoing Spinal Cord Stimulation for Persistent Post Surgical Pain

2021 ◽  
Vol 48 (s3) ◽  
pp. S63-S64
Author(s):  
V Varshney ◽  
R Sahjpaul ◽  
J Osborn
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Pain Management ◽  
Retrospective Analysis ◽  
Spinal Cord Stimulation ◽  
Workers Compensation ◽  
Low Back ◽  
Chronic Pain Management ◽  
Surgical Pain

Background: The challenges of chronic pain management, and resulting poorer outcomes, in workers’ compensation (WCB) patients has been well established. Spinal cord stimulation (SCS) has been used for the management of low back and radicular neuropathic pain with varying effectiveness and it’s efficacy in the WCB population has been challenged. We sought to examine our experience using SCS in WCB compared to non WCB patients. Methods: A retrospective analysis of 71 WCB patients assessed and treated at the St Pauls Hospital neuromodulation program between 2016-2021 was performed. This group was compared to a cohort on non WCB patients in terms of the likelhood of being offered a trial, proceeding with trial if offered, and the likelhood of a successful trial proceeding to implant. Results: Compared to non WCB, the WCB patients were more likely to be offered a trial (86% vs 77%) and more likely to proceed with a trial if offered (82% vs 71%). Trial to implant ratios were similar in both WCB and non WCB patients (78% vs 77%). Conclusions: WCB patients were more likely to be offered a SCS trial and more likely to accept if offered, compared to non-WCB patients. However, both groups were similar in trial to implant probability.

scholarly journals Intravenous Infusions in Chronic Pain Management

2013 ◽  
Vol 3;16 (3;5) ◽  
pp. 231-249
Author(s):  
Boleslav Kosharskyy
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
The United States ◽  
Treatment Modalities ◽  
Sufficient Evidence ◽  
Chronic Pain Management ◽  
Intravenous Infusions ◽  
Regional Pain Syndromes ◽  
Complex Regional Pain Syndromes ◽  
Chronic Pain Conditions

In the United States, millions of Americans are affected by chronic pain, which adds heavily to national rates of morbidity, mortality, and disability, with an ever-increasing prevalence. According to a 2011 report titled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research by the Institute of Medicine of the National Academies, pain not only exacts its toll on people’s lives but also on the economy with an estimated annual economic cost of at least $560 - 635 billion in health care costs and the cost of lost productivity attributed to chronic pain. Intravenous infusions of certain pharmacologic agents have been known to provide substantial pain relief in patients with various chronic painful conditions. Some of these infusions are better, and although not necessarily the first therapeutic choice, have been widely used and extensively studied. The others show promise, however are in need of further investigations. This article will focus on non-opiate intravenous infusions that have been utilized for chronic painful disorders such as fibromyalgia, neuropathic pain, phantom limb pain, post-herpetic neuralgia, complex regional pain syndromes (CRPS), diabetic neuropathy, and central pain related to stroke or spinal cord injuries. The management of patients with chronic pain conditions is challenging and continues to evolve as new treatment modalities are explored and tested. The following intravenous infusions used to treat the aforementioned chronic pain conditions will be reviewed: lidocaine, ketamine, phentolamine, dexmedetomidine, and bisphosphonates. This overview is intended to familiarize the practitioner with the variety of infusions for patients with chronic pain. It will not, however, be able to provide guidelines for their use due to the lack of sufficient evidence. Key words: Intravenous infusions in chronic pain management, bisphosphonates, phentolamine, ketamine, lidocaine, Dexmedetomidine, chronic pain

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