Long-Term Opioid Therapy for Chronic Pain

Abstract Background There are significant medical risks of long-term opioid therapy (LTOT) for chronic pain. Consequently, there is a need to identify effective interventions for the reduction of high-dose full-agonist opioid medication use. Methods The current study details a retrospective review of 240 patients with chronic pain and LTOT presenting for treatment at a specialty opioid refill clinic. Patients first were initiated on an outpatient taper or, if taper was not tolerated, transitioned to buprenorphine. This study analyzes potential predictors of successful tapering, successful buprenorphine transition, or failure to complete either intervention and the effects of this clinical approach on pain intensity scores. Results One hundred seven patients (44.6%) successfully tapered their opioid medications under the Centers for Disease Control and Prevention guideline target dose (90 mg morphine-equianalgesic dosage), 45 patients (18.8%) were successfully transitioned to buprenorphine, and 88 patients (36.6%) dropped out of treatment: 11 patients during taper, eight during buprenorphine transition, and 69 before initiating either treatment. Conclusions. Higher initial doses of opioids predicted a higher likelihood of requiring buprenorphine transition, and a co-occurring benzodiazepine or z-drug prescription predicted a greater likelihood of dropout from both interventions. Patterns of change in pain intensity according to treatment were mixed: among successfully tapered patients, 52.8% reported greater pain and 23.6% reported reduced pain, whereas 41.8% reported increased pain intensity and 48.8% reported decreased pain after buprenorphine transition. Further research is needed on predictors of treatment retention and dropout, as well as factors that may mitigate elevated pain scores after reduction of opioid dosing.

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Poster 530 Nutrition and Eating Behavior in Patients with Chronic Pain Receiving Long-Term Opioid Therapy

PM&R ◽

10.1016/j.pmrj.2014.08.401 ◽

2014 ◽

Vol 6 (9) ◽

pp. S181

Author(s):

Joseph Walker ◽

Alec L. Meleger ◽

Cameron K. Froude

Keyword(s):

Chronic Pain ◽

Eating Behavior ◽

Opioid Therapy

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

Journal of Opioid Management ◽

10.5055/jom.2005.0055 ◽

2005 ◽

Vol 1 (5) ◽

pp. 257 ◽

Cited By ~ 53

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.

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The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop

Annals of Internal Medicine ◽

10.7326/m14-2559 ◽

2015 ◽

Vol 162 (4) ◽

pp. 276 ◽

Cited By ~ 723

Author(s):

Roger Chou ◽

Judith A. Turner ◽

Emily B. Devine ◽

Ryan N. Hansen ◽

Sean D. Sullivan ◽

...

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Opioid Therapy ◽

National Institutes Of Health

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Dose Escalation During the First Year of Long-Term Opioid Therapy for Chronic Pain

Pain Medicine ◽

10.1111/pme.12634 ◽

2015 ◽

Vol 16 (4) ◽

pp. 733-744 ◽

Cited By ~ 26

Author(s):

Stephen G. Henry ◽

Barth L. Wilsey ◽

Joy Melnikow ◽

Ana-Maria Iosif

Keyword(s):

Chronic Pain ◽

Dose Escalation ◽

Opioid Therapy ◽

First Year

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Long-Term Opioid Therapy for Chronic Pain

Annals of Internal Medicine ◽

10.7326/l15-5109-3 ◽

2015 ◽

Vol 163 (2) ◽

pp. 148 ◽

Cited By ~ 1

Author(s):

Roger Chou

Keyword(s):

Chronic Pain ◽

Opioid Therapy

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Nutrition and Eating Behavior in Patients With Chronic Pain Receiving Long-Term Opioid Therapy

PM&R ◽

10.1016/j.pmrj.2013.08.597 ◽

2013 ◽

Vol 6 (1) ◽

pp. 7-12.e1 ◽

Cited By ~ 15

Author(s):

Alec L. Meleger ◽

Cameron Kiely Froude ◽

Joseph Walker

Keyword(s):

Chronic Pain ◽

Eating Behavior ◽

Opioid Therapy

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Opioid Misuse and Addiction Among Patients With Chronic Pain

Pain Care Essentials ◽

10.1093/med/9780199768912.003.0021 ◽

2019 ◽

pp. 339-354

Author(s):

Marc O. Martel ◽

Robert N. Jamison

Keyword(s):

Chronic Pain ◽

Opioid Therapy ◽

Screening Tools ◽

Prescription Opioid ◽

Opioid Misuse ◽

Chronic Noncancer Pain ◽

Medication Misuse ◽

Opioid Medications ◽

Noncancer Pain

Chapter 20 provides an introduction to understanding the prevalence and risk factors as well as screening tools for assessing opioid misuse and addiction in patients with chronic pain. In the era of the opioid epidemic in North America and beyond, the use of prescription opioid medications to help improve function in chronic noncancer pain is frequently debated. Out of fear of iatrogenic addiction, litigation, and/or potential medication misuse, some clinicians are refusing to prescribe opioids for chronic pain. Evidence indicates that rates of opioid misuse and addiction are fairly high among chronic pain patients prescribed long-term opioid therapy, but there is consensus that opioids can be safe and effective for carefully selected and monitored patients.

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A Two-Year Prospective Multicenter Study of Opioid Therapy for Chronic Noncancer Pain: Prescription Trends and Predictors

Pain Medicine ◽

10.1093/pm/pny275 ◽

2018 ◽

Vol 20 (11) ◽

pp. 2166-2178 ◽

Cited By ~ 1

Author(s):

Dalila R Veiga ◽

Liliane Mendonça ◽

Rute Sampaio ◽

José M Castro-Lopes ◽

Luís F Azevedo

Keyword(s):

Chronic Pain ◽

Clinical Outcomes ◽

Opioid Therapy ◽

Opioid Use ◽

Opioid Prescription ◽

Chronic Noncancer Pain ◽

Noncancer Pain ◽

Opioid Users

Abstract Objectives Opioid use in chronic pain has increased worldwide in recent years. The aims of this study were to describe the trends and patterns of opioid therapy over two years of follow-up in a cohort of chronic noncancer pain (CNCP) patients and to assess predictors of long-term opioid use and clinical outcomes. Methods A prospective cohort study with two years of follow-up was undertaken in four multidisciplinary chronic pain clinics. Demographic data, pain characteristics, and opioid prescriptions were recorded at baseline, three, six, 12, and 24 months. Results Six hundred seventy-four CNCP patients were recruited. The prevalence of opioid prescriptions at baseline was 59.6% (N = 402), and 13% (N = 86) were strong opioid prescriptions. At 24 months, opioid prescription prevalence was as high as 74.3% (N = 501), and strong opioid prescription was 31% (N = 207). Most opioid users (71%, N = 479) maintained their prescription during the two years of follow-up. Our opioid discontinuation was very low (1%, N = 5). Opioid users reported higher severity and interference pain scores, both at baseline and after two years of follow-up. Opioid use was independently associated with continuous pain, pain location in the lower limbs, and higher pain interference scores. Conclusions This study describes a pattern of increasing opioid prescription in chronic pain patients. Despite the limited improvement of clinical outcomes, most patients keep their long-term opioid prescriptions. Our results underscore the need for changes in clinical practice and further research into the effectiveness and safety of chronic opioid therapy for CNPC.

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