scholarly journals European* clinical practice recommendations on opioids for chronic noncancer pain – Part 1: Role of opioids in the management of chronic noncancer pain

2021 ◽  
Vol 25 (5) ◽  
pp. 949-968 ◽  
Author(s):  
Winfried Häuser ◽  
Bart Morlion ◽  
Kevin E. Vowles ◽  
Kirsty Bannister ◽  
Eric Buchser ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Chronic Noncancer Pain ◽  
Practice Recommendations ◽  
Noncancer Pain

scholarly journals European clinical practice recommendations on opioids for chronic noncancer pain – Part 2: Special situations*

2021 ◽  
Author(s):  
Nevenka Krcevski–Škvarc ◽  
Bart Morlion ◽  
Kevin E. Vowles ◽  
Kirsty Bannister ◽  
Eric Buchsner ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Chronic Noncancer Pain ◽  
Practice Recommendations ◽  
Noncancer Pain

scholarly journals Feasibility of patient-focused behavioral interventions to support adults experiencing chronic noncancer pain during opioid tapering: a systematic literature review

2021 ◽  
Author(s):  
Ruth White ◽  
Laura Bruggink ◽  
Chris Hayes ◽  
Allison Boyes ◽  
Chris Paul
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Adverse Events ◽  
Quality Assessment ◽  
Behavioral Interventions ◽  
Completion Rates ◽  
Chronic Noncancer Pain ◽  
Behavioral Treatments ◽  
Opioid Tapering ◽  
Noncancer Pain

Abstract Guidelines for chronic noncancer pain prioritize behavioral treatments. In clinical practice transition from opioids to behavioral treatments is often not endorsed by patients or providers. Feasible interventions to support opioid tapering are needed, particularly in primary care. The objectives of this paper is to review the feasibility of behavioral interventions to support opioid tapering. Electronic databases (MEDLINE, Embase, PsycINFO, and CINAHL) were searched from inception to June 2019 to identify original studies reporting feasibility (consent rates; completion rates; patient-reported acceptability; integration into clinical practice; and adverse events) of opioid tapering and transition to behavioral treatments for adults experiencing chronic noncancer pain. Google scholar and contents tables of key journals were also searched. Two authors independently extracted data and assessed methodological quality using The Quality Assessment Tool for Quantitative Studies. Eleven publications met inclusion criteria, of which three were conducted in primary care. Consent rates ranged from 27% to 98% and completion rates from 6.6% to 100%. Four studies rated at least one component of patient acceptability: helpfulness from 50%–81%; satisfaction 71%–94%, and “recommend to others” 74%–91%. Three studies reported provider perspectives and two studies reported adverse events. Quality assessment indicated all 11 studies were moderate or weak, primarily due to selection bias and lack of assessor blinding. There was also considerable heterogeneity in study design. The limited available data suggest that attempts to translate opioid tapering interventions into practice are likely to encounter substantial feasibility challenges. One possible way to ameliorate this challenge may be a clear policy context, which facilitates and support opioid reduction.

Increasing Evidence for the Limited Role of Opioids to Treat Chronic Noncancer Pain

JAMA ◽  
2018 ◽  
Vol 320 (23) ◽  
pp. 2427 ◽  
Author(s):  
Michael A. Ashburn ◽  
Lee A. Fleisher
Keyword(s):  
Chronic Noncancer Pain ◽  
Limited Role ◽  
Noncancer Pain

scholarly journals The Role of a Neuropsychologist on a Movement Disorders Deep Brain Stimulation Team

2018 ◽  
Vol 33 (3) ◽  
pp. 365-374 ◽  
Author(s):  
Cynthia S Kubu
Keyword(s):  
Clinical Practice ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Movement Disorders ◽  
Practice Recommendations ◽  
Specific Focus ◽  
Motor Problems ◽  
Deep Brain

Abstract The term movement disorders is misleading in the implication that the symptoms are limited to motor problems. Most movement disorders include a variety of neurobehavioral and neurocognitive symptoms that require neuropsychological expertise. The goal of this paper is to provide a rationale and practical roadmap for neuropsychologists’ involvement in a Movement Disorders team with a specific focus on pre-operative deep brain stimulation (DBS) evaluations. Pragmatic recommendations regarding requisite skills, clinical practice, recommendations, communication, and benefits are outlined.

scholarly journals Efficacy and Abuse Potential of Opioid Analgesics and the Treatment of Chronic Noncancer Pain

1999 ◽  
Vol 4 (2) ◽  
pp. 104-109 ◽  
Author(s):  
Andrew C Darke ◽  
John H Stewart
Keyword(s):  
Clinical Trials ◽  
Physical Dependence ◽  
Opioid Analgesics ◽  
Controlled Clinical Trials ◽  
Appropriate Use ◽  
Chronic Noncancer Pain ◽  
Prescribe Opioid ◽  
Noncancer Pain ◽  
Made In

While the role of opioid analgesics has been established in the treatment of cancer pain, reservations persist about appropriate use in patients with chronic noncancer pain. Recent evidence from controlled clinical trials supports the effectiveness of opioids for treating noncancer pain of varying etiologies. The safety of opioids in noncancer patients has been an area of controversy because of confusion between physical dependence, which develops in all patients receiving opioids chronically, and addiction, which is a behavioural diagnosis that is rarely made in patients appropriately treated with opioids for pain. Abuse by secondary recipients of opioids is well documented and arises as a result of diversion by primary recipients, double-doctoring, forgery and theft. The frequency of forgery and theft of different opioids appears to be largely related to the corresponding number of legitimate prescriptions. While it is legitimate medical practice to prescribe opioid analgesics to patients with chronic noncancer pain, there is clear evidence that prescribing is affected by concerns of regulatory sanctions. Recent guidelines, including most recently comprehensive guidelines issued by the Canadian Pain Society, should help to reduce inappropriate undertreatment because of such concerns.

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