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 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 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.

scholarly journals Gender Differences in Depression and Sex Hormones among Patients Receiving Long-Term Opioid Treatment for Chronic Noncancer Pain in Taiwan—A Multicenter Cross-Sectional Study

2021 ◽  
Vol 18 (15) ◽  
pp. 7837
Author(s):  
Shung-Tai Ho ◽  
Tso-Chou Lin ◽  
Chun-Chang Yeh ◽  
Kuang-I Cheng ◽  
Wei-Zen Sun ◽  
...  
Keyword(s):  
Sexual Function ◽  
Sex Hormones ◽  
Sex Hormone ◽  
Cross Sectional ◽  
Chronic Noncancer Pain ◽  
Depression Diagnosis ◽  
Opioid Treatment ◽  
Hormone Levels ◽  
Noncancer Pain

Background: Long-term use of opioids for chronic noncancer pain is associated with sex hormone disturbances. The interferences with sex hormones, sexual function, and depression were investigated in patients with chronic noncancer pain. Methods: A cross-sectional multicenter survey was conducted on 170 officially registered outpatients receiving long-term opioid treatment in nine medical centers in Taiwan between October 2018 and July 2019. Serum sex hormone levels were examined after the collection of self-administered questionnaires containing the Taiwanese version of the Brief Pain Inventory, depressive status, and sexual function interference. Results: Among 117 (68.8%) questionnaire responses from 170 enrolled outpatients, 38 women and 62 men completed the sex hormone tests, among whom only 23 (23%) had previously received blood hormone tests. Low serum total testosterone levels were detected in 34 (89.5%) women (<30 ng/dL) and 31 (50%) men (<300 ng/dL). Over 60% of women and men reported reduced sexual desire and function despite a nearly 50% reduction in pain intensity and daily function interference over the previous week after opioid treatment. Women generally had higher risks of a depression diagnosis (p = 0.034) and severe depressive symptoms (p = 0.003) and nonsignificantly lower opioid treatment duration (median 81 vs. 120 months) and morphine milligram equivalent (median 134 vs. 165 mg/day) compared with men. Conclusions: This survey demonstrated the high prevalence of depression diagnosis, low sex hormone levels, and reduced sexual function among Taiwanese patients with chronic noncancer pain receiving prolonged opioid therapy. Regular hypogonadal screenings are recommended for further management.

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