scholarly journals Long‐term opioid therapy definitions and predictors: A systematic review

2019 ◽  
Vol 29 (3) ◽  
pp. 252-269 ◽  
Author(s):  
Ruchir N. Karmali ◽  
Christopher Bush ◽  
Sudha R. Raman ◽  
Cynthia I. Campbell ◽  
Asheley C. Skinner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Opioid Therapy

scholarly journals A Systematic Review of Randomized Trials of Long-Term Opioid Management for Chronic Non-Cancer Pain

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. 91-121
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Cancer Pain ◽  
Systematic Reviews ◽  
Randomized Trials ◽  
Opioid Therapy ◽  
Functional Improvement ◽  
Controlled Trials ◽  
Chronic Opioid Therapy ◽  
Level Of Evidence

Background: Even though opioids have been used for pain for thousands of years, opioid therapy for chronic non-cancer pain is controversial due to concerns regarding the long-term effectiveness and safety, particularly the risk of tolerance, dependance, or abuse. While the debate continues, the use of chronic opioid therapy for chronic non-cancer pain has increased exponentially. Even though evidence is limited, multiple expert panels have concluded that chronic opioid therapy can be effective therapy for carefully selected and monitored patients with chronic non-cancer pain. Study Design: A systematic review of randomized trials of opioid management for chronic noncancer pain. Objective: The objective of this systematic review is to evaluate the clinical efficacy of opioids in the treatment of chronic non-cancer pain. Methods: A comprehensive evaluation of the literature relating to opioids in chronic non-cancer pain was performed. The literature was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs) and Jadad criteria. A literature search was conducted by using PubMed, EMBASE, Cochrane library, ECRI Institute Library, U.S. Food and Drug Administration (FDA) website, U.S. National Guideline Clearinghouse (NGC), Database of Abstracts of Reviews of Effectiveness (DARE), clinical trials, systematic reviews and cross references from systematic reviews. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF) and used by other systematic reviews and guidelines. Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, withdrawals, and adverse effects. Results: Based on the USPSTF criteria, the indicated level of evidence was fair for Tramadol in managing osteoarthritis. For all the drugs assessed, including Tramadol, for all other conditions, the evidence was poor based on either weak positive evidence, indeterminate evidence, or negative evidence. Limitations: A paucity of literature, specifically with follow-up beyond 12 weeks for all types of opioids with controlled trials for various chronic non-cancer pain conditions. Conclusions: This systematic review illustrated fair evidence for Tramadol in managing osteoarthritis with poor evidence for all other drugs and conditions. Thus, recommendations must be based on non-randomized studies. Key words: Chronic non-cancer pain, opioids, opioid efficacy, opioid effectiveness, significant pain relief, functional improvement, adverse effects, morphine, hydrocodone, hydromorphone, fentanyl, tramadol, buprenorphine, methadone, tapentadol, oxycodone, oxymorphone, systematic reviews, randomized trials

scholarly journals Health-related quality of life in patients receiving long-term opioid therapy: a systematic review with meta-analysis

2017 ◽  
Vol 26 (8) ◽  
pp. 1955-1967 ◽  
Author(s):  
J. Douglas Thornton ◽  
Rashmi Goyat ◽  
Nilanjana Dwibedi ◽  
George A. Kelley
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Meta Analysis ◽  
Opioid Therapy ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

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

2015 ◽  
Vol 162 (4) ◽  
pp. 276 ◽  
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

scholarly journals Association Between Harm Reduction Strategies and Healthcare Utilization and Outcomes in Patients on Long-term Prescribed Opioid Therapy Presenting to Acute Healthcare Settings: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Jean Deschamps ◽  
James Gilbertson ◽  
Sebastian Straube ◽  
Kathryn Dong ◽  
Frank P. MacMaster ◽  
...  
Keyword(s):  
Systematic Review ◽  
Harm Reduction ◽  
Meta Analysis ◽  
Opioid Therapy ◽  
Reduction Strategy ◽  
Healthcare Settings ◽  
Harm Reduction Strategy ◽  
Reduction Strategies ◽  
Acute Healthcare

Abstract BackgroundLong-term prescription of opioids by healthcare professionals has been linked to poor individual patient outcomes and high resource utilization. Harm reduction strategies in this population in regard to acute healthcare settings may have substantial impact.MethodsWe performed a systematic review and meta-analysis of primary studies. The studies were included according to the following criteria: 1) age 18 and older; 2) long-term/chronic prescribed opioid therapy; 3) acute healthcare setting presentation from a complication of opioid therapy; 4) evaluating a harm reduction strategy; 5) comparing the effectiveness of different interventions; 6) addressing patient or healthcare related outcomes. We performed a qualitative analysis of harm reduction strategies identified. We pooled patient and system related outcome data for each harm reduction strategy.ResultsA total of 5664 studies were screened and 21 studies were included. A total of 11 broad categories of harm reduction strategies were identified. Meta-analysis was performed for the “supports for patients in pain” harm reduction strategy on two system-related outcomes using a ratio of means. The number of emergency department (ED) visits were significantly reduced for cohort studies (n=6, 0.36, 95% CI [0.20-0.62], I2 = 87%) and randomized controlled trials (RCTs) (n=3, 0.71, 95% CI [0.61-0.82], I2 = 0%). The number of opioid prescriptions at ED discharge was significantly reduced for RCTs (n=3, 0.34, 95% CI [0.14-0.82], I2 = 78%).InterpretationFor patients presenting to acute healthcare settings with complications related to long-term opioid therapy, the intervention with the most robust data is “supports for patients in pain”.Study registrationCRD42018088962

scholarly journals Variations in Long-Term Opioid Therapy Definitions: A Systematic Review of Observational Studies Using Routinely Collected Data (2000–2019)

2020 ◽  
Author(s):  
Juliana de Oliveira Costa ◽  
Claudia Bruno ◽  
Navya Baranwal ◽  
Natasa Gisev ◽  
Timothy Dobbins ◽  
...  
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Opioid Therapy ◽  
Routinely Collected Data

scholarly journals Association between supportive interventions and healthcare utilization and outcomes in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jean Deschamps ◽  
James Gilbertson ◽  
Sebastian Straube ◽  
Kathryn Dong ◽  
Frank P. MacMaster ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Healthcare Setting ◽  
Opioid Therapy ◽  
Outcome Data ◽  
Substantial Impact ◽  
Healthcare Settings ◽  
High Resource ◽  
Acute Healthcare

Abstract Background Long-term prescription of opioids by healthcare professionals has been linked to poor individual patient outcomes and high resource utilization. Supportive strategies in this population regarding acute healthcare settings may have substantial impact. Methods We performed a systematic review and meta-analysis of primary studies. The studies were included according to the following criteria: 1) age 18 and older; 2) long-term prescribed opioid therapy; 3) acute healthcare setting presentation from a complication of opioid therapy; 4) evaluating a supportive strategy; 5) comparing the effectiveness of different interventions; 6) addressing patient or healthcare related outcomes. We performed a qualitative analysis of supportive strategies identified. We pooled patient and system related outcome data for each supportive strategy. Results A total of 5664 studies were screened and 19 studies were included. A total of 9 broad categories of supportive strategies were identified. Meta-analysis was performed for the “supports for patients in pain” supportive strategy on two system-related outcomes using a ratio of means. The number of emergency department (ED) visits were significantly reduced for cohort studies (n = 6, 0.36, 95% CI [0.20–0.62], I2 = 87%) and randomized controlled trials (RCTs) (n = 3, 0.71, 95% CI [0.61–0.82], I2 = 0%). The number of opioid prescriptions at ED discharge was significantly reduced for RCTs (n = 3, 0.34, 95% CI [0.14–0.82], I2 = 78%). Conclusion For patients presenting to acute healthcare settings with complications related to long-term opioid therapy, the intervention with the most robust data is “supports for patients in pain”.

scholarly journals Association Between Supportive Interventions and Healthcare Utilization and Outcomes in Patients on Long-Term Prescribed Opioid Therapy Presenting to Acute Healthcare Settings: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Jean Deschamps ◽  
James Gilbertson ◽  
Sebastian Straube ◽  
Kathryn Dong ◽  
Frank P. MacMaster ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Healthcare Setting ◽  
Opioid Therapy ◽  
Outcome Data ◽  
Substantial Impact ◽  
Healthcare Settings ◽  
High Resource ◽  
Acute Healthcare

Abstract Background Long-term prescription of opioids by healthcare professionals has been linked to poor individual patient outcomes and high resource utilization. Supportive strategies in this population regarding acute healthcare settings may have substantial impact. Methods We performed a systematic review and meta-analysis of primary studies. The studies were included according to the following criteria: 1) age 18 and older; 2) long-term prescribed opioid therapy; 3) acute healthcare setting presentation from a complication of opioid therapy; 4) evaluating a supportive strategy; 5) comparing the effectiveness of different interventions; 6) addressing patient or healthcare related outcomes. We performed a qualitative analysis of supportive strategies identified. We pooled patient and system related outcome data for each supportive strategy.Results A total of 5664 studies were screened and 19 studies were included. A total of 9 broad categories of supportive strategies were identified. Meta-analysis was performed for the “supports for patients in pain” supportive strategy on two system-related outcomes using a ratio of means. The number of emergency department (ED) visits were significantly reduced for cohort studies (n = 6, 0.36, 95% CI [0.20-0.62], I2 = 87%) and randomized controlled trials (RCTs) (n = 3, 0.71, 95% CI [0.61-0.82], I2 = 0%). The number of opioid prescriptions at ED discharge was significantly reduced for RCTs (n = 3, 0.34, 95% CI [0.14-0.82], I2 = 78%).Conclusion For patients presenting to acute healthcare settings with complications related to long-term opioid therapy, the intervention with the most robust data is “supports for patients in pain”.

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