scholarly journals Opioid Tapering/Detoxification Protocols, A Compendium: Narrative Review

Pain Medicine ◽  
2021 ◽  
Author(s):  
David A Fishbain
Keyword(s):  
Search Strategy ◽  
Outpatient Setting ◽  
Narrative Review ◽  
Drug Rehabilitation ◽  
Tabular Form ◽  
Lack Of Information ◽  
Quality Ratings ◽  
Chronic Pain Patients ◽  
Opioid Tapering ◽  
Pain Patients

Abstract Objectives The opioid epidemic has put pressure on clinicians to taper their chronic pain patients (CPPs) from opioids. This has resulted in rapid or forced tapers and opioid discontinuation. Partially responsible is lack of information on how to taper (tapering protocols).The objectives of this narrative review were then the following: compile all the published opioid tapering/detoxification protocols from the pain/drug rehabilitation/psychiatric literature whether for inpatient or outpatient use; organize these into general types; compare the types for advantages/disadvantages for use by a clinician in an outpatient setting; and answer some commonly asked questions relating to opioid tapering. Methods Relevant references were identified by a search strategy utilizing the terms tapering, tapering protocols, detoxification, detoxification protocols, withdrawal, dependence, addiction and drug rehabilitation. These were exploded with the term opioids. Identified abstract were reviewed for any study relating to the objectives of this review. Those studies were then included in this review. As this is a narrative review, no quality ratings of these references were performed. Results Of 1922 abstracts identified by this search strategy, 301 were reviewed in detail for potential inclusion. Of these, 104 were utilized in this review. Nine types of opioid tapering protocols were identified and compared in tabular form. Twenty-two questions in reference to opioid tapering were addressed. Conclusions Based on this review, the protocol utilizing the opioid of current use is the simplest to use as it requires no rotation to another opioid and thereby avoids rotation errors. It also has behavior advantages.

scholarly journals Correlation between the Neuropathic PainDETECT Screening Questionnaire and Pain Intensity in Chronic Pain Patients

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 353
Author(s):  
Sebastian Lukas König ◽  
Michal Prusak ◽  
Sibylle Pramhas ◽  
Marita Windpassinger
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Treatment Response ◽  
Rating Scale ◽  
Significant Proportion ◽  
Outpatient Setting ◽  
Baseline Visit ◽  
Wide Range ◽  
Chronic Pain Patients ◽  
Pain Patients

Background and Objectives: Pain is a multidimensional phenomenon with a wide range regarding the location, intensity and quality. Patients with chronic pain, in particular those suffering from mixed pain, often present a special challenge. The PainDETECT questionnaire (PD-Q) is a screening instrument designed to classify whether a patient has neuropathic pain (NP), often rated as more distressing compared to nociceptive pain. The objective of this study was to investigate whether the PD-Q score correlates with pain intensity, measured with the numeric rating scale (NRS), in chronic pain patients in an outpatient setting. Materials and Methods: A questionnaire-based study was conducted to identify the associations between the unidimensional NRS scale for pain intensity and the PD-Q score for screening of an NP component in an outpatient setting. Participants were asked to fill in the questionnaire themselves. Results: One hundred seventy-six participants completed the PD-Q questionnaire and rated pain on the NRS scale at the baseline visit. The PD-Q and NRS scores significantly correlated at the baseline visit and the 1-month follow-up visit in chronic pain patients. The identification of a neuropathic component in chronic pain may permit more targeted and effective pain management. Conclusions: The findings of our questionnaire suggest that a significant proportion of chronic pain patients had manifested features of NP at the first visit to the outpatient clinic. The PD-Q is a useful screening tool to alert clinicians of NP that may need further diagnostic evaluation or therapeutic intervention and may also help to predict treatment response. Further research is needed to investigate if a correlation is predictive of treatment response when pain therapy targets NP.

Does Opioid Tapering in Chronic Pain Patients Result in Improved Pain or Same Pain vs Increased Pain at Taper Completion? A Structured Evidence-Based Systematic Review

Pain Medicine ◽  
2018 ◽  
Vol 20 (11) ◽  
pp. 2179-2197 ◽  
Author(s):  
David A Fishbain ◽  
Aditya Pulikal
Keyword(s):  
Chronic Pain ◽  
Health Care Policy ◽  
Exclusion Criteria ◽  
Levels Of Evidence ◽  
Chronic Pain Patients ◽  
Opioid Tapering ◽  
Type 3 ◽  
Pain Patients ◽  
Consistency Rating

Abstract Objective To support or refute the hypothesis that opioid tapering in chronic pain patients (CPPs) improves pain or maintains the same pain level by taper completion but does not increase pain. Methods Of 364 references, 20 fulfilled inclusion/exclusion criteria. These studies were type 3 and 4 (not controlled) but reported pre/post-taper pain levels. Characteristics of the studies were abstracted into tabular form for numerical analysis. Studies were rated independently by two reviewers for quality. The percentage of studies supporting the above hypothesis was determined. Results No studies had a rejection quality score. Combining all studies, 2,109 CPPs were tapered. Eighty percent of the studies reported that by taper completion pain had improved. Of these, 81.25% demonstrated this statistically. In 15% of the studies, pain was the same by taper completion. One study reported that by taper completion, 97% of the CPPs had improved or the same pain, but CPPs had worse pain in 3%. As such, 100% of the studies supported the hypothesis. Applying the Agency for Health Care Policy and Research Levels of Evidence Guidelines to this result produced an A consistency rating. Conclusions There is consistent type 3 and 4 study evidence that opioid tapering in CPPs reduces pain or maintains the same level of pain. However, these studies represented lower levels of evidence and were not designed to test the hypothesis, with the evidence being marginal in quality with large amounts of missing data. These results then primarily reveal the need for controlled studies (type 2) to address this hypothesis.

scholarly journals Impaired Discriminative Function in Patients with Chronic Pain Measured by Variance in Straight Leg Raising

1996 ◽  
Vol 1 (3) ◽  
pp. 146-149 ◽  
Author(s):  
Ann Marie Hoirch ◽  
Vicky Smith ◽  
Sophie Beugnot ◽  
Joanne Turner ◽  
Richard FH Catchlove
Keyword(s):  
Chronic Pain ◽  
The State ◽  
Exercise Programs ◽  
Feedback Mechanisms ◽  
End Point ◽  
Lack Of Information ◽  
Chronic Pain Patients ◽  
Straight Leg Raising ◽  
Discriminative Function ◽  
Pain Patients

Many chronic pain patients seem to have difficulty regulating exercise programs and require detailed, precise instructions of what exercises to do as well as their frequency and timing. This may be due to a lack of information concerning the state of the damaged tissues, which may result from inadequate feedback mechanisms for pain, stretch and position. The straight leg raising test was used as a model of this mechanism, and variance in targeting the end-point of this test was measured in patients with chronic pain and in controls. Variance about the end-point in chronic pain patients was more than three times larger than that in controls. Although chronic pain patients were older, there was no correlation between straight leg raising and age. The implications of these findings to the maintenance of the original injury and the importance of this in the maintenance and continuation of chronic pain states are discussed.

Pain Influences Several Levels of Attention

2005 ◽  
Vol 16 (4) ◽  
pp. 235-242 ◽  
Author(s):  
Astrid von Bueren Jarchow ◽  
Bogdan P. Radanov ◽  
Lutz Jäncke
Keyword(s):  
Chronic Pain ◽  
Divided Attention ◽  
Covert Attention ◽  
Attention Task ◽  
Attentional Deficits ◽  
Control Subjects ◽  
Chronic Pain Patients ◽  
Divided Attention Task ◽  
Pain Stimuli ◽  
Pain Patients

Abstract: The aim of the present study was to examine to what extent chronic pain has an impact on various attentional processes. To measure these attention processes a set of experimental standard tests of the “Testbatterie zur Aufmerksamkeitsprüfung” (TAP), a neuropsychological battery testing different levels of attention, were used: alertness, divided attention, covert attention, vigilance, visual search, and Go-NoGo tasks. 24 chronic outpatients and 24 well-matched healthy control subjects were tested. The control subjects were matched for age, gender, and education. The group of chronic pain patients exhibited marked deficiencies in all attentional functions except for the divided attention task. Thus, the data supports the notion that chronic pain negatively influences attention because pain patients` attention is strongly captivated by the internal pain stimuli. Only the more demanding divided attention task has the capability to distract the focus of attention to the pain stimuli. Therefore, the pain patients are capable of performing within normal limits. Based on these findings chronic pain patients' attentional deficits should be appropriately evaluated and considered for insurance and work related matters. The effect of a successful distraction away from the pain in the divided attention task can also open new therapeutic aspects.

Sign in / Sign up

Export Citation Format

Share Document