Health benefits of an adverse events reporting system for chronic pain patients using long-term opioids

2018 ◽  
Vol 63 (2) ◽  
pp. 248-258 ◽  
Author(s):  
Beatriz Planelles ◽  
César Margarit ◽  
Raquel Ajo ◽  
Yolanda Sastre ◽  
Javier Muriel ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Adverse Events ◽  
Reporting System ◽  
Health Benefits ◽  
Chronic Pain Patients ◽  
Pain Patients

scholarly journals Long-term results of therapeutic local anesthesia (neural therapy) in 280 referred refractory chronic pain patients

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Simon Egli ◽  
Mirjam Pfister ◽  
Sabina M. Ludin ◽  
Katia Puente de la Vega ◽  
André Busato ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Local Anesthesia ◽  
Long Term Results ◽  
Neural Therapy ◽  
Chronic Pain Patients ◽  
Pain Patients

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

2005 ◽  
Vol 1 (5) ◽  
pp. 257 ◽  
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.

Review of the Performance of Quantitative Sensory Testing Methods to Detect Hyperalgesia in Chronic Pain Patients on Long-term Opioids

2015 ◽  
Vol 122 (3) ◽  
pp. 677-685 ◽  
Author(s):  
Nathaniel P. Katz ◽  
Florence C. Paillard ◽  
Robert R. Edwards
Keyword(s):  
Chronic Pain ◽  
Controlled Trial ◽  
Controlled Study ◽  
Injection Pain ◽  
Heat Pain ◽  
Cold Pain ◽  
Chronic Pain Patients ◽  
Opioid Induced Hyperalgesia ◽  
Pain Patients

Abstract Background: Opioid-induced hyperalgesia is a clinical syndrome whereby patients on long-term opioids become more sensitive to pain while taking opioids. Opioid-induced hyperalgesia is characterized by increased pain intensity over time, spreading of pain to other locations, and increased pain sensation to external stimuli. To characterize opioid-induced hyperalgesia, laboratory methods to measure hyperalgesia have been developed. To determine the performance of these methods, the authors conducted a systematic review of clinical studies that incorporate measures of hyperalgesia in chronic pain patients on long-term opioids. Methods: PubMed and Cochrane databases were searched (terms: opioid induced hyperalgesia, study or trial, and long-term or chronic). Studies published in English were selected if they were conducted in chronic pain patients on long-term opioids and incorporated measures of hyperalgesia; acute/single-dose studies and/or conducted in healthy volunteers were excluded. Results: Fourteen articles made the final selection (11 were selected from the search and 3 others were found from additional sources); there was one randomized controlled trial, one prospective controlled study, three prospective uncontrolled studies, and nine cross-sectional observation studies. Hyperalgesia measurement paradigms used included cold pain, heat pain, pressure pain, electrical pain, ischemic pain, and injection pain. Although none of the stimuli were capable of detecting patients’ hyperalgesia, heat pain sensitivity showed some promising results. Conclusions: None of the measures reviewed herein met the criteria of a definitive standard for the measurement of hyperalgesia. Additional studies that use improved study design should be conducted.

Adverse childhood experiences predict autonomic indices of emotion dysregulation and negative emotional cue-elicited craving among female opioid-treated chronic pain patients

2019 ◽  
Vol 31 (3) ◽  
pp. 1101-1110 ◽  
Author(s):  
Eric L. Garland ◽  
Sarah E. Reese ◽  
Carter E. Bedford ◽  
Anne K. Baker
Keyword(s):  
Chronic Pain ◽  
Adverse Childhood Experiences ◽  
Emotion Dysregulation ◽  
Opioid Analgesic ◽  
Opioid Use ◽  
Childhood Experiences ◽  
Adverse Childhood ◽  
Chronic Pain Patients ◽  
Pain Patients

AbstractThrough autonomic and affective mechanisms, adverse childhood experiences (ACEs) may disrupt the capacity to regulate negative emotions, increasing craving and exacerbating risk for opioid use disorder (OUD) among individuals with chronic pain who are receiving long-term opioid analgesic pharmacotherapy. This study examined associations between ACEs, heart rate variability (HRV) during emotion regulation, and negative emotional cue-elicited craving among a sample of female opioid-treated chronic pain patients at risk for OUD. A sample of women (N= 36, mean age = 51.2 ± 9.5) with chronic pain receiving long-term opioid analgesic pharmacotherapy (mean morphine equivalent daily dose = 87.1 ± 106.9 mg) were recruited from primary care and pain clinics to complete a randomized task in which they viewed and reappraised negative affective stimuli while HRV and craving were assessed. Both ACEs and duration of opioid use significantly predicted blunted HRV during negative emotion regulation and increased negative emotional cue-elicited craving. Analysis of study findings from a multiple-levels-of-analysis approach suggest that exposure to childhood abuse occasions later emotion dysregulation and appetitive responding toward opioids in negative affective contexts among adult women with chronic pain, and thus this vulnerable clinical population should be assessed for OUD risk when initiating a course of extended, high-dose opioids for pain management.

scholarly journals The Anxiety and Pain of Fibromyalgia Patients during the COVID-19 Pandemic

2020 ◽  
Author(s):  
A. Y. Kharko ◽  
K. J. Hansford ◽  
P. L. Furlong ◽  
S. D. Hall ◽  
M. E. Roser
Keyword(s):  
Chronic Pain ◽  
Online Survey ◽  
Mixed Effects ◽  
Caffeine Intake ◽  
Health Decline ◽  
Chronic Pain Patients ◽  
The Impact ◽  
Pain Patients ◽  
Mild Analgesics

AbstractBackgroundEarly research on the impact of the COVID-19 pandemic found persistent related anxiety in the general population. We hypothesised that this anxiety will be associated with increased pain in chronic pain patients diagnosed with fibromyalgia (FM).MethodsTo study this, we carried out a 10-day online survey with 58 female participants, diagnosed with FM and no other pain condition. We identified which aspects of the COVID-19 pandemic evoked anxiety. We then asked participants to provide daily ratings of both anxiety and pain on 101-point visual analogue scales (VAS). Key participant characteristics were included as mediators in a mixed-effects analysis, where the primary outcome was pain VAS.ResultsWe found that participants were most often anxious about “impact on relationships”, “a family member contracting COVID-19”, and “financial hardships”, but on average rated “financial hardship”, “access to medication”, and “home loss/eviction” as evoking the strongest anxiety. Mixed-effects modelling showed that an increase in pain was significantly associated with an increase in anxiety, when taking into account individual variance and daily caffeine intake. Age and intake of some mild analgesics were also linked to stronger pain.ConclusionOur results extend the initial findings from the literature about the effects of COVID-19 pandemic on chronic pain sufferers. We found that not only is pandemic anxiety in FM patients present, but it is associated with amplified self-assessed chronic pain.SignificanceThe long-term support of fibromyalgia patients is challenging for healthcare professionals due to the nature of the condition. The new normal introduced by the pandemic particularly hinders pain management, which is the leading request from this patient group. Our study demonstrates that mental health decline during the COVID-19 pandemic is directly related to the worsening of pain in fibromyalgia. Core stressors that evoke the strongest anxiety were identified thus providing guidance for where to focus patient support.

Opioid Prescribing in Stigmatized and Special Populations

2018 ◽  
Author(s):  
Kelly K. Dineen
Keyword(s):  
Decision Making ◽  
Chronic Pain ◽  
End Of Life Care ◽  
Vulnerable Groups ◽  
Special Populations ◽  
Opioid Prescribing ◽  
The Past ◽  
Chronic Pain Patients ◽  
Pain Patients

There is no question that a lack of careful decision-making around opioid prescribing in the past contributed to the current opioid-related harms. Yet opioids—usually in combination with other treatments—are sometimes the only effective therapies for certain chronic pain patients, in whom the benefits of opioids outweigh the risks of a substance use disorder. This chapter examines special populations such as those with sickle cell disease or those experiencing pain in end-of-life care. Caring for chronic pain patients can be challenging, especially now that the use of opioids for long-term pain control has been called into question. This chapter draws attention to attitudes and biases that may contribute to decision-making errors on the part of providers who are trying to balance the benefits and harms of opioids when treating these particularly vulnerable groups.

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