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.

scholarly journals Differential Prescribing of Opioid Analgesics According to Physician Specialty for Medicaid Patients with Chronic Noncancer Pain Diagnoses

2014 ◽  
Vol 19 (4) ◽  
pp. 179-185 ◽  
Author(s):  
Chris Ringwalt ◽  
Hallam Gugelmann ◽  
Mariana Garrettson ◽  
Nabarun Dasgupta ◽  
Arlene E Chung ◽  
...  
Keyword(s):  
Opioid Analgesics ◽  
Total Sample ◽  
Prescribing Practices ◽  
Chronic Noncancer Pain ◽  
Logistic Regression Models ◽  
Opioid Prescribing ◽  
Multivariable Analyses ◽  
One Year ◽  
Noncancer Pain

BACKGROUND: Despite >20 years of studies investigating the characteristics of patients seeking or receiving opioid analgesics, research characterizing factors associated with physicians’ opioid prescribing practices has been inconclusive, and the role of practitioner specialty in opioid prescribing practices remains largely unknown.OBJECTIVE: To examine the relationships between physicians’ and other providers’ primary specialties and their opioid prescribing practices among patients with chronic noncancer pain (CNCP).METHODS: Prescriptions for opioids filled by 81,459 Medicaid patients with CNCP in North Carolina (USA), 18 to 64 years of age, enrolled at any point during a one-year study period were examined. χ2statistics were used to examine bivariate differences in prescribing practices according to specialty. For multivariable analyses, maximum-likelihood logistic regression models were used to examine the effect of specialty on prescribing practices, controlling for patients’ pain diagnoses and demographic characteristics.RESULTS: Of prescriptions filled by patients with CNCP, who constituted 6.4% of the total sample of 1.28 million individuals, 12.0% were for opioids. General practitioner/family medicine specialists and internists were least likely to prescribe opioids, and orthopedists were most likely. Across specialties, men were more likely to receive opioids than women, as were white individuals relative to other races/ethnicities. In multivariate analyses, all specialties except internal medicine had higher odds of prescribing an opioid than general practitioners: orthopedists, OR 7.1 (95% CI 6.7 to 7.5); dentists, OR 3.5 (95% CI 3.3 to 3.6); and emergency medicine physicians, OR 2.7 (95% CI 2.6 to 2.8).CONCLUSIONS: Significant differences in opioid prescribing practices across prescriber specialties may be reflective of differing norms concerning the appropriateness of opioids for the control of chronic pain. If so, sharing these norms across specialties may improve the care of patients with CNCP.

Racial Differences in Prescription of Opioid Analgesics for Chronic Noncancer Pain in a National Sample of Veterans

2014 ◽  
Vol 15 (4) ◽  
pp. 447-455 ◽  
Author(s):  
Diana J. Burgess ◽  
David B. Nelson ◽  
Amy A. Gravely ◽  
Matthew J. Bair ◽  
Robert D. Kerns ◽  
...  
Keyword(s):  
Racial Differences ◽  
Opioid Analgesics ◽  
National Sample ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain

Role of autophagy in cancer prevention, development and therapy

2013 ◽  
Vol 55 ◽  
pp. 133-151 ◽  
Author(s):  
G. Vignir Helgason ◽  
Tessa L. Holyoake ◽  
Kevin M. Ryan
Keyword(s):  
Quality Control ◽  
Clinical Trials ◽  
Cancer Prevention ◽  
Mammalian Cells ◽  
Physiological Role ◽  
Anticancer Therapy ◽  
Substantial Progress ◽  
Health And Disease ◽  
Made In

Autophagy is a process that takes place in all mammalian cells and ensures homoeostasis and quality control. The term autophagy [self (auto)-eating (phagy)] was first introduced in 1963 by Christian de Duve, who discovered the involvement of lysosomes in the autophagy process. Since then, substantial progress has been made in understanding the molecular mechanism and signalling regulation of autophagy and several reviews have been published that comprehensively summarize these findings. The role of autophagy in cancer has received a lot of attention in the last few years and autophagy modulators are now being tested in several clinical trials. In the present chapter we aim to give a brief overview of recent findings regarding the mechanism and key regulators of autophagy and discuss the important physiological role of mammalian autophagy in health and disease. Particular focus is given to the role of autophagy in cancer prevention, development and in response to anticancer therapy. In this regard, we also give an updated list and discuss current clinical trials that aim to modulate autophagy, alone or in combination with radio-, chemo- or targeted therapy, for enhanced anticancer intervention.

Effectiveness of Opioid Analgesics in Chronic Noncancer Pain

Pain Practice ◽  
2014 ◽  
Vol 15 (3) ◽  
pp. 272-278 ◽  
Author(s):  
Renata Ferrari ◽  
Maria E. Zanolin ◽  
Genni Duse ◽  
Marco Visentin
Keyword(s):  
Opioid Analgesics ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain

scholarly journals Abuse-deterrent formulations of prescription opioid analgesics in the management of chronic noncancer pain

2016 ◽  
Vol 6 (5) ◽  
pp. 497-508 ◽  
Author(s):  
Martin E Hale ◽  
Derek Moe ◽  
Mary Bond ◽  
Maciej Gasior ◽  
Richard Malamut
Keyword(s):  
Opioid Analgesics ◽  
Prescription Opioid ◽  
Chronic Noncancer Pain ◽  
Prescription Opioid Analgesics ◽  
Noncancer Pain

scholarly journals The chronic need to improve the management of pain

2003 ◽  
Vol 8 (4) ◽  
pp. 187-188 ◽  
Author(s):  
Eldon Tunks
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Primary Care Physicians ◽  
Opioid Analgesics ◽  
Care Practice ◽  
Eligibility Criteria ◽  
Chronic Noncancer Pain ◽  
Primary Care Doctors ◽  
Third Line ◽  
Noncancer Pain

In this issue, Drs Morley-Forster, Clark, Speechley and Moulin report on their survey conducted by Ipsos-Reid in June 2001 (pages 189-194). Only physicians who met the eligibility criteria of having written 20 or more prescriptions for moderate to severe pain in the preceding four weeks or having devoted 20% of their time to palliative care were eligible to participate. Sixty-eight per cent of the respondents thought that moderate to severe chronic pain was not well managed in Canada. Despite this opinion, 23% of physicians in palliative care practice and 34% of primary care doctors stated that they would not use opioids to treat moderate to severe chronic noncancer pain even as a third-line treatment after two previous medications had failed. One-quarter to one-third were concerned about the potential for addiction, and a smaller percentage reported concern about the potential for patient abuse and/or misuse, and side effects. Fear of a College audit resulting in the loss of their medical licence was cited by 10% of primary care physicians. When asked what obstacle hindered their use of strong opioid analgesics, an unexplained 10% of palliative care doctors and 14% of primary care doctors answered "nothing in particular".

scholarly journals Chronic Pain in Canada - Prevalence, Treatment, Impact and the Role of Opioid Analgesia

2002 ◽  
Vol 7 (4) ◽  
pp. 179-184 ◽  
Author(s):  
Dwight E Moulin ◽  
Alexander J Clark ◽  
Mark Speechley ◽  
Patricia K Morley-Forster
Keyword(s):  
Chronic Pain ◽  
Economic Impact ◽  
Severe Pain ◽  
Census Data ◽  
Multidisciplinary Treatment ◽  
Opioid Analgesics ◽  
Prescription Medication ◽  
Average Intensity ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain

OBJECTIVE:To assess the prevalence, treatment and impact of chronic pain in Canada.METHODS:A stratified random sample of 2012 adult Canadians (weighted by sex, age and region according to 1996 census data) was surveyed by telephone in 2001 to determine the prevalence of chronic pain, defined as continuous or intermittent pain for at least six months. A second sample of 340 chronic pain sufferers who were taking prescription medication for their pain was studied in detail to determine current therapeutic approaches and to assess the social and economic impact of chronic pain.RESULTS:Chronic noncancer pain was reported by 29% of the respondents, with increased frequency in women and older age groups. The average duration of pain was 10.7 years and the average intensity was 6.3 (on a scale from 1 to 10), with 80% reporting moderate or severe pain. Anti-inflammatory agents were prescribed for 49% of respondents and opioid analgesics were prescribed for 22% (two-thirds of these were codeine). Almost 70% were worried about addiction potential, and one-third felt that strong analgesics should be reserved for terminal illnesses. Almost one-half were unable to attend social and family events, and the mean number of days absent from work in the past year due to chronic pain was 9.3.INTERPRETATION:Chronic noncancer pain is common in Canadian adults and has a major social and economic impact. Despite growing evidence supporting the efficacy and safety of major opioid analgesics for chronic noncancer pain, less than 10% of chronic pain patients taking prescription medication were treated with a major opioid. Chronic pain is undertreated in Canada, and major opioid analgesics are probably underutilized in the management of moderate to severe pain as part of a multidisciplinary treatment program.

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