scholarly journals A Review of the Use of Methadone for the Treatment of Chronic Noncancer Pain

2005 ◽  
Vol 10 (3) ◽  
pp. 133-144 ◽  
Author(s):  
Mary E Lynch
Keyword(s):  
Chronic Pain ◽  
Low Cost ◽  
Interindividual Variation ◽  
Duration Of Action ◽  
Chronic Noncancer Pain ◽  
Opioid Dose ◽  
Long Duration ◽  
Attractive Option ◽  
Noncancer Pain ◽  
High Bioavailability

Methadone, although having been available for approximately half a century, is now receiving increasing attention in the management of chronic pain. This is due to recent research showing that methadone exhibits at least three different mechanisms of action including potent opioid agonism, N-methyl-D-aspartate antagonism and monoaminergic effects. This, along with methadone's excellent oral and rectal absorption, high bioavailability, long duration of action and low cost, make it a very attractive option for the treatment of chronic pain. The disadvantages of significant interindividual variation in pharmacokinetics, graduated dose equivalency ratios based on prerotation opioid dose when switching from another opioid, and the requirement for special exemption for prescribing methadone make it more complicated to use. The present review is intended to educate physicians interested in adding methadone to their armamentarium for assisting patients with moderate to severe pain.

scholarly journals Does familiarity with CDC guidelines, continuing education, and provider characteristics influence adherence to chronic pain management practices and opioid prescribing?

2018 ◽  
Vol 14 (2) ◽  
pp. 103 ◽  
Author(s):  
Jean C. McCalmont, DNP, FNP ◽  
Kim D. Jones, PhD, FNP, FAAN ◽  
Robert M. Bennett, MD, FRCP, MACR ◽  
Ronald Friend, PhD
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Management Practices ◽  
Cross Sectional ◽  
Chronic Noncancer Pain ◽  
Opioid Dose ◽  
Cdc Guidelines ◽  
Control And Prevention ◽  
Recommended Practices ◽  
Noncancer Pain

Objectives: (1) To assess providers’ experience and knowledge of chronic noncancer pain (CNCP) management. (2) To assess providers’ utilization of the Centers for Disease Control and Prevention (CDC) 2016 Guideline for Prescribing Opioids for Chronic Pain. (3) To assess the influence of the 2016 CDC guideline on provider confidence in managing CNCP and adherence to the CDC recommendations.Methods: A cross-sectional, web-based survey conducted with 417 Oregon prescribing providers, divided into three continuing medical education (CME) groups composed of minimal (0-3), moderate (4-10), and high (≥11) hours of training. Results: The three CME groups were associated with increased use of CDC opioid recommended practices (29.4, 34.2, 38.8; p = 0.001; scale 0-50), opioid conversion confidence (5.5, 6.5, 7.4; p < 0.001; scale 0-9), and confidence in pain management (5.5, 5.9, 6.9; p < 0.001, scale 0-9). Slightly more providers utilized CDC recommended practices than did not (57 vs 43 percent). However, CME groups differed substantially in utilization of CDC practices (42 vs 57 vs 72 percent; p < 0.001). Neither providers’ profession (physician vs nurse practitioner [NP]) nor geographic setting (urban vs rural) showed differences in use of recommended practices or general confident in pain management (all p > 0.05); however, physicians were slightly more confident in opioid dose conversion than NPs (6.9 vs 5.9; p < 0. 001, scale 0-9).Conclusions: Higher hours of recent CME positively benefit provider confidence in pain management and utilization of CDC recommended practices. NPs and rural providers were equivalent to their physician and urban counterparts on confidence and adherence to CDC practices, with minor exceptions.

scholarly journals Treatment of chronic noncancer pain in patients on opioid therapy in primary care: A retrospective cohort study

2019 ◽  
Vol 153 (1) ◽  
pp. 52-58
Author(s):  
Arden R. Barry ◽  
Chantal E. Chris
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Back Pain ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Opioid Therapy ◽  
Opioid Agonist ◽  
Chronic Noncancer Pain ◽  
Opioid Dose ◽  
Noncancer Pain

Background: This study sought to characterize the real-world treatment of chronic noncancer pain (CNCP) in patients on opioid therapy in primary care. Methods: A retrospective cohort study from 2014-18 was conducted at a multidisciplinary primary care clinic in Chilliwack, British Columbia. Included were adults on daily opioid therapy for CNCP. Patients receiving palliative care or ≤1 visit were excluded. Outcomes of interest included use of opioid/nonopioid pharmacotherapy, number/frequency of visits and proportion of patients able to reduce/discontinue opioid therapy. Results: Seventy patients (mean age 53 years, 53% male, 51% back pain) were included. Median follow-up was 6 visits over 12 months. Sixty-two patients (89%) reduced their opioid dose, 6 patients had no change and 2 patients required a dose increase. Mean opioid dose was reduced from 183 to 70 mg morphine equivalents daily. Twenty-four patients (34%) discontinued opioid therapy, 6 patients (9%) transitioned to opioid agonist therapy and 6 patients (9%) breached their opioid treatment agreement. Nonopioid pharmacotherapy included nonsteroidal anti-inflammatory drugs (64%), gabapentinoids (63%), tricyclic antidepressants (56%) and nabilone (51%). Discussion: Over half of patients were no longer on opioid therapy by the end of the study. Most patients had a disorder (e.g., back pain) for which opioids are generally not recommended. Overall mean opioid dose was reduced from baseline by approximately 60% over 1 year. Lack of access to specialized pain treatments may have accounted for high nonopioid pharmacotherapy usage. Conclusions: This study demonstrates that treatment of CNCP and opioid tapering can successfully be achieved in a primary care setting. Can Pharm J (Ott) 2020;153:xx-xx.

How opioid prescribing policies influence primary care clinicians’ treatment decisions and conversations with patients with chronic pain

2021 ◽  
Vol 17 (6) ◽  
pp. 499-509
Author(s):  
Elizabeth C. Danielson, PhD ◽  
Christopher A. Harle, PhD ◽  
Sarah M. Downs, MPH ◽  
Laura Militello, MA ◽  
Olena Mazurenko, MD, PhD
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Treatment Decisions ◽  
Healthcare Organizations ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Prevention Guideline ◽  
Multistep Process ◽  
Primary Care Clinicians ◽  
Noncancer Pain

Objective: The 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain aimed to assist primary care clinicians in safely and effectively prescribing opioids for chronic noncancer pain. Individual states, payers, and health systems issued similar policies imposing various regulations around opioid prescribing for patients with chronic pain. Experts argued that healthcare organizations and clinicians may be misapplying the federal guideline and subsequent opioid prescribing policies, leading to an inadequate pain management. The objective of this study was to understand how primary care clinicians involve opioid prescribing policies in their treatment decisions and in their conversations with patients with chronic pain.Design: We conducted a secondary qualitative analysis of data from 64 unique primary care visits and 87 post-visit interviews across 20 clinicians from three healthcare systems in the Midwestern United States. Using a multistep process and thematic analysis, we systematically analyzed data excerpts addressing opioid prescribing policies.Results: Opioid prescribing policies influenced clinicians’ treatment decisions to not initiate opioids, prescribe fewer opioids overall (theme #1), and begin tapering and discontinuation of opioids (theme #2) for most patients with chronic pain. Clinical precautions, described in the opioid prescribing policies to monitor use, were directly invoked during visits for patients with chronic pain (theme #3).Conclusions: Opioid prescribing policies have multidimensional influence on clinician treatment decisions for patients with chronic pain. Our findings may inform future studies to explore mechanisms for aligning pressures around opioid prescribing, stemming from various opioid prescribing policies, with the need to deliver individualized pain care.

scholarly journals The effects of a multiday (10–14 days) subanesthetic dose IV ketamine infusion in the treatment of refractory chronic pain

2021 ◽  
Author(s):  
Amokrane Chebini ◽  
Sina Marzoughi ◽  
Jason Randhawa ◽  
Daphne Guh ◽  
Stephen Wiseman ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Prospective Trial ◽  
Pain Syndrome ◽  
Chronic Patients ◽  
Chronic Neuropathic Pain ◽  
Chronic Noncancer Pain ◽  
Ketamine Infusion ◽  
Pain Syndromes ◽  
Clinically Significant ◽  
Noncancer Pain

Aim: Ketamine is an anesthetic agent that at lower doses can be a potent analgesic. There has been an interest in the use of low dose ketamine in treatment of chronic pain syndromes. Patients & methods: We report the results of a retrospective observational study for patients diagnosed with a chronic noncancer pain syndrome receiving a 2-week continuous subanesthetic IV ketamine infusion. Results & conclusion: We conclude that a 10–14 days of subanesthetic ketamine infusion in chronic patients results in clinically significant lowering of patients' numerical pain score. Further studies looking at subanesthetic ketamine infusion in a prospective trial of multi-day IV ketamine infusion in chronic refractory chronic neuropathic pain are needed to further assess the efficacy of ketamine.

scholarly journals The Role of Testosterone Supplemental Therapy in Opioid-Induced Hypogonadism: A Retrospective Pilot Analysis

2016 ◽  
Vol 11 (4) ◽  
pp. 1208-1213 ◽  
Author(s):  
Omer A. Raheem ◽  
Sunil H. Patel ◽  
David Sisul ◽  
Tim J. Furnish ◽  
Tung-Chin Hsieh
Keyword(s):  
Chronic Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Opioid Therapy ◽  
Total Testosterone ◽  
Chronic Noncancer Pain ◽  
Numerical Rating ◽  
Noncancer Pain ◽  
Supplemental Therapy

Chronic opioid therapy for pain management is known to induce several endocrine changes. The authors examined the effect of testosterone supplemental therapy (TST) in patients with chronic, noncancer pain undergoing opioid therapy. It was hypothesized that treatment of opioid-induced hypogonadism (OIH) can reduce opioid requirements in patients suffering from chronic pain and approve their quality of life. Over 18 months period, patients with OIH were identified in a tertiary referral pain center, Numerical Rating Scale (NRS) pain scores and daily morphine equivalent dose (MED) were the primary outcomes measured. Data were collected and comparative analysis performed between men undergoing TST versus nontreatment group. Twenty-seven OIH patients (total testosterone <300 ng/dL) were identified during the study period. TST group consists of 11 patients, while non-TST group consists of 16 patients as control cohort. Mean patient age (55 and 54.4, p = .4) and basic metabolic index (28.5 and 31.9, p = .07) in TST and non-TST groups, respectively. Mean follow-up total testosterone (ng/dL) was significantly higher after TST compared with the non-TST group (497.5 vs. 242.4 ng/dL, p = .03). Median follow-up NRS was 0 and 2 in the TST and non-TST groups ( p = .02). Mean MED (mg) decreased by 21 mg in TST group and increased by 2.5 mg in non-TST group ( p < .05). This study reports that treatment of OIH with TST can reduce opioid requirements in men with chronic pain as quantified by MED. It also confirms previous reports on the potential effects of OIH and that TST is effective in correcting opioid-induced endocrine abnormalities.

Opioid Misuse and Addiction Among Patients With Chronic Pain

2019 ◽  
pp. 339-354
Author(s):  
Marc O. Martel ◽  
Robert N. Jamison
Keyword(s):  
Chronic Pain ◽  
Opioid Therapy ◽  
Screening Tools ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Chronic Noncancer Pain ◽  
Medication Misuse ◽  
Opioid Medications ◽  
Noncancer Pain

Chapter 20 provides an introduction to understanding the prevalence and risk factors as well as screening tools for assessing opioid misuse and addiction in patients with chronic pain. In the era of the opioid epidemic in North America and beyond, the use of prescription opioid medications to help improve function in chronic noncancer pain is frequently debated. Out of fear of iatrogenic addiction, litigation, and/or potential medication misuse, some clinicians are refusing to prescribe opioids for chronic pain. Evidence indicates that rates of opioid misuse and addiction are fairly high among chronic pain patients prescribed long-term opioid therapy, but there is consensus that opioids can be safe and effective for carefully selected and monitored patients.

A Two-Year Prospective Multicenter Study of Opioid Therapy for Chronic Noncancer Pain: Prescription Trends and Predictors

Pain Medicine ◽  
2018 ◽  
Vol 20 (11) ◽  
pp. 2166-2178 ◽  
Author(s):  
Dalila R Veiga ◽  
Liliane Mendonça ◽  
Rute Sampaio ◽  
José M Castro-Lopes ◽  
Luís F Azevedo
Keyword(s):  
Chronic Pain ◽  
Clinical Outcomes ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain ◽  
Opioid Users

Abstract Objectives Opioid use in chronic pain has increased worldwide in recent years. The aims of this study were to describe the trends and patterns of opioid therapy over two years of follow-up in a cohort of chronic noncancer pain (CNCP) patients and to assess predictors of long-term opioid use and clinical outcomes. Methods A prospective cohort study with two years of follow-up was undertaken in four multidisciplinary chronic pain clinics. Demographic data, pain characteristics, and opioid prescriptions were recorded at baseline, three, six, 12, and 24 months. Results Six hundred seventy-four CNCP patients were recruited. The prevalence of opioid prescriptions at baseline was 59.6% (N = 402), and 13% (N = 86) were strong opioid prescriptions. At 24 months, opioid prescription prevalence was as high as 74.3% (N = 501), and strong opioid prescription was 31% (N = 207). Most opioid users (71%, N = 479) maintained their prescription during the two years of follow-up. Our opioid discontinuation was very low (1%, N = 5). Opioid users reported higher severity and interference pain scores, both at baseline and after two years of follow-up. Opioid use was independently associated with continuous pain, pain location in the lower limbs, and higher pain interference scores. Conclusions This study describes a pattern of increasing opioid prescription in chronic pain patients. Despite the limited improvement of clinical outcomes, most patients keep their long-term opioid prescriptions. Our results underscore the need for changes in clinical practice and further research into the effectiveness and safety of chronic opioid therapy for CNPC.

scholarly journals Epidemiology of Chronic Pain in Denmark and Sweden

2012 ◽  
Vol 2012 ◽  
pp. 1-30 ◽  
Author(s):  
Julie Harker ◽  
Kim J. Reid ◽  
Geertruida E. Bekkering ◽  
Eliane Kellen ◽  
Malgorzata M. Bala ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Epidemiological Data ◽  
Future Research ◽  
Perceived Health Status ◽  
Policy Makers ◽  
Chronic Noncancer Pain ◽  
Pain Medications ◽  
Care Workers ◽  
Noncancer Pain

Introduction. Estimates on the epidemiology of chronic pain vary widely throughout Europe. It is unclear whether this variation reflects true differences between populations or methodological factors. Information on the epidemiology of chronic pain can support decision makers in allocating adequate health care resources. Methods. In order to obtain epidemiological data on chronic pain in Denmark and Sweden, we conducted a literature review of epidemiological data primarily on chronic noncancer pain, prioritising studies of highest quality, recency, and validity by conducting a systematic search for relevant studies. Following quality assessment, data were summarised and assigned to the research questions. Results. The prevalence of moderate to severe noncancer pain was estimated at 16% in Denmark and 18% in Sweden. Chronic pain impacts negatively on perceived health status, quality of life and is associated with increased cost. Despite using pain medications, a large proportion of chronic pain sufferers have inadequate pain control. There was a lack of high-quality and low-bias studies with clear inclusion criteria. Conclusions. In both Denmark and Sweden, chronic pain is a common health problem which is potentially undertreated and warrants attention of health care workers, policy makers and researchers. Future research should utilise clear reporting guidelines to assist decision and policy makers, in this important area.

scholarly journals Combination of Intrathecal Opioids with Bupivacaine Attenuates Opioid Dose Escalation in Chronic Noncancer Pain Patients

Pain Medicine ◽  
2011 ◽  
Vol 12 (10) ◽  
pp. 1481-1489 ◽  
Author(s):  
I. Elias Veizi ◽  
Salim M. Hayek ◽  
Samer Narouze ◽  
Jason E. Pope ◽  
Nagy Mekhail
Keyword(s):  
Dose Escalation ◽  
Chronic Noncancer Pain ◽  
Opioid Dose ◽  
Noncancer Pain ◽  
Pain Patients

scholarly journals Do Patients with Chronic Noncancer Pain Accept Treatment of Questionable Benefit More Readily that those Who Are Pain Free?

2004 ◽  
Vol 9 (2) ◽  
pp. 81-85
Author(s):  
Mark K Simmonds ◽  
Saifee Rashiq ◽  
Philip Klemka ◽  
Alexander S Sclanachan
Keyword(s):  
Chronic Pain ◽  
Pain Treatment ◽  
Chronic Noncancer Pain ◽  
Nonparametric Testing ◽  
Significant Difference ◽  
Hypothetical Treatment ◽  
Group 2 ◽  
Noncancer Pain ◽  
Epidural Steroids ◽  
Group 1

BACKGROUND:The efficacy of some common, questionable chronic pain interventions has been debated and it is unclear why sufferers of chronic noncancer pain agree to receive them. This study attempts to determine if chronic pain sufferers characteristically more readily accept treatment with questionable benefit.OBJECTIVES:This study aims to compare the strength of acceptance or rejection of a hypothetical, mock chronic pain treatment of debatable value by two groups of patients: those reporting chronic noncancer pain and those who are 'pain free'.METHODS:A questionnaire proposing a hypothetical treatment for chronic pain was distributed to two groups: Group 1 (n=160), patients attending a chronic pain centre, and Group 2 (n=240), patients attending a family practice centre. Patients were asked to score their 'treatment acceptance' using a modified Likert scale. The treatment was based on the risks and benefits of epidural steroids.RESULTS:Ninety-three patients in Group 1 were eligible for inclusion in the 'chronic pain' group and 92 patients from Group 2, for the 'pain free' group. The median scores were identical at +3; nonparametric testing revealed no significant difference between the groups in their acceptance of the treatment.CONCLUSIONS:An analogue study such as this removes the potential bias of clinical interaction with a physician, but lacks some reality. Nonetheless, the results from this study did not support the hypothesis that patients with chronic noncancer pain accept treatment of questionable benefit more readily than those who are 'pain-free'.

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