Management of Chronic Nonmalignant Pain

1998 ◽  
Vol 11 (5) ◽  
pp. 374-381 ◽  
Author(s):  
James T. O'Donnell ◽  
Moriah B. Richie ◽  
Lori A. Nesbitt
Keyword(s):  
Chronic Pain ◽  
Clinical Research ◽  
Interpersonal Relationships ◽  
State Level ◽  
Social Consequences ◽  
High Quality ◽  
Level Of Functioning ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

Although advances in knowledge about the pathophysiology of pain have been impressive in recent years, high-quality clinical research in patients with chronic pain has not been abundant. Because chronic pain often leads to profound changes in psychologic state, level of functioning, and interpersonal relationships, treatment requires attention not only to the pathophysiologic cause of the pain (if one can be found) but also to the psychologic and social consequences (and antecedents).

Is Chronic Pain a Disease in Its Own Right? Discussions from a Pre-OMERACT 2014 Workshop on Chronic Pain

2015 ◽  
Vol 42 (10) ◽  
pp. 1947-1953 ◽  
Author(s):  
Ann M. Taylor ◽  
Kristine Phillips ◽  
Justin O. Taylor ◽  
Jasvinder A. Singh ◽  
Philip G. Conaghan ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Outcome Measures ◽  
Outcome Measure ◽  
Disease State ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

At the pain workshop held prior to the Outcome Measures in Rheumatology (OMERACT) 12 conference, chronic nonmalignant pain (CP) as a “disease” was discussed, in response to growing interest in this concept and in terms of the effect on the OMERACT Filter 2.0 framework. CP is often assessed as a unidimensional outcome measure; however, if CP is a disease, then outcome measures need to define the disease state and identify all its manifestations as well as its effects, as specified by Filter 2.0. The aim was to write a discussion piece, reflecting the workshop contributions and debate, as an important step in opening a dialogue around future OMERACT Filter 2.0 Framework developments.

Adverse effects and cognitive function among primary care patients taking opioids for chronic nonmalignant pain

2006 ◽  
Vol 2 (3) ◽  
pp. 137 ◽  
Author(s):  
Randall T. Brown, MD ◽  
Megan Zuelsdorff, BS ◽  
Michael Fleming, MD, MPH
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Chronic Pain ◽  
Cognitive Function ◽  
Adverse Effects ◽  
Primary Care Physicians ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

Chronic opioid therapy is commonly prescribed for chronic nonmalignant pain. Few published data describe the adverse effects experienced by patients with chronic nonmalignant pain being treated by primary care physicians. A prevalence study was conducted on a sample of 1,009 patients (889 receiving chronic opioids) being treated by 235 primary care physicians. Standardized questionnaires and medical record reviews were used to assess rates of addiction, pain diagnosis and severity, opioid adverse effects, and mental health. The mean daily dose of opioids was 92 mg using a morphine-equivalent conversion. Side effects included constipation (40 percent), sleeping problems (25 percent), loss of appetite (23 percent), and sexual dysfunction (18 percent), with patients on daily opioids experiencing more side effects than subjects on intermittent medication. The Medical Outcomes Study Mental Health Inventory (MOS-MHI) cognitive functioning scale indicated poorer cognitive function in the overall sample of chronic pain patients as compared to a general clinical sample (Δ x 95 percent CI = 9.28, 13.76). However, there were limited differences in MOS scores between chronic pain subjects on daily opioids vs. intermittent opioids vs. no prescription opioids. A regression model suggests that psychological measures and pain severity are more predictive of decrements in cognitive function than specific opioid preparations or daily opioid dose. Physicians should closely monitor patients for adverse effects and adequacy of pain control when using chronic opioid therapy for chronic pain treatment. Psychological health, an important predictor of cognitive dysfunction, is a particularly important measure to actively monitor and manage.

Evaluation of the benefits from the introduction meeting for patients with chronic non-malignant pain and their relatives in interdisciplinary pain center

2017 ◽  
Vol 16 (1) ◽  
pp. 188
Author(s):  
H.L.A. Kristensen ◽  
M. Madsen ◽  
P.B.F. Jensen ◽  
W.Z. Pawlak
Keyword(s):  
Chronic Pain ◽  
Research Study ◽  
Pain Treatment ◽  
Multidisciplinary Therapy ◽  
Social Phobias ◽  
Nonmalignant Pain ◽  
Pain Center ◽  
Chronic Nonmalignant Pain ◽  
In The Beginning ◽  
Multidisciplinary Pain Center

AbstractBackgroundTreatment of patients with chronic nonmalignant pain (CNMP) is challenging and requires a multidisciplinary effort. In a multidisciplinary pain center, patients are treated by a team of doctor, nurse, physiotherapist, psychologist and social worker. Especially in the beginning of treatment patients receive much information. Many patients and their relatives have problems with comprehending it.ObjectiveThis is an action research study aimed to find the optimal mode for to introduce patients with CNMP and their relatives to the multidisciplinary pain treatment.MethodIn the fall of 2016, we began to invite patients and their relatives to the introduction meeting (IM), which takes place in groups of up to 20 people, has duration of 1 hour and is led by the physiotherapist and nurse, but the physician is also present. Invited patients are able to understand written and oral Danish and are not suffering from social phobias. During IM facts about the center, treatment course and pain physiology are presenter. Immediately after IM, participants are anonymously asked about their experiences.ResultsUp to date (February 2017) 254 patients were invited. Invitation was rejected by 63 patients (24,8%). Question about understanding of chronic pain was answered by 108 participants (both patients and their relatives), and 103 participants declared better understanding of chronic pain after IM end before. 69 participants answered question about understanding of treatment course in the center. All but 2 participants declared after IM at their understanding was better end before. In fact, 31 (44,9%) participants estimated changes in understanding of treatment course as much significant.ConclusionThe IM at the beginning of multidisciplinary therapy seems to be a promising activity for patients with CNMP referred to the multidisciplinary pain center, as well as for their relatives. Study is ongoing and updated results will be presented at the conference.

scholarly journals Medication management of chronic pain

2017 ◽  
Vol 150 (2) ◽  
pp. 112-117 ◽  
Author(s):  
Marlene Slipp ◽  
Robert Burnham
Keyword(s):  
Chronic Pain ◽  
Treatment Plan ◽  
Medication Management ◽  
Cost Of Care ◽  
Dose Titration ◽  
Team Approach ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain ◽  
Team Model ◽  
Physician Team

Background: The prevalence of chronic pain is high and increasing. Medication management is an important component of chronic pain management. There is a shortage of physicians who are available and comfortable providing this service. In Alberta, pharmacists have been granted an advanced scope of practice. Given this empowerment, their availability, training and skill set, pharmacists are well positioned to play an expanded role in the medication management of chronic pain sufferers. Objective: To compare the effectiveness and cost of a physician-only vs a pharmacist-physician team model of medication management for chronic nonmalignant pain sufferers. Method: Data was analyzed for 89 patients who had received exclusively medication management at a rural Alberta multidisciplinary clinic. 56 were managed by a sole physician. 33 were managed by a team (pharmacist + physician). In the team model, the physician did the medical assessment, diagnosis, and established a treatment plan in consultation with the patient and pharmacist. The pharmacist then provided the ongoing follow-up including education, dose titration and side effect management and consulted with the physician as needed. Change in pain (Numerical Rating Scale) and disability (Pain Interference Questionnaire) over the course of treatment were recorded. The treatment duration and number of visits were used to calculate cost of care. Results: Both models of medication management resulted in significant and comparable improvements in pain, disability and patient perception of medication effectiveness. Patients in the physician-only group were seen more frequently and at a greater cost. The pharmacist-physician team approach was markedly more cost-effective, and patients expressed a high level of satisfaction with their medication management. Conclusions: The pharmacist-physician team model of medication management results in significant reductions of pain and disability for chronic nonmalignant pain sufferers at a reduced cost and is well accepted by patients.

scholarly journals Exploring the Role of Chronic Pain Clinics: Potential for Opioid Reduction

2018 ◽  
Vol 1 (21;1) ◽  
pp. E603-E610
Author(s):  
Mohab Ibrahim
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Pain Clinic ◽  
High Dose ◽  
Opioid Use ◽  
Pain Clinics ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain ◽  
And Function

Background: The management of chronic nonmalignant pain with high-dose opioids has partially contributed to the current opioid epidemic, with some responsibility shared by chronic pain clinics. Traditionally, both primary care providers and patients used chronic pain clinics as a source for continued medical management of patients on high-dose opioids, often resulting in tolerance and escalating doses. Although opioids continue to be an important component of the management of some chronic pain conditions, improvement in function and comfort must be documented. Pain clinics are ideally suited for reducing opioid usage while improving pain and function with the use of a multimodal approach to pain management. We assessed whether the application of multimodal treatment directed by pain specialists in a pain clinic provides for improved function and reduced dosages of opioid analgesics. Objective: We evaluated the role of a pain clinic staffed by fellowship-trained pain physicians in reducing pain and opioid use in chronic nonmalignant pain patients. Study Design: This study used a retrospective design. Setting: The research took place in an outpatient pain clinic in a tertiary referral center/teaching hospital. Methods: Of 1268 charts reviewed, 296 patients were on chronic opioids at the time of first evaluation. After a thorough evaluation, the patients were treated with nonopioid pharmacotherapy and interventional pain procedures as necessary. The data utilized from patients’ latest follow-up visit included current pain level using the Numerical Rating Scale (NRS-11), opioid usage, and various functional parameters. Results: NRS-11 scores decreased by 33.8% from 6.8 (± 0.1)/10 to 4.5 (± 0.2)/10. The pain frequency and number of pain episodes improved by 36.8 ± 2 and 36.2 ± 2.1, respectively. Additionally, the ability to sleep, work, and perform chores significantly improved. Total opioid use decreased by about 55.4% from 53.8 ± 4 to about 24 ± 2.8 MME/patient/day. Limitation: This study is not a randomized prospective controlled study. The patients analyzed are still getting therapy and their pain status may change. Some opioids are underrepresented in the analyzed cohort. Finally, this study lacks in-depth stratification by type of pain, age, gender, and duration of opioid use. Conclusion: Chronic pain clinics can play a pivotal role in reducing opioid usage while improving pain and function in patients on chronic opioids. We wish to emphasize the importance of allocating resources toward nonopioid treatments that may improve the function and well-being of patients. Key words: Pain clinic, pain management, multimodal pain management, chronic pain, opioid reduction, improved pain, improved functional capacity

scholarly journals Opioid Therapy for Chronic Nonmalignant Pain

1996 ◽  
Vol 1 (1) ◽  
pp. 17-28 ◽  
Author(s):  
Russell K Portenoy
Keyword(s):  
Chronic Pain ◽  
Opioid Therapy ◽  
Minimal Risk ◽  
Addiction Medicine ◽  
Nonmalignant Pain ◽  
Term Administration ◽  
Chronic Nonmalignant Pain ◽  
Physician Prescribing ◽  
Structured Approach

Long term administration of an opioid drug for chronic nonmalignant pain continues to be controversial, but is no longer uniformly rejected by pain specialists. This is true despite concerns that the regulatory agencies that oversee physician prescribing of opioid drugs continue to stigmatize the practice. The changing clinical perspective has been driven, in part, by widespread acknowledgement of the remarkably favourable outcomes achieved during opioid treatment of cancer pain. These outcomes contrast starkly with popular teaching about chronic opioid therapy and affirm the potential for prolonged efficacy, tolerable side effects, enhanced function associated with improved comfort and minimal risk of aberrant drug-related behaviours consistent with addiction. A large anecdotal experience in populations with nonmalignant pain suggests that these patients are more heterogeneous and that opioid therapy will greatly benefit some and will contribute to negative outcomes for others. The few controlled clinical trials that have been performed support the safety and efficacy of opioid therapy, but have been too limited to ensure generalization to the clinical setting. A critical review of the medical literature pertaining to chronic pain, opioid pharmacology and addiction medicine can clarify misconceptions about opioid therapy and provide a foundation for patient selection and drug administration. The available data support the view that opioids are no panacea for chronic pain, but should be considered in carefully selected patients using clinically derived guidelines that stress a structured approach and ongoing monitoring of efficacy, adverse effects, functional outcomes and the occurrence of aberrant drug-related behaviours.

scholarly journals The Pain and Sleep Questionnaire Three-Item Index (PSQ-3): A Reliable and Valid Measure of The Impact of Pain on Sleep in Chronic Nonmalignant Pain of Various Etiologies

2012 ◽  
Vol 17 (4) ◽  
pp. 281-290 ◽  
Author(s):  
Lindsay E Ayearst ◽  
Zoltan Harsanyi ◽  
Kenneth J Michalko
Keyword(s):  
Chronic Pain ◽  
Outcome Measures ◽  
Internal Consistency ◽  
Regression Analyses ◽  
Controlled Clinical Trials ◽  
Single Item ◽  
Nonmalignant Pain ◽  
Health Related ◽  
Chronic Nonmalignant Pain ◽  
The Impact

BACKGROUND: Sleep disturbance is among the more common complaints reported by chronic pain patients. Because pain-related sleep disturbance may serve as a marker for the assessment of responses to treatment for chronic pain, inclusion of a measure designed to assess the impact of pain on sleep in clinical trial protocols is important, if not necessary. Measures typically used for this purpose lack scales specifically designed for the assessment of the impact of pain on sleep or are based on a single item. Single-item scales lack reliability and, therefore, validity.OBJECTIVES: To investigate the psychometric properties of the five-item Pain and Sleep Questionnaire (PSQ) Index, which is embedded in the eight-item inventory, by applying an accepted methodology using retrospective analyses in controlled clinical trials in which the measure had been administered among patients with chronic nonmalignant pain.METHODS: Data were pooled from nine independent, single-site, double-blind, randomized placebo-controlled clinical trials conducted over a period of approximately 10 years, the majority of which were cross-over designs. A cross-validation approach was adopted with exploratory and confirmatory factor analyses conducted to evaluate the underlying structure and dimensionality of the measure. Internal consistency reliability was evaluated using Cronbach’s alpha coefficient. Mean score differences were used to assess the ability of the index to detect important treatment changes. Correlation coefficients were calculated between index scores and scores from other health-related outcome measures to evaluate the criterion validity of the index. Finally, predictive validity was assessed using multiple regression analyses.RESULTS: Pooling the data resulted in a sample of 605 patients (65.5% female; mean age 55.7 years). Findings suggested a revised three-item PSQ Index (PSQ-3). The PSQ-3 demonstrated high internal consistency across samples (ranging from 0.82 to 0.93) and was sensitive to detecting meaningful treatment effects within different chronic pain categories. Moderate to strong correlations (r>0.40) between the PSQ-3 and other health-related outcome measures provided preliminary evidence for criterion-related validity. Results of multiple regression analyses demonstrated that the PSQ-3 accounted for between 29% and 40% of the variance in scores from other health-related outcome measures.CONCLUSIONS: Results support the scoring of a revised three-item index for the assessment of the impact of pain on sleep. The revised index demonstrated acceptable levels of internal consistency and preliminary support for the structural, criterion-related and predictive validity of the index was achieved.

Continuous Intrathecal Meperidine via an Implantable Infusion Pump for Chronic, Nonmalignant Pain

1997 ◽  
Vol 31 (11) ◽  
pp. 1306-1308 ◽  
Author(s):  
Susan C Harvey ◽  
Michael G O'Neil ◽  
Catherine A Pope ◽  
Brian G Cuddy ◽  
Thomas A Duc
Keyword(s):  
Chronic Pain ◽  
Continuous Infusion ◽  
Infusion Pump ◽  
Leg Pain ◽  
Multiple Drug ◽  
Low Back ◽  
Short Term ◽  
Case Summary ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

OBJECTIVE: To report a continuous infusion of intrathecal meperidine via an implanted infusion pump for nonmalignant, chronic pain. CASE SUMMARY: A 69-year-old white woman had chronic, nonmalignant low-back pain and bilateral leg pain. Multiple drug therapies and other interventional techniques had failed. The patient achieved significant pain relief by a continuous infusion of intrathecal meperidine via an implanted infusion pump. DISCUSSION: To our knowledge, this is the first report of meperidine administered intrathecally by continuous infusion. Continuous infusion of intrathecal and epidural opiates by implanted infusion pumps is becoming more widely recognized as an alternative treatment for patients with chronic, benign pain. Epidural and intrathecal meperidine is an effective analgesic for short-term surgical procedures. Data reporting effective relief and safety with continuous intrathecal meperidine remain limited. CONCLUSIONS: Continuous intrathecal meperidine via an implantable infusion pump may be an effective alternative in the treatment of chronic pain.

ER/LA opioid REMS supplement

2014 ◽  
Vol 10 (7) ◽  
pp. 1 ◽  
Author(s):  
Paul A. Sloan, MD ◽  
Mellar P. Davis, MD, FCCP ◽  
Pamela Garnier, RN, BSN, CHPN
Keyword(s):  
Chronic Pain ◽  
Sustained Release ◽  
Extended Release ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain ◽  
Long Acting

Extended-Release and Long-Acting Opioids for Chronic Pain ManagementGeneral Pharmacology of Long-Acting, Extended-Release, and Sustained-Release Opioids for the Treatment of Chronic Nonmalignant PainSpecific Pharmacology of Long-Acting, Extended-Release, and Sustained-Release Opioids for the Treatment of Chronic Nonmalignant PainCase Studies of Long-Acting, Extended-Release, and Sustained-Release Opioids for the Treatment of Chronic Nonmalignant Pain

Intranasal abuse of prescription hydrocodone/acetaminophen results in oronasal fistula: A case report

2018 ◽  
Vol 5 (6) ◽  
pp. 383-385 ◽  
Author(s):  
Paul A. Sloan, MD ◽  
Oksana Klimkina, MD
Keyword(s):  
Chronic Pain ◽  
Case Report ◽  
Foreign Body ◽  
Chronic Back Pain ◽  
Oronasal Fistula ◽  
Body Sensation ◽  
Nonmalignant Pain ◽  
Hypernasal Speech ◽  
Chronic Nonmalignant Pain ◽  
Unusual Symptoms

Opioids are becoming more common in the treatment of chronic nonmalignant pain. With increased availability of opioids for chronic pain we may expect an increased misuse of these as analgesics as well. The authors describe the case report of a young woman with chronic back pain and intranasal abuse of prescribed hydrocodone/acetaminophen who was diagnosed after presenting for hypernasal speech and foreign body in the nose. This case report highlights the need for vigilance on the part of the physician for any aberrant drug-related behaviors. Any unusual symptoms or signs such as hypernasal speech, chronic nasal infection, or unexplained foreign body sensation in the nose should be thoroughly investigated.

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