scholarly journals Blood Testing in Chronic Pain Management

2015 ◽  
Vol 2;18 (2;3) ◽  
pp. E157-E161
Author(s):  
Timothy R. Deer
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Patient Compliance ◽  
Drug Testing ◽  
Opioid Therapy ◽  
Current Evidence ◽  
Opioid Tolerance ◽  
Opioid Overdose ◽  
Chronic Pain Management ◽  
Blood Testing

Blood testing is quickly becoming a useful laboratory tool for opioid prescribers who wish to document and assess patient tolerance, more objectively monitor patient safety, and evaluate patient compliance using information that is not available with traditional urine drug testing (UDT). Blood testing does not need to be performed as frequently as UDT but provides extremely valuable information which can be used to more accurately evaluate patient compliance and assist with interpreting blood toxicology results commonly used in impairment or overdose cases. This narrative review presents the current evidence supporting the use of blood testing within the chronic pain management setting. In addition, this review aims to introduce and discuss the role of routine blood testing within the chronic pain management setting. Blood testing for the purpose of documenting opioid tolerance is a relatively novel tool for pain physicians and as such this review is not intended to be a comprehensive or exhaustive review of the scientific or medical literature. Prescribers must also be aware that this type of laboratory testing need only be administered to chronic pain patients receiving daily opioid therapy. Patients taking infrequent, low dose, or as needed medications are not anticipated to benefit from this type of test. Based on the complexity of both achieving acceptable outcomes with opioid treatment and the legal and societal issues at hand, we feel that the addition of blood concentration levels will become the standard of care in the near future. Key words: Chronic pain, blood testing, opioids, opioid tolerance, patient compliance, opioid overdose

scholarly journals Provider confidence in opioid prescribing and chronic pain management: results of the Opioid Therapy Provider Survey

2017 ◽  
Vol Volume 10 ◽  
pp. 1395-1400 ◽  
Author(s):  
Amy Pearson ◽  
Rajat Moman ◽  
Susan Moeschler ◽  
Jason Eldrige ◽  
W. Michael Hooten
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Opioid Therapy ◽  
Chronic Pain Management ◽  
Opioid Prescribing ◽  
Provider Survey

The Role of Cannabidiol (CBD) in Chronic Pain Management: An Assessment of Current Evidence

2020 ◽  
Vol 24 (2) ◽  
Author(s):  
Shafik Boyaji ◽  
Justin Merkow ◽  
R. Noel M. Elman ◽  
Alan D. Kaye ◽  
R. Jason Yong ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Current Evidence ◽  
Chronic Pain Management

scholarly journals Repeated Quantitative Urine Toxicology Analysis May Improve Chronic Pain Patient Compliance with Opioid Therapy

2017 ◽  
Vol 2 (20;2) ◽  
pp. s135-s145 ◽  
Author(s):  
Nebojsa Nick Knezevic
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Retrospective Analysis ◽  
Drug Testing ◽  
Illicit Drugs ◽  
Opioid Therapy ◽  
Urine Toxicology ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Improve Compliance

Background: Even though serious efforts have been undertaken by different medical societies to reduce opioid use for treating chronic benign pain, many Americans continue to seek pain relief through opioid consumption. Assuring compliance of these patients may be a difficult aspect of proper management even with regular behavioral monitoring. Objective: The purpose of this study was to accurately assess the compliance of chronic opioidconsuming patients in an outpatient setting and evaluate if utilizing repeated urine drug testing (UDT) could improve compliance. Study Design: Retrospective analysis of prospectively collected data. Setting: Outpatient pain management clinic. Methods: After Institutional Review Board (IRB) approval, a retrospective analysis of data for 500 patients was conducted. We included patients who were aged 18 years and older who were treated with opioid analgesic medication for chronic pain. Patients were asked to provide supervised urine toxicology specimens during their regular clinic visits, and were asked to do so without prior notification. The specimens were sent to an external laboratory for quantitative testing using liquid chromatography-tandem mass spectrometry. Results: Three hundred and eighty-six (77.2%) patients were compliant with prescribed medications and did not use any illicit drugs or undeclared medications. Forty-one (8.2%) patients tested positive for opioid medication(s) that were not prescribed in our clinic; 8 (1.6%) of the patients were positive for medication that was not prescribed by any physician and was not present in the Illinois Prescription Monitoring Program; 5 (1%) patients tested negative for prescribed opioids; and 60 (12%) patients were positive for illicit drugs (8.6% marijuana, 3.2% cocaine, 0.2% heroin). Repeated UDTs following education and disclosure, showed 49 of the 77 patients (63.6%) had improved compliance. Limitations: This was a single-site study and we normalized concentrations of opioids in urine with creatinine levels while specific gravity normalization was not used. Conclusions: Our results showed that repeated UDT can improve compliance of patients on opioid medications and can improve overall pain management. We believe UDT testing should be used as an important adjunctive tool to help guide clinical decision-making regarding opioid therapy, potentially increasing future quality of care. Key words: Urine toxicology analysis, chronic pain, opioids, compliance, pain management, urine drug testing, urine drug screening

scholarly journals Utilization of Magnesium for the Treatment of Chronic Pain

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ivan Urits ◽  
Jai Won Jung ◽  
Ariunzaya Amgalan ◽  
Luc Fortier ◽  
Anthony Anya ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
International Association ◽  
Treatment Options ◽  
Pharmacological Therapy ◽  
Narrative Review ◽  
Current Evidence ◽  
Chronic Pain Management ◽  
Surgical Interventions ◽  
Psychological Therapies

Context: The International Association for the Study of Pain (IASP) defines chronic pain as pain that persists or recurs for longer than 3 months. Chronic pain has a significant global disease burden with profound effects on health, quality of life, and socioeconomic costs. Evidence Acquisition: Narrative review. Results: There are several treatment options, including pharmacological therapy, physical rehabilitation, psychological therapies, and surgical interventions, for chronic pain management. Magnesium has been FDA-approved for several indications including hypomagnesemia, arrhythmia, prevention of seizures in eclampsia/preeclampsia, and constipation. Magnesium has been used for numerous off-label uses, notably for acute and chronic pain management. The mechanism of magnesium in pain management is primarily through its action as a voltage-gated antagonist of NMDA receptors, which are involved in pain transduction. Conclusions: This narrative review will focus on the current evidence and data surrounding the utilization of magnesium as a treatment option for chronic pain.

scholarly journals Framing of the opioid problem in cancer pain management in Canada

2019 ◽  
Vol 26 (3) ◽  
Author(s):  
R. Asthana ◽  
S. Goodall ◽  
J. Lau ◽  
C. Zimmermann ◽  
P. L. Diaz ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Cancer Pain ◽  
Opioid Therapy ◽  
Position Paper ◽  
Chronic Pain Management ◽  
Opioid Use ◽  
Cancer Pain Management ◽  
Canadian Guideline ◽  
Patients With Cancer

Two guidelines about opioid use in chronic pain management were published in 2017: the Canadian Guideline for Opioids for Chronic Non-Cancer Pain and the European Pain Federation position paper on appropriate opioid use in chronic pain management. Though the target populations for the guidelines are the same, their recommendations differ depending on their purpose. The intent of the Canadian guideline is to reduce the incidence of serious adverse effects. Its goal was therefore to set limits on the use of opioids. In contrast, the European Pain Federation position paper is meant to promote safe and appropriate opioid use for chronic pain.     The content of the two guidelines could have unintentional consequences on other populations that receive opioid therapy for symptom management, such as patients with cancer. In this article, we present expert opinion about those chronic pain management guidelines and their impact on patients with cancer diagnoses, especially those with histories of substance use disorder and psychiatric conditions. Though some principles of chronic pain management can be extrapolated, we recommend that guidelines for cancer pain management should be developed using empirical data primarily from patients with cancer who are receiving opioid therapy.

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