Evolving Role of the Neurologist in the Diagnosis and Treatment of Chronic Noncancer Pain

2003 ◽  
Vol 78 (1) ◽  
pp. 80-84 ◽  
Author(s):  
Peter Lars Jacobson ◽  
J. Douglas Mann
Keyword(s):  
Diagnosis And Treatment ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain

Increasing Evidence for the Limited Role of Opioids to Treat Chronic Noncancer Pain

JAMA ◽  
2018 ◽  
Vol 320 (23) ◽  
pp. 2427 ◽  
Author(s):  
Michael A. Ashburn ◽  
Lee A. Fleisher
Keyword(s):  
Chronic Noncancer Pain ◽  
Limited Role ◽  
Noncancer Pain

scholarly journals European* clinical practice recommendations on opioids for chronic noncancer pain – Part 1: Role of opioids in the management of chronic noncancer pain

2021 ◽  
Vol 25 (5) ◽  
pp. 949-968 ◽  
Author(s):  
Winfried Häuser ◽  
Bart Morlion ◽  
Kevin E. Vowles ◽  
Kirsty Bannister ◽  
Eric Buchser ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Chronic Noncancer Pain ◽  
Practice Recommendations ◽  
Noncancer Pain

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.

Do pain specialists meet the needs of the referring physician? A survey of primary care providers

2018 ◽  
Vol 4 (1) ◽  
pp. 13 ◽  
Author(s):  
Jane R. Wilkens, MD ◽  
Miles J. Belgrade, MD
Keyword(s):  
Primary Care ◽  
Outcome Measures ◽  
Primary Care Providers ◽  
Care Providers ◽  
Chronic Noncancer Pain ◽  
Psychological Issues ◽  
Pain Specialist ◽  
Noncancer Pain

Objective: To study the factors that influence the use of opioids in the management of chronic noncancer pain (CNCP) by primary care providers (PCPs) for patients returning from a pain specialist.Design: A survey of PCPs.Setting: Two physician groups in the Minneapolis-St. Paul metropolitan area.Participants: Two seventy-six PCPs surveyed and 80 surveys returned. Main outcome measures: Participants rated the importance of specific concerns regarding the role of pain specialists and the use of opioids in the management of CNCP. Past experience with pain specialists, comfort using opioids, and opinions regarding a trilateral opioid agreement were also examined.Results: The top concerns for PCPs were as follows: the use of opioids in patients with chemical dependency or psychological issues, the escalation of opioid dosing, and the use of opioids in pain states without objective findings. They also ranked highly the importance of coordinating the return of patients from a pain specialist with explicit opioid instructions and the availability of consultation by phone or a timely follow-up visit. PCPs were supportive of the concept of a trilateral opioid agreement.Conclusions: PCPs have significant concerns regarding the prescribing of opioids in CNCP. They desire closer collaboration with pain specialists, including more explicit plans of care when patients are transferred back to them. The trilateral agreement may provide one framework for better collaboration.

scholarly journals Importance of Urine Drug Testing in the Treatment of Chronic Noncancer Pain: Implications of Recent Medicare Policy Changes in Kentucky

2010 ◽  
Vol 2;13 (1;2) ◽  
pp. 167-186
Author(s):  
John W. John W.
Keyword(s):  
Chronic Pain ◽  
Drug Abuse ◽  
Prescription Drug ◽  
Drug Testing ◽  
Diagnosis And Treatment ◽  
Drug Misuse ◽  
Chronic Noncancer Pain ◽  
Urine Drug Testing ◽  
Urine Drug ◽  
Noncancer Pain

Background: Urine drug testing has become a widely used tool in American society for deterring illicit drug use. In the practice of medicine, urine drug testing is commonly used to help diagnose substance misuse, abuse, or addiction. Objective: This narrative review provides an informed perspective on the importance of urine drug testing in the medical treatment of chronic noncancer pain. The history and current uses of urine drug tests in the United States are reviewed, the prevalence and nature of prescription drug misuse is described as is related to chronic noncancer pain, and implications and considerations for practitioners are presented related to the noncancer pain diagnosis and treatment. Discussion: Practitioners are confronted with the ethical and legal dilemma of being called to adequately treat chronic pain in a culture with a high prevalence of prescription drug abuse. Yet the symptoms of drug abuse are nonspecific and therefore of limited value to the practitioner in determining patient compliance to drug treatment regimens. In contrast, urine drug testing has a reliable history, both in and out of medicine, as an independent sign of drug misuse. This sign can be used to aid in the diagnosis and treatment of drug misuse and underlying addictions to improve patient outcomes. Conclusion: Regular urine drug testing should be a part of acute and chronic pain management whether or not the patient has any signs or symptoms of drug misuse. Key words: chronic noncancer pain, Medicare, Medicaid, urine drug testing, opioids, drug abuse

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.

1763: Stage Migration of upper Tract Transitional Cell Carcinoma: An Argument for the Continued Role of Endourologic Diagnosis and Treatment

2004 ◽  
Vol 171 (4S) ◽  
pp. 466-466
Author(s):  
Stephen A. Boorjian ◽  
Casey K. Ng ◽  
Ravi Munver ◽  
R. Ernest Sosa ◽  
E. Darracott Vaughan ◽  
...  
Keyword(s):  
Transitional Cell Carcinoma ◽  
Cell Carcinoma ◽  
Transitional Cell ◽  
Diagnosis And Treatment ◽  
Stage Migration ◽  
Upper Tract

Neuromyelitis optica spectrum: novel concept of pathogenesis, diagnosis and treatment of Devic’s disease

2009 ◽  
Vol 150 (46) ◽  
pp. 2101-2109 ◽  
Author(s):  
Péter Csécsei ◽  
Anita Trauninger ◽  
Sámuel Komoly ◽  
Zsolt Illés
Keyword(s):  
Neuromyelitis Optica ◽  
Water Channel ◽  
Diagnostic Procedures ◽  
Diagnosis And Treatment ◽  
Clinical Settings ◽  
Permanent Disability ◽  
Therapeutic Decisions ◽  
Novel Concept ◽  
The Brain

The identification of autoantibodies generated against the brain isoform water channel aquaporin4 in the sera of patients, changed the current diagnostic guidelines and concept of neuromyelitis optica (NMO). In a number of cases, clinical manifestation is spatially limited to myelitis or relapsing optic neuritis creating a diverse. NMO spectrum. Since prevention of relapses provides the only possibility to reduce permanent disability, early diagnosis and treatment is mandatory. In the present study, we discuss the potential role of neuroimaging and laboratory tests in differentiating the NMO spectrum from other diseases, as well as the diagnostic procedures and therapeutic options. We also present clinical cases, to provide examples of different clinical settings, diagnostic procedures and therapeutic decisions.

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