Opioid Trial Periods for Management of Chronic Non-cancer Pain

Opioid Trial Periods for Management of Chronic Non-cancer Pain
Author:
Publisher:
Total Pages: 16
Release: 2012
Genre: Chronic pain
ISBN:
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While opioid analgesics are widely used to treat chronic pain associated with cancer and end of life, controversy exists regarding the use of chronic opioid therapy (COT) for treating chronic non-cancer pain (CNCP). According to the International Association for the Study of Pain, chronic pain is defined as pain that persists beyond the normal tissue healing time of three months. CNCP affects approximately 25% of Canadians and is often associated with common conditions including back pain, osteoarthritis, fibromyalgia, and headaches. While some physicians are reluctant to prescribe opioids for CNCP due to the risk of harms, there was a 50% increase in Canadian prescriptions between 2000 and 2004. Increased prescribing is associated with increased misuse, abuse, injury and overdose-related deaths among opioid users. A national study found that most Canadians who inject opioids are now injecting prescription opioids, such as morphine (51%), and hydromorphine (50%), rather than street-derived heroin. A National Opioid Use Guideline Group (NOUGG) was formed in 2007 to provide evidence-based guidance on COT for CNCP. The Canadian guideline is intended to inform physicians about starting trials of opioid therapy for patients with CNCP and guide monitoring of long-term therapy. A trial of opioid therapy includes initiation, titration, and maintenance phases. Initiation involves selecting an appropriate opioid and dose based on a comprehensive patient assessment. During titration, the dosage is adjusted to maximize pain relief while minimizing unmanageable side effects. When the daily dose stabilizes, the patient has entered the maintenance phase. If pain gets worse after a period of stable maintenance, it may indicate disease progression, increased activity, tolerance, or an increased sensitivity to pain. If no response is found despite increasing the dosage, the opioid is discontinued. This review summarizes the clinical effectiveness, and guidelines and recommendations regarding opioid trial periods for the management of CNCP to determine the optimal duration.

Pain Management and the Opioid Epidemic

Pain Management and the Opioid Epidemic
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
Total Pages: 483
Release: 2017-09-28
Genre: Medical
ISBN: 0309459575
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Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.

Opioid trial periods for management of chronic non-cancer pain

Opioid trial periods for management of chronic non-cancer pain
Author:
Publisher:
Total Pages: 0
Release: 2012
Genre:
ISBN:
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While opioid analgesics are widely used to treat chronic pain associated with cancer and end of life, controversy exists regarding the use of chronic opioid therapy (COT) for treating chronic non-cancer pain (CNCP). According to the International Association for the Study of Pain, chronic pain is defined as pain that persists beyond the normal tissue healing time of three months. CNCP affects approximately 25% of Canadians and is often associated with common conditions including back pain, osteoarthritis, fibromyalgia, and headaches. While some physicians are reluctant to prescribe opioids for CNCP due to the risk of harms, there was a 50% increase in Canadian prescriptions between 2000 and 2004. Increased prescribing is associated with increased misuse, abuse, injury and overdose-related deaths among opioid users. A national study found that most Canadians who inject opioids are now injecting prescription opioids, such as morphine (51%), and hydromorphine (50%), rather than street-derived heroin. A National Opioid Use Guideline Group (NOUGG) was formed in 2007 to provide evidence-based guidance on COT for CNCP. The Canadian guideline is intended to inform physicians about starting trials of opioid therapy for patients with CNCP and guide monitoring of long-term therapy. A trial of opioid therapy includes initiation, titration, and maintenance phases. Initiation involves selecting an appropriate opioid and dose based on a comprehensive patient assessment. During titration, the dosage is adjusted to maximize pain relief while minimizing unmanageable side effects. When the daily dose stabilizes, the patient has entered the maintenance phase. If pain gets worse after a period of stable maintenance, it may indicate disease progression, increased activity, tolerance, or an increased sensitivity to pain. If no response is found despite increasing the dosage, the opioid is discontinued. This review summarizes the clinical effectiveness, and guidelines and recommendations regarding opioid trial periods for the management.

Opioids in Non-Cancer Pain

Opioids in Non-Cancer Pain
Author: Cathy Stannard
Publisher: OUP Oxford
Total Pages: 207
Release: 2013-03-21
Genre: Medical
ISBN: 0191667226
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Opioids have been used as analgesics for many years, and their use in the management of acute pain related to trauma and surgery is well established. However, patients with persisting pain need a pain management plan that brings relief of symptoms without adverse effects in both the short and longer terms. The prescribing of opioids for chronic non-cancer pain has increased substantially since the first edition of this pocketbook was published, prompting considerable debate regarding the appropriateness of prescribing for this indication and the potential harms to individuals and to society that may result from this trend. This second edition of Opioids in Non-Cancer Pain brings clinicians up to date on the current use of opioid drugs in patients with non-cancer pain, and highlights the potential benefits of therapy as well as the problems that can occur. The edition includes new chapters on the history of opioids to help contextualize the following discussions, and a new chapter covering the emerging field of pharmacogenomics which provides explanations for differing responsiveness to opioids and propensity to adverse effects. An international perspective on opioid prescribing trends is also a valuable new addition.

Expert Decision Making on Opioid Treatment

Expert Decision Making on Opioid Treatment
Author: Jane Ballantyne
Publisher: Oxford University Press
Total Pages: 156
Release: 2013-03-21
Genre: Medical
ISBN: 0199768889
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This book offers expert, balanced, concise guidance on how clinicians can navigate a number of complex considerations to formulate a treatment plan for chronic pain that either includes or advisedly excludes opioids.

Behavioral and Psychopharmacologic Pain Management

Behavioral and Psychopharmacologic Pain Management
Author: Michael H. Ebert
Publisher: Cambridge University Press
Total Pages: 507
Release: 2010-11-25
Genre: Medical
ISBN: 113949354X
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Pain is the most common symptom bringing a patient to a physician's attention. Physicians training in pain medicine may originate from different disciplines and approach the field with varying backgrounds and experience. This book captures the theory and evidence-based practice of behavioral, psychotherapeutic and psychopharmacological treatments in modern pain medicine. The book's contributors span the fields of psychiatry, psychology, anesthesia, neurology, physical medicine and rehabilitation, and nursing. Thus the structure and content of the book convey the interdisciplinary approach that is the current standard for the successful practice of pain management. The book is designed to be used as a text for training fellowships in pain medicine, as well as graduate courses in psychology, nursing, and other health professions.

Holland-Frei Cancer Medicine

Holland-Frei Cancer Medicine
Author: Robert C. Bast, Jr.
Publisher: John Wiley & Sons
Total Pages: 2004
Release: 2017-03-10
Genre: Medical
ISBN: 111900084X
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Holland-Frei Cancer Medicine, Ninth Edition, offers a balanced view of the most current knowledge of cancer science and clinical oncology practice. This all-new edition is the consummate reference source for medical oncologists, radiation oncologists, internists, surgical oncologists, and others who treat cancer patients. A translational perspective throughout, integrating cancer biology with cancer management providing an in depth understanding of the disease An emphasis on multidisciplinary, research-driven patient care to improve outcomes and optimal use of all appropriate therapies Cutting-edge coverage of personalized cancer care, including molecular diagnostics and therapeutics Concise, readable, clinically relevant text with algorithms, guidelines and insight into the use of both conventional and novel drugs Includes free access to the Wiley Digital Edition providing search across the book, the full reference list with web links, illustrations and photographs, and post-publication updates

Long-acting Opioids for Chronic Non-cancer Pain

Long-acting Opioids for Chronic Non-cancer Pain
Author:
Publisher:
Total Pages: 13
Release: 2015
Genre:
ISBN:
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Opioid analgesics are used widely in the treatment of chronic pain. The majority of evidence, however, is from studies on short term use, and opioids are associated with individual adverse events of sedation, cognitive slowing, respiratory depression, overdose, and substance dependence. Upward trends of prescription of opioids have been associated with increased reports of opioid-related deaths, addiction, and drug diversion. It, therefore, is important that opioid prescription be tailored appropriately to need. Long-acting opioids have been recommended for the management of chronic pain to improve compliance. A 2011 descriptive systematic Drug Class Review (Carson 2011) identified 10 trials from fair to poor quality that compared long-acting opioids with each other, but concluded that there was insufficient evidence to suggest that any one was superior. The authors found no significant difference in measures of pain relief or function in trials of long-acting opioids with the exception of two poor-quality open-label trials. This rapid response report reviews recent research comparing long-acting opioids, such as morphine, hydromorphone, oxycodone, and fentanyl, in adults with chronic non-cancer pain.

Opioid Therapy in the 21st Century

Opioid Therapy in the 21st Century
Author: Howard S. Smith
Publisher: Oxford University Press
Total Pages: 306
Release: 2013-01-28
Genre: Medical
ISBN: 0190236752
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Over the last thirty years, the concern of Pain Medicine practitioners about the potential for their patients to develop a dependence on opioids has left opioid therapy as a largely underutilized treatment. While there is no simple answer to chronic pain, opioids remain the only class of drugs capable of providing relief to patients experiencing serious pain. Opioid Therapy in the 21st Century, Second Edition fills a dearth of clinical knowledge about analgesics to aid practitioners in weighing the risks versus the benefits of opioid therapy for their chronic pain patients. This second edition provides updated information on recently approved opioids as well as approved indications for older opioids and clinical trials. Part of the Oxford American Pain Library, this concise guide serves as a practical, accessible reference for physicians across the range of primary care and medical specialties. It includes an overview of appropriate clinical applications of opioids, covering such topics as opioid pharmacology, route selection, and individualization of therapy, as well as strategies for managing and mitigating the risk of abuse, addiction, and diversion. There are also special sections dedicated to the unique needs of pediatric, geriatric, and palliative care patient populations.

Framing Opioid Prescribing Guidelines for Acute Pain

Framing Opioid Prescribing Guidelines for Acute Pain
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
Total Pages: 223
Release: 2020-03-20
Genre: Medical
ISBN: 030949687X
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The opioid overdose epidemic combined with the need to reduce the burden of acute pain poses a public health challenge. To address how evidence-based clinical practice guidelines for prescribing opioids for acute pain might help meet this challenge, Framing Opioid Prescribing Guidelines for Acute Pain: Developing the Evidence develops a framework to evaluate existing clinical practice guidelines for prescribing opioids for acute pain indications, recommends indications for which new evidence-based guidelines should be developed, and recommends a future research agenda to inform and enable specialty organizations to develop and disseminate evidence-based clinical practice guidelines for prescribing opioids to treat acute pain indications. The recommendations of this study will assist professional societies, health care organizations, and local, state, and national agencies to develop clinical practice guidelines for opioid prescribing for acute pain. Such a framework could inform the development of opioid prescribing guidelines and ensure systematic and standardized methods for evaluating evidence, translating knowledge, and formulating recommendations for practice.