Interventions for the reduction of prescribed opioid use in chronic non-cancer pain. BackgroundThis is the first update of the original Cochrane Review published in 2013. The conclusions of this review have not changed from the 2013 publication. People with chronic non-cancer pain who are prescribed and are taking opioids can have a history of long-term, high-dose opioid use without effective pain relief. In those without good pain relief, reduction of prescribed opioid dose may be the desired and shared goal of both patient and clinician. Simple, unsupervised reduction of opioid use is clinically challenging, and very difficult to achieve and maintain. Interventions for the reduction of prescribed opioid use in chronic non-cancer pain (Review)We searched for studies up to January 2017. We found five studies, and they investigated 278 people. Most people included in the studies were women, who were around 50 years of age, and reported a mixture of chronic pain conditions (e.g. headache, back pain, muscle pain). The studies included acupuncture, mindfulness, and cognitive behavioral therapy as strategies to decrease the amount of opioids taken by adults with chronic pain. Key resultsNo conclusions can be drawn from this small amount of information. Therefore, it is not clear whether these treatments decrease the amount of opioids in adults with chronic pain (primary outcome) or reduce pain intensity, physical ability or mood (secondary outcomes). Three studies did include negative effects of their treatment, and two reported that the participants did not have anything negative happen to them because of the trial they were in. Non-randomised studies, not included in this review, do indicate that for many people intensive rehabilitation packages may bring about major reduction in opioid use. Reducing prescribed opioid use in chronic non-cancer pain is an important topic in need of more systematic research. Quality of the evidence2 Interventions for the reduction of prescribed opioid use in chronic non-cancer pain (Review) MO. Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: results from an early stage randomized controlled trial. Journal of Consulting and Clinical Psychology 2014;82 (3):448-59. Jamison 2010 {published data only} Jamison RN, Ross EL, Michna E, ChenL LQ, Holcomb C, Wasan AD. Substance misuse treatment for high-risk chronic pain patients on opioid therapy: a randomized trial. Pain 2010;150:390-400. Naylor 2010 {published data only} Naylor MR, Keefe FJ, Brigidi B, Naud S, Helzer JE. Therapeutic interactive voice response for chronic pain reduction and relapse prevention. Pain 2008;134(3): 335-45.

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Empirical methods are used to explore the relationship between chronic pain, somatic awareness and attention. Using a primary task paradigm, 46 chronic pain patients performed an attentionally demanding task. Patients were classified according to self reported pain intensity and the extent of their reporting of the perception of bodily sensations (somatic awareness). Results showed that, as predicted, disruption of attentional performance was most pronounced in those who reported high pain intensity and high somatic awareness. Further analysis revealed that these patients also reported high negative affect. These findings are discussed in terms of their theoretical implications for the concept of hypervigilance and their clinical implications for chronic pain control.

Our mistake is to treat chronic pain as if it were acute or end of life pain

BackgroundThis is an update of an earlier review that considered both neuropathic pain and fibromyalgia (Issue 6, 2014), which has now been split into separate reviews for the two conditions. This review considers neuropathic pain only.Opioid drugs, including oxycodone, are commonly used to treat neuropathic pain, and are considered e ective by some professionals. Most reviews have examined all opioids together. This review sought evidence specifically for oxycodone, at any dose, and by any route of administration. Separate reviews consider other opioids. ObjectivesTo assess the analgesic e icacy and adverse events of oxycodone for chronic neuropathic pain in adults. Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE from inception to 6 November 2013 for the original review and from January 2013 to 21 December 2015 for this update. We also searched the reference lists of retrieved studies and reviews, and two online clinical trial registries. This update di ers from the earlier review in that we have included studies using oxycodone in combination with naloxone, and oxycodone used as add-on treatment to stable, but inadequate, treatment with another class of drug. Selection criteriaWe included randomised, double-blind studies of two weeks' duration or longer, comparing any dose or formulation of oxycodone with placebo or another active treatment in chronic neuropathic pain. Data collection and analysisTwo review authors independently searched for studies, extracted e icacy and adverse event data, and examined issues of study quality and potential bias. Where pooled analysis was possible, we used dichotomous data to calculate risk ratio and numbers needed to treat for one additional event, using standard methods.We assessed the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and created a 'Summary of findings' table. Main resultsThe updated searches identified one additional published study, and one clinical trial registry report. We included five studies reporting on 687 participants; 637 had painful diabetic neuropathy and 50 had postherpetic neuralgia. Two studies used a cross-over design and three Oxycodone for neuropathic pain in adults (Review)