Analgesic opioid use disorders in patients with chronic non-cancer pain: A holistic approach for tailored management

Bertin, Célian; Delage, Noémie; Rolland, Benjamin; Pennel, Lucie; Fatséas, Mélina; Trouvin, Anne-Priscille; Delorme, Jessica; Chenaf, Chouki; Authier, Nicolas

doi:10.1016/j.neubiorev.2020.12.015

Cited by 15 publications

(8 citation statements)

References 165 publications

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“…When it comes to organizing care settings to address co-occurring pain and OUD, several authors favour a global, integrated and interdisciplinary approach (Ashburn et al, 2019;Bertin et al, 2021;Kakko et al, 2018;Kraus et al, 2020;Pade et al, 2012;Wachholtz et al, 2015). For instance, Kraus et al (2020) To ensure flexibility in responding to individual needs, some authors recommend stepped care models (Clark et al, 2008), personalized treatment plans (Kraus et al, 2020) and a patient-centered approach (Becker et al, 2016).…”

Section: Service Delivery Modelmentioning

confidence: 99%

The current state of knowledge on care for co‐occurring chronic pain and opioid use disorder: A scoping review

Archambault,

Bertrand,

Martel

et al. 2024

Journal of Clinical Nursing

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Background and AimsOpioid use disorder often co‐occurs with chronic pain but assessment and treatment of these co‐occurring disorders is complex. This review aims to identify current treatments and delivery models for co‐occurring chronic pain and opioid use disorder (OUD) documented in the scientific literature.DesignScoping review.MethodsThe review was conducted in six databases in June 2022 (no time limit): CINAHL, PsycINFO, Web of Science, Cochrane, PubMed and Embase. The PRISMA‐ScR checklist was used to guide reporting.ResultsForty‐seven publications addressing the issue of co‐occurring chronic pain and OUD management were included. Randomized controlled trials provide evidence for the effectiveness of opioid agonist treatments (OAT) such as methadone or buprenorphine/naloxone, as well as for combining OAT with Mindfulness‐Oriented Recovery Enhancement or cognitive behavioural therapy. A number of other pharmacological treatments (opioid and nonopioid), nonpharmacological treatments (e.g. physiotherapy) and service delivery models (e.g. simultaneous treatment of comorbidities, interdisciplinary and interprofessional collaboration) are also underlined. In most cases, authors recommend a combination of strategies to meet patient needs.ConclusionsThe scoping review reveals gaps in evidence‐based knowledge to effectively care for co‐occurring chronic pain and OUD, but several experts recommend the uptake of known ‘best’ practices such as integrated treatment of the multiple biopsychosocial dimensions of the co‐occurring disorders as well as collaborative interdisciplinary work.Clinical RelevanceImproving services is dependent on alleviating barriers such as working in silos, the costs associated with nonpharmacological treatments, and the double stigma associated with pain in people with a substance use disorder.

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Section: Service Delivery Modelmentioning

confidence: 99%

The current state of knowledge on care for co‐occurring chronic pain and opioid use disorder: A scoping review

Archambault,

Bertrand,

Martel

et al. 2024

Journal of Clinical Nursing

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“…In this context, clinical stability provided by LA-BUP could be helpful. Like for treating addictive disorders, this multidimensional and multimodal approach aims at improving the functional autonomy of patients, allowing them to achieve personal life goals and projects for a better quality of life, even if the pain is not entirely suppressed [114,115]. Patients' access to treatment is crucial for treating OUD, regardless of their country of origin.…”

Section: Chronic Painmentioning

confidence: 99%

Long-Acting Buprenorphine Formulations as a New Strategy for the Treatment of Opioid Use Disorder

Maremmani,

Dematteis,

Gorzelanczyk

et al. 2023

JCM

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Long-acting buprenorphine formulations have been recently marketed for the Opioid Agonist Treatment (OAT) of opioid use disorder (OUD) associated with medical, social, and psychological support. Their duration of action ranges from one week up to 6 months. The non-medical use of opioids is increasing with a parallel rise in lethal overdoses. Methadone and buprenorphine are the standard treatment for opioid dependence. Methadone Maintenance Treatment (MMT) is widely recognized as one of the most effective ways of reducing the risks of overdose, crime, and transmission of HIV (Human Immunodeficiency Virus) in people who use opioids; however, its effectiveness has been hindered by low rates of uptake and retention in treatment. Furthermore, both methadone and buprenorphine are widely diverted and misused. Thus, a crucial aspect of treating OUD is facilitating patients’ access to treatment while minimizing substance-related harm and improving quality of life. The newly developed long-acting buprenorphine formulations represent a significant change in the paradigm of OUD treatment, allowing an approach individualized to patients’ needs. Strengths of this individualized approach are improved adherence (lack of peaks and troughs in blood concentrations) and a reduced stigma since the patient doesn’t need to attend their clinic daily or nearly daily, thus facilitating social and occupational integrations as the quality of life. However, less frequent attendance at the clinic should not affect the patient–physician relationship. Therefore, teleconsulting or digital therapeutic services should be developed in parallel. In addition, diversion and intravenous misuse of buprenorphine are unlikely due to the characteristics of these formulations. These features make this approach of interest for treating OUD in particular settings, such as subjects staying or when released from prison or those receiving long-term residential treatment for OUD in the therapeutic communities. The long-lasting formulations of buprenorphine can positively impact the OUD treatment and suggest future medical and logistic developments to maximize their personalized management and impact.

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“…The diagnosis of OUD is based on the guidelines presented in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) [ 5 , 6 ], in which it has been reported that OUD is defined as a “problematic pattern of opioid use leading to clinically significant impairment or distress” [ 2 ]. Opioid medications are employed for the treatment of moderate-to-severe chronic cancer and non-cancer pain [ 7 , 8 , 9 , 10 , 11 , 12 ], although some opioids can be used for treating diarrhea [ 13 , 14 , 15 ] and cough [ 16 , 17 ]. Moreover, opioids can be used by patients suffering from chronic backaches [ 18 , 19 ] and headaches [ 20 , 21 ], by people recovering from surgery [ 22 , 23 , 24 ], and by both adults and children who have suffered serious injuries in falls, while playing sports, or in auto accidents, etc.…”

Section: Introductionmentioning

confidence: 99%

Targeting Opioid Receptors in Addiction and Drug Withdrawal: Where Are We Going?

Tabanelli

Brogi

Calderone

2023

IJMS

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This review article offers an outlook on the use of opioids as therapeutics for treating several diseases, including cancer and non-cancer pain, and focuses the analysis on the opportunity to target opioid receptors for treating opioid use disorder (OUD), drug withdrawal, and addiction. Unfortunately, as has been well established, the use of opioids presents a plethora of side effects, such as tolerance and physical and physiological dependence. Accordingly, considering the great pharmacological potential in targeting opioid receptors, the identification of opioid receptor ligands devoid of most of the adverse effects exhibited by current therapeutic agents is highly necessary. To this end, herein, we analyze some interesting molecules that could potentially be useful for treating OUD, with an in-depth analysis regarding in vivo studies and clinical trials.

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Analgesic opioid use disorders in patients with chronic non-cancer pain: A holistic approach for tailored management

Cited by 15 publications

References 165 publications

The current state of knowledge on care for co‐occurring chronic pain and opioid use disorder: A scoping review

The current state of knowledge on care for co‐occurring chronic pain and opioid use disorder: A scoping review

Long-Acting Buprenorphine Formulations as a New Strategy for the Treatment of Opioid Use Disorder

Targeting Opioid Receptors in Addiction and Drug Withdrawal: Where Are We Going?

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