Buprenorphine transdermal system in adults with chronic low back pain: A randomized, double-blind, placebo-controlled crossover study, followed by an open-label extension phase

Gordon, Allan; Callaghan, Denis J; Spink, D.R.; Cloutier, Christian; Dzongowski, Peter; O’Mahony, William; Sinclair, Duncan; Rashiq, Saifee; Buckley, Norm; Cohen, Geoffrey

doi:10.1016/j.clinthera.2010.04.018

Cited by 102 publications

(91 citation statements)

References 41 publications

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“…Most of these only reported complications with an incidence of greater than 5 or 10% or serious adverse advents that were considered related to the study medication. The majority of trials did not report any infectious complications (Roth et al 2000;Caldwell et al 2002;Raja et al 2002;Watson et al 2003;Babul et al 2004;Hale et al 2005;Matsumoto et al 2005;Gana et al 2006;Kivitz et al 2006;Hale et al 2007;Beaulieu et al 2008;Gordon et al 2010). Only 6 out of 18 trials reported infectious complications but their incidence was too low to detect statistically significant differences (see Table 3; (Gimbel et al 2003;Markenson et al 2005;Langford et al 2006;Burch et al 2007;Katz et al 2007;O'Donnell et al 2009).…”

Section: Relationship Between Opioid Use and Infectious Complicationsmentioning

confidence: 93%

Immunosuppressive Effects of Opioids—Clinical Relevance

Brack

Rittner

Stein

2011

J Neuroimmune Pharmacol

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Opioid-induced immunosuppression has been demonstrated in cell culture experiments and in animal models. This is in striking contrast to the paucity of confirmatory studies in humans. This review describes the basic pharmacokinetics and -dynamics of opioid use in patients. It summarizes the major findings on opioid use and infectious complications in intensive care unit (ICU) patients, in patients with acute or chronic non-malignant pain, and in intravenous drug users (IDU). The limitations of studies in each area are discussed. For example, ethical concerns may complicate randomized placebo-controlled trials (RCT) in acute postoperative pain and for a large part of ICU patients. Importantly, most studies in patients with chronic (non-malignant) pain only inadequately report infectious complications in relation to opioid use since their incidence is usually not considered to be drug related. Infectious complications in IDUs are very frequent but cannot easily be distinguished from risk behavior or risk environment. In summary, convincing clinical evidence is lacking that opioids per se increase the rate of infectious complications in most patient categories. From a clinical standpoint, important unresolved issues are i) selection of relevant animal models, ii) opioid selection and discontinuation, and iii) the role of coexisting diseases and concomitant other medications.

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Section: Relationship Between Opioid Use and Infectious Complicationsmentioning

confidence: 93%

Immunosuppressive Effects of Opioids—Clinical Relevance

Brack

Rittner

Stein

2011

J Neuroimmune Pharmacol

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“…When comparing two different types of procedures for low back pain treatment from the d index and the percentage of changes, before and after treatment, it was found that acupuncture, performed in 130 individuals with non-specific back pain, after 12 sessions, two times per week, per six weeks, reached important positive results (d=1.86), corresponding to 55% of improvement (24) . And still, regarding the other treatments, the use of transdermal opioid buprenorphine analgesic medication for chronic moderate and severe low back pain reached a side effect of 26% (d=0.86), for 50 individuals (25) . Those two last studies were clinical trials with a placebo group.…”

Section: Discussionmentioning

confidence: 99%

Occupational low back pain in nursing workers: massage versus pain

Borges

Kurebayashi

Silva

2014

Rev. esc. enferm. USP

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RESUmEnObjetivo: Evaluar la eficacia del masaje para la reducción de la lumbalgia ocupacional en trabajadores del equipo de enfermería. Método: Ensayo clínico randomizado, en el cual se utilizaron el Cuestionario sociodemográfico/morbilidad y la escala numérica de dolor. Se distribuyeron aleatoriamente 45 sujetos en: grupo intervenido (G1-Masaje por acupresión), grupo placebo (G2-aplicación de Laser Arseniuro de Galio 904 nm apagado) y grupo control (G3-sin intervención). Resultados: El principal factor desencadenante, así como del empeoramiento del dolor fue la manipulación del paciente, ambos con 34,9% de prevalencia. El principal tratamiento para la lumbalgia antes del estudio fue el uso de fármacos en el 44,2% de los participantes. Según el análisis de la varianza, sólo el G1 logró una diferencia estadísticamente significativa, con mejores resultados después de 12 sesiones. El masaje obtuvo un efecto enorme (d=4,59), correspondiente a la reducción del 86% en los niveles del dolor. Conclusión: El masaje fue efectivo para reducir el dolor de espalda de estos trabajadores de enfermería.

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“…Furthermore, early studies indicate that partial agonist therapy may also be a suitable option for ongoing analgesia in some patients with chronic pain. 18 With effective and safe alternative therapies in their armamentaria, providers may be less likely to continue inappropriate prescribing.…”

Section: Refining Treatment Pathways For Use When Safety Efficacy Ormentioning

confidence: 99%

A Research Agenda for Enhancing Appropriate Opioid Prescribing in Primary Care

et al. 2013

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The challenges facing patients and providers in managing ongoing opioid analgesic therapy for chronic pain are complex. Benefit of long-term opioid therapy, for which there are scant data, must be balanced against myriad potential undesired outcomes, including safety problems, ranging from mild toxicities to overdose and death; inadequate efficacy, which may mean continued patient suffering and unwarranted exposure to toxicities; and misuse of these potent medications. To help patients and providers navigate these challenges and optimize therapy, we present a research agenda in which we first characterize appropriate ongoing opioid prescribing and then describe three areas where quality improvement work is needed: 1) developing brief validated measures of patient-reported safety, efficacy, and misuse that improve outcomes; 2) designing evidence-based algorithms to guide changes in therapy when issues related to safety, efficacy or misuse are identified; and 3) promoting use of patientcentered, multi-modal treatment plans.KEY WORDS: opioid analgesics; medication safety; provider behavior; quality of care.

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Buprenorphine transdermal system in adults with chronic low back pain: A randomized, double-blind, placebo-controlled crossover study, followed by an open-label extension phase

Cited by 102 publications

References 41 publications

Immunosuppressive Effects of Opioids—Clinical Relevance

Immunosuppressive Effects of Opioids—Clinical Relevance

Occupational low back pain in nursing workers: massage versus pain

A Research Agenda for Enhancing Appropriate Opioid Prescribing in Primary Care

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