Long-term opioid management for chronic noncancer pain

Noble, Meredith; Treadwell, Jonathan; Tregear, Stephen; Coates, Vivian; Wiffen, Philip J; Akafomo, Clarisse; Schoelles, Karen M; Chou, Roger

doi:10.1002/14651858.cd006605.pub2

Cited by 406 publications

(168 citation statements)

References 94 publications

Supporting

Mentioning

162

Contrasting

Unclassified

Order By: Relevance

“…23 % of patients discontinued THC/CBD spray due to AEs. By contrast, a meta-analysis of long-term opioid use for chronic non-cancer pain showed 34 % of patients discontinued strong oral opioids due to AEs [30]. No increase in intoxication was observed with long-term use of THC/CBD spray and no new significant safety issues were raised as a result of the study.…”

Section: Discussionmentioning

confidence: 84%

A multicentre, open-label, follow-on study to assess the long-term maintenance of effect, tolerance and safety of THC/CBD oromucosal spray in the management of neuropathic pain

Hoggart

Ratcliffe²,

Ehler

et al. 2014

J Neurol

View full text Add to dashboard Cite

Peripheral neuropathic pain (PNP) poses a significant clinical challenge. The long-term efficacy of delta-9-tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray was investigated in this 38-week open-label extension study. In total, 380 patients with PNP associated with diabetes or allodynia entered this study from two parent randomised, controlled trials. Patients received THC/CBD spray for a further 38 weeks in addition to their current analgesic therapy. Neuropathic pain severity was the primary efficacy measure using a pain 0-10 numerical rating scale (NRS). Additional efficacy, safety and tolerability outcomes were also investigated. In total, 234 patients completed the study (62 %). The pain NRS showed a decrease in score over time in patients from a mean of 6.9 points (baseline in the parent studies) to a mean of 4.2 points (end of open-label follow-up). The proportion of patients who reported at least a clinically relevant 30 % improvement in pain continued to increase with time (up to 9 months); at least half of all patients reported a 30 % improvement at all time points. Improvements were observed for all secondary efficacy outcomes, including sleep quality 0-10 NRS scores, neuropathic pain scale scores, subject global impression of change and EQ-5D questionnaire scores. THC/CBD spray was well tolerated for the study duration and patients did not seek to increase their dose with time, with no new safety concerns arising from long-term use. In this previously difficult to manage patient population, THC/CBD spray was beneficial for the majority of patients with PNP associated with diabetes or allodynia.

show abstract

Section: Discussionmentioning

confidence: 84%

A multicentre, open-label, follow-on study to assess the long-term maintenance of effect, tolerance and safety of THC/CBD oromucosal spray in the management of neuropathic pain

Hoggart

Ratcliffe²,

Ehler

et al. 2014

J Neurol

View full text Add to dashboard Cite

show abstract

“…Die in versorgungsnäheren unkontrollierten Studien erhobenen Schmerzlinderungen sind eher geringer [12,13,14,15,16,17,18] als in randomisierten kontrollierten Studien ermittelte Effekte.…”

Section: Wirkungsprognose Ohne Gewährunclassified

Opioidleitlinien: gestern und heute

et al. 2012

View full text Add to dashboard Cite

Guidelines on opioid therapy for patients with chronic non-tumor pain should support pain relief, prevent iatrogenic suffering, collateral health damage and legal restrictions on the availability of opioid analgesics. A total of six North American and two European committees recently developed guidelines which differ from the previous ones by being based on many more randomized controlled trials. In anticipation of lower analgesic effects than are to be expected from solely consensus-based guidelines, they recommended a more thorough control of individual therapeutic opioid trials than before. Drafting recommendations for a preferably individual efficacy prognosis is a further objective of the guidelines. This article will discuss if previous and current recommendations of opioid guidelines meet these requirements.

show abstract

“…A review of studies on patients with chronic pain found nonadherence rates ranged from 2% to 53% [40•]. A separate review found that a sizeable percentage of patients on long-term opioid therapy discontinue its use [41]. Even if they are effective, patients may discontinue opioids for a variety of reasons, including side effects, a lack of efficacy (at the prescribed level or in general), and fear of addiction [42].…”

Section: Optimizing Opioid Prescribing Practices To Increase Benefitsmentioning

confidence: 99%

Opioid Use in Primary Care: Asking the Right Questions

Lewis

Trafton²

2011

Curr Pain Headache Rep

View full text Add to dashboard Cite

Pain is one of the most common reasons that patients seek treatment from health care professionals, often their primary care providers. One tool for treating pain is opioid therapy, and opioid prescriptions have increased dramatically in recent years in the United States. This article will review recent research about opioids that is most relevant to treating chronic pain in the context of a typical primary care practice. It will focus on four key practices that providers can engage in before and during the course of opioid therapy that we believe will enhance the likelihood that opioids, when used, are an effective tool for pain management: avoiding sole reliance on opioids; using adequate opioid doses to address pain; mitigating the risk of opioid misuse by patients; and fostering collaborative relationships for treating complex patients.

show abstract

Long-term opioid management for chronic noncancer pain

Cited by 406 publications

References 94 publications

A multicentre, open-label, follow-on study to assess the long-term maintenance of effect, tolerance and safety of THC/CBD oromucosal spray in the management of neuropathic pain

A multicentre, open-label, follow-on study to assess the long-term maintenance of effect, tolerance and safety of THC/CBD oromucosal spray in the management of neuropathic pain

Opioidleitlinien: gestern und heute

Opioid Use in Primary Care: Asking the Right Questions

Contact Info

Product

Resources

About