Long-term opioid management for chronic noncancer pain

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

doi:10.1002/14651858.cd006605

Cited by 261 publications

(385 citation statements)

References 18 publications

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“…Fleming et al (2007), considering 801 patients with non-cancer pain in chronic treatment with opioids, reported that 9.7% of the sample met the DSM-IV diagnostic criteria for opioid use disorder; the prevalence found by the authors was four times the prevalence in the general population. Finally, a recent review of the prolonged use of opioids in patients with non-cancer pain estimated the prevalence of addiction indicators as 0.27% of the total number of patients examined (Noble et al, 2010); the authors also observed that minor unwanted effects (e.g. nausea, headache) are frequent during treatment with opioids, but more serious adverse events, such as addiction, are rare.…”

Section: Wwwintechopencommentioning

confidence: 99%

Risk Factors in Opioid Treatment of Chronic Non-Cancer Pain: A Multidisciplinary Assessment

Ferrari¹,

Capraro²,

Visentin³

2012

Pain Management - Current Issues and Opinions

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Section: Wwwintechopencommentioning

confidence: 99%

Risk Factors in Opioid Treatment of Chronic Non-Cancer Pain: A Multidisciplinary Assessment

Ferrari¹,

Capraro²,

Visentin³

2012

Pain Management - Current Issues and Opinions

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“…Despite uncertainty regarding the long-term effectiveness of opioids for treating chronic musculoskeletal pain [35,43] and emerging evidence that preoperative opioid use is associated with greater pain, disability, and dissatisfaction after orthopaedic surgery [10,25,31,32,42,53], opioids continue to be prescribed. Although it is well established that high-risk opioid use (abuse or dependence) may result from prolonged opioid exposure during the preoperative period [57], little is known about its prevalence and effect in the perioperative orthopaedic surgery setting.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

Menendez

Ring

Bateman

2015

Clinical Orthopaedics &Amp; Related Research

308

176

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Background Many patients having discretionary orthopaedic surgery take opioids daily, either with a prescription or illicitly, however little is known regarding the prevalence and effect of high-risk opioid use (eg, abuse, dependence) in the perioperative orthopaedic setting. Questions/purposes We sought (1) to determine the prevalence of opioid abuse and dependence in patients undergoing major elective orthopaedic surgery; (2) to characterize the relationship of opioid abuse and dependence with in-hospital postoperative mortality and adverse events, failure to rescue, prolonged length of stay, and nonroutine disposition; and (3) to identify factors associated with high-risk opioid use.

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“…6,7 Chronic pain is most common in older adults, who are most at risk from adverse effects from medications, such cognitive effects of medications and drug interactions. 8 Research indicates that several non-drug treatment alternatives may be effective for CNCP.…”

Section: Introductionmentioning

confidence: 99%

Health service utilisation by people living with chronic non-cancer pain: findings from the Pain and Opioids IN Treatment (POINT) study

Nielsen¹,

Campbell²,

Peacock

et al. 2016

Aust. Health Review

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Objective. The aims of the present study were to describe the use, and barriers to the use, of non-medication pain therapies and to identify the demographic and clinical correlates of different non-opioid pain treatments.Methods. The study was performed on a cohort (n = 1514) of people prescribed pharmaceutical opioids for chronic noncancer pain (CNCP). Participants reported lifetime and past month use of healthcare services, mental and physical health, pain characteristics, current oral morphine equivalent daily doses and financial and access barriers to healthcare services.Results. Participants reported the use of non-opioid pain treatments, both before and after commencing opioid therapy. Services accessed most in the past month were complementary and alternative medicines (CAMs; 41%), physiotherapy (16%) and medical and/or pain specialists (15%). Higher opioid dose was associated with increased financial and access barriers to non-opioid treatment. Multivariate analyses indicated being younger, female and having private health insurance were the factors most commonly associated with accessing non-opioid treatments.Conclusions. Patients on long-term opioid therapy report using multiple types of pain treatments. High rates of CAM use are concerning given limited evidence of efficacy for some therapies and the low-income status of most people with CNCP. Financial and insurance barriers highlight the importance of considering how different types of treatments are paid for and subsidised.What is known about the topic? Given concerns regarding long-term efficacy, adverse side-effects and risk of misuse and dependence, prescribing guidelines recommend caution in prescribing pharmaceutical opioids in cases of CNCP, typically advising a multidisciplinary approach to treatment. There is a range of evidence supporting different (non-drug) treatment approaches for CNCP to reduce pain severity and increase functioning. However, little is known about the non-opioid treatments used among those with CNCP and the demographic and clinical characteristics that may be associated with the use HEALTH SERVICE RESEARCH of different types of treatments. Understanding the use of non-drug therapy among people with CNCP is crucial given the potential to improve pain control for these patients. What does this paper add? The present study found that a wide range of non-opioid treatments was accessed by the study sample, both before and after commencing opioids, indicating that in this sample opioids were not the sole strategy used for pain management. The most common treatment (other than opioids) was CAM, reported by two-fifths of the sample. Having private health insurance was associated with increased use of non-opioid treatments for pain, highlighting the importance of considering how treatments are paid for and potential financial barriers to effective treatments. What are the implications for practitioners? Patients' beliefs and financial barriers may affect the uptake of different treatments. Many patients may be using com...

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Long-term opioid management for chronic noncancer pain

Cited by 261 publications

References 18 publications

Risk Factors in Opioid Treatment of Chronic Non-Cancer Pain: A Multidisciplinary Assessment

Risk Factors in Opioid Treatment of Chronic Non-Cancer Pain: A Multidisciplinary Assessment

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

Health service utilisation by people living with chronic non-cancer pain: findings from the Pain and Opioids IN Treatment (POINT) study

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