Multimodal Treatment Options, Including Rotating to Buprenorphine, Within a Multidisciplinary Pain Clinic for Patients on Risky Opioid Regimens: A Quality Improvement Study

Oldfield, Benjamin J.; Edens, Ellen L.; Agnoli, Alicia; Bone, Curtis; Cervone, Dana J; Edmond, Sara N.; Manhapra, Ajay; Sellinger, John; Becker, William C.

doi:10.1093/pm/pny086

Cited by 24 publications

(18 citation statements)

References 28 publications

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“…119 Buprenorphine, an opioid medication that the FDA has approved for clinical use, is a partial agonist at the mu opioid receptor and therefore has a reduced potential for respiratory depression; it is thus safer than full agonists such as morphine, hydrocodone, and oxycodone. 120,121 Buprenorphine also acts as an antagonist at the kappa receptor, an effect shown in experimental studies to reduce anxiety, depression, and the unpleasantness of opioid withdrawal. Buprenorphine is widely used and encouraged for treating patients with OUD and is approved for the treatment of pain.…”

Section: Behavioralmentioning

confidence: 99%

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Darnall¹,

Krishnamurthy²,

Tsuei³

et al. 2020

JMIR Form Res

104

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Background Patients with chronic pain often have limited access to comprehensive care that includes behavioral pain management strategies. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapy with analgesic efficacy for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations. Objective The primary aim of this study is to evaluate the feasibility of a self-administered VR program that included content and skills informed by evidence-based behavioral treatment for chronic pain. The secondary aim is to determine the preliminary efficacy of the VR program in terms of average pain intensity and pain-related interference with activity, stress, mood, and sleep, and its impact on pain-related cognition and self-efficacy. The tertiary aim was to conduct a randomized controlled trial (RCT) and compare the VR treatment with an audio-only treatment. This comparison isolated the immersive effects of the VR program, thereby informing potential mechanisms of effect. Methods We conducted an RCT involving a web-based convenience sample of adults (N=97) aged 18-75 years with self-reported chronic nonmalignant low back pain or fibromyalgia, with an average pain intensity >4 over the past month and chronic pain duration >6 months. Enrolled participants were randomly assigned to 1 of 2 unblinded treatments: (1) VR: a 21-day, skills-based VR program for chronic pain; and (2) audio: an audio-only version of the 21-day VR program. The analytic data set included participants who completed at least 1 of 8 surveys administered during the intervention period: VR (n=39) and audio (n=35). Results The VR and audio groups launched a total of 1067 and 1048 sessions, respectively. The majority of VR participants (n=19/25, 76%) reported no nausea or motion sickness. High satisfaction ratings were reported for VR (n=24/29, 83%) and audio (n=26/33, 72%). For VR efficacy, symptom improvement over time was found for each pain variable (all P<.001), with results strengthening after 2 weeks. Importantly, significant time×group effects were found in favor of the VR group for average pain intensity (P=.04), pain-related inference with activity (P=.005), sleep (P<.001), mood (P<.001), and stress (P=.003). For pain catastrophizing and pain self-efficacy, we found a significant declining trend for both treatment groups. Conclusions High engagement and satisfaction combined with low levels of adverse effects support the feasibility and acceptability of at-home skills-based VR for chronic pain. A significant reduction in pain outcomes over the course of the 21-day treatment both within the VR group and compared with an audio-only version suggests that VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain.

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Section: Behavioralmentioning

confidence: 99%

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Darnall¹,

Krishnamurthy²,

Tsuei³

et al. 2020

JMIR Form Res

104

View full text Add to dashboard Cite

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“…9,11 There is evidence that buprenorphine can provide analgesia for chronic pain 16 including sublingual buprenorphine/naloxone preparations approved for OUD treatment. 11,[17][18][19][20] However, conclusive evidence regarding the effectiveness and safety of sublingual buprenorphine/naloxone for CPOD and chronic pain awaits prospective randomized trials. These trials will also need to determine the effective buprenorphine dose, frequency of dosing, and treatment length for treating CPOD.…”

Section: Buprenorphine Treatmentmentioning

confidence: 99%

“…More detailed discussion regarding the current methods of buprenorphine utilization in CPOD is beyond the scope of this article and is provided elsewhere. 11,20 Methadone, an effective OUD treatment, has also been used in clinical situations suggestive of CPOD with reasonable effectiveness, 19,22 but the higher burden of dependence that may worsen pain and elevated opioid risk associated with methadone makes buprenorphine a more appealing choice. 11,19 There is little evidence or clinical experience with naltrexone, another medication used in OUD treatment, but its antagonism of the mu receptor suggests disutility in pain treatment.…”

Section: Buprenorphine Treatmentmentioning

confidence: 99%

Complex Persistent Opioid Dependence with Long-term Opioids: a Gray Area That Needs Definition, Better Understanding, Treatment Guidance, and Policy Changes

et al. 2020

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“…69 There are encouraging preliminary data supporting buprenorphine rotation in patients on LTOT who wish to reduce their opioid-related risk or who are experiencing poor pain control and declining function. 70 Note that when one is prescribing buprenorphine for patients with OUD, an X waiver added to a clinician's Drug Enforcement Administration license is required. The Health and Human Services released new buprenorphine practice guidelines, effective April 27, 2021, that allow Drug Enforcement Administration-licensed clinicians to submit a notice of intent to apply for an X waiver to treat up to 30 patients with OUD without completing the additional educational training or attesting to the ability to refer for counseling.…”

Section: Make a Diagnosis Of Oud And Offer Treatmentmentioning

confidence: 99%

Approaches to opioid prescribing in cancer survivors: Lessons learned from the general literature

Jones

Merlin

2021

Cancer

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Multimodal Treatment Options, Including Rotating to Buprenorphine, Within a Multidisciplinary Pain Clinic for Patients on Risky Opioid Regimens: A Quality Improvement Study

Abstract: Results suggest the ORC was effective in reducing total prescribed opioid doses and in transitioning patients to partial-agonist therapy, but PCP adoption strategies are needed.

Cited by 24 publications

References 28 publications

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Complex Persistent Opioid Dependence with Long-term Opioids: a Gray Area That Needs Definition, Better Understanding, Treatment Guidance, and Policy Changes

Approaches to opioid prescribing in cancer survivors: Lessons learned from the general literature

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