Novel Pharmacological Nonopioid Therapies in Chronic Pain

Kaye, Alan D.; Cornett, Elyse M.; Hart, Brendon M.; Patil, Shilpadevi; Pham, Andrew; Spalitta, Matthew J; Mancuso, Kenneth

doi:10.1007/s11916-018-0674-8

Cited by 26 publications

(12 citation statements)

References 108 publications

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“…79,80 In response to the public health crisis resulting from the current opioid epidemic, there is a surge of interest in non-opioid pharmacotherapies for chronic pain. [81][82][83] Non-opioid medications that are commonly used include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants (e.g., serotonin-norepinephrine reuptake inhibitors [SNRIs], tricyclic antidepressants [TCAs]), anticonvulsants, musculoskeletal agents, biologics, topical analgesics and anxiolytics. [83][84][85][86] Non-opioid medications can mitigate and minimize opioid exposure.…”

Section: Medicationmentioning

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

103

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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: Medicationmentioning

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

103

View full text Add to dashboard Cite

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“…Nonmedical opioid drug abuse, notably that of the prescription mu opioid receptor (MOR) agonists oxycodone and fentanyl, has reached epidemic proportions not only in the Americas, but also globally . The United States is particularly affected, with the number of both fentanyl and heroin deaths each increasing by over 500% from 2009 to 2016 and in 2017, the number of overdose deaths involving opioids was reported to be six times higher than in 1999 …”

Section: Introductionmentioning

confidence: 99%

Who is HOT and who is LOT? Detailed characterization of prescription opioid‐induced changes in behavior between 129P3/J and 129S1/SvlmJ mouse substrains

Szumlinski

Coelho

Tran

et al. 2019

Genes Brain and Behavior

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Genetic factors are theorized to contribute to the substantial inter-individual variability in opioid abuse/addiction. To advance the behavioral genetics of prescription opioid abuse, our prior work identified the 129S1/SvlmJ (S1) and related 129P3/J (P3) mouse substrains, respectively, as low and high opioid-taking. Herein, we related our prior results to measures of sucrose reward/reinforcement, basal anxiety, opioidinduced place-conditioning, locomotor activity and Straub tail reaction, as well as behavioral and physiological signs of withdrawal. Substrains were also re-examined for higher-dose oxycodone and fentanyl intake under limited-access drinking procedures. S1 mice failed to acquire sucrose self-administration under various operantconditioning procedures and exhibited lower sucrose intake in the home-cage.However, sucrose intake under limited-access procedures escalated in both substrains with repeated sucrose experience. S1 mice exhibited less spontaneous locomotor activity, as well as less opioid-induced locomotor activity and Straub tail reaction, than P3 mice and failed to exhibit an oxycodone-induced place-preference.The lack of conditioned behavior by S1 mice was unrelated to behavioral signs of withdrawal-induced negative affect or dependence severity, but might reflect high levels of basal anxiety-like behavior. Intriguingly, S1 and P3 mice initially exhibited equivalent oxycodone and fentanyl consumption in the home-cage; however opioid intake escalated only in P3 mice with repeated opioid experience. No sex differences were observed for any of our measures. These data provide additional evidence for robust differences in opioid addiction-related behaviors between P3 and S1 substrains and suggest that anxiety, learning, and/or motivational impairments might confound interpretation of operant-and place-conditioning studies employing the S1 substrain. K E Y W O R D Sdependence, fentanyl, negative affect, oxycodone, self-administration, strain differences, withdrawal

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“…Further, the more recent evidence available with multiple randomized controlled trials (RCTs), real-world evidence, and systematic reviews shows clinical and cost-effectiveness [65][66][67][68][69][70][71][72][73][74][75][76][77][78][79]. In addition to the interventional techniques, guidelines have been developed for regenerative medicine, antithrombotic usage, and sedation based on evidence-based principles [101][102][103][104][105][106].…”

Section: Pain Management Best Practicesmentioning

confidence: 99%

“…Effective pain management for chronic pain is achieved through a patient-centered, multidisciplinary approach that may include pharmacotherapy including opioid and non-opioid options [ 1 ]. However, due to the opioid epidemic and the public care crisis, there is a surge of interest in non-opioid pharmacotherapies for chronic pain, while continuing with the research to best opioid therapy [ 105 , 107 , 108 ]. Non-opioid medications that are commonly used include acetaminophen, non-steroidal anti-inflammatory (NSAIDS), antidepressants, anticonvulsants, musculoskeletal agents, biologics, topical analgesics, and anxiolytics [ 1 ].…”

Section: Best Practices For the Futurementioning

confidence: 99%

Lessons for Better Pain Management in the Future: Learning from the Past

et al. 2020

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The treatment of noncancer pain in the United States and globally is met with significant challenges, resulting in profound physical, emotional, and societal costs. Based on this need, numerous modalities have been proposed to manage chronic pain, including opioid and nonopioid interventions as well as surgical approaches. Thus, the future of pain management continues to be mired in evolving concepts and constant debates. Consequently, it is crucial to understand the past as we move towards the future. The evolution of lessons for better pain management at present and for the future starting from the 1990s to the present date are reviewed and emphasized with a focus Digital Features To view digital features for this article go to

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Novel Pharmacological Nonopioid Therapies in Chronic Pain

Cited by 26 publications

References 108 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

Who is HOT and who is LOT? Detailed characterization of prescription opioid‐induced changes in behavior between 129P3/J and 129S1/SvlmJ mouse substrains

Lessons for Better Pain Management in the Future: Learning from the Past

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