Opioid Cessation and Multidimensional Outcomes After Interdisciplinary Chronic Pain Treatment

Murphy, Jennifer L.; Clark, Michael E.; Banou, Evangelia

doi:10.1097/ajp.0b013e3182579935

Cited by 68 publications

(54 citation statements)

References 36 publications

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“…Although back pain was the most common primary pain location (33%), it was less frequent than typically observed in other VA or community chronic pain samples [43][44]. Headaches were present in 59 percent of participants.…”

Section: Pain Complaintsmentioning

confidence: 85%

Pain and psychiatric comorbidities among two groups of Iraq and Afghanistan era Veterans

et al. 2016

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Abstract-This study aimed to (1) identify the prevalence and severity of pain and psychiatric comorbidities among personnel who had been deployed during Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND) and (2) assess whether the Department of Veterans Affairs (VA) Polytrauma System of Care and an OIF/OEF/OND registry reflect real differences among patients. Participants (N = 359) were recruited from two VA hospitals. They completed a clinical interview, structured diagnostic interview, and selfreport measures. Results indicated pain was the most common complaint, with 87% experiencing pain during the prior week and 56% reporting moderate or severe pain. Eighty percent of participants met criteria for at least one of seven assessed comorbid problems (moderate or severe pain, postconcussional disorder, posttraumatic stress disorder [PTSD], anxiety disorder, mood disorder, substance use disorder, psychosis), and 59 percent met criteria for two or more problems. PTSD and postconcussional disorder rarely occurred in the absence of pain or other comorbidities (0.3% and 0%, respectively). The Polytrauma group had more comorbid psychiatric conditions ( χ 2 = 48.67, p < 0.05) and reported greater severity of symptoms (p < 0.05) than the Registry group. This study confirmed the high prevalence of pain and concurrent mental health problems among personnel returning from military deployment.

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Section: Pain Complaintsmentioning

confidence: 85%

Pain and psychiatric comorbidities among two groups of Iraq and Afghanistan era Veterans

et al. 2016

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“…69,70 A masked taper during a mean of 7 days has been described as part of a residential, multidisciplinary pain treatment program. 71 To our knowledge, there is no trial that compares rapid or ultrarapid vs slower protocols in patients with CNCP.…”

Section: Methodsmentioning

confidence: 99%

“…85,86 Interdisciplinary programs for chronic pain (ie, a combination of physical therapy, CBT, pain management, and occupational therapy) 87 often include tapering as a mandatory or optional part of the program. The active treatment phases span approximately 1 month, on an inpatient 40,71 or outpatient basis, such as the Mayo Clinic Pain Rehabilitation program. [42][43][44]46,72,73 A recent systematic review of the body of literature studying CBT and interdisciplinary programs for patients with CNCP tapering from long-term opioid treatment pointed out its limitations 88 : only 2 studies are randomized clinical trials, both with small sample sizes or methodological issues.…”

Section: Risk Management and Taper Supportmentioning

confidence: 99%

“…One program reports 78% abstinence at 6 month follow-up 42 and another one the same percentage at 12 months. 55 Studies of interdisciplinary programs found no differences in improvement in matters of psychological functioning, physical activity, or return to work between patients with and without opioids before the treatment, 42,71,73 even if these medications were not tapered. 92 This literature can be interpreted in favor of opioid tapering (patients improve after the program, despite less medication) or against it (patients improve despite continuing to take opioids).…”

Section: Risk Management and Taper Supportmentioning

confidence: 99%

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Tapering Long-term Opioid Therapy in Chronic Noncancer Pain

Berna

Kulich

Rathmell

2015

Mayo Clinic Proceedings

195

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Increasing concern about the risks and limited evidence supporting the therapeutic benefit of long-term opioid therapy for chronic noncancer pain are leading prescribers to consider discontinuing the use of opioids. In addition to overt addiction or diversion, the presence of adverse effects, diminishing analgesia, reduced function and quality of life, or the absence of progress toward functional goals can justify an attempt at weaning patients from long-term opioid therapy. However, discontinuing opioid therapy is often hindered by patients' psychiatric comorbidities and poor coping skills, as well as the lack of formal guidelines for the prescribers. The aim of this article is to review the existing literature and formulate recommendations for practitioners aiming to discontinue long-term opioid therapy. Specifically, this review aims to answer the following questions: What is an optimal opioid tapering regimen? How can the risks involved in a taper be managed? What are the alternatives to an opioid taper? A PubMed literature search was conducted using the keywords chronic pain combined with opioid withdrawal, taper, wean and detoxification. Six hundred ninety-five documents were identified and screened; 117 were deemed directly relevant and are included. On the base of this literature review, this article proposes evidence-based recommendations and expert-based suggestions for clinical practice. Furthermore, areas of lack of evidence are identified, providing opportunities for further research.

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“…The Samsung Oculus Gear VR headset has also been utilized in previous research for acute pain management among hospitalized patients [20]. The Samsung Oculus Gear VR offers advantages over higher-end of the program, see Murphy et al [56,57]. This inpatient environment was chosen in part to reduce risk for adverse outcomes associated with VR use in this population (e.g., balance issues).…”

Section: Intensitymentioning

confidence: 99%

Virtual Reality as a Therapy Adjunct for Fear of Movement in Veterans With Chronic Pain: Single-Arm Feasibility Study (Preprint)

Fowler¹,

Ballistrea²,

Mazzone³

et al. 2018

Preprint

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Opioid Cessation and Multidimensional Outcomes After Interdisciplinary Chronic Pain Treatment

Cited by 68 publications

References 36 publications

Pain and psychiatric comorbidities among two groups of Iraq and Afghanistan era Veterans

Pain and psychiatric comorbidities among two groups of Iraq and Afghanistan era Veterans

Tapering Long-term Opioid Therapy in Chronic Noncancer Pain

Virtual Reality as a Therapy Adjunct for Fear of Movement in Veterans With Chronic Pain: Single-Arm Feasibility Study (Preprint)

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