Opioids and the treatment of chronic pain: Controversies, current status, and future directions.

Rosenblum, Andrew; Marsch, Lisa A.; Joseph, Herman; Portenoy, Russell K.

doi:10.1037/a0013628

Cited by 577 publications

(413 citation statements)

References 114 publications

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“…In addition, long-term administration of analgesic medications (such as opioids) involves a variety of risks [2][3][4][5]. Collectively, while opioid analgesics remain a treatment of choice for the management of cancer pain, and are widely used to treat chronic non-cancer pain [6][7][8], moderate-to long-term opioid use is potentially associated with a variety of adverse impacts [9,10]. One such outcome is a paradoxical amplification of pain sensitivity, a phenomenon termed opioid-induced hyperalgesia (OIH).…”

Section: Introductionmentioning

confidence: 99%

Changes in Pain Sensitivity and Pain Modulation During Oral Opioid Treatment: The Impact of Negative Affect

Edwards¹,

Dolman²,

Michna³

et al. 2016

Pain Med

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Objective. Opioids are frequently prescribed for chronic low back pain (CLBP), but there are broad individual differences in the benefits and risks of opioid therapy, including the development opioidinduced hyperalgesia. This study examined quantitative sensory testing (QST) data among a group of CLBP patients undergoing sustained oral opioid treatment. We investigated whether individual differences in psychological characteristics were related to opioid-induced changes in pain perception and pain modulation.Design. The six-month, open-label trial evaluated patients with low to high levels of negative affect (e.g., symptoms of distress, depression and anxiety); participants underwent QST at baseline (prior to initiating treatment) and during oral opioid treatment.Setting. A chronic pain management center.Patients. The 31 study participants had chronic discogenic back pain, with a pain intensity rating >3/10. Participants were divided into groups with high vs. low levels of Negative Affect (NA).Results. In the previously-published manuscript describing the clinical outcomes of the trial, high NA patients achieved only about half of the analgesic effect observed in the low NA group (Wasan AD, Michna E, Edwards RR, et al. Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain. Anesthesiology 2015;123:86172). The QST findings reported here suggested that tolerance to experimental (cold pressor) pain and conditioned pain modulation tended to decrease in the high NA group over the course of opioid treatment, while temporal summation of mechanical pain declined in the low NA group.Conclusions. These results reveal that while the low NA group seemed to exhibit a generally adaptive, analgesic pattern of changes during opioid management, the high NA group showed a pattern more consistent with opioid-induced hyperalgesic

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Section: Introductionmentioning

confidence: 99%

Changes in Pain Sensitivity and Pain Modulation During Oral Opioid Treatment: The Impact of Negative Affect

Edwards¹,

Dolman²,

Michna³

et al. 2016

Pain Med

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show abstract

“…The Sumerians first cultivated the opium poppy around 3400 B.C. 11 Opium use spread throughout the ancient world to every major civilization in Eurasia where it was used for a variety of medical applications including the treatment of pain. 11 In 1803, Serturner extracted morphine from opium and named the newly isolated compound after Morpheus, the Greek god of dreams.…”

Section: Opioids: a Brief Historymentioning

confidence: 99%

“…11 Opium use spread throughout the ancient world to every major civilization in Eurasia where it was used for a variety of medical applications including the treatment of pain. 11 In 1803, Serturner extracted morphine from opium and named the newly isolated compound after Morpheus, the Greek god of dreams. 11,12 Thereafter, opium use became widespread throughout the United States; indeed, it is estimated that, during the Civil War, the Union army consumed 2.8 million ounces of opium tincture or powder and about 500,000 opium pills, with a high rate of addiction among its soldiers.…”

Section: Opioids: a Brief Historymentioning

confidence: 99%

The prescription opioid epidemic: an overview for anesthesiologists

Alam

Juurlink

2015

Can J Anesth/J Can Anesth

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Purpose The objectives for preparing this article were to review the historical context and epidemiology surrounding the North American prescription opioid crisis, to summarize the evidence regarding the benefits and harms of long-term opioid therapy for non-cancer pain, and to outline ways in which anesthesiologists may help ameliorate the problem. Source We searched PubMed, Google Scholar, and EMBASE TM for relevant articles using various search terms, including pain, opioid epidemic, history of opioid use, perioperative care, and addiction. Related citations were further explored and searched depending on the specific subtopic of interest. Principal findings In the 1980s and early 1990s, opioids were infrequently used for the treatment of chronic pain. Thereafter, however, physicians were gradually inculcated with the message that long-term opioid therapy was a safe and effective treatment option for patients with chronic non-cancer pain. Pharmaceutical companies supported this growing movement and employed aggressive and sometimes misleading marketing strategies for new opioid formulations. As a result, the practice of prescribing opioids flourished in the late 1990s. The surge in prescribing opioids was accompanied by a marked increase in opioid-related morbidity and mortality. This change in practice transpired despite the absence of randomized trials showing clinically significant benefit from the long-term use of opioids. Subsequently, however, a large and growing body of evidence has emerged quantifying the harms associated with long-term opioid therapy. Anesthesiologists widely prescribe opioids for acute and chronic pain; yet, as a group, they may be largely unaware of the current state of this growing epidemic and what role they can play to rectify this problem.Conclusion Anesthesiologists are well positioned to take a leadership role in the management of postoperative discharge opioid therapy in an effort to curb the overutilization of opioids. Furthermore, anesthesiologists who regularly prescribe opioids for chronic pain patients should appreciate the limited evidence base for this practice and communicate the risks of opioid therapy to their patients.

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“…Opium, which is derived from the unripe seed capsules of the opium poppy, Papaver somniferum , has a long history; in fact, opioids have been used and abused by humans for longer than any drug aside from alcohol ( 1,2 ). Historical records indicate that opium was used in the Middle East as early as 4,000 BC.…”

Section: Introductionmentioning

confidence: 99%

Pharmacology of Opioids and their Effects on Gastrointestinal Function

Holzer¹

2014

Am J Gastroenterol Suppl

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Opioids are perhaps the most effi cacious analgesic agents available to the clinician in everyday clinical practice. While providing highly effective pain relief, the therapeutic activity of opioids is compromised by gastrointestinal adverse events related to their interaction with the opioid signaling system of the gut, a complex network of peptides and receptors with opioid-like properties that helps to coordinate gastrointestinal motility and secretion. The effects of opioids on the gut are modulated by genetic polymorphisms in opioid receptors, downstream signaling pathways, and enzymes involved in the metabolism of these opioid analgesics. Here, we focus on the physiology of endogenous opioids and their receptors with particular reference to their effects on gastrointestinal function, the pharmacology of opioid drugs, and molecular and genetic factors that drive the activity of these powerful agents.

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Opioids and the treatment of chronic pain: Controversies, current status, and future directions.

Cited by 577 publications

References 114 publications

Changes in Pain Sensitivity and Pain Modulation During Oral Opioid Treatment: The Impact of Negative Affect

Changes in Pain Sensitivity and Pain Modulation During Oral Opioid Treatment: The Impact of Negative Affect

The prescription opioid epidemic: an overview for anesthesiologists

Pharmacology of Opioids and their Effects on Gastrointestinal Function

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