Opioids for Chronic Noncancer Pain: Prediction and Identification of Aberrant Drug-Related Behaviors: A Review of the Evidence for an American Pain Society and American Academy of Pain Medicine Clinical Practice Guideline

Chou, Roger; Fanciullo, Gilbert J.; Fine, Perry G.; Miaskowski, Christine; Passik, Steven D.; Portenoy, Russell K.

doi:10.1016/j.jpain.2008.10.009

Cited by 330 publications

(271 citation statements)

References 61 publications

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“…In addition, there was a high incidence of alterations in patients' personality profiles: over half of the women and approximately one third of the men reported high scores in at least one of the clinical content scales of the MMPI-2. This result too seems coherent with the reports in the literature, that the presence of psychiatric and personality disorders is more frequent in these patients (Banta-Green et al, 2009a;Haller & Acosta;, and therefore it is advisable to involve a psychotherapist or psychiatrist in the treatment process (Chou, 2009;Chou et al, 2009a;Chou et al, 2009b;Chou et al, 2009c;Trescot et al, 2006;Trescot at al., 2008). The analyses carried out to date have shown that only one patient in twenty five did not test positive to the prescribed drug; and no patients tested positive for illegal substances in the urine toxicology screening.…”

Section: Discussionsupporting

confidence: 87%

“…The clear and urgent need to answer these questions is reflected in the considerable increase in studies on this topic in the last decade (Ballantyne & Shin, 2008). Moreover, many guidelines for the use of opioids in patients with chronic noncancer pain have been produced, which recommend their use for those patients who have not benefited from other pharmacological and non-pharmacological treatments (Chou, 2009;Chou et al, 2009a;Chou et al, 2009b;Chou et al, 2009c;Kalso et al, 2003;Trescot et al, 2006;Trescot at al., 2008). The following section will provide some notes on pain, on the recommendations contained in the guidelines for the prolonged use of opioids and on the terminology used.…”

Section: Risk Factors In Opioid Treatment Of Patients With Chronic Pamentioning

confidence: 99%

“…These guidelines should be applied flexibly: every physician must establish a treatment plan that takes account of the specific medical conditions of the patient and his personal preferences and needs, and of the physician's own professional experience (Trescot et al, 2006;. Based on a systematic review of the efficacy of treatment with opioids in chronic non-cancer pain by a multidisciplinary group of experts, the American Academy of Pain Medicine formulated a series of recommendations for: patient selection and the stratification of risk of www.intechopen.com abuse, informed consent to treatment with opioids, initiation and titration of chronic opioid therapy, the use of methadone, patient monitoring, the use of opioids in high risk patients, the assessment of the effectiveness of the drug and the aberrant drug-related behaviours, dose escalation and high dose therapy, opioid rotation, indications for discontinuation of therapy, prevention and management of opioid-related side effects and issues about driving and work safety during treatment with such drugs (Chou, 2009;Chou et al, 2009a;Chou et al, 2009b;Chou et al, 2009c). The recommendations of the American Pain Society and the American Academy of Pain Medicine are shown in table 1.…”

Section: Opioid Treatment Of Chronic Non-cancer Painmentioning

confidence: 99%

“…Guidelines suggest that the use of opioids in patients with chronic non-cancer pain must be preceded by an initial stratification of the risk of drug misuse; this evaluation should include even a psychological and psychiatric assessment (Chou, 2009;Chou et al, 2009a;Chou et al, 2009b;Chou et al, 2009c;Kalso et al, 2003;Trescot et al, 2006;Trescot at al., 2008). In recent years, many tools have been developed and examined for this purpose; most investigate the presence of a family and/or personal history of addiction and other factors correlated with opioid misuse, such as age, history of childhood sexual abuse and the presence of mental distress.…”

Section: Tools To Assess the Risk Of Addiction And Dependencementioning

confidence: 99%

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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: Discussionsupporting

confidence: 87%

Section: Risk Factors In Opioid Treatment Of Patients With Chronic Pamentioning

confidence: 99%

Section: Opioid Treatment Of Chronic Non-cancer Painmentioning

confidence: 99%

Section: Tools To Assess the Risk Of Addiction And Dependencementioning

confidence: 99%

See 2 more Smart Citations

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

Ferrari¹,

Capraro²,

Visentin³

2012

Pain Management - Current Issues and Opinions

View full text Add to dashboard Cite

“…Systematic reviews have noted the paucity (especially in primary care settings) and poor quality of studies of clinical outcomes associated with UDTs for COT patients. 2,[49][50][51] Clearly, more research is needed concerning the impact of UDTs on patient and public health safety and the cost-effectiveness of specific UDT guidelines in various settings. Different patient population scenarios may need different guidelines.…”

mentioning

confidence: 99%

Chronic Opioid Therapy Urine Drug Testing in Primary Care: Prevalence and Predictors of Aberrant Results

et al. 2014

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BACKGROUND: Urine drug tests (UDTs) are recommended for patients on chronic opioid therapy (COT). Knowledge of the risk factors for aberrant UDT results could help optimize their use. OBJECTIVE: To identify primary care COT patient and opioid regimen characteristics associated with aberrant UDT results. DESIGN: Population-based observational. SAMPLE: 5,420 UDTs for Group Health integrated group practice COT patients. MEASURES: Group Health database measures of patient demographics, medical history, COT characteristics, and UDT results. RESULTS: Thirty percent of UDTs had aberrant results, including prescribed opioid non-detection (12.3 %), tetrahydrocannabinol (THC; 11.2 %), non-prescribed opioid (5.3 %), illicit drug (excluding THC; 0.6 %), nonprescribed benzodiazepine (1.7 %), and dilute (4.8 %). Adjusted odds ratios (95 % CI) of any aberrant result were higher for males than females CONCLUSIONS: In this primary care setting, results were aberrant for 30 % of UDTs of COT patients, largely because of prescribed opioid non-detection and THC. Aberrant results of almost all types were more likely among patients under the age of 45. Other risk factors varied across aberrancies, but commonly included current smoking and prior substance use disorder diagnosis.KEY WORDS: urine drug test; chronic opioid therapy; chronic pain; marijuana.

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Chronic Use of Opioid Medications Before and After Bariatric Surgery

Raebel

Newcomer

Reifler

et al. 2013

JAMA

213

158

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IMPORTANCE Obesity is associated with chronic noncancer pain. It is not known if opioid use for chronic pain in obese individuals undergoing bariatric surgery is reduced.OBJECTIVES To determine opioid use following bariatric surgery in patients using opioids chronically for pain control prior to their surgery and to determine the effect of preoperative depression, chronic pain, or postoperative changes in body mass index (BMI) on changes in postoperative chronic opioid use. DESIGN, SETTING, AND PARTICIPANTSRetrospective cohort study in a distributed health network (10 demographically and geographically varied US health care systems) of 11 719 individuals aged 21 years and older, who had undergone bariatric surgery between 2005 and 2009, and were assessed 1 year before and after surgery, with latest follow-up by December 31, 2010.MAIN OUTCOMES AND MEASURES Opioid use, measured as morphine equivalents 1 year before and 1 year after surgery, excluding the first 30 postoperative days. Chronic opioid use is defined as 10 or more opioid dispensings over 90 or more days or as dispensings of at least a 120-day supply of opioids during the year prior to surgery. RESULTS Before surgery, 8% (95% CI, 7%-8%; n = 933) of bariatric patients were chronic opioid users. Of these individuals, 77% (95% CI, 75%-80%; n = 723) continued chronic opioid use in the year following surgery. Mean daily morphine equivalents for the 933 bariatric patients who were chronic opioid users before surgery were 45.0 mg (95% CI, 40.0-50.1) preoperatively and 51.9 mg (95% CI, 46.0-57.8) postoperatively (P < .001). For this group with chronic opiate use prior to surgery, change in morphine equivalents before vs after surgery did not differ between individuals with loss of more than 50% excess BMI vs those with 50% or less (>50% BMI loss: adjusted incidence rate ratio [adjusted IRR, 1.17; 95% CI, 1.07-1.28] vs Յ50% BMI loss [adjusted IRR, 1.03; 95% CI, 0.93-1.14] model interaction, P = .06). In other subgroup analyses of preoperative chronic opioid users, changes in morphine equivalents before vs after surgery did not differ between those with or without preoperative diagnosis of depression or chronic pain (depression only [n = 75; IRR, 1.08; 95% CI, 0.90-1.30]; chronic pain only [n = 440; IRR, 1.17; 95% CI, 1.08-1.27]; both depression and chronic pain [n = 226; IRR, 1.11; 95% CI, 0.96-1.28]; neither depression nor chronic pain [n = 192; IRR, 1.22; 95% CI, 0.98-1.51); and P values for model interactions when compared with neither were P = .42 for depression, P = .76 for pain, and P = .48 for both. CONCLUSIONS AND RELEVANCEIn this cohort of patients who underwent bariatric surgery, 77% of patients who were chronic opioid users before surgery continued chronic opioid use in the year following surgery, and the amount of chronic opioid use was greater postoperatively than preoperatively. These findings suggest the need for better pain management in these patients following surgery.

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Opioids for Chronic Noncancer Pain: Prediction and Identification of Aberrant Drug-Related Behaviors: A Review of the Evidence for an American Pain Society and American Academy of Pain Medicine Clinical Practice Guideline

Cited by 330 publications

References 61 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

Chronic Opioid Therapy Urine Drug Testing in Primary Care: Prevalence and Predictors of Aberrant Results

Chronic Use of Opioid Medications Before and After Bariatric Surgery

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