Opioids in chronic noncancer pain

Manchikanti, Laxmaiah; Benyamin, Ramsin; Datta, Sukdeb; Vallejo, Ricardo; Smith, Howard S.

doi:10.1586/ern.10.37

Cited by 48 publications

(76 citation statements)

References 139 publications

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“…However, if some patients benefit from such treatment in terms of reduction of pain and improvement in quality of life (Dillie et al, 2008), others do not (Ballantyne, 2007;Trescot et al, 2008). Side effects, the absence of any improvement in physical function, the excessive use of opioids, abuse and addiction are common problems that may present during the administration of opioid analgesics (Manchikanti et al, 2010). So in recent years experts and researchers have sought to answer many questions regarding risk factor for opioid misuse, selection of patients, efficacy of treatment particularly over time, whether opioids are able to improve physical function and quality of life.…”

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

confidence: 99%

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: Risk Factors In Opioid Treatment Of Patients With Chronic Pamentioning

confidence: 99%

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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“…[2][3][4] Despite limited evidence of effectiveness, use of opioids for nonmalignant chronic pain has increased dramatically. 5,6 Among patients served by the Veterans Health Administration (VHA), the annual prevalence of opioid prescribing is reported to have increased from 18.9% in fiscal year (FY) 2004 to 33.4% in FY2012 in less than a decade. 7 Expert guidelines recommend that chronic opioid therapy should be reserved for those suffering from intractable chronic pain not adequately managed with more conservative approaches (ie, cognitive and behavioural methods or rehabilitation) or interventional methods.…”

Section: Introductionmentioning

confidence: 99%

Opioid medication use in patients with gastrointestinal diagnoses vs unexplained gastrointestinal symptoms in the US Veterans Health Administration

Sayuk

Kanuri

Gyawali

et al. 2018

Aliment Pharmacol Ther

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SummaryBackgroundWhile opioid prescriptions have increased alarmingly in the United States (US), their use for unexplained chronic gastrointestinal (GI) pain (eg, irritable bowel syndrome) carries an especially high risk for adverse effects and questionable benefit.AimTo compare opioid use among US veterans with structural GI diagnoses (SGID) and those with unexplained GI symptoms or functional GI diagnoses (FGID), a group for whom opioids have no accepted role.MethodsVeterans Health Administration (VHA) administrative data from fiscal year 2012 were used to identify veterans with diagnostic codes recorded for SGID and FGID. This cohort study examined VHA pharmacy data to compare groups receiving ≥ 1 opioid prescription during the year and number of prescriptions filled. Bivariate and multiple logistic regression analyses adjusted for potential confounding factors (demographics, medical diagnoses, social factors) and identified potential mediators (service use, psychiatric comorbidity) of opioid use in these groups.ResultsA greater proportion of veterans with FGID received an opioid prescription during fiscal year 2012 (36.0% of 272 431) compared to only 28.9% of 1 223 744 in the SGID group (Relative Risk [RR] = 1.25). In multivariate logistic regression, personality disorders and drug abuse (OR 1.23 for each group), recent homelessness (OR 1.22), psychotropic medication fills (OR 1.55) and emergency department encounters (OR 1.21) were independently associated with opioid prescription use.ConclusionsDespite the potential for adverse consequences, opioids more often are prescribed for veterans with chronic, unexplained GI symptoms compared to those with structural diagnoses. Psychiatric comorbidities and frequent healthcare encounters mediate some of the opioid use risk.

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“…From 1997 to 2006 there was a 327% increase in therapeutic opioid use. 1 Several recent studies have confirmed that primary care physicians feel unprepared and uncomfortable managing CNMP, 4,9,[17][18][19][20] especially with regard to the management of chronic opioids. 11,15,20,21 There are fewer data describing PCPs' actual prescription of opioids for CNMP.…”

mentioning

confidence: 99%

“…10,11 For many providers, decisions about the use and management of chronic opioids remain one of the most difficult aspects of caring for patients with CNMP. 12 Use of opioids to treat CNMP is complicated because there is limited evidence for their longterm effectiveness in reducing pain or increasing quality of life in patients with chronic pain, 1 while increasing reports of overdoses and deaths 13 have led to controversies about opioids' usefulness and safety. 1,14 -16 Despite this, opioids have become an increasingly common way to treat CNMP.…”

mentioning

confidence: 99%

Care for Patients with Chronic Nonmalignant Pain with and without Chronic Opioid Prescriptions: A Report from the Cincinnati Area Research Group (CARinG) Network

Elder

Simmons

Regan

et al. 2012

The Journal of the American Board of Family Medicine

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Background: The use of chronic opioids for patients with chronic nonmalignant pain (CNMP) is a common problem for family physicians, yet little is known about the management of CNMP in family medicine offices.Methods: Twenty one physicians at 8 practices of the Cincinnati Area Research Group (CARinG) network completed 25 to 30 modified Primary Care Network Survey 2 surveys. Each survey contained the question, "To your knowledge, does this patient have chronic (>3 months) pain, even if they are not being seen for pain today?" Chart reviews of all patients identified as having chronic pain were performed to examine assessment, management, and monitoring of chronic opioids. Ten of these physicians and 10 office nurses or medical assistants were interviewed about caring for patients with chronic pain.Results: Primary Care Network Survey 2 questionnaires were completed for 533 patients, 138 (26%) of which had CNMP, and 65 (47%) of those were taking chronic opioids; 25% of patients taking chronic opioids had a urine drug screen and 22% had an opioid contract in the chart. Patients with CNMP who were taking chronic opioids were more likely to be younger (54 vs 59 years; P ‫؍‬ .003), have a coexisting mental health diagnosis (69% vs 44%; P ‫؍‬ .005), and have assessments for pain (P ‫؍‬ .031), function (P ‫؍‬ .003), and psychological distress (P < .001) and a second opinion (P ‫؍‬ .001) in the chart than did patients with CNMP who were not taking opioids. Physicians described suspicion of patients as a primary difficulty in prescribing or considering chronic opioids; they also expressed interest in practicing evidence-based CNMP care, but there was little teamwork between physicians and medical assistants caring for patients with CNMP who were taking chronic opioids.Conclusions: Chronic opioids are frequently prescribed to patients with CNMP. Although patients taking opioids have better documentation of pain assessments and management, care for all patients with CNMP fell short of evidence-based guidelines and was primarily performed by the physician alone.

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Opioids in chronic noncancer pain

Cited by 48 publications

References 139 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

Opioid medication use in patients with gastrointestinal diagnoses vs unexplained gastrointestinal symptoms in the US Veterans Health Administration

Care for Patients with Chronic Nonmalignant Pain with and without Chronic Opioid Prescriptions: A Report from the Cincinnati Area Research Group (CARinG) Network

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