Systematic Literature Review and Meta-Analysis of the Efficacy and Safety of Prescription Opioids, Including Abuse-Deterrent Formulations, in Non-Cancer Pain Management

Michna, Edward; Cheng, Wendy Y.; Korves, Caroline; Birnbaum, Howard G.; Andrews, Ryan M.; Zhou, Zhou; Joshi, Ashish V.; Schaaf, David; Mardekian, Jack; Sheng, Mao

doi:10.1111/pme.12233

Cited by 23 publications

(19 citation statements)

References 77 publications

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“…Headache or migraine was significantly related to fewer BMs and lower probability of sufficient laxative use. Headaches can be an adverse event of various opioid formulations and can also be sporadic in nature. Perhaps the intermittent nature of headache/migraine affected the need for consistent laxative use.…”

Section: Discussionmentioning

confidence: 99%

Opioid-Induced Constipation Among Patients with Chronic Noncancer Pain in the United States, Canada, Germany, and the United Kingdom: Laxative Use, Response, and Symptom Burden Over Time

Coyne¹,

Margolis²,

Yeomans

et al. 2015

Pain Med

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Section: Discussionmentioning

confidence: 99%

Opioid-Induced Constipation Among Patients with Chronic Noncancer Pain in the United States, Canada, Germany, and the United Kingdom: Laxative Use, Response, and Symptom Burden Over Time

Coyne¹,

Margolis²,

Yeomans

et al. 2015

Pain Med

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“…6,7 Chronic pain is most common in older adults, who are most at risk from adverse effects from medications, such cognitive effects of medications and drug interactions. 8 Research indicates that several non-drug treatment alternatives may be effective for CNCP.…”

Section: Introductionmentioning

confidence: 99%

Health service utilisation by people living with chronic non-cancer pain: findings from the Pain and Opioids IN Treatment (POINT) study

Nielsen¹,

Campbell²,

Peacock

et al. 2016

Aust. Health Review

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Objective. The aims of the present study were to describe the use, and barriers to the use, of non-medication pain therapies and to identify the demographic and clinical correlates of different non-opioid pain treatments.Methods. The study was performed on a cohort (n = 1514) of people prescribed pharmaceutical opioids for chronic noncancer pain (CNCP). Participants reported lifetime and past month use of healthcare services, mental and physical health, pain characteristics, current oral morphine equivalent daily doses and financial and access barriers to healthcare services.Results. Participants reported the use of non-opioid pain treatments, both before and after commencing opioid therapy. Services accessed most in the past month were complementary and alternative medicines (CAMs; 41%), physiotherapy (16%) and medical and/or pain specialists (15%). Higher opioid dose was associated with increased financial and access barriers to non-opioid treatment. Multivariate analyses indicated being younger, female and having private health insurance were the factors most commonly associated with accessing non-opioid treatments.Conclusions. Patients on long-term opioid therapy report using multiple types of pain treatments. High rates of CAM use are concerning given limited evidence of efficacy for some therapies and the low-income status of most people with CNCP. Financial and insurance barriers highlight the importance of considering how different types of treatments are paid for and subsidised.What is known about the topic? Given concerns regarding long-term efficacy, adverse side-effects and risk of misuse and dependence, prescribing guidelines recommend caution in prescribing pharmaceutical opioids in cases of CNCP, typically advising a multidisciplinary approach to treatment. There is a range of evidence supporting different (non-drug) treatment approaches for CNCP to reduce pain severity and increase functioning. However, little is known about the non-opioid treatments used among those with CNCP and the demographic and clinical characteristics that may be associated with the use HEALTH SERVICE RESEARCH of different types of treatments. Understanding the use of non-drug therapy among people with CNCP is crucial given the potential to improve pain control for these patients. What does this paper add? The present study found that a wide range of non-opioid treatments was accessed by the study sample, both before and after commencing opioids, indicating that in this sample opioids were not the sole strategy used for pain management. The most common treatment (other than opioids) was CAM, reported by two-fifths of the sample. Having private health insurance was associated with increased use of non-opioid treatments for pain, highlighting the importance of considering how treatments are paid for and potential financial barriers to effective treatments. What are the implications for practitioners? Patients' beliefs and financial barriers may affect the uptake of different treatments. Many patients may be using com...

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“…Tramadol, morphine and other opioids exert an antinociceptive effect through inhibition of central reuptake of noradrenaline by NET transporters as well as binding to mu-opioid receptors [ 79 ]. A randomized double-blind placebo-controlled study using tramadol confi rmed that dry mouth was associated with decreased salivary fl ow rates in 75 % of subjects [ 80 ].…”

Section: Medications With An Unintended Activation Of α2 Adrenoceptorsmentioning

confidence: 98%

Medication-Induced Dry Mouth

Proctor

2014

Dry Mouth

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A wide range of medications have been found to be associated with xerostomia, the subjective symptom of dry mouth. The assessment of medication-induced xerostomia (MIX) is usually made through a subject's responses to relevant questions or the use of visual analogue scales whereby the subject is asked to rate the severity of their oral dryness. It is uncertain how much MIX is accompanied or can be ascribed to medication-induced salivary gland hypofunction and reduced secretion of saliva. MIX in older age groups is associated with the number of medications being taken and is higher than seen in the younger subjects. Many medications cause xerostomia as a side effect, but some of these, for example, selective serotonin reuptake inhibitors, do not appear to cause salivary gland hypofunction. However, there have been relatively few studies assessing objective changes in salivary fl ow in response to medications. The salivary refl ex has peripheral and central components which can be the targets of medications, leading to interruption of the refl ex and medication-induced salivary gland dysfunction (MISGD) characterized by reduced production of saliva. The principal peripheral target is the cholinergic muscarinic (M3) receptor of salivary gland acinar cells which is blocked by antimuscarinic drugs used in the treatment of, for example, irritable bladder and chronic obstructive pulmonary disease. Tricyclic antidepressants not only have targets in the central nervous system but interact with and block muscarinic receptors in the periphery. Sympathetic nervemediated stimuli enhance salivary secretion, and there is no peripheral inhibition. Although adrenergic antagonists cause MIX, there is no evidence that they reduce salivary secretion. However, antihypertensive β-adrenoceptor blockers

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Systematic Literature Review and Meta-Analysis of the Efficacy and Safety of Prescription Opioids, Including Abuse-Deterrent Formulations, in Non-Cancer Pain Management

Abstract: ADFs and non-ADFs had comparable efficacy and safety profiles, while both were more efficacious than placebo in reducing pain intensity.

Cited by 23 publications

References 77 publications

Opioid-Induced Constipation Among Patients with Chronic Noncancer Pain in the United States, Canada, Germany, and the United Kingdom: Laxative Use, Response, and Symptom Burden Over Time

Opioid-Induced Constipation Among Patients with Chronic Noncancer Pain in the United States, Canada, Germany, and the United Kingdom: Laxative Use, Response, and Symptom Burden Over Time

Health service utilisation by people living with chronic non-cancer pain: findings from the Pain and Opioids IN Treatment (POINT) study

Medication-Induced Dry Mouth

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