Use of strong opioids for chronic non-cancer pain: a retrospective analysis at a pain centre in Singapore

Abstract

INTRODUCTIONThe use of opioids in chronic non-cancer pain (CNCP) is controversial, as it presents both benefits and risks. There is currently no available data on the incidence, prescription pattern, functional outcomes and adverse effects of opioids in patients with CNCP in Singapore. This study aimed to address the aforementioned deficit. METHODSAll records of patients who were prescribed strong opioids (for > 3 months per year) for the management of CNCP over a two-year period were retrospectively analysed. Factors including type of opioid, indications for opioid prescription, uncontrolled side effects, functional status, coexisting psychological issues and suspicion of aberrant drug-seeking behaviour were studied. RESUlTSOut of the 1,389 new patients who visited the centre, 42 (3.0%) with CNCP received strong opioids for more than three months a year. The most commonly prescribed opioid was methadone (42.9%). The principal diagnosis for opioid prescription was spinal pain (38.1%). Ten patients had severe side effects. 15 patients saw improvement in activities of daily living scores. Although ten patients returned to work, one stopped following the commencement of opioids. Aberrancy was seen in 5 (11.9%) patients, while 19 (45.2%) had psychological issues and 10 (23.8%) required psychiatric co-management.CONClUSION Opioids are not a panacea for chronic pain. Therefore, functional outcomes should be considered more important end points than mere reductions in pain scores. A multidisciplinary team approach is essential for the effective management of patients with CNCP who are on opioids.

Correlates of Non-Medical Prescription Drug Misuse Among a Treatment-Seeking Population: A Comparison with Illicit Drug Users

“…Offences involving PDs (e.g., nimetazapam) also face similar legal consequences as illegal drugs. A study conducted locally among those with chronic non-cancer pain has indicated methadone (45.2%), morphine (38.1%), oxycodone (23.8%) and fentanyl (9.5%) being the most prescribed pain medications [ 21 ]. Prescription opioids such as buprenorphine are highly discouraged in Singapore following a rapid increase in buprenorphine-related deaths in 2006 [ 22 ].…”

Cultural Differences in Chronic Pain: A Brief Review

“…33 In Singapore, one study reported that 3% of chronic pain patients received strong opioids for at least three months. 34 The study noted several key findings. First, improved function was demonstrated in 61.9% of the patients.…”

“…Third, 11.6% of this group ultimately demonstrated aberrancy. 34 In a similar study out of Japan, physicians reported that strong opioids showed clinical effectiveness in 77.3% of patients, opioid therapeutic goals were reached in 64.5% of patients, and 0.6% of patients experienced drug dependence. 35 In both studies, strong opioids were used on patients that were not responsive to other treatments.…”

“…29,33,38 Positive outcomes with opioid use were reported in studies that focused on improvement of functional status, activities of daily living, and stress management, but were not reported in the context of pain intensity or pain scores. 34,35 These results were found only in Singapore and Japan, two developed countries that used opioids in conjunction with traditional medicine. 34,35 Traditional medicine has been found to produce a beneficial impact on the emotional and physical components of pain.…”

“…34,35 These results were found only in Singapore and Japan, two developed countries that used opioids in conjunction with traditional medicine. 34,35 Traditional medicine has been found to produce a beneficial impact on the emotional and physical components of pain. Perhaps the increased use of traditional medicine in Western countries is due to the complexity of chronic pain management, and to the fact that traditional techniques have been found to improve function, to assist with pain coping, and to reduce distress and disability.…”