Use of Ultra Rapid Opioid Detoxification in the Treatment of US Military Burn Casualties

Maani, Christopher V.; DeSocio, Peter A.; Jansen, Richard K.; Merrell, J.; McGhee, Laura L.; Young, Alan; Williams, James; Tyrell, Katie; Jackson, Bonnie A.; Serio-Melvin, Maria; Blackbourne, Lorne H.; Renz, Evan M.

doi:10.1097/ta.0b013e3182219209

Cited by 18 publications

(6 citation statements)

References 11 publications

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“…Group and peer support, as well as family involvement, were additional behavioural components of many programs [ 21 , 22 , 28 – 30 , 33 – 35 , 37 , 38 , 40 , 42 , 44 – 48 , 50 – 53 , 56 – 61 , 65 – 70 , 73 – 75 , 79 – 81 , 83 , 85 , 87 , 89 , 90 , 92 – 94 , 96 , 103 , 104 , 106 , 108 – 112 ]. One program listed “agreement to family member or significant other involvement in treatment” as one of just five treatment inclusion criteria [ 61 ], another encouraged spouses to participate weekly in the inpatient program [ 22 ], and another included group psychotherapy for all patients [ 69 , 70 ].…”

Section: Resultsmentioning

confidence: 99%

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Multidisciplinary care for opioid dose reduction in patients with chronic non-cancer pain: A systematic realist review

et al. 2020

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Context Opioid related deaths are at epidemic levels in many developed nations globally. Concerns about the contribution of prescribed opioids, and particularly high-dose opioids, continue to mount as do initiatives to reduce prescribing. Evidence around opioid tapering, which can be challenging and potentially hazardous, is not well developed. A recent national guideline has recognized this and recommended referral to multidisciplinary care for challenging cases of opioid tapering. However, multidisciplinary care for opioid tapering is not well understood or defined. Objective Identify the existing literature on any multidisciplinary care programs that evaluate impact on opioid use, synthesize how these programs work and clarify whom they benefit. Study design Systematic rapid realist review.

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Section: Resultsmentioning

confidence: 99%

“…Program duration was variable, with the shortest program running between 1 and 5 days [83], to the longest program of 14 months [42]. The modal program length was between 3 and 4 weeks (n = 22 programs) and program durations between 2-4 months were the second most common (n = 11 programs).…”

Section: Program Characteristicsmentioning

confidence: 99%

Multidisciplinary care for opioid dose reduction in patients with chronic non-cancer pain: A systematic realist review

et al. 2020

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“…There is no strong evidence from the SUD literature toward rapid or ultrarapid tapers compared with slower ones, 68 and the usefulness of faster tapers for patients receiving long-term opioid treatment in the community has been questioned. 69 A fast or ultrafast taper can be considered when inpatient taper is needed because of significant coexisting psychiatric or medical illness, such as SUD or unstable cardiac disease (recommendation GRADE C). 37,38 In the absence of validated protocols, empirical plans have been proposed (recommendation GRADE D).…”

Section: Methodsmentioning

confidence: 99%

“…68 There are case reports of patients treated with such protocols for opioid dependence in the context of pain from burns or cancer. 69,70 A masked taper during a mean of 7 days has been described as part of a residential, multidisciplinary pain treatment program. 71 To our knowledge, there is no trial that compares rapid or ultrarapid vs slower protocols in patients with CNCP.…”

Section: Methodsmentioning

confidence: 99%

Tapering Long-term Opioid Therapy in Chronic Noncancer Pain

Berna

Kulich

Rathmell

2015

Mayo Clinic Proceedings

195

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Increasing concern about the risks and limited evidence supporting the therapeutic benefit of long-term opioid therapy for chronic noncancer pain are leading prescribers to consider discontinuing the use of opioids. In addition to overt addiction or diversion, the presence of adverse effects, diminishing analgesia, reduced function and quality of life, or the absence of progress toward functional goals can justify an attempt at weaning patients from long-term opioid therapy. However, discontinuing opioid therapy is often hindered by patients' psychiatric comorbidities and poor coping skills, as well as the lack of formal guidelines for the prescribers. The aim of this article is to review the existing literature and formulate recommendations for practitioners aiming to discontinue long-term opioid therapy. Specifically, this review aims to answer the following questions: What is an optimal opioid tapering regimen? How can the risks involved in a taper be managed? What are the alternatives to an opioid taper? A PubMed literature search was conducted using the keywords chronic pain combined with opioid withdrawal, taper, wean and detoxification. Six hundred ninety-five documents were identified and screened; 117 were deemed directly relevant and are included. On the base of this literature review, this article proposes evidence-based recommendations and expert-based suggestions for clinical practice. Furthermore, areas of lack of evidence are identified, providing opportunities for further research.

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“…Preexisting addiction and patients who become narcotic dependant during burn treatment can pose a diffi cult management problem for the burn team. For these patients a referral to an outpatient detoxication program or even an inpatient rapid detoxifi cation program will be necessary [ 9 ].…”

Section: Control Of Pain and Pruritusmentioning

confidence: 99%