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Kim MJ, Kim JY, Lim YH, Hong SJ, Jeong JH, Choi HR, Park SK, Kim JE, Lee MK, Kim JH. Actual situation and prescribing patterns of opioids by pain physicians in South Korea. Korean J Pain 2022; 35:475-487. [PMID: 36175347 PMCID: PMC9530690 DOI: 10.3344/kjp.2022.35.4.475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/10/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background Use of opioids for chronic intractable pain is increasing globally, and their proper use can improve patients’ quality of life. In contrast, opioid use disorders, such as abuse or addiction, caused by prescribing opioids, are a worldwide issue. This study aimed to understand current opioid prescribing patterns and pain physicians’ experiences with opioid use in South Korea. Methods Pain physicians in 42 university hospitals in South Korea were asked to complete anonymous questionnaires regarding opioid prescriptions. Results A total of 69 surveys were completed. Most pain physicians started prescribing opioids at a pain score of 7/10 and aimed to reduce pain by 50%. Most physicians (73.1%) actively explained the prescribed medications and possible side effects, and 61.2% of physicians preferred the prescription interval of 4 weeks. Immediate-release opioids were the most popular treatment for breakthrough pain (92.6%). The most common side effect encountered by physicians was constipation (43.3%), followed by nausea/vomiting (34.3%). Of the physicians, 56.5% replied that addiction and misuse prevalences were less than 5%. However, the most concerning side effect was addiction (33.0%). Conclusions The survey results showed that the prescribing patterns of pain physicians generally followed Korean guidelines. Physicians were most interested in the safety and effectiveness of opioid prescriptions. They were most concerned about respiratory depression and abuse or addiction. A significant number of physicians agreed that the NHIS regulations needed improvement for patient convenience and safe and effective treatment, though there were pros and cons of the NHIS restrictions on prescription conditions.
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Affiliation(s)
- Min Jung Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Ji Yeon Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Yun Hee Lim
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Sung Jun Hong
- Department of Anesthesiology and Pain Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Jae Hun Jeong
- Department of Anesthesiology and Pain Medicine, Jeong-clinic, Seoul, Korea
| | - Hey Ran Choi
- Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Sun Kyung Park
- Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Jung Eun Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Min Ki Lee
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Clinical impact of a personalized pharmaceutical plan on opioid management in non-cancer pain: a pilot study. Clin Rheumatol 2021; 40:4659-4663. [PMID: 34032934 DOI: 10.1007/s10067-021-05776-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/01/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Non-cancer pain of the locomotor apparatus is the main symptom justifying referral to a rheumatologist with potential introduction of opioids, leading to addiction if misused. The objective was to evaluate the impact of a personalized pharmaceutical plan on patients' knowledge of their opioid treatment and its duration. This prospective non-randomized pilot study was conducted during 7 months with standardized data collected in a French rheumatology department. Patients with rheumatic diseases and non-cancer pain requiring opioid treatment were included. The intervention group had a 30-min opioid-targeted pharmaceutical interview and received a full medication plan and the control group received usual care. A total of 17 patients were included in the intervention group and 18 in the control group. Among patients in the intervention group, only 6 (35%) knew that immediate-release opioids have a rapid and short action, 9 (53%) were worried about taking opioids, and 13 (76%) reported that they would refer to the information document provided if side effects occurred. A trend toward a shorter duration of treatment was observed in the study group (HR = 1.87, 95% CI 0.93 to 3.76, p = 0.08), but this trend was attenuated when adjusting on hospital duration (HR = 1.53, 95% CI 0.74 to 3.15, p = 0.25). This pilot study provides preliminary evidence on the role of the clinical pharmacist in the management of non-cancer pain with strong opioids. Clinical benefits will be assessed in a randomized study. Key Points • Knowledge of opioids is insufficient in rheumatology patients with non-cancer pain. • Pharmaceutical interviews may improve patients' knowledge of opioids.
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De Sola H, Dueñas M, Salazar A, Ortega-Jiménez P, Failde I. Prevalence of Therapeutic use of Opioids in Chronic non-Cancer Pain Patients and Associated Factors: A Systematic Review and Meta-Analysis. Front Pharmacol 2020; 11:564412. [PMID: 33364942 PMCID: PMC7750787 DOI: 10.3389/fphar.2020.564412] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/16/2020] [Indexed: 02/01/2023] Open
Abstract
Objectives: To determine the prevalence and factors associated with the use of opioids among patients with chronic non-cancer pain (CNCP). Methods: A systematic review and meta-analysis. Comprehensive literature searches in Medline-PubMed, Embase and SCOPUS databases. Original studies published between 2009 and 2019 with a cross-sectional design were included. The quality of the studies was assessed with Critical Appraisal Checklist for Studies Reporting Prevalence Data from the Joanna Briggs Institute. Protocol registered in the International Prospective Register of Systematic Reviews with reference number: CRD42019137990. Results: Out of the 1,310 potential studies found, 25 studies fulfilled the inclusion criteria. Most of the studies were of high quality. High levels of heterogeneity were found in the studies included. In the general population, the prevalence of long-term opioid use was 2.3% (95% CI: 1.5–3.6%), the prevalence of short-term opioid use was 8.1% (95% CI: 5.6–11.6%), and among people with chronic low back pain it was 5.8% (95% CI: 0.5–45.5%). The prevalence of opioid use among patients from the health records or medical surveys was 41% (95% CI: 23.3–61.3%). Finally, in patients with musculoskeletal pain, the prevalence was 20.5% (95% CI: 12.9–30.9%) and in patients with fibromyalgia, 24.5% (95% CI: 22.9–26.2%). A higher prevalence of opioid use was observed among men, younger people, patients receiving prescriptions of different types of drugs, smokers and patients without insurance or with noncommercial insurance. In addition, non-white and Asian patients were less likely to receive opioids than non-Hispanic white patients. Conclusions: The prevalence of opioid use among patients with CNCP was higher in subjects with short or occasional use compared to those with long-term use. Men, younger people, more chronic pain conditions, and patients without insurance or with noncommercial insurance were most related to opioid use. However, non-white and Asian patients, and those treated by a physician trained in complementary medicine were less likely to use opioids.
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Affiliation(s)
- Helena De Sola
- The Observatory of Pain, University of Cádiz, Cádiz, Spain.,Preventive Medicine and Public Health Area, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
| | - María Dueñas
- The Observatory of Pain, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Department of Statistics and Operational Research, University of Cádiz, Cádiz, Spain
| | - Alejandro Salazar
- The Observatory of Pain, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain.,Department of Statistics and Operational Research, University of Cádiz, Cádiz, Spain
| | - Patricia Ortega-Jiménez
- The Observatory of Pain, University of Cádiz, Cádiz, Spain.,Department of Statistics and Operational Research, University of Cádiz, Cádiz, Spain
| | - Inmaculada Failde
- The Observatory of Pain, University of Cádiz, Cádiz, Spain.,Preventive Medicine and Public Health Area, University of Cádiz, Cádiz, Spain.,Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Puerta del Mar University Hospital, University of Cádiz, Cádiz, Spain
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Opioid prescribing and risk of drug-opioid interactions in older discharged patients with polypharmacy in Australia. Int J Clin Pharm 2020; 43:365-374. [PMID: 33206289 DOI: 10.1007/s11096-020-01191-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/28/2020] [Indexed: 01/19/2023]
Abstract
Background Opioids are commonly prescribed to managing chronic pain in older persons. However, these patients are often at risk of drug-opioid interactions due to polypharmacy. Objectives To identify the prevalence of opioid prescribing and drug-opioid interactions in poly-medicated older patients and factors associated with opioid prescribing. Setting Patients were included if they were admitted to the Royal Adelaide Hospital between September 2015 and August 2016, aged ≥ 75 years and took ≥ 5 medications at discharge. Methods After ethics approval, data of were retrospectively collected from case notes. The Charlson Comorbidity Index and Drug Burden Index were determined and opioids were classified as strong or weak. The association between opioid use and concurrent medications was computed using logistic regression and the results presented as odds ratios (OR) and 95% confidence intervals (95% CI), adjusted for age, sex, Charlson Comorbidity Index, number of prescribed medications and modified-Drug Burden Index. Main outcome measure Association between concurrent medications and opioid prescribing. Results 15,000 geriatric admissions were identified, of which 1192 were included. A total of 283 (23.7%) patients were prescribed opioids, with oxycodone accounting for 56% of these prescriptions. Opioid users were prescribed more medications (11.2 vs. 9.0, P < 0.001) and had higher Drug Burden Index (1.2 vs. 0.14, P < 0.001) compared to non-users. Opioid use was associated with concurrent prescription of antiepileptics (OR = 1.7, 95% CI 1.1-2.6), and negatively associated with Charlson Comorbidity Index (OR = 0.9, 95% CI 0.8-0.98) and concurrent use of antipsychotics (OR = 0.5, 95% CI 0.3-0.9) and beta blocking agents (OR = 0.4, 95% CI 0.3-0.6). Conclusions Strong opioids were prescribed more often than weak opioids and opioid users presented with characteristics and concurrent medications which increased the risk of opioid related adverse drug effects.
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Shipton EA, Shipton EE, Shipton AJ. A Review of the Opioid Epidemic: What Do We Do About It? Pain Ther 2018; 7:23-36. [PMID: 29623667 PMCID: PMC5993689 DOI: 10.1007/s40122-018-0096-7] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Indexed: 01/24/2023] Open
Abstract
The opioid epidemic, with its noticeable increase in opioid prescriptions and related misuse, abuse and resultant deaths in the previous 12 years, is a particularly North American phenomenon. Europe, and particularly low- and middle-income countries, appear to be less influenced by this problem. There is undisputable value in using opioids not only in the treatment of acute pain, but in cancer pain as well. However, opioids are progressively being prescribed more and more for chronic non-cancer pain, despite inadequate data on their efficacy. In this paper, we describe the current prevalence of opioid misuse in a number of countries and the rationale for the commencement of opioid therapy. The safe initiation and monitoring of opioid therapy as well as the need for concurrent use of interdisciplinary multimodal therapy is discussed. The possible consequences of long-term use and predictors of high opioid use and overdose are presented. In particular, the management of opioid use disorders and the prevention of opioid abuse and dependence in the young, the old and the pregnant are discussed. Measures to prevent overprescribing and to alleviate risk are described, including the tapering of opioids and the use of opioid deterrents. Finally, the paper looks at the future development of pioneering medications and technologies to potentially treat abuse. In those parts of the world with an opioid epidemic, coroners and medical examiners, private and public health agencies, and agencies that enforce the law need to cooperate in an effort to slow down and reverse the indiscriminate use of prescribing opioids in the long-term for chronic non-cancer pain. Ongoing research is needed to create ways to minimise risks of opioid use, and to provide evidence for effective strategies for treating chronic pain.
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Affiliation(s)
- Edward A Shipton
- Department of Anaesthesia, University of Otago, Christchurch, New Zealand.
| | - Elspeth E Shipton
- Department of Anaesthesia, University of Otago, Christchurch, New Zealand
| | - Ashleigh J Shipton
- Department of Anaesthesia, University of Otago, Christchurch, New Zealand
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6
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Shipton EE, Shipton AJ, Williman JA, Shipton EA. Deaths from Opioid Overdosing: Implications of Coroners' Inquest Reports 2008-2012 and Annual Rise in Opioid Prescription Rates: A Population-Based Cohort Study. Pain Ther 2017; 6:203-215. [PMID: 28887789 PMCID: PMC5693811 DOI: 10.1007/s40122-017-0080-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION In the late 1990s multiple physicians and advocacy organizations promoted increased use of opioids for the treatment of acute, chronic and cancer pain. There has been an exponential growth in opioid prescribing in the last 20 years in the United States of America, in Australia, and in other developed Western countries. There are negative consequences associated with the liberal use of opioids. The primary aim of this population-based cohort study is to investigate the opioid-related death rate in New Zealand between 1 January 2008 and 31 December 2012. The secondary aims of this cohort study are: (1) to compare the opioid-related death rate per population in New Zealand in 2001/2002 with that between 2011/2012; (2) to investigate the number of opioid prescriptions in New Zealand between 2001 and 2012; (3) to compare the opioid-related death rate per population in New Zealand between 2001 and 2012 with the number of opioid prescriptions in New Zealand between 2001 and 2012. METHODS Permission to access records from the Coronial Services Office in Wellington for 2008-2012 was acquired. Permission to access records for prescriptions containing opioids (dose and formulation) was obtained from the Pharmaceutical Collection. RESULTS The rate of opioid-related deaths in New Zealand has increased by 33% from 2001 to 2012. More than half of the opioid-related deaths between 2008 and 2012 were unintentional opioid overdoses. Opioid analgesic deaths were most likely due to methadone, morphine and codeine prescribed by healthcare professionals. That 179 of these opioid-related deaths between 2008 and 2012 were unintentional opioid overdoses, and thus could have been avoided, is tragic. This study shows that there was a steady annual increases in opioid prescriptions in New Zealand from 2001 to 2012. This rise in opioid analgesic deaths was associated with the increases in the numbers of opioid prescriptions. CONCLUSION A multifaceted national public health approach is needed to bring together the various stakeholders involved with pain management, opioid dependence, opioid availability and opioid diversion. There needs to be a targeted approach to educate current and future medical practitioners regarding the appropriate use of opioid prescriptions for the management of pain, as well as a strengthening of primary, secondary and tertiary resources to support medical practitioners managing their patients who suffer with pain.
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Affiliation(s)
- Elspeth E Shipton
- Department of Anaesthesia, University of Otago, Christchurch, New Zealand
| | - Ashleigh J Shipton
- Department of Anaesthesia, University of Otago, Christchurch, New Zealand
| | - Jonathan A Williman
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Edward A Shipton
- Department of Anaesthesia, University of Otago, Christchurch, New Zealand.
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Chenaf C, Kabore JL, Delorme J, Pereira B, Mulliez A, Roche L, Eschalier A, Delage N, Authier N. Incidence of tramadol shopping behavior in a retrospective cohort of chronic non-cancer pain patients in France. Pharmacoepidemiol Drug Saf 2016; 25:1088-98. [PMID: 27363310 DOI: 10.1002/pds.4056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 05/25/2016] [Accepted: 06/06/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE Opioid analgesic use in chronic non-cancer pain (CNCP) is increasingly prevalent, but the benefits and risks are inadequately understood. In France, tramadol is one of the most used prescription opioids, but studies on its misuse liability in CNCP are still lacking. The aim was to assess the incidence of tramadol shopping behavior in CNCP patients and to identify the associated risk factors. METHODS A retrospective cohort of CNCP patients aged 18 years and older treated by tramadol for at least six consecutive months between 2005 and 2013 from a sample of the French Health Insurance database was established. Doctor shopping was defined as at least 1 day of overlapping prescriptions written by two or more different prescribers and filled in at least three different pharmacies. RESULTS A total of 3505 CNCP patients were included with a majority of women (66.4%) and a mean age of 66.4 ± 14.7 years. The median tramadol treatment duration was 260 [interquartile range: 211-356] days. The 1-year incidence rate of tramadol shopping behavior was 1.0% [95%CI: 0.7-1.5]. On multivariate analysis, risk factors associated with tramadol shopping behavior were age (hazard ratio [HR] = 7.4 [95%CI: 2.8-19.7] for age <40, HR = 2.8 [95%CI: 1.0-7.7] for 40 ≤ age < 50, versus age ≥50), low-income status (HR = 8.5 [95%CI: 3.6-20.5]), and prior use of strong opioids (HR = 5.7 [95%CI: 1.9-17.0]). CONCLUSION Tramadol shopping behavior incidence appears low in CNCP patients but may represent a public health concern given the widespread use of tramadol. Education and best monitoring of high-risk patients are needed to reduce doctor shopping. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Chouki Chenaf
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, Clermont-Ferrand, France
| | - Jean-Luc Kabore
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, Clermont-Ferrand, France
| | - Jessica Delorme
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation, Clermont-Ferrand, France
| | - Aurélien Mulliez
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l'Innovation, Clermont-Ferrand, France
| | - Lucie Roche
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, Clermont-Ferrand, France
| | - Alain Eschalier
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, Clermont-Ferrand, France.,CHU Clermont-Ferrand Centre d'Evaluation et de Traitement de la Douleur (CETD), Service de Pharmacologie Médicale, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
| | - Noémie Delage
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand Centre d'Evaluation et de Traitement de la Douleur (CETD), Service de Pharmacologie Médicale, Clermont-Ferrand, France
| | - Nicolas Authier
- INSERM, UMR 1107 NEURO-DOL, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centres Addictovigilance et Pharmacovigilance Auvergne (CEIP-CRPV), Service de Pharmacologie Médicale, Clermont-Ferrand, France.,CHU Clermont-Ferrand Centre d'Evaluation et de Traitement de la Douleur (CETD), Service de Pharmacologie Médicale, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
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Abstract
PURPOSE OF REVIEW Opioid-based management of noncancer pain has become much more prevalent over the last 2 decades and is responsible for a wide range of side-effects, particularly affecting the intestinal tract causing opioid-induced constipation (OIC). This review will consider results of recent clinical trials that have provided evidence of new pharmacological management options for the treatment of OIC. RECENT FINDINGS Supportive use of conventional agents, such as stool softeners, osmotic laxatives, and stimulating laxatives in OIC has limited efficacy. The peripheral μ-opioid receptor antagonist (PAMORA) methylnaltrexone (MNTX) was first FDA approved for OIC in patients with advanced illness and later also for OIC in noncancer pain patients; clinical trial results indicated MNTX did not reverse opioid analgesia and did not trigger central opioid withdrawal. Another PAMORA, the orally available naloxegol, has also gained recent FDA approval for the treatment of OIC in adults with chronic, noncancer pain. Lubiprostone, a bicyclical fatty acid acting via activation of intestinal chloride channel-2 (ClC-2), was also approved for OIC treatment in patients with noncancer pain. SUMMARY PAMORA MNTX and naloxegol and the intestinal chloride channel-2 (ClC-2) activator lubiprostone represent additional possible therapeutic options for the management of OIC in patients with chronic noncancer pain.
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Affiliation(s)
- H Christian Weber
- Section of Gastroenterology, Boston University School of Medicine, Boston, Massachusetts, USA
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Cunningham JL, Evans MM, King SM, Gehin JM, Loukianova LL. Opioid Tapering in Fibromyalgia Patients: Experience from an Interdisciplinary Pain Rehabilitation Program. PAIN MEDICINE 2016; 17:1676-85. [DOI: 10.1093/pm/pnv079] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 11/02/2015] [Indexed: 11/14/2022]
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10
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Argoff CE, Brennan MJ, Camilleri M, Davies A, Fudin J, Galluzzi KE, Gudin J, Lembo A, Stanos SP, Webster LR. Consensus Recommendations on Initiating Prescription Therapies for Opioid-Induced Constipation. PAIN MEDICINE 2015; 16:2324-37. [PMID: 26582720 PMCID: PMC4738423 DOI: 10.1111/pme.12937] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective Aims of this consensus panel were to determine (1) an optimal symptom‐based method for assessing opioid‐induced constipation in clinical practice and (2) a threshold of symptom severity to prompt consideration of prescription therapy. Methods A multidisciplinary panel of 10 experts with extensive knowledge/experience with opioid‐associated adverse events convened to discuss the literature on assessment methods used for opioid‐induced constipation and reach consensus on each objective using the nominal group technique. Results Five validated assessment tools were evaluated: the Patient Assessment of Constipation–Symptoms (PAC‐SYM), Patient Assessment of Constipation–Quality of Life (PAC‐QOL), Stool Symptom Screener (SSS), Bowel Function Index (BFI), and Bowel Function Diary (BF‐Diary). The 3‐item BFI and 4‐item SSS, both clinician administered, are the shortest tools. In published trials, the BFI and 12‐item PAC‐SYM are most commonly used. The 11‐item BF‐Diary is highly relevant in opioid‐induced constipation and was developed and validated in accordance with US Food and Drug Administration guidelines. However, the panel believes that the complex scoring for this tool and the SSS, PAC‐SYM, and 28‐item PAC‐QOL may be unfeasible for clinical practice. The BFI is psychometrically validated and responsive to changes in symptom severity; scores range from 0 to 100, with higher scores indicating greater severity and scores >28.8 points indicating constipation. Conclusions The BFI is a simple assessment tool with a validated threshold of clinically significant constipation. Prescription treatments for opioid‐induced constipation should be considered for patients who have a BFI score of ≥30 points and an inadequate response to first‐line interventions.
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Affiliation(s)
- Charles E Argoff
- The American Academy of Pain Medicine Foundation and Comprehensive Pain Center, Albany Medical Center, Albany, New York, USA
| | | | - Michael Camilleri
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Andrew Davies
- Supportive and Palliative Care, Royal Surrey County Hospital and St. Luke's Cancer Centre, Surrey, UK
| | - Jeffrey Fudin
- Remitigate, LLC, and Department of Pharmacy, Stratton Veterans Affairs Medical Center, Albany, New York, USA
| | - Katherine E Galluzzi
- Department of Geriatrics, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Jeffrey Gudin
- Pain Management and Palliative Care, Englewood Hospital and Medical Center, Englewood, New Jersey, USA
| | - Anthony Lembo
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Steven P Stanos
- Pain and Headache Center, Swedish Medical Center, Seattle, Washington, USA
| | - Lynn R Webster
- Scientific Affairs, PRA Health Sciences, Salt Lake City, Utah, USA
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Chang SC, Ma CC, Lee CT, Hsieh SW. Pharmacoepidemiology of chronic noncancer pain patients requiring chronic opioid therapy: A nationwide population-based study. ACTA ACUST UNITED AC 2015; 53:89-94. [DOI: 10.1016/j.aat.2015.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 03/30/2015] [Accepted: 04/11/2015] [Indexed: 01/24/2023]
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12
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Setnik B, Roland CL, Sommerville KW, Pixton GC, Berke R, Calkins A, Goli V. A multicenter, primary-care-based, open-label study to assess the success of converting opioid-experienced patients with chronic moderate-to-severe pain to morphine sulfate and naltrexone hydrochloride extended-release capsules using a standardized conversion guide. J Pain Res 2015; 8:347-60. [PMID: 26185466 PMCID: PMC4501243 DOI: 10.2147/jpr.s82395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To evaluate the conversion of opioid-experienced patients with chronic moderate-to-severe pain to extended-release morphine sulfate with sequestered naltrexone hydrochloride (MSN) using a standardized conversion guide. METHODS This open-label, single-arm study was conducted in 157 primary care centers in the United States. A total of 684 opioid-experienced adults with chronic moderate-to-severe pain were converted to oral administration of MSN from transdermal fentanyl and oral formulations of hydrocodone, hydromorphone, methadone, oxycodone, oxymorphone, and other morphine products using a standardized conversion guide. The primary endpoint was the percentage of patients achieving a stable MSN dose within a 6-week titration phase. Secondary endpoints included duration of time to stable dose, number of titration steps, safety and efficacy measures, and investigator assessment of conversion guide utility. RESULTS Of the 684 patients, 51.3% were converted to a stable dose of MSN (95% confidence interval: 47.5%, 55.1%). The mean (standard deviation) number of days to stable dose was 20 (8.94), and number of titration steps to stable dose was 2.4 (1.37). The majority of adverse events were mild/moderate and consistent with opioid therapy. Mean pain scores at stable dose decreased from baseline. Investigators were generally satisfied with the conversion guide and, in 94% of cases, reported they would use it again. CONCLUSION Conversion to MSN treatment using the standardized MSN conversion guide was an attainable goal in approximately half of the population of opioid-experienced patients with chronic moderate-to-severe pain. Investigators found the guide to be a useful tool to assist conversion of opioid-experienced patients to MSN.
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Affiliation(s)
| | | | | | | | - Robert Berke
- Family Health Medical Services PLLC, Mayville, Buffalo, NY, USA
- Department of Social and Preventive Medicine, State University of New York at Buffalo, Buffalo, NY, USA
| | - Anne Calkins
- New York Spine & Wellness Center, Syracuse, NY, USA
| | - Veeraindar Goli
- Pfizer Inc, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
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Heimer R, Zhan W, Grau LE. Prevalence and experience of chronic pain in suburban drug injectors. Drug Alcohol Depend 2015; 151:92-100. [PMID: 25841984 PMCID: PMC4447527 DOI: 10.1016/j.drugalcdep.2015.03.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 03/06/2015] [Accepted: 03/06/2015] [Indexed: 01/05/2023]
Abstract
AIMS To explore the relationship between chronic pain and characteristics, behaviors, and psychological status of suburban Connecticut injection drug users. METHODS Cross-sectional study with quantitative interview and serological testing for HIV and hepatitis B and C in 456 individuals who injected drugs in the past month. Participants were dichotomized into those reporting current chronic pain of at least six months duration and all others. The interview covered (i) sociodemographics, (ii) injection drug use, (iii) interactions with drug treatment, criminal justice, and harm reduction, (iv) screening for alcohol use, chronic pain, anxiety, and depression, and (v) knowledge regarding HIV, hepatitis B (HBV) and C (HCV), and opioid overdose. Serological testing for HIV, HBV, and HCV was conducted. RESULTS One-third (n = 143) reported chronic pain. These individuals differed significantly from those not reporting chronic pain on characteristics that included older age, lower educational achievement, and injection of pharmaceutical opioids. They also reported experiencing more psychological and family problems on the ASI and higher levels of depression and anxiety. Four of five individuals with chronic pain (n = 117) reported non-medical opioid use prior to the onset of chronic pain. CONCLUSIONS Chronic pain is common among drug injectors in our study population although it was unusual for chronic pain to have preceded non-medical opioid use. Psychological problems in injectors with co-occurring chronic pain are likely pose significant complications to successful treatment for substance abuse, pain, or infectious disease treatment.
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Affiliation(s)
- Robert Heimer
- Center for Interdisciplinary Research on AIDS and the Department of Epidemiology of Microbial Disease, Yale University School of Public Health, 60 College Street, New Haven, CT 06520, United States.
| | - Weihai Zhan
- Center for Interdisciplinary Research on AIDS and the Department of Epidemiology of Microbial Disease, Yale University School of Public Health, 60 College Street, New Haven, CT 06520, United States
| | - Lauretta E Grau
- Center for Interdisciplinary Research on AIDS and the Department of Epidemiology of Microbial Disease, Yale University School of Public Health, 60 College Street, New Haven, CT 06520, United States
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Cazacu I, Mogosan C, Loghin F. Safety issues of current analgesics: an update. ACTA ACUST UNITED AC 2015; 88:128-36. [PMID: 26528060 PMCID: PMC4576793 DOI: 10.15386/cjmed-413] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/17/2015] [Indexed: 12/18/2022]
Abstract
Pain represents a complex experience which can be approached by various medicines. Non-opioid and opioid analgesics are the most common drugs used to manage different types of pain. The increased attention nowadays to pain management entailed concomitantly more frequent adverse drug reactions (ADRs) related to analgesic use. Drug-drug interactions can be sometimes responsible for the adverse effects. However, a significant proportion of analgesic ADRs are preventable, which would avoid patient suffering. In order to draw the attention to analgesics risks and to minimize the negative consequences related to their use, the present review comprises a synthesis of the most important safety issues described in the scientific literature. It highlights the potential risks of the most frequently used analgesic medicines: non-opioid (paracetamol, metamizole, non-steroidal anti-inflammatory drugs) and opioid analgesics. Even if there is a wide experience in their use, they continue to capture attention with safety concerns and with potential risks recently revealed. Acknowledging potential safety problems represents the first step for health professionals in assuring a safe and efficient analgesic treatment with minimum risks to patients. Taking into consideration all medical and environmental factors and carefully monitoring the patients are also essential in preventing and early detecting analgesic ADRs.
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Affiliation(s)
- Irina Cazacu
- Department of Pharmacology, Physiology and Pathophysiology, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristina Mogosan
- Department of Pharmacology, Physiology and Pathophysiology, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Felicia Loghin
- Department of Toxicology, Faculty of Pharmacy, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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15
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Yazdy MM, Desai RJ, Brogly SB. Prescription Opioids in Pregnancy and Birth Outcomes: A Review of the Literature. J Pediatr Genet 2015; 4:56-70. [PMID: 26998394 PMCID: PMC4795985 DOI: 10.1055/s-0035-1556740] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 02/05/2015] [Indexed: 12/29/2022]
Abstract
Prescription opioids are used prenatally for the management of pain, as well as for opiate dependency. Opioids are known to cross the placenta and despite the evidence of possible adverse effects on fetal development, studies have consistently shown prescription opioids are among the most commonly prescribed medications and the prevalence of use is increasing among pregnant women. This article summarizes the available literature documenting potential harms associated with prescription opioid use during pregnancy, including poor fetal growth, preterm birth, birth defects, and neonatal abstinence syndrome.
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Affiliation(s)
- Mahsa M. Yazdy
- Slone Epidemiology Center at Boston University, Boston, Massachusetts, United States
| | - Rishi J. Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Susan B. Brogly
- Department of Medicine and Surgery, Queen's University, Kingston, Ontario, Canada
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17
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CAMILLERI M, DROSSMAN DA, BECKER G, WEBSTER LR, DAVIES AN, MAWE GM. Emerging treatments in neurogastroenterology: a multidisciplinary working group consensus statement on opioid-induced constipation. Neurogastroenterol Motil 2014; 26:1386-95. [PMID: 25164154 PMCID: PMC4358801 DOI: 10.1111/nmo.12417] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/23/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Opioids are effective for acute and chronic pain conditions, but their use is associated with often difficult-to-manage constipation and other gastrointestinal (GI) effects due to effects on peripheral μ-opioid receptors in the gut. The mechanism of opioid-induced constipation (OIC) differs from that of functional constipation (FC), and OIC may not respond as well to most first-line treatments for FC. The impact of OIC on quality of life (QoL) induces some patients to decrease or stop their opioid therapy to relieve or avoid constipation. PURPOSE At a roundtable meeting on OIC, a working group developed a consensus definition for OIC diagnosis across disciplines and reviewed current OIC treatments and the potential of treatments in development. By consensus, OIC is defined as follows: 'A change when initiating opioid therapy from baseline bowel habits that is characterized by any of the following: reduced bowel movement frequency, development or worsening of straining to pass bowel movements, a sense of incomplete rectal evacuation, or harder stool consistency'. The working group noted the prior validation of a patient response outcome and end point for clinical trials and recommended future efforts to create treatment guidelines and QoL measures specific for OIC. Details from the working group's discussion and consensus recommendations for patient care and research are presented in this article.
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Affiliation(s)
- M. CAMILLERI
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - D. A. DROSSMAN
- Drossman Gastroenterology, PLLC, UNC Center for Functional GI and Motility Disorders, Chapel Hill, NC, USA
| | - G. BECKER
- Department of Palliative Care, Freiburg University Medical Center, Freiburg, Germany
| | | | - A. N. DAVIES
- Department of Supportive and Palliative Care, The Royal Surrey County Hospital, Guildford, Surrey, UK
| | - G. M. MAWE
- Department of Neurological Sciences, University of Vermont College of Medicine, Burlington, VT, USA
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18
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Grossbard JR, Malte CA, Saxon AJ, Hawkins EJ. Clinical monitoring and high-risk conditions among patients with SUD newly prescribed opioids and benzodiazepines. Drug Alcohol Depend 2014; 142:24-32. [PMID: 24969956 DOI: 10.1016/j.drugalcdep.2014.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Opioid therapy alone or in combination with benzodiazepines poses safety concerns among patients with substance use disorders (SUD). Guidelines for opioid therapy recommend SUD treatment and enhanced monitoring, especially in patients with additional risk factors, but information on monitoring practices is sparse. This study estimated high-risk conditions - psychiatric comorbidity, suicide risk, and age <35 and ≥65 - and described clinical monitoring among patients with SUD who were newly prescribed opioids alone and concurrent with benzodiazepines long-term. METHODS This study included VA Northwest Veterans Network patients with SUD who started opioids only (n=980) or benzodiazepines and opioids concurrently (n=353) long-term (≥90 days) in 2009-2010. Clinical characteristics, outpatient visits and urine drug screens (UDS) documented within 7-months after starting medications were extracted from VA data. RESULTS Approximately 67% (95% CI: 64-70) of opioids only and 94% (92-97) of concurrent medications groups had ≥1 psychiatric diagnoses. Prevalences of suicide risk and age <35 and ≥65 were 7% (5-8), 6% (5-8) and 18% (15-20) among the opioids only group, and 20% (16-24), 8% (5-11) and 13% (9-16) among the concurrent medications group. Among patients prescribed opioids only and medications concurrently, 87% and 91% attended primary care, whereas 28% and 26% attended SUD specialty-care. Overall, 30% and 48% of opioids only and concurrent medications groups engaged in mental health or SUD care, and 35% and 39% completed UDS. CONCLUSIONS Improvements in clinical monitoring are needed as many VA patients with SUD and comorbid risks who initiate opioid therapy do not receive sufficient mental health/SUD care or UDS monitoring.
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Affiliation(s)
- Joel R Grossbard
- VA Health Services Research & Development, 1100 Olive Way, Suite 1400, Seattle, WA 98101, United States.
| | - Carol A Malte
- VA Health Services Research & Development, 1100 Olive Way, Suite 1400, Seattle, WA 98101, United States; Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, WA 98108, United States
| | - Andrew J Saxon
- Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, WA 98108, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, United States
| | - Eric J Hawkins
- VA Health Services Research & Development, 1100 Olive Way, Suite 1400, Seattle, WA 98101, United States; Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, WA 98108, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, United States
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20
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Abstract
Millions of Americans have chronic pain for which chronic opioid therapy may be warranted. In light of recent abuse of these medications, clinicians must exercise caution and develop uniform approaches to prescribing. It is possible to assess for opioid risk and safely prescribe opioids.
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Affiliation(s)
- Kathleen Broglio
- Kathleen Broglio is a palliative care nurse practitioner at Columbia University Medical Center, an independent consultant, pain palliative care, and adjunct faculty at Pace University, New York, N.Y. B. Eliot Cole is a director of education at Nevada Psychiatric Association, Las Vegas, Nev. and a psychiatric locum tenems
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Crawford C, Lee C, Bingham J. Sensory Art Therapies for the Self-Management of Chronic Pain Symptoms. PAIN MEDICINE 2014; 15 Suppl 1:S66-75. [DOI: 10.1111/pme.12409] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sukhtankar DD, Lee H, Rice KC, Ko MC. Differential effects of opioid-related ligands and NSAIDs in nonhuman primate models of acute and inflammatory pain. Psychopharmacology (Berl) 2014; 231:1377-87. [PMID: 24217900 PMCID: PMC3954905 DOI: 10.1007/s00213-013-3341-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/09/2013] [Indexed: 11/30/2022]
Abstract
RATIONALE Carrageenan-induced hyperalgesia is a widely used pain model in rodents. However, characteristics of carrageenan-induced hyperalgesia and effects of analgesic drugs under these conditions are unknown in nonhuman primates. OBJECTIVE The aims of this study were to develop carrageenan-induced hyperalgesia in rhesus monkeys and determine the efficacy and potency of agonists selective for the four opioid receptor subtypes in this model versus acute pain, as compared to non-steroidal anti-inflammatory drugs (NSAIDs). RESULTS Tail injection of carrageenan produced long-lasting thermal hyperalgesia in monkeys. Systemically administered agonists selective for opioid receptor subtypes, i.e., fentanyl (mu/MOP), U-50488H (kappa/KOP), SNC80 (delta/DOP) and Ro 64-6198 (nociceptin/orphanin FQ/NOP) dose-dependently attenuated carrageenan-induced thermal hyperalgesia with different potencies. In absence of carrageenan, these agonists, except SNC80, blocked acute thermal nociception. Opioid-related ligands, especially Ro 64-6198, were much more potent for their antihyperalgesic than antinociceptive effects. Both effects were mediated by the corresponding receptor mechanisms. Only fentanyl produced scratching at antihyperalgesic and antinociceptive doses consistent with its pruritic effects in humans, illustrating a translational profile of MOP agonists in nonhuman primates. Similar to SNC80, systemically administered NSAIDs ketorolac and naproxen dose-dependently attenuated carrageenan-induced hyperalgesia but not acute nociception. CONCLUSION Using two different pain modalities in nonhuman primates, effectiveness of clinically available analgesics like fentanyl, ketorolac and naproxen was distinguished and their efficacies and potencies were compared with the selective KOP, DOP, and NOP agonists. The opioid-related ligands displayed differential pharmacological properties in regulating hyperalgesia and acute nociception in the same subjects. Such preclinical primate models can be used to investigate novel analgesic agents.
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Affiliation(s)
- Devki D. Sukhtankar
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA,Corresponding authors: Dr. D. Sukhtankar () and Dr. H. Lee ()
| | - Heeseung Lee
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul 158-710, S. Korea,Corresponding authors: Dr. D. Sukhtankar () and Dr. H. Lee ()
| | - Kenner C. Rice
- Chemical Biology Research Branch, National Institute on Drug Abuse, Bethesda, MD 20892, USA
| | - Mei-Chuan Ko
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA,Center for Comparative Medicine Research, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Turk DC, Dansie EJ, Wilson HD, Moskovitz B, Kim M. Physicians' Beliefs and Likelihood of Prescribing Opioid Tamper-Resistant Formulations for Chronic Noncancer Pain Patients. PAIN MEDICINE 2014; 15:625-36. [DOI: 10.1111/pme.12352] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chapman CR, Bradshaw DH. Only Modest Long-Term Opioid Dose Escalation Occurs Over Time in Chronic Nonmalignant Pain Management. J Pain Palliat Care Pharmacother 2013; 27:370-7. [DOI: 10.3109/15360288.2013.846957] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kissin I. Long-term opioid treatment of chronic nonmalignant pain: unproven efficacy and neglected safety? J Pain Res 2013; 6:513-29. [PMID: 23874119 PMCID: PMC3712997 DOI: 10.2147/jpr.s47182] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND For the past 30 years, opioids have been used to treat chronic nonmalignant pain. This study tests the following hypotheses: (1) there is no strong evidence-based foundation for the conclusion that long-term opioid treatment of chronic nonmalignant pain is effective; and (2) the main problem associated with the safety of such treatment - assessment of the risk of addiction - has been neglected. METHODS Scientometric analysis of the articles representing clinical research in this area was performed to assess (1) the quality of presented evidence (type of study); and (2) the duration of the treatment phase. The sufficiency of representation of addiction was assessed by counting the number of articles that represent (1) editorials; (2) articles in the top specialty journals; and (3) articles with titles clearly indicating that the addiction-related safety is involved (topic-in-title articles). RESULTS Not a single randomized controlled trial with opioid treatment lasting >3 months was found. All studies with a duration of opioid treatment ≥6 months (n = 16) were conducted without a proper control group. Such studies cannot provide the consistent good-quality evidence necessary for a strong clinical recommendation. There were profound differences in the number of addiction articles related specifically to chronic nonmalignant pain patients and to opioid addiction in general. An inadequate number of chronic pain-related publications were observed with all three types of counted articles: editorials, articles in the top specialty journals, and topic-in-title articles. CONCLUSION There is no strong evidence-based foundation for the conclusion that long-term opioid treatment of chronic nonmalignant pain is effective. The above identified signs indicating neglect of addiction associated with the opioid treatment of chronic nonmalignant pain were present.
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Affiliation(s)
- Igor Kissin
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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26
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Tehrani M, Aguiar M, Katz JD. Narcotics in rheumatology. Health Serv Insights 2013; 6:39-45. [PMID: 25114559 PMCID: PMC4089834 DOI: 10.4137/hsi.s10461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Patients with rheumatic conditions often suffer from related chronic pain. When first-line traditional medications such as acetaminophen and anti-inflammatory medications do not suffice, then other options are needed. The traditional medications may ultimately not provide sufficient pain relief, or alternatively, they can pose as a contraindication due to underlying hypertension, renal, and/or hepatic disease. Therefore, narcotics are an alluring alternative, which if used in a multidisciplinary and systematic approach to the patient, can prove to be quite beneficial in the lives of these patients.
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Affiliation(s)
- Mahsa Tehrani
- Department of Rheumatology, George Washington University, Washington, DC, USA
| | - Mathia Aguiar
- Department of Immunology and Rheumatology, Hospital General de Occidente and University of Guadalajara, Guadalajara, Mexico
| | - James D Katz
- Department of Rheumatology, George Washington University, Washington, DC, USA
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