Where now for opioids in chronic pain
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TLDR
There is a need to reconsider the place of opioids in the management of chronic pain, and the so-called weak opioids, as well as tramadol (a non-selective agonist at mu, delta and kappa opioid receptors with monoaminergic properties), which should be considered alongside the strong opioids.Abstract:
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Chronic pain has always been and will remain difficult to manage. There have been important developments in our understanding of the neurobiology of pain, but perhaps the greatest advance is our ability to analyse trial data more critically and to realise that we may have been wrongly optimistic about the use of some therapies. Although the publication of high-quality literature reviews may have reduced our therapeutic options, it also provides an opportunity to improve patient care by ensuring that we are not exposing patients with pain, whose lives are difficult enough as it is, to the harms of medicines that do not help them.
In particular, there is a need to reconsider the place of opioids in the management of chronic pain. This includes the so-called weak opioids (eg, codeine and dihydrocodeine), and strong opioids (eg, morphine, oxycodone, fentanyl and buprenorphine), as well as tramadol (a non-selective agonist at mu, delta and kappa opioid receptors with monoaminergic properties), which should be considered alongside the strong opioids.
Opioids emerged into the chronic pain management scene in the 1990s. The recognition of their potent role in the management of acute and end-of-life pain, the inappropriate adoption of WHO analgesic ladder designed for …read more
Citations
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Pain relief and improvement in quality of life with 10 kHz SCS therapy: Summary of clinical evidence
TL;DR: Current and emerging data as they relate to the clinical use of the high‐frequency 10 kHz spinal cord stimulation therapy in various pain syndromes are summarized.
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Prevalence of sleep-disordered breathing in opioid users with chronic pain: a systematic review and meta-analysis.
Talha Mubashir,Mahesh Nagappa,Nilufar Esfahanian,Joseph Botros,Abdul A Arif,Colin Suen,Jean Wong,Jean Wong,Clodagh M. Ryan,Frances Chung +9 more
TL;DR: The pooled prevalence of SDB in chronic pain patients on opioid therapy is not significantly different compared to Pain: no-opioids and No-pain:No-OPioids groups and varies considerably depending on site of patient recruitment (i.e. sleep versus pain clinics).
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Efficacy and Safety of 10 kHz Spinal Cord Stimulation for the Treatment of Chronic Pain: A Systematic Review and Narrative Synthesis of Real-World Retrospective Studies
Ganesan Baranidharan,Deborah Edgar,Beatrice Bretherton,Beatrice Bretherton,Tracey Crowther,Abdul-Ghaaliq Lalkhen,Ann-Katrin Fritz,Girish Vajramani +7 more
TL;DR: In this article, the authors performed a systematic literature search of PubMed between 1 January 2009 and 21 August 2020 for English-language retrospective studies of ≥3 human subjects implanted with a Senza® 10 kHz spinal cord stimulation (SCS) system and followed-up for ≥3 months.
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10 kHz spinal cord stimulation for the treatment of chronic back and/or leg pain: Summary of clinical studies.
TL;DR: Overall, the literature suggests that 10 kHz SCS provides long-term pain relief in a high proportion of patients, along with improved quality of life and reduced opioid consumption.
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Chronic Pain Patients’ Perceptions of Prescription Opioids: a Systematic Review
TL;DR: A number of common perceptions arose from the review, including patients feeling stigmatised by others, fears of addiction, usefulness in controlling pain, concerns of opioids impairing work and interfering with functioning, and healthcare professionals’ unease prescribing and discussing opioids with patients.
References
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Journal ArticleDOI
CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016.
TL;DR: This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death.
Journal ArticleDOI
Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain
Roger Chou,Gilbert J. Fanciullo,Perry G. Fine,Jeremy A Adler,Jane C. Ballantyne,Pamela Stitzlein Davies,Marilee I. Donovan,David A. Fishbain,Kathy M. Foley,Jeffrey Fudin,Aaron M. Gilson,Alexander Kelter,Alexander Mauskop,Patrick G. O'Connor,Steven D. Passik,Gavril W. Pasternak,Russell K. Portenoy,Ben A. Rich,Richard G. Roberts,Knox H. Todd,Christine Miaskowski +20 more
TL;DR: Safe and effective chronic opioid therapy for chronic noncancer pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion.
Journal ArticleDOI
The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop
Roger Chou,Judith A. Turner,Emily B Devine,Ryan N. Hansen,Sean D. Sullivan,Ian Blazina,Tracy Dana,Christina Bougatsos,Richard A. Deyo +8 more
TL;DR: In this paper, a review found that prescriptions of opioid medications for chronic pain have increased dramatically, as have opioid overdoses, abuse, and other harms and uncertainty about long-term effectiveness.
Journal ArticleDOI
Opioids in chronic non-cancer pain: systematic review of efficacy and safety
TL;DR: The short‐term efficacy of opioids was good in both neuropathic and musculoskeletal pain conditions, however, only a minority of patients in these studies went on to long‐term management with opioids, and conclusions concerning problems such as tolerance and addiction are not allowed.