Oral or transdermal opioids for osteoarthritis of the knee or hip

“…A 2009 Cochrane review of opioids in people with chronic non-cancer pain due to osteoarthritis concluded that small to moderate improvements in pain are outweighed by the large increase in adverse events, and that they should not be routinely used, even for severe osteoarthritis pain [14]. Study of long-term benefits from opioids is challenging, and the findings inconclusive.…”

Section: Summary Of Evidence For Opioids In Chronic Non-cancer Painmentioning

confidence: 99%

Severe chronic pain following spinal cord damage: a pragmatic perspective for prescribing opioids

New

2018

Spinal Cord Ser Cases

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The controversial issue of prescribing opioids to people with spinal cord damage who have severe pain is discussed in this paper. The reasons for concern regarding the increase in opioid prescription over recent years are outlined, along with a summary of the major potential adverse outcomes associated with opioids, such as falls, respiratory suppression, adverse endocrine effects, cognitive impairment, and the potential for opioid abuse, addiction and death. Situations when opioids are more appropriate are considered to be in the immediate post-trauma or post-operative periods. More controversial is the use of opioids in chronic non-cancer pain. A brief review of the evidence regarding opioids in chronic non-cancer pain is presented, and strategies outlined for reducing the risk of adverse consequences from opioid use in chronic non-cancer pain. These strategies include considerations before starting opioids, during initiation, monitoring activities and the cessation process. A vital consideration before starting opioids includes ensuring that all alternatives to opioids have been fully considered and trialled. Finally, some pragmatic proposals for prescribing opioids in people with SCD are suggested. It is recommended that before opioids are commenced, that the informed consent process should be complimented by a treatment agreement, with an initial 4-week trial period, and close monitoring of established goals.

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“…There is limited evidence for single dose oral ibuprofen plus codeine being more effective for post-operative pain than either drug in isolation (Baratta et al, 2013). A meta-analysis of opioids for osteoarthritis of the knee or hip reported that modest benefits of codeine were outweighed by adverse consequences (Nuesch et al, 2009). According to Murnion (2010), given the low-dose codeine used in non-prescription medicines, it may be the case that nonopioid analgesics perform better.…”

Section: Medical and Pharmacy-based Interventions And Innovationsmentioning

confidence: 99%

“Doctor shopping and pharmacy hopping”: practice innovations relating to codeine

Hout

2014

Drugs and Alcohol Today

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Purpose – The misuse of pharmaceutical opioid analgesics is identified as a global public health concern. Codeine represents an interesting quandary in terms of its regulated status, with individuals varying in their metabolism of codeine, estimation of safe dosages, risk of adverse health consequences and abuse potential. Efforts to quantify and address hidden non-compliant medical codeine use, overuse and intentional misuse is compromised by availability to the public in prescribed and over the counter forms. The paper aims to discuss these issues. Design/methodology/approach – A review of literature on codeine use, misuse and dependence, and associated innovative medical and pharmacy interventions is presented, and was conducted as part of a larger scoping review on codeine. Findings – The review highlights the complexities associated with monitoring public health awareness of codeine's abuse potential, and customer/patients trends in non-compliant codeine use for therapeutic and recreational purposes. Aberrant codeine behaviours centre on visiting multiple doctors for prescriptions, repeated lost or stolen prescriptions, forging prescriptions and use of multiple pharmacies. Innovations to monitor misuse of codeine include national prescription databases and recent developments in real-time monitoring of dispensing activity. Practical implications – Further development of real-time monitoring processes with process evaluation is advised. Originality/value – This viewpoint is intended to demonstrate how efforts to quantify and address codeine use are compromised by its availability. It intends to encourage further policy and practitioner dialogue on how to monitor, support and intervene with consumers misusing codeine.

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Oral or transdermal opioids for osteoarthritis of the knee or hip

Abstract: BACKGROUND: Osteoarthritis is the most common form of joint disease and the leading cause of pain and physical disability in the elderly. Opioids may

Cited by 9 publications

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A Comparison between Enriched and Nonenriched Enrollment Randomized Withdrawal Trials of Opioids for Chronic Noncancer Pain

A Comparison between Enriched and Nonenriched Enrollment Randomized Withdrawal Trials of Opioids for Chronic Noncancer Pain

Severe chronic pain following spinal cord damage: a pragmatic perspective for prescribing opioids

“Doctor shopping and pharmacy hopping”: practice innovations relating to codeine

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