Opioid Analgesics in Primary Care: Challenges and New Advances in the Management of Noncancer Pain

Sinatra, Raymond S.

doi:10.3122/jabfm.19.2.165

Cited by 30 publications

(21 citation statements)

References 75 publications

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“…1,4 Psychosocial factors have been shown to be more predictive of return-to-work status than physical or biomechanical measures. 5 Many studies have examined predictors of return to work in patients with acute low back pain.…”

mentioning

confidence: 99%

Factors Influencing Work Interference in Patients With Chronic Low Back Pain: A Residency Research Network of Texas (RRNeT) Study

Young¹,

Benold²,

Whitham³

et al. 2011

The Journal of the American Board of Family Medicine

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confidence: 99%

Factors Influencing Work Interference in Patients With Chronic Low Back Pain: A Residency Research Network of Texas (RRNeT) Study

Young¹,

Benold²,

Whitham³

et al. 2011

The Journal of the American Board of Family Medicine

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“…Tampoco es despreciable la presión que pueda ejercer la industria farmacéutica para promocionar opiáceos nuevos diferentes a la morfina (28)(29)(30). Sin embargo, su dosificación y administración es fácil para el facultativo y el paciente (17,21,27) y no parece provocar una excesiva iatrogenia tras una adecuada titulación (6).…”

Section: Discussionunclassified

“…Además, esta circunstancia encarece mucho el coste económico de la prescripción analgésica realizada. Como alternativa a la suma de prescripciones, se deberían utilizar correctamente los fármacos analgésicos de otros escalones así como otras terapias adyuvantes (1,21). Tanto la adición de diferentes opiáceos como el uso de principios activos diferentes provoca un encarecimiento del tratamiento analgésico sin asegurar por ello una mayor eficacia.…”

Section: Discussionunclassified

“…Históricamen-te su prescripción ha sido deficiente debido a la ausencia de medidas objetivas o fisiológicas del dolor, la falta de experiencia en el tratamiento del dolor crónico o el temor a los efectos adversos y los trastornos coexistentes (como la adicción, la falta de interés en el manejo del dolor y la preocupación del médico acerca del uso indebido) (2,6,(17)(18)(19)(20). En las últimas tres décadas, por el contrario, parece existir un cambio de actitud en Atención Primaria sobre el uso de los opioides con una actitud positiva por parte de los médicos que ha permitido incrementar la experiencia en la evaluación del dolor y mejorar el control del mismo (18,21,22).…”

Section: Introductionunclassified

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Manejo del dolor crónico en Atención Primaria, perfil de prescripción de opiáceos mayores: indicación, coste y efectos secundarios

Guzmán-Ruiz

Mora-Moscoso²,

Delgado-Mediano

et al. 2014

Rev. Soc. Esp. Dolor

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Objectives:The main objective of the study was to determine the characteristics of major opioids prescribing in Primary Care.Material and methods: A retrospective study was designed through the use of a historical cohort, assessing patients who have consumed major opiates in all Jaén city health centers during 2011, by systematic sampling, 215 patients, computing the sample size for a confidence level of 95 %, accuracy 5 %, 5 % losses (expanding the 5 % sample by reporting bias). Medical records were audited to collect the following data: Age, sex, medical history, social status, number of appointments and use of hospital resources, characteristics of opioids prescription (dose, duration, cost, adverse reaction) and use of other analgesics/adjuvants. Data were processed for a descriptive study and a subsequent comparison according to the prescribed opioid.Results: 215 patients were included (44 % of total population) those obtained 323 prescriptions for opiates in the study year (23 % of the sample with two prescriptions of opiates and 13 % with three). Most prescribed opioids were fentanyl (60 %) and buprenorphine (22 %) and the least prescribed is by 3 % morphine. Buprenorphine is the most used in monotherapy (70 %), preferably in older women and pensioners, especially for joint pain by the general practitioner. The fentanyl is mainly used in patches (95 % of prescriptions of fentanyl) and hydromorphone is used in younger patients (< 60 years), prescribed by the Pain and Rheumatology Departments (43 % and 20 % of total prescriptions, respectively). Oxycodone is used in patients from areas with social transformation needs (46 % of prescribed opioids in ZNTS) and exclusively for neuropathic and mixed pain (52 % and 48 % respectively of total prescriptions of oxycodone), especially by the Rheumatology and Pain Unit. Morphine is used orally in cancer patients (46 % of prescriptions for morphine), half in retard formulation (45 % of prescriptions for morphine), and these patients were who have a higher healthcare demands (91 % of totals patients prescribed morphine, go to the emergency department, and 46 % required hospital admission).Conclusions: As improvement measure, after contrasting the results, we should encourage the prescription of morphine as an analgesic of choice in both acute and chronic severe pain. An improvement in the measuring instruments specific to each type of pain considering its pathogenesis is required, as well as fostering a greater use of rating scales, both at the start of treatment and during the follow-up of each patient to assess the evolution of pain and treatment effectiveness. RESUMENObjetivos: el objetivo principal del estudio es conocer las características de la prescripción de opiáceos mayores en Atención Primaria.Material y métodos: se diseña un estudio retrospectivo mediante una cohorte histórica, valorando a los pacientes que hayan consumido opiáceos mayores en todos los centros de salud de Jaén capital durante 2011, mediante un muestreo sistemático, 215 pacientes, c...

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“…For example, absorption of methadone is mediated by gastric pH and P-glycoprotein and is metabolized in part by CYP3A4 and CYP2D6, resulting in many potential drug interactions 86. Morphine, hydromorphone, oxymorphone, and tapentadol are among the few opioid agents that undergo phase II hepatic metabolism via glucuronidation, bypassing CYP-mediated metabolism and thereby reducing the risk of drug–drug interactions involving the CYP450 system 114,123,133–136. However, the metabolites themselves may vary in biologic effect, activity, and potency, and therefore awareness of these pathways alone might not be sufficient in avoiding drug–drug interactions or the consequences of accumulated breakdown products.…”

Section: Clinical Practices To Promote Appropriate Choice and Use Of mentioning

confidence: 99%

Update on prescription extended-release opioids and appropriate patient selection

Brennan¹

2013

JMDH

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Chronic pain is largely underdiagnosed, often undertreated, and expected to increase as the American population ages. Many patients with chronic pain require long-term treatment with analgesic medications, and pain management may involve use of prescription opioids for patients whose pain is inadequately controlled through other therapies. Yet because of the potential for abuse and addiction, many clinicians hesitate to treat their patients with pain with potentially beneficial agents. Finding the right opioid for the right patient is the first – often complicated – step. Ensuring that patients continue to properly use the medication while achieving therapeutic analgesic effects is the long-term goal. Combined with careful patient selection and ongoing monitoring, new formulations using extended-release technologies incorporating tamper-resistant features may help combat the growing risk of abuse or misuse, which will hopefully reduce individual suffering and the societal burden of chronic pain. The objective of this manuscript is to provide an update on extended-release opioids and to provide clinicians with a greater understanding of which patients might benefit from these new opioid formulations and how to integrate the recommended monitoring for abuse potential into clinical practice.

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Opioid Analgesics in Primary Care: Challenges and New Advances in the Management of Noncancer Pain

Cited by 30 publications

References 75 publications

Factors Influencing Work Interference in Patients With Chronic Low Back Pain: A Residency Research Network of Texas (RRNeT) Study

Factors Influencing Work Interference in Patients With Chronic Low Back Pain: A Residency Research Network of Texas (RRNeT) Study

Manejo del dolor crónico en Atención Primaria, perfil de prescripción de opiáceos mayores: indicación, coste y efectos secundarios

Update on prescription extended-release opioids and appropriate patient selection

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