Opioid therapy and headache

Lipton, Richard B.; Bigal, Marcelo E.

doi:10.1212/wnl.62.10.1662

Cited by 18 publications

(23 citation statements)

References 6 publications

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“…[9;20] There is also concern about opioid treatment of headaches. [19] Due to health risks associated with NSAIDs and Cox-2 inhibitors, however, there is increasing advocacy for the use of opioids as a second-line treatment for osteoarthritis. [25] Overall, the broad-based increase in proportion of NCPC patients treated with opioids, in the number of days supplied, and in the potency of the opioids used can likely be attributed to both increased attention to the problem of untreated pain and to the liberalization of clinical standards and attitudes concerning the use of opioids for NCPC.…”

Section: Discussionmentioning

confidence: 99%

Trends in use of opioids for non-cancer pain conditions 2000–2005 in Commercial and Medicaid insurance plans: The TROUP study

Sullivan

Edlund

Fan

et al. 2008

Pain

330

302

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Opioids are widely prescribed for non-cancer pain conditions (NCPC), but there have been no large observational studies in actual clinical practice assessing patterns of opioid use over extended periods of time. The TROUP (Trends and Risks of Opioid Use for Pain) study reports on trends in opioid therapy for NCPC in two disparate populations, one national and commercially insured (HealthCore Blue Cross and Blue Shield plans) and one state-based and publicly-insured (Arkansas Medicaid) population over a six year period (2000)(2001)(2002)(2003)(2004)(2005). We track enrollees with the four most common NCPC conditions: arthritis/joint pain, back pain, neck pain, headaches, as well as HIV/AIDS. Rates of NCPC diagnosis and opioid use increased linearly during this period in both groups, with the Medicaid group starting at higher rates and the HealthCore group increasing more rapidly. The proportion of enrollees receiving NCPC diagnoses increased (HealthCore 33%, Medicaid 9%), as did the proportion of enrollees with NCPC diagnoses who received opioids (HealthCore 58%, Medicaid 29%). Cumulative yearly opioid dose (in mg. morphine equivalents) received by NCPC patients treated with opioids increased (HealthCore 38%, Medicaid 37%) due to increases in number of days supplied rather than dose per day supplied. Use of short-acting Drug Enforcement Administration Schedule II opioids increased most rapidly, both in proportion of NCPC patients treated (HealthCore 54%, Medicaid 38%) and in cumulative yearly dose (HealthCore 95%, Medicaid 191%). These trends have occurred without any significant change in the underlying population prevalence of NCPC or new evidence of the efficacy of long-term opioid therapy and thus likely represent a broad-based shift in opioid treatment philosophy.

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Section: Discussionmentioning

confidence: 99%

Trends in use of opioids for non-cancer pain conditions 2000–2005 in Commercial and Medicaid insurance plans: The TROUP study

Sullivan

Edlund

Fan

et al. 2008

Pain

330

302

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“…It is involved in the regulation of experimental and clinical pain perception, as well as in the analgesic action of opioid drugs [6][7][8][9] which have been associated with the chronification of migraine attacks 10 …”

Section: Introductionmentioning

confidence: 99%

3D-Neuronavigation <em>In Vivo</em> Through a Patient's Brain During a Spontaneous Migraine Headache

DaSilva

Nascimento

Love³

et al. 2014

JoVE

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A growing body of research, generated primarily from MRI-based studies, shows that migraine appears to occur, and possibly endure, due to the alteration of specific neural processes in the central nervous system. However, information is lacking on the molecular impact of these changes, especially on the endogenous opioid system during migraine headaches, and neuronavigation through these changes has never been done. This study aimed to investigate, using a novel 3D immersive and interactive neuronavigation (3D-IIN) approach, the endogenous µ-opioid transmission in the brain during a migraine headache attack in vivo. This is arguably one of the most central neuromechanisms associated with pain regulation, affecting multiple elements of the pain experience and analgesia. A 36 year-old female, who has been suffering with migraine for 10 years, was scanned in the typical headache (ictal) and nonheadache (interictal) migraine phases using Positron Emission Tomography (PET) with the selective radiotracer [ 11 C]carfentanil, which allowed us to measure µ-opioid receptor availability in the brain (non-displaceable binding potential -µOR BP ND ). The short-life radiotracer was produced by a cyclotron and chemical synthesis apparatus on campus located in close proximity to the imaging facility. Both PET scans, interictal and ictal, were scheduled during separate mid-late follicular phases of the patient's menstrual cycle. During the ictal PET session her spontaneous headache attack reached severe intensity levels; progressing to nausea and vomiting at the end of the scan session. There were reductions in µOR BP ND in the pain-modulatory regions of the endogenous µ-opioid system during the ictal phase, including the cingulate cortex, nucleus accumbens (NAcc), thalamus (Thal), and periaqueductal gray matter (PAG); indicating that µORs were already occupied by endogenous opioids released in response to the ongoing pain. To our knowledge, this is the first time that changes in µOR BP ND during a migraine headache attack have been neuronavigated using a novel 3D approach. This method allows for interactive research and educational exploration of a migraine attack in an actual patient's neuroimaging dataset.

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“…An American Heart Association panel, however, has suggested that opioids may be preferred as a first-line treatment over NSAIDS for those with cardiovascular disease 3. The role of opioids in the treatment of chronic or recurrent headache is controversial due to their potential to cause medication overuse headache 17, 25, 39. If clinical use of opioids followed randomized trial evidence, we would expect to see stable to declining rates of use in back and neck pain and headache, with some increasing use in arthritis and joint pain.…”

Section: Introductionmentioning

confidence: 99%

Trends in Use of Opioids by Noncancer Pain Type 2000-2005 Among Arkansas Medicaid and HealthCore Enrollees: Results From the TROUP Study

Braden¹,

Fan²,

Edlund³

et al. 2008

The Journal of Pain

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Use of prescription opioids for non-cancer pain has increased significantly in recent years, but it is not known if trends differ among the most common non-cancer pain conditions. We examined trends in opioid prescribing for the years 2000 through 2005 for individuals with arthritis/joint pain, back pain, neck pain, and headaches by type and number of pain diagnoses, using data from claims records from two health insurers: HealthCore commercially insured members (N=3,768,223) and Arkansas Medicaid (N=127,866). Rates of headache, back pain, and neck pain diagnoses increased significantly in Arkansas Medicaid enrollees, but more modestly among HealthCore enrollees. Rates of opioid use increased in both groups, with long term use (>90 days supply per year) increasing at twice the rate of any use. Rates of opioid use did not differ widely between non-cancer pain conditions, but long-term opioid use rates doubled with each additional pain diagnosis. Mean days supply and cumulative yearly dose increased between 2000 and 2005 for all pain types and with increasing number of pain diagnoses, but dose per day supply remained relatively stable. The greatest increases in dose among all the pain conditions were seen in short-acting DEA Schedule II opioids. PERSPECTIVE This study demonstrates increased use of opioids, particularly long-term use, in non-cancer pain over a six-year period among those with multiple pain types. These results appear to reflect a general increase in use of prescription opioids for non-cancer pain rather than a condition-specific change in prescribing practices.

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Opioid therapy and headache

Cited by 18 publications

References 6 publications

Trends in use of opioids for non-cancer pain conditions 2000–2005 in Commercial and Medicaid insurance plans: The TROUP study

Trends in use of opioids for non-cancer pain conditions 2000–2005 in Commercial and Medicaid insurance plans: The TROUP study

3D-Neuronavigation <em>In Vivo</em> Through a Patient's Brain During a Spontaneous Migraine Headache

Trends in Use of Opioids by Noncancer Pain Type 2000-2005 Among Arkansas Medicaid and HealthCore Enrollees: Results From the TROUP Study

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