Opioids compared to placebo or other treatments for chronic low-back pain

Chaparro, Luis Enrique; Furlan, Andrea D.; Deshpande, Amol; Mailis-Gagnon, Angela; Atlas, Steven J.; Turk, Dennis C.

doi:10.1002/14651858.cd004959.pub4

Cited by 176 publications

(89 citation statements)

References 86 publications

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“…Our finding that male sex was associated with opioid abuse and dependence is consistent with prior research using claims data to identify patients at risk for inappropriate opioid use [46,55]. The observation that patients having spinal fusion showed the highest prevalence of opioid abuse and dependence was not surprising given that opioids play an increasingly pivotal role in the long-term management of chronic back pain, which is the primary reason for patients to undergo such procedures [13,14]. Patients with mental health and nonopioid substance use disorders had greater odds of abusing or being dependent on opioids, thus confirming the generalizability of previous studies to orthopaedic surgical inpatients [16,17,46,49,55].…”

Section: Discussionsupporting

confidence: 88%

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

Menendez

Ring

Bateman

2015

Clinical Orthopaedics &Amp; Related Research

296

176

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Background Many patients having discretionary orthopaedic surgery take opioids daily, either with a prescription or illicitly, however little is known regarding the prevalence and effect of high-risk opioid use (eg, abuse, dependence) in the perioperative orthopaedic setting. Questions/purposes We sought (1) to determine the prevalence of opioid abuse and dependence in patients undergoing major elective orthopaedic surgery; (2) to characterize the relationship of opioid abuse and dependence with in-hospital postoperative mortality and adverse events, failure to rescue, prolonged length of stay, and nonroutine disposition; and (3) to identify factors associated with high-risk opioid use.

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Section: Discussionsupporting

confidence: 88%

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

Menendez

Ring

Bateman

2015

Clinical Orthopaedics &Amp; Related Research

296

176

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“…Opioid use in Japan has recently started, but it has not been related to improvement in disability or dysfunction 46) . There is an evidence of short-term efficacy (moderate for pain and mild for function) of opioid to treat chronic low back pain compared with placebo 47) . There have been no signs of substantial progress in developing safe and effective medication in these 35 years 48) .…”

Section: Pharmacological Therapymentioning

confidence: 99%

The Recent Trend in Diagnosis and Treatment of Chronic Low Back Pain

Kikuchi

2017

Spine Surg Relat Res

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Abstract:Introduction: Development of evidence-based medicine has made a big change in diagnosis and treatment of chronic low back pain. The recent trend is assessed through a review of literature. Methods: The articles published in these 10 years are reviewed, and important points are examined. Results: In diagnosis, challenges for history taking and limit of imaging or clinical guidelines are revealed. In treatment, cognitive behavioral treatment and exercises are proved effective. Sleep disturbance has recently attracted attention as a factor associated with low back pain. Cost-effectiveness of diagnosis and treatment modalities has come to be emphasized. Conclusions: Diagnosis and treatment of chronic low back pain have been significantly changing. Multidisciplinary and multidimensional approach is essential. Chronic low back pain should be treated as a total pain, not a local pain.

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“…chronic abdominal pain, fibromyalgia) should be strongly discouraged. In these patients, other multidisciplinary approaches to manage pain are often more effective and definitely safer (Chaparro et al, 2013). Where opioids are required, administration can frequently be optimised in patients experiencing adverse effects.…”

Section: Optimisation Of Opioid Administrationmentioning

confidence: 99%

Management of opioid-induced constipation

2016

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Up to 40% of patients taking opioids develop constipation. Opioid induced constipation (OIC) may limit the adequate dosing of opioids for pain relief and reduce quality of life.Hence, healthcare providers must inquire about bowel function in patients receiving opioids.The management of OIC includes carefully reevaluating the necessity, type, and dose of opioids at each visit. Lifestyle modification and alteration of aggravating factors, the use of simple laxatives, and when essential, the addition of newer laxatives or opioid antagonists (naloxone, naloxegol or methylnaltrexone) can be used to treat OIC. This review discusses the recent literature regarding the management of OIC and provides a rational approach to assessing and managing constipation in individuals receiving opioids.Abstract word count -115

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Opioids compared to placebo or other treatments for chronic low-back pain

Cited by 176 publications

References 86 publications

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

The Recent Trend in Diagnosis and Treatment of Chronic Low Back Pain

Management of opioid-induced constipation

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