Quality of Life Associated with Daily Opioid Therapy in a Primary Care Chronic Pain Sample

Dillie, K. Sullivan; Fleming, Michael F.; Mundt, Marlon; French, Michael T.

doi:10.3122/jabfm.2008.02.070144

Cited by 77 publications

(59 citation statements)

References 20 publications

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“…Patients with opioid-treated chronic pain are in a desperate need of new, effective, and safe treatments. 4 Although research on the efficacy of MM-based interventions for reducing pain is promising, existing evidence on MM's effects for pain and/or function in chronic noncancer pain is inconclusive and based on a limited number of rigorous RCTs. 27,34,35,49 In addition, there is an overall scarcity of research on long-term efficacy of therapeutic modalities, including MM and CBT, in opioid-treated populations.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 In addition, patients commonly face barriers to evidence-based pain care, such as limited availability of pain medicine specialists and specialty treatments, or inadequate insurance coverage, that further contribute to suboptimal outcomes. 1 Therefore, it is not surprising that patients with CLBP frequently turn to opioid therapy, 4 which may have limited efficacy and lead to negative effects, including overdose. 4,5 Transformation of care in chronic pain, with efforts focused on personalized and safe care that fosters self-management and addresses all components of the biopsychosocial model of chronic pain, is called for.…”

mentioning

confidence: 99%

“…1 Therefore, it is not surprising that patients with CLBP frequently turn to opioid therapy, 4 which may have limited efficacy and lead to negative effects, including overdose. 4,5 Transformation of care in chronic pain, with efforts focused on personalized and safe care that fosters self-management and addresses all components of the biopsychosocial model of chronic pain, is called for. 1 Psychological therapies and complementary and integrative health approaches are ideal for CLBP management.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy

Zgierska

Burzinski

Cox

et al. 2016

The Journal of Alternative and Complementary Medicine

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Objective: Although mindfulness meditation (MM) is increasingly used for chronic pain treatment, limited evidence supports its clinical application for opioid-treated chronic low back pain (CLBP). The goal of this study was to determine feasibility, acceptability, and safety of an MM-based intervention in patients with CLBP requiring daily opioid therapy. Design: 26-week pilot randomized controlled trial comparing MM-based intervention, combined with usual care, to usual care alone. Setting: Outpatient. Patients: Adults with CLBP treated with ‡30 mg of morphine-equivalent dose (MED) per day for 3 months or longer. Interventions: Targeted MM-based intervention consisted of eight weekly 2-hour group sessions and home practice (30 minutes/d, 6 days/wk) during the study. ''Usual care'' for opioid-treated CLBP was provided to participants by their regular clinicians. Outcome measures: Feasibility and acceptability of the MM intervention were assessed by adherence to intervention protocol and treatment satisfaction among experimental participants. Safety was evaluated by inquiry about side effects/adverse events and opioid dose among all study participants. Results: Thirty-five participants enrolled during the 10-week recruitment period. The mean age (-standard deviation) was 51.8 -9.7 years; the patients were predominantly female, with substantial CLBP-related pain and disability, and treated with 148.3 -129.2 mg of MED per day. All participants completed baseline assessments; none missed both follow-up assessments or withdrew. Among experimental participants (n = 21), 19 attended 1 or more intervention sessions and 14 attended 4 or more. They reported, on average, 164.0 -122.1 minutes of formal practice per week during the 26-week study and 103.5 -111.5 minutes of brief, informal practice per week. Seventeen patients evaluated the intervention, indicating satisfaction; their qualitative responses described the course as useful for pain management (n = 10) and for improving pain coping skills (n = 8). No serious adverse events or safety concerns occurred among the study participants. Conclusions: MM-based intervention is feasible, acceptable, and safe in opioid-treated CLBP.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy

Zgierska

Burzinski

Cox

et al. 2016

The Journal of Alternative and Complementary Medicine

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“…Of the many reported studies, only one study reported a positive difference in relation to most healthrelated QOL (HRQOL) domains of the Short Form (SF)-36 with administration of oxycodone [56]. The 10-year follow-up by Jensen et al showed that opioid users had lower SF-36 scores than chronic pain patients who were not using opioids [57].…”

Section: Effectiveness On Quality Of Lifementioning

confidence: 99%

“…Quality of life improvement has been evaluated less frequently than pain relief [56]. Of the many reported studies, only one study reported a positive difference in relation to most healthrelated QOL (HRQOL) domains of the Short Form (SF)-36 with administration of oxycodone [56].…”

Section: Effectiveness On Quality Of Lifementioning

confidence: 99%

Opioids in chronic noncancer pain

Manchikanti

Benyamin

Datta

et al. 2010

Expert Review of Neurotherapeutics

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A Clinical Ethics Approach to Opioid Treatment of Chronic Noncancer Pain

Cohen

Jangro

2015

AMA Journal of Ethics

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Ballantyne JC, Fleisher LA. Ethical issues in opioid prescribing for chronic pain. Pain. 2010;148(3):365-367.We are writing both to respond to Ballantyne and Fleisher's 2010 article on the ethics of opioid prescribing [1] and to join the authors in calling for continued progress in rational, ethical, and practical decision making surrounding the use of opioids in the treatment of patients with noncancer chronic pain. Given the current state of knowledge regarding long-term opioid treatment, we suggest that dilemmas associated with this treatment are best approached using patient-centered clinical ethics. We believe principle-based, deontological, and classical Hippocratic ethical approaches have less relevance in sorting out current controversies surrounding opioid treatment.We agree with the authors' concise history of how opioid use in medicine has most often been determined by fearful attitudes and politics [1] and rarely arrived at rationally [2], let alone through application of ethical models or evidence-based practice [3]. We welcome exactly this sort of thoughtful reflection on the ethical implications of opioid prescription for chronic painful illness. Ballantyne and Fleisher accurately reflect expert consensus that the most difficult clinical dilemmas involving opioid analgesics arise in treating chronic nonmalignant pain, not acute postinjury or perioperative pain [4,5] or even terminal painful illness [6][7][8]. Even though there is widespread consensus about the majority of uses for opioids for chronic malignant pain, approximately 50 percent of cancer patients still face barriers to pain care [9]. If this is the status of pain care in cancer, an area about which there is reasonable ethical consensus, it is not surprising that noncancer chronic pain is even less adequately addressed. This discrepancy highlights the need to work toward greater agreement on solutions to the ethical questions involved in delivery of care to patients with this kind of pain [10,11].Ballantyne and Fleisher trace the most recent wave of arbitrary limitations on opioid prescribing to the early twentieth century, when physician influence on treatments offered to patients began a steady decline. This decreasing influence has been ascribed to a combination of factors, including increased regulation of the manufacture, trade, and prescription of opioids; stigmatization of opioids through special prescribing requirements and criminalization of addiction [1]; expanded tracking and limitation of physician practice through "managed" care; attention to control of medical "utilization";

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Quality of Life Associated with Daily Opioid Therapy in a Primary Care Chronic Pain Sample

Cited by 77 publications

References 20 publications

Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy

Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy

Opioids in chronic noncancer pain

A Clinical Ethics Approach to Opioid Treatment of Chronic Noncancer Pain

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