Research Gaps on Use of Opioids for Chronic Noncancer Pain: Findings From a Review of the Evidence for an American Pain Society and American Academy of Pain Medicine Clinical Practice Guideline

Chou, Roger; Ballantyne, Jane C.; Fanciullo, Gilbert J.; Fine, Perry G.; Miaskowski, Christine

doi:10.1016/j.jpain.2008.10.007

Cited by 292 publications

(209 citation statements)

References 129 publications

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“…In spite of there being little evidence for their specific use in the elderly [59,60], opioids are well established for the treatment of cancer pain, and increasingly used for the treatment of chronic pain. Similarly to prescribing other analgesics, the general rule for prescribing opioids in older adults is to 'start low and go slow', anticipating side-effects and treating them accordingly [61] rather than stopping treatment, and introducing different medications sequentially.…”

Section: Opioid Therapymentioning

confidence: 99%

The assessment and management of peri‐operative pain in older adults

Schofield

2013

Anaesthesia

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SummaryA number of recent reports have highlighted the inadequate provision of pain relief for older inpatients. Despite the availability of numerous validated pain measures, pain remains poorly assessed in some cases and, particularly, in the cognitively impaired. Without proper assessment, patients may receive inadequate or inappropriate analgesia, both of which can worsen outcome. Most drugs and techniques that are used for analgesia in younger patients are also suitable for older patients, although dosages may have to be adjusted to avoid the side‐effects that are consequent upon age‐related changes in drug pharmacokinetics and pharmacodynamics, co‐morbidity, frailty, cognitive impairment and polypharmacy. This paper reviews current guidelines and methods of assessing pain in the older adult, and describes the use of, and problems with, mild, moderate, strong, adjuvant and local anaesthetic drugs in the older population for analgesia, advocating multimodal intervention to reduce dose‐related side‐effects, particularly of opioids.

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Section: Opioid Therapymentioning

confidence: 99%

The assessment and management of peri‐operative pain in older adults

Schofield

2013

Anaesthesia

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“…10 Recommendations include urine drug testing, regular face-toface office visits to evaluate patients' response to opioids and risk of misuse, and adhering to a pre-defined refill schedule (i.e., restricting refills of opioids prior to expiration of the previous prescription). Although strong evidence to support these recommendations is lacking, 11,12 experts endorse their role especially for patients at high risk of opioid misuse. [7][8][9]13 Several patient characteristics have been associated with an increased risk of opioid misuse in observational studies.…”

Section: Introductionmentioning

confidence: 99%

Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain

et al. 2011

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“…Despite these limitations, these studies provide sufficient evidence of efficacy, that is, lower short-term pain scores than placebo, to satisfy regulators and obtain market approval. 40 The recent approval of Zohydro Ò ER, an extendedrelease analgesic containing hydrocodone made by Zogenix, is a prime example of this phenomenon. This product was approved for ''moderate-to-severe chronic pain'' in 2014 despite having no features to deter abuse and an outright backlash from lawmakers, industry groups, medical professionals, and US Food and Drug Administration panel advisors alike.…”

Section: Benefits Of Therapymentioning

confidence: 99%

The prescription opioid epidemic: an overview for anesthesiologists

Alam

Juurlink

2015

Can J Anesth/J Can Anesth

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Purpose The objectives for preparing this article were to review the historical context and epidemiology surrounding the North American prescription opioid crisis, to summarize the evidence regarding the benefits and harms of long-term opioid therapy for non-cancer pain, and to outline ways in which anesthesiologists may help ameliorate the problem. Source We searched PubMed, Google Scholar, and EMBASE TM for relevant articles using various search terms, including pain, opioid epidemic, history of opioid use, perioperative care, and addiction. Related citations were further explored and searched depending on the specific subtopic of interest. Principal findings In the 1980s and early 1990s, opioids were infrequently used for the treatment of chronic pain. Thereafter, however, physicians were gradually inculcated with the message that long-term opioid therapy was a safe and effective treatment option for patients with chronic non-cancer pain. Pharmaceutical companies supported this growing movement and employed aggressive and sometimes misleading marketing strategies for new opioid formulations. As a result, the practice of prescribing opioids flourished in the late 1990s. The surge in prescribing opioids was accompanied by a marked increase in opioid-related morbidity and mortality. This change in practice transpired despite the absence of randomized trials showing clinically significant benefit from the long-term use of opioids. Subsequently, however, a large and growing body of evidence has emerged quantifying the harms associated with long-term opioid therapy. Anesthesiologists widely prescribe opioids for acute and chronic pain; yet, as a group, they may be largely unaware of the current state of this growing epidemic and what role they can play to rectify this problem.Conclusion Anesthesiologists are well positioned to take a leadership role in the management of postoperative discharge opioid therapy in an effort to curb the overutilization of opioids. Furthermore, anesthesiologists who regularly prescribe opioids for chronic pain patients should appreciate the limited evidence base for this practice and communicate the risks of opioid therapy to their patients.

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Research Gaps on Use of Opioids for Chronic Noncancer Pain: Findings From a Review of the Evidence for an American Pain Society and American Academy of Pain Medicine Clinical Practice Guideline

Cited by 292 publications

References 129 publications

The assessment and management of peri‐operative pain in older adults

The assessment and management of peri‐operative pain in older adults

Low Use of Opioid Risk Reduction Strategies in Primary Care Even for High Risk Patients with Chronic Pain

The prescription opioid epidemic: an overview for anesthesiologists

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