Rethinking the role of opioids in the outpatient management of chronic nonmalignant pain

Provenzano, David; Viscusi, Eugene R.

doi:10.1185/03007995.2014.921610

Cited by 20 publications

(14 citation statements)

References 136 publications

(164 reference statements)

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“…Such temporary allowances include enabling pharmacists to: extend prescriptions for a limited period of time; act on a verbal order by a physician for refill of controlled substances; deliver prescriptions of controlled substances to patient's homes or other locations of self‐isolation; and permitting registered practitioners to prescribe opioids without an in‐person medical evaluation as long as some necessary conditions are met . Although controlled substances may be provided without a direct in‐person medical evaluation, it is still recommended that opioid safe prescribing procedures be performed including: assessing for adequate response; adverse events; aberrant behaviours; function; and quality of life improvements . Pill counts can still be performed and informed consent obtained via video communication.…”

Section: Considerations and Recommendationsmentioning

confidence: 99%

Caring for patients with pain during the COVID‐19 pandemic: consensus recommendations from an international expert panel

Shanthanna

Strand

Provenzano³

et al. 2020

Anaesthesia

214

276

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Summary Chronic pain causes significant suffering, limitation of daily activities and reduced quality of life. Infection from COVID‐19 is responsible for an ongoing pandemic that causes severe acute respiratory syndrome, leading to systemic complications and death. Led by the World Health Organization, healthcare systems across the world are engaged in limiting the spread of infection. As a result, all elective surgical procedures, outpatient procedures and patient visits, including pain management services, have been postponed or cancelled. This has affected the care of chronic pain patients. Most are elderly with multiple comorbidities, which puts them at risk of COVID‐19 infection. Important considerations that need to be recognised during this pandemic for chronic pain patients include: ensuring continuity of care and pain medications, especially opioids; use of telemedicine; maintaining biopsychosocial management; use of anti‐inflammatory drugs; use of steroids; and prioritising necessary procedural visits. There are no guidelines to inform physicians and healthcare providers engaged in caring for patients with pain during this period of crisis. We assembled an expert panel of pain physicians, psychologists and researchers from North America and Europe to formulate recommendations to guide practice. As the COVID‐19 situation continues to evolve rapidly, these recommendations are based on the best available evidence and expert opinion at this present time and may need adapting to local workplace policies.

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Section: Considerations and Recommendationsmentioning

confidence: 99%

Caring for patients with pain during the COVID‐19 pandemic: consensus recommendations from an international expert panel

Shanthanna

Strand

Provenzano³

et al. 2020

Anaesthesia

214

276

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“…Opioids have been shown to be effective in reducing pain by approximately 30% in the initial 12 weeks following skeletal injury [5,25,44,63]. However, for patients experiencing skeletal pain lasting more than 12 weeks, opioid-induced pain relief frequently did not differentiate from placebo, and several studies suggest that long-term opioid therapy for nonmalignant skeletal pain has negative effects on the patient’s functional status [83,92]. …”

Section: Introductionmentioning

confidence: 99%

Exuberant sprouting of sensory and sympathetic nerve fibers in nonhealed bone fractures and the generation and maintenance of chronic skeletal pain

Chartier

Thompson

Longo

et al. 2014

Pain

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Skeletal injury is a leading cause of chronic pain and long-term disability worldwide. While most acute skeletal pain can be effectively managed with nonsteroidal anti-inflammatory drugs and opiates, chronic skeletal pain is more difficult to control using these same therapy regimens. One possibility as to why chronic skeletal pain is more difficult to manage over time is that there may be nerve sprouting in non-healed areas of the skeleton that normally receive little (mineralized bone) to no (articular cartilage) innervation. If such ectopic sprouting did occur, it could result in normally nonnoxious loading of the skeleton being perceived as noxious and/or the generation of a neuropathic pain state. To explore this possibility, a mouse model of skeletal pain was generated by inducing a closed fracture of the femur. Examined animals had comminuted fractures and did not fully heal even at 90+ days post fracture. In all mice with nonhealed fractures, exuberant sensory and sympathetic nerve sprouting, an increase in the density of nerve fibers, and the formation of neuroma-like structures near the fracture site were observed. Additionally, all of these animals exhibited significant pain behaviors upon palpation of the nonhealed fracture site. In contrast, sprouting of sensory and sympathetic nerve fibers or significant palpation-induced pain behaviors was never observed in naïve animals. Understanding what drives this ectopic nerve sprouting and the role it plays in skeletal pain may allow a better understanding and treatment of this currently difficult-to-control pain state.

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“…4 Other reports in the literature also suggested a very low (0% to 3%) incidence of neuropathic sequelae, even when restricted to popliteal blocks (1786 cases). 2,6,8,16 However, followup times were short, and possible bias was introduced with reporting by anesthetists only. In 2007, Watts et al made brief mention, with no detail, of a higher incidence of transient symptoms.…”

Section: Introductionmentioning

confidence: 99%

Neuropathic Symptoms following Continuous Popliteal Block After Foot and Ankle Surgery

Gartke¹,

Portner²,

Taljaard³

2012

Foot Ankle Int.

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Rethinking the role of opioids in the outpatient management of chronic nonmalignant pain

Cited by 20 publications

References 136 publications

Caring for patients with pain during the COVID‐19 pandemic: consensus recommendations from an international expert panel

Caring for patients with pain during the COVID‐19 pandemic: consensus recommendations from an international expert panel

Exuberant sprouting of sensory and sympathetic nerve fibers in nonhealed bone fractures and the generation and maintenance of chronic skeletal pain

Neuropathic Symptoms following Continuous Popliteal Block After Foot and Ankle Surgery

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