Annals Academy of Medicine Evidence-Based Guidelines on the Use of Opioids in Chronic Non-Cancer Pain—A Consensus Statement by the Pain Association of Singapore Task Force (original) (raw)
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Annals of the Academy of Medicine, Singapore, 2013
While opioids are effective in carefully selected patients with chronic non-cancer pain (CNCP), they are associated with potential risks. Therefore, treatment recommendations for the safe and effective use of opioids in this patient population are needed. A multidisciplinary expert panel was convened by the Pain Association of Singapore to develop practical evidence-based recommendations on the use of opioids in the management of CNCP in the local population. This article discusses specific recommendations for various common CNCP conditions. Available data demonstrate weak evidence for the long-term use of opioids. There is moderate evidence for the short-term benefit of opioids in certain CNCP conditions. Patients should be carefully screened and assessed prior to starting opioids. An opioid treatment agreement must be established, and urine drug testing may form part of this agreement. A trial duration of up to 2 months is necessary to determine efficacy, not only in terms of pain...
Standard Therapy with Opioids in Chronic Pain Management
Clinical Drug Investigation, 2009
Objective: Moderate to severe pain is commonly experienced by cancer and non-Abstract cancer patients. Although opioids are generally the most important drugs in chronic pain management, their use in Italy remains low. We designed a prospective open trial to assess the efficacy and safety of a standard therapy clinically available for a large range of patients. Methods: A total of 172 consecutive patients (89 women and 83 men) with chronic pain (daily mean visual analogue scale (VAS) score > 4) that was not adequately managed by their existing pain regimen were enrolled to receive an immediate release (IR) dose of morphine: 30 mg/day (opioid-naive patients) or 60 mg/day (non-naive patients) for 5 days. After this period (start therapy), all patients were switched to slow release (SR) opioid therapy for 30 days (steady therapy). Each breakthrough pain (BTP) episode was treated with a single dose of IR morphine (20% of the daily dose) during all study periods. Results: Daily VAS score was reduced from 7.4 ± 1.3 at baseline to 3.8 ± 1.5 (p < 0.0001) after 30 days of steady therapy in cancer and non-cancer patients. Fewer patients reported BTP events by study end (55% of patients with BTP at basal time had no BTP at last follow up), and the number of daily BTP events experienced by patients was reduced by therapy to 1-2 per day in 75% of patients reporting BTP. Further, the time delay to reach pain relief following administration of a rescue dose of IR morphine was 15 minutes or less in 52.1% of patients at study end. The standard therapy was well tolerated and fewer adverse effects were recorded at the end of the study period compared with baseline, with the exception of constipation, which showed a moderate increase (from 18.2% to 25.0%). Conclusion: Start therapy with IR morphine followed by conversion to SR opioid therapy could be implemented as a standard therapy to manage moderate to severe 18 Gatti et al.
Systematic Reviews, 2013
Background: Opioids are prescribed frequently and increasingly for the management of chronic non-cancer pain (CNCP). Current systematic reviews have a number of limitations, leaving uncertainty with regard to the benefits and harms associated with opioid therapy for CNCP. We propose to conduct a systematic review and meta-analysis to summarize the evidence for using opioids in the treatment of CNCP and the risk of associated adverse events.
Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects Review
C hronic non-cancer-related pain (CNCP) includes chronic pain of a nociceptive or neuropathic nature with variable influence by psychological and socioenvironmental factors. Opioids are the most potent analgesics available and are well established for the treatment of severe acute, 1 surgical 2 and cancer pain. 3 However, their use to ameliorate CNCP is still controversial because of the side effects of opioids, the physical tolerance they build up (with the related withdrawal reactions and possibility of addiction) and anxiety over disapproval by regulatory bodies. The prevalence of CNCP varies according to the type of pain and the population studied. A study conducted in the United Kingdom in a community in the greater London area to quantify the prevalence of chronic pain found that 46.5% of the general population reported chronic pain; low-back problems and arthritis were the leading causes. 5 A recent epidemiological study in Denmark 6 found that nearly 130 000 adults, corresponding to 3% of the Danish population, regularly used opioids. CNCP had a prevalence of 19%, and 12% of those who had CNCP used opioid medications.
Opioid therapy for chronic non-cancer pain: guidelines for Hong Kong
Hong Kong Medical Journal, 2016
Opioids are increasingly used to control chronic non-cancer pain globally. International opioid guidelines have been issued in many different countries but a similar document is not generally available in Hong Kong. Chronic opioid therapy has a role in multidisciplinary management of chronic non-cancer pain despite insufficient evidence for its effectiveness and safety for long-term use. This document reviews the current literature to inform Hong Kong practitioners about the rational use of chronic opioid therapy in chronic non-cancer pain. It also aims to provide useful recommendations for the appropriate, effective, and safe use of such therapy in the management of chronic non-cancer pain in adults. Physicians should conduct a comprehensive biopsychosocial evaluation of patients prior to the commencement of opioid therapy. When opioid use is deemed appropriate, the patient should provide informed consent within an agreement that specifies treatment goals and expectations. A trial of opioid can be commenced and, provided there is progress towards treatment goals, then chronic therapy can be considered at a dose that minimises harm. Monitoring of effectiveness, safety, and drug misuse should be continued. Treatment should be stopped when opioids become ineffective, intolerable, or misused. The driving principles for opioid prescription in chronic pain management should be: start with a low dose, titrate slowly, and maintain within the shortest possible time.
Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects
Canadian Medical Association Journal, 2006
C hronic non-cancer-related pain (CNCP) includes chronic pain of a nociceptive or neuropathic nature with variable influence by psychological and socioenvironmental factors. Opioids are the most potent analgesics available and are well established for the treatment of severe acute, 1 surgical 2 and cancer pain. 3 However, their use to ameliorate CNCP is still controversial because of the side effects of opioids, the physical tolerance they build up (with the related withdrawal reactions and possibility of addiction) and anxiety over disapproval by regulatory bodies. The prevalence of CNCP varies according to the type of pain and the population studied. A study conducted in the United Kingdom in a community in the greater London area to quantify the prevalence of chronic pain found that 46.5% of the general population reported chronic pain; low-back problems and arthritis were the leading causes. 5 A recent epidemiological study in Denmark 6 found that nearly 130 000 adults, corresponding to 3% of the Danish population, regularly used opioids. CNCP had a prevalence of 19%, and 12% of those who had CNCP used opioid medications.
EAU Guidelines on Pain Management
2003
Pain is the most common symptom of any illness; the physician's therapeutic task is twofold: to discover and treat the cause of pain and the pain itself, whether or not the underlying cause is treatable, to provide relief and reduce the suffering caused by pain. Although we use the term of pain to define all sensations that hurt or are unpleasant, actually two quite different kinds of pain exist. The first (nociceptive) is associated with tissue damage or inflammation, the second (neuropathic) results from a lesion to the peripheral or central nervous systems. Pain can also be divided in acute and chronic.
An overview of treatment approaches for chronic pain management
Rheumatology international, 2016
Pain which persists after healing is expected to have taken place, or which exists in the absence of tissue damage, is termed chronic pain. By definition chronic pain cannot be treated and cured in the conventional biomedical sense; rather, the patient who is suffering from the pain must be given the tools with which their long-term pain can be managed to an acceptable level. This article will provide an overview of treatment approaches available for the management of persistent non-malignant pain. As well as attempting to provide relief from the physical aspects of pain through the judicious use of analgesics, interventions, stimulations, and irritations, it is important to pay equal attention to the psychosocial complaints which almost always accompany long-term pain. The pain clinic offers a biopsychosocial approach to treatment with the multidisciplinary pain management programme; encouraging patients to take control of their pain problem and lead a fulfilling life in spite of t...
Opioids in chronic non-cancer pain, indications and controversies
European Journal of Pain, 2005
The use of opioid analgesics for long term management of chronic non-cancer pain is now an accepted, although still a controversial medical practice. In some well selected patients with long-lasting or recurrent pain, severe enough to markedly reduce their quality of life, and for whom no other more effective and less risky therapy is available, opioid analgesics may reduce intensity of pain, increase functioning and improve quality of life for prolonged periods. The type of pain and pain history of the patients do not predict reliably the chance of long term success or risk of complications from opioid therapy. However, the outlook for successful long term opioid therapy is better in a patient with a stable psychosocial situation having nociceptive type pain that is markedly relieved by a moderate dose of a long lasting oral or transdermal opioid, than a patient from a complex and unstable psychosocial background having neuropathic type pain that is relieved only partly by a higher dose of a potent opioid. When a patient is managed by a multidisciplinary team, the compliance is better and risk of loss of control and complications are less than when a single doctor is managing the patient. The evidence base for this type of pain management is meagre because the needed randomized controlled trials, which ideally should last for several years, have not been performed. Therefore a number of national and international guidelines are being published, recommending expertsÕ opinion on appropriate use and responsible follow-up of long term treatment with opioids for chronic non-cancer pain.