chronic-pain-opioid-treatment-report-140929

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Author year Outcomes Assessed ResultsCowan,2005Effects of cessation ofopioids: Unvalidated 19-item questionnaireBrief Pain InventoryEvaluation of physiologicparameters (heart rate,blood pressure,temperature, respiration,pupil size)Continued sustained-release morphine vs.abrupt cessationBrief Pain Inventory, average pain in last 24hours (0 to 10): 3.2 vs. 5.3 (p
Author YearRalphs, 1994StudyDesignDurationNonrandomizedtrial6 monthsSettingCountry Eligibility Criteria Interventions Sample CharacteristicsInpatient,single centerUnitedKingdomPatients referred to inpatient pain management, onopioids, chronic non-cancer pain, with any two offollowing: widespread disruption in activity due to pain,habitual over-activity leading to increased pain, regularuse of analgesics and/or sedatives for >6months, high affective distress, use of unnecessaryaids, high levels of reported or observed painbehaviors, work reduced, impaired, or ceased owingto painExclude: Cannot use English, cannot climb stairs,current major psychiatric illness, unavailable for 4-week program, suitable for further physical treatmentsafter medical examinations, pain of less than 1 year'sduration, under 18 years old, currently using opioidsfor treatment of drug dependencyA: Patient-controlledreduction (patientdiscussed desired rate ofreduction, aiming forabstinence by discharge,allowed to take longer ifthey wished, patients keptpills in room, plansadjusted as appropriate)B: Cocktail method (opioidmixed into a cocktail withdose gradually reduced,patient unaware ofreduction schedule)Mean age: 47 vs. 50 yearsFemale gender: 49% vs. 71%Non-white race: Not reportedPain duration: 124 vs. 101 monthsPain distress (0 to 100): 66 vs. 73Mean opiate dose: 35.8 mg/dayTennant, 1982Nonrandomizedclinical trial3 to 18monthsSingle centerOutpatientclinicUnited StatesPatients on opioids who volunteered for outpatienttreatment for withdrawing opioidsA: Detoxification/counseling: Detoxificationover 3 weeks withmethadone, propoxyphene,clonidine, diphenoxylate, orsedative-hypnotics,followed by weeklypsychotherapeuticcounselingMean age: 33 vs. 44 yearsFemale gender: 48% vs. 52%Nonwhite race: 19% vs. 14%Duration of opioid use: 7.2 vs. 9.2yearsProportion with chronic pain: 62%vs. 71%Back/spine disorder: 24% vs. 19%Use of codeine: 67% vs. 48%B: Detoxification/maintenance:Detoxification as above,with maintenance on opioidif detoxificationunsuccessfulNote: The references are located in Appendix C.NR=not reportedE-44
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Evidence Report/Technology Assessme
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PrefaceThe Agency for Healthcare Re
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Charles Inturrisi, Ph.D.Professor o
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Robert Jamison, Ph.D.Professor of A
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Conclusions. Evidence on long-term
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no opioid on: (1) opioid abuse, add
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References ........................
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The purpose of this report is to sy
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patient education, (3) urine drug s
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Each abstract was independently rev
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We rated the quality of each cohort
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ResultsOverviewThe search and selec
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Key Question 4. Risk Assessment and
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Table A. Summary of evidence (conti
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Evidence on the effectiveness of di
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ApplicabilityA number of issues cou
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the exception of buccal or intranas
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References1. International Associat
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outcome study of long-term opioid d
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patients? Pain Physician. 2006;9(1)
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American Academy of Pain Medicine,
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d. What is the comparative effectiv
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inclusion to English-language artic
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adequately reported and acceptable;
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eview comments will be made availab
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Key Question 1aIn patients with chr
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Key Question 2aIn patients with chr
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and F2). 49-58 All were rated fair-
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Table 1. Uncontrolled studies of lo
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Table 1. Uncontrolled studies of lo
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The annual overdose rate was 256 pe
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The SOE for the association between
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One fair-quality cross-sectional st
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5300 controls who did not visit the
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Key Question 3cIn patients with chr
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Table 2. Head-to-head trials and ob
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Table 2. Head-to-head trials and ob
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withdrawal due to opioid misuse, bu
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Table 3. Trials of different strate
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Table 3. Trials of different strate
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• Two studies evaluated the Scree
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Table 4. Studies of risk assessment
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Detailed SynthesisThe APS review id
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Evidence on the effectiveness of di
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Table 6. Summary of evidence (conti
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The setting in which studies were c
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switching to other prescription opi
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States: Fact Sheet. Atlanta, GA: Ce
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overdose: a cohort study. Ann Inter
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placebo-controlled study. Clin Ther
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pain. Ann Intern Med. 2014;160(1):3
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Appendix A. Search StrategiesDataba
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19. 18 and (random$ or control$ or
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11. (urine adj7 (screen$ or test$ o
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3. (alfentanil or alphaprodine or b
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25. Risk Reduction Behavior/ or Ris
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KQ 4a-4c: Risk Prediction and Mitig
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"meperidine" OR "meptazinol" OR (MH
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PICOT Include ExcludeOutcomes • F
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Moore TM, Jones T, Browder JH, et a
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Banning A, Sjogren P, Kaiser F. Rea
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study. Pain. 2004;108(1-2):17-27. P
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Edlund MJ, Sullivan M, Steffick D,
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Gianutsos L, Safrenek S. Is there a
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China. Addiction. 2011;106(10):1801
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study. Compr Psychiatry. 1979;20(1)
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2009;10(4):531-43. PMID: 19243306.
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Mercadante S, Casuccio A, Tirelli W
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2003;107(3):486-92. PMID: 14506751.
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Quigley C. Hydromorphone for acute
Page 151 and 152: osteoarthritis-related pain: placeb
Page 153 and 154: 2013;7(2):96-101. PMID: 23385449. E
Page 155 and 156: effect of maternal, postnatal, adol
Page 157 and 158: Vestergaard P, Rejnmark L, Mosekild
Page 159 and 160: Yulug B, Ozan E. Buprenorphine: a s
Page 161 and 162: Author, YearType of StudySettingDur
Page 167 and 168: Author,yearDunn,2010ScreenedEligibl
Page 169 and 170: Author,yearGomes,2011ScreenedEligib
Page 171 and 172: Author,yearLi, 2013Method For Asses
Page 173 and 174: Author,yearMethod For AssessingOutc
Page 175 and 176: Appendix Table E4. Observational St
Page 177 and 178: Author, YearKQLi, 2013 KQ2a Case-Co
Page 179 and 180: Appendix Table E5. Observational St
Page 181 and 182: 0Appendix Table E6. Observational S
Page 183 and 184: Appendix Table E7. Trials of Differ
Page 185 and 186: Appendix Table E8a. Head-to-Head Tr
Page 187 and 188: AuthorYearStudydesignDurationWild 2
Page 189 and 190: Author,YearHartung,2007Type of Stud
Page 191 and 192: Author,YearKrebs,2011Type of Study,
Page 193 and 194: AuthorYearStudyDesignDurationRCT12
Page 195 and 196: Author yearAshburn, 2011Study Desig
Page 197 and 198: Author yearPortenoy, 2007Study Desi
Page 199 and 200: Author yearSimpson, 2007Study Desig
Page 201: Author yearStudy designDurationCowa
Page 205 and 206: Author,Year Study DesignAkbik 2006
Page 207 and 208: Author,YearWebster2005Study DesignP
Page 209 and 210: Appendix F. Quality Assessment Tabl
Page 211 and 212: Author,YearGomes,2011Gomes,2013KQKQ
Page 213 and 214: Evaluatespopulationother than theon
Page 215 and 216: Key QuestionOutcomeStudy DesignNumb
Page 217 and 218: Key QuestionOutcomeStudy DesignNumb
Page 219: Key Question Outcome4. Risk assessm
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