chronic-pain-opioid-treatment-report-140929
chronic-pain-opioid-treatment-report-140929
chronic-pain-opioid-treatment-report-140929
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Author YearRalphs, 1994StudyDesignDurationNonrandomizedtrial6 monthsSettingCountry Eligibility Criteria Interventions Sample CharacteristicsInpatient,single centerUnitedKingdomPatients referred to inpatient <strong>pain</strong> management, on<strong>opioid</strong>s, <strong>chronic</strong> non-cancer <strong>pain</strong>, with any two offollowing: widespread disruption in activity due to <strong>pain</strong>,habitual over-activity leading to increased <strong>pain</strong>, regularuse of analgesics and/or sedatives for >6months, high affective distress, use of unnecessaryaids, high levels of <strong>report</strong>ed or observed <strong>pain</strong>behaviors, work reduced, impaired, or ceased owingto <strong>pain</strong>Exclude: Cannot use English, cannot climb stairs,current major psychiatric illness, unavailable for 4-week program, suitable for further physical <strong>treatment</strong>safter medical examinations, <strong>pain</strong> of less than 1 year'sduration, under 18 years old, currently using <strong>opioid</strong>sfor <strong>treatment</strong> 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 (<strong>opioid</strong>mixed into a cocktail withdose gradually reduced,patient unaware ofreduction schedule)Mean age: 47 vs. 50 yearsFemale gender: 49% vs. 71%Non-white race: Not <strong>report</strong>edPain 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 <strong>opioid</strong>s who volunteered for outpatient<strong>treatment</strong> for withdrawing <strong>opioid</strong>sA: 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 <strong>opioid</strong> use: 7.2 vs. 9.2yearsProportion with <strong>chronic</strong> <strong>pain</strong>: 62%vs. 71%Back/spine disorder: 24% vs. 19%Use of codeine: 67% vs. 48%B: Detoxification/maintenance:Detoxification as above,with maintenance on <strong>opioid</strong>if detoxificationunsuccessfulNote: The references are located in Appendix C.NR=not <strong>report</strong>edE-44
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