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López-Arteaga T, Moreno-Rubio C, Mohedano-Moriano A. Risk factors for opioid addiction in chronic non-cancer pain. Heliyon 2023; 9:e19707. [PMID: 37809400 PMCID: PMC10558926 DOI: 10.1016/j.heliyon.2023.e19707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 07/17/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
Opioids are very effective pain medications, but they are not without complications. Its use in chronic cancer pain is clearly established, but not in chronic non-cancer pain. Opioid use has increased in recent years, but at the same time, it has been accompanied by an increase in side effects and related complications, including abuse, abuse and opioid addiction. If we look in the literature on the subject there is a global concern to make an adequate therapy with risk reduction, but the samples studied make it difficult to extrapolate results to the general population and even more so if we take into account factors such as psychiatric comorbidity. This leads us to consider the need to study our own population, its characteristics and see how it is being treated, to refine as much as possible on an appropriate prescription. The authors have carried out a cross-sectional study on patients with non-cancer chronic pain referred to psychiatry and the presence of opioid use disorder. We found risk factors related to the biopsychosocial characteristics of the patients and the characteristics of pain and its treatment. Knowing the risk factors, we can avoid yatrogeny, implement primary and secondary prevention and, ultimately, improve the quality of patient care.
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Affiliation(s)
- Teresa López-Arteaga
- Médico Psiquiatra. Directora Médica Área Integrada de Talavera. Hospital General Universitario Ntra. Sra. Del Prado. Talavera de la Reina, Spain
| | - Carlos Moreno-Rubio
- Jefe de Servicio de Psiquiatría. Hospital General Universitario Ntra. Sra. Del Prado. Talavera de la Reina, Spain
| | - Alicia Mohedano-Moriano
- Titular de la Facultad de Ciencias de la Salud Talavera de la Reina. Universidad de Castilla-La Mancha, Spain
- Académica del Vicerrectorado de Ciencias de la Salud de la Universidad de Castilla-La Mancha, Spain
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Kerckhove N, Delage N, Bertin C, Kuhn E, Cantagrel N, Vigneau C, Delorme J, Lambert C, Pereira B, Chenaf C, Authier N. Cross-sectional study of the prevalence of prescription opioids misuse in French patients with chronic non-cancer pain: An update with the French version of the POMI scale. Front Pharmacol 2022; 13:947006. [PMID: 36133827 PMCID: PMC9484362 DOI: 10.3389/fphar.2022.947006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Public health issues related to chronic pain management and the risks of opioid misuse and abuse remain a challenge for practitioners. Data on the prevalence of disorders related to the use of prescribed opioids in patients suffering from chronic pain remains rather patchy, in particular because of the absence of a gold standard for their clinical assessment. We estimated the prevalence of prescription opioid misuse (POM), using a specific and validated opioid misuse scale (POMI-5F scale), in adults with chronic non-cancer pain. Nine-hundred-fifty-one (951) patients with opioids prescription and followed-up in pain clinics and addictology centers for chronic non-cancer pain (CNCP) completed the survey interview. The results suggest that 44.4% of participants have POM, accompanied by overuse (42.5%), use of opioids for effects other than analgesia (30.9%), withdrawal syndrome (65.7%), and craving (6.9%). The motivations cited for POM, apart from pain relief, were to calm down, relax and improve mood. POM was shown to be related to male sex (OR 1.52), young age (OR 2.21) and the presence of nociplastic pain (OR 1.62) of severe intensity (OR 2.31), codeine use (OR 1.72) and co-prescription of benzodiazepines (OR 1.59). Finally, despite the presence of three subgroups of misusers, no factor was associated with the intensity of misuse, reinforcing the view that distinguishing between strong and weak opioids is not appropriate in the context of use disorder. Almost half of patients with CNCP misuse their prescribed opioid. Practitioners should be attentive of profiles of patients at risk of POM, such as young, male patients suffering from severe nociplastic pain, receiving prescription for codeine and a co-prescription for benzodiazepine. We encourage French-speaking practitioners to use the POMI-5F scale to assess the presence of POM in their patients receiving opioid-based therapy. Clinical Trial Registrationclinicaltrials.gov, identifier NCT03195374
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Affiliation(s)
- Nicolas Kerckhove
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
- *Correspondence: Nicolas Kerckhove,
| | - Noémie Delage
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Célian Bertin
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA), CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Emmanuelle Kuhn
- Centre d'évaluation et d’information sur la Pharmacodépendance—Addictovigilance, CHU Nantes, Nantes, France
| | - Nathalie Cantagrel
- Centre d’Evaluation et de Traitement de la Douleur, CHU Toulouse, Toulouse, France
| | - Caroline Vigneau
- Centre d'évaluation et d’information sur la Pharmacodépendance—Addictovigilance, CHU Nantes, Nantes, France
| | - Jessica Delorme
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Céline Lambert
- Unité de Biostatistiques, DRCI, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Unité de Biostatistiques, DRCI, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Chouki Chenaf
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA), CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Nicolas Authier
- Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre d’Evaluation et de Traitement de la Douleur, Inserm, CHU Clermont-Ferrand, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Université Clermont Auvergne, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA), CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
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Hradetzky E, Ohlmeier C, Brinkmann C, Schild M, Galetzka W, Schmedt N, John T, Kaleth D, Gothe H. Epidemiology and routine care treatment of patients with hip or knee osteoarthritis and chronic lower back pain: real-world evidence from Germany. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Aim
Musculoskeletal disorders are a major public health problem in most developed countries. As a main cause of chronic pain, they have resulted in an increasing prescription of opioids worldwide. With regard to the situation in Germany, this study aimed at estimating the prevalence of musculoskeletal diseases such as chronic low back pain (CLBP) and hip/knee osteoarthritis (OA) and at depicting the applied treatment patterns.
Subject and methods
German claims data from the InGef Research Database were analyzed over a 6-year period (2011–2016). The dataset contains over 4 million people, enrolled in German statutory health insurances. Inpatient and outpatient diagnoses were considered for case identification of hip/knee OA and CLBP. The World Health Organization (WHO) analgesic ladder was applied to categorize patients according to their pain management interventions. Information on demographics, comorbidities, and adjuvant medication was collected.
Results
In 2016, n = 2,693,481 individuals (50.5% female, 49.5% male) were assigned to the study population; 62.5% of them were aged 18–60 years. In 2016, n = 146,443 patients (5.4%) with CLBP and n = 307,256 patients (11.4%) with hip/knee OA were identified. Of those with pre-specified pain management interventions (CLBP: 66.3%; hip/knee OA: 65.1%), most patients received WHO I class drugs (CLBP: 73.6%; hip/knee OA: 68.7%) as the highest level.
Conclusion
This study provides indications that CLBP and hip/knee OA are common chronic pain conditions in Germany, which are often subjected to pharmacological pain management. Compared to non-opioid analgesic prescriptions of the WHO I class, the dispensation of WHO class II and III opioids was markedly lower, though present to a considerable extent.
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[Critical discussion of new data regarding prevalence of opioid use disorder in patients with chronic pain in Germany]. Schmerz 2021; 36:13-18. [PMID: 34505947 PMCID: PMC8821065 DOI: 10.1007/s00482-021-00582-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/03/2022]
Abstract
Hintergrund Es gibt keine Opioidkrise in Deutschland. Neue Studien mit Nichttumorpatienten mit chronischen Schmerzen (CNTS) in Deutschland zeigen jedoch eine unerwartet hohe Prävalenz von Opioidgebrauchsstörungen nach Diagnostic and Statistical Manual for Psychiatric Diseases 5 (DSM-5). Ziel der Arbeit Kritische Diskussion neuer Studienergebnisse zur Prävalenz von Opioidgebrauchsstörungen bei Schmerzpatienten in Deutschland. Material und Methoden Selektive Literaturrecherche und multiprofessionelle Einordnung der Ergebnisse durch Expertenrunde (Schmerztherapie, Neurologie, Psychiatrie, Palliativmedizin, Allgemeinmedizin und Suchttherapie). Ergebnisse Die Kriterien für die Diagnose „Opioidgebrauchsstörung“ des DSM‑5 sind auf Patienten mit CNTS nur eingeschränkt anwendbar, können aber für problematisches Verhalten sensibilisieren. Hierbei ist die Diagnose Opioidgebrauchsstörung nicht mit der Diagnose einer Substanzabhängigkeit nach ICD-10 gleichzusetzen, da die Diagnose nach DSM‑5 ein deutlich breiteres Spektrum abdeckt (mild, moderat, schwer). Risikofaktoren für eine Opioidgebrauchsstörung sind jüngeres Alter, depressive Störungen, somatoforme Störungen und hohe Opioidtagesdosen. Die interdisziplinäre Leitlinie zur Langzeitanwendung von Opioiden bei chronischen nichttumorbedingten Schmerzen (LONTS) enthält Empfehlungen, welche das Risiko für eine Opioidgebrauchsstörung reduzieren sollen. Diskussion Eine Anpassung der DSM-5-Diagnosekriterien der Opioidgebrauchsstörung an die besondere Situation von Patienten mit CNTS und eine Validierung dieser Kriterien könnte helfen, in der Zukunft genauere Daten zu Opioidgebrauchsstörungen von Patienten mit chronischen Schmerzen in Deutschland zu erheben. Verordner sollten für diese Problematik sensibilisiert werden, ohne die Patienten zu pathologisieren oder gar zu stigmatisieren. Weitere Forschung zur Einordnung dieses bisher unterschätzten Phänomens ist notwendig.
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Abstract
This paper is the forty-second consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2019 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, 65-30 Kissena Blvd., Flushing, NY, 11367, United States.
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Analgesic Opioid Misuse and Opioid Use Disorder among Patients with Chronic Non-Cancer Pain and Prescribed Opioids in a Pain Centre in France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042097. [PMID: 33670004 PMCID: PMC7926319 DOI: 10.3390/ijerph18042097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 02/06/2023]
Abstract
(1) Background: Chronic non-cancer pain (CNCP) remains a public health challenge around the world. Opioids (PO) have been increasingly used in the treatment of CNCP in the last 20 years. This study aimed to assess the prevalence of opioid misuse and prescribed-opioid use disorder (p-OUD) among patients with CNCP in a pain centre in France, and to analyse risk factors for moderate or severe p-OUD. (2) Method: A cross-sectional study was conducted, including patients consulting for pain management in the pain centre of Brest University Hospital. A self-questionnaire was administered (sociodemographic data, medical data, PO misuse, and p-OUD according the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) criteria). Descriptive, univariate, and multivariate analyses were conducted, together with a principal component analysis, in order to identify factors associated with p-OUD. (3) Results: In total, 115 patients were included, the majority of whom were women, with a mean age of 52 years old [18–82]; 64.3% (n = 74) had a current prescription for opioid analgesics (weak or strong). In this group, 56.7% (n = 42) had no or only mild p-OUD and 43.3% (n = 32) had current moderate or severe p-OUD. Patients with moderate or severe p-OUD were more likely to have a current antidepressant prescription, to have had psychotherapy, to currently use strong opioids and oxycodone, and to report taking more frequent doses than prescribed and feeling dependent. (4) Conclusions: We showed that the prevalence of current moderate/severe p-OUD concerned 43.3% of the patients with a CNCP seeking treatment in a pain centre. According to these results, several measures are relevant in managing p-OUD among patients with CNCP.
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Boscarino JA, Withey CA, Dugan RJ, Hu Y, Auciello J, Alfieri T. Opioid Medication Use Among Chronic Non-Cancer Pain Patients Assessed with a Modified Drug Effects Questionnaire and the Association with Opioid Use Disorder. J Pain Res 2020; 13:2697-2705. [PMID: 33122939 PMCID: PMC7591039 DOI: 10.2147/jpr.s275397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Identifying opioid use disorder (OUD) in patients prescribed opioid therapy for chronic pain is challenging but critically important. Patients may have multiple reasons for taking medications, which they may not reveal if not properly interviewed. In this study, modified Drug Effects Questionnaires (DEQ) were used to assess the liking of and desire to take prescription opioids both for reasons of pain relief and for reasons excluding pain relief. We hypothesized patients would more strongly endorse their medications for reasons of pain relief compared to reasons excluding pain relief, and patients who endorse medications for reasons excluding pain relief may be at higher risk of developing OUD. Patients and Methods A cross-sectional telephone survey was administered to 200 adult outpatients currently being prescribed opioids. A two-year retrospective analysis of electronic health records supplemented survey findings. Results Based on DSM-5 criteria, 9.0% (n = 18) of patients had moderate or severe OUD. The mean (SD) for drug-liking was 54 (33.4) on a 0 to 100 scale. When liking for pain relief was specified, the mean (SD) was significantly higher compared to when excluding pain relief was specified, 70 (27.8) vs 24 (31.2), p<0.001. A similar pattern was observed for patients’ ratings of desire to take their medication again, and “feel good effects” of their medications. Higher scores on items that excluded pain relief were associated with other indications of drug misuse. Conclusion The observed rate of OUD in this patient sample was consistent with findings from other recent research. A better understanding of patients’ reasons for using opioid medication may help researchers and health care providers identify those at greatest risk for developing OUD.
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Affiliation(s)
- Joseph A Boscarino
- Department of Population Health Sciences, Geisinger Clinic, Danville, PA, 17822, USA
| | - Carrie A Withey
- Department of Population Health Sciences, Geisinger Clinic, Danville, PA, 17822, USA
| | - Ryan J Dugan
- Department of Population Health Sciences, Geisinger Clinic, Danville, PA, 17822, USA
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger Clinic, Danville, PA, 17822, USA
| | | | - Thomas Alfieri
- Medical Affairs, Purdue Pharma L.P, Stamford, CT 06901, USA
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Glare P, Ashton-James C, Han E, Nicholas M. Deprescribing long-term opioid therapy in patients with chronic pain. Intern Med J 2020; 50:1185-1191. [PMID: 33111411 DOI: 10.1111/imj.15023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022]
Abstract
Proposed regulatory changes will limit the access to opioids by Australian patients with chronic pain, many of whom are under the care of consultant physicians. This review summarises points of consensus on opioid deprescribing that emerged from the interaction of an expert panel and the audience at a symposium on the topic held in Sydney in 2019. Each of these consensus points speaks to the need for an individualised, patient-centred approach. In other words, 'treat the patient, not the pill count'.
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Affiliation(s)
- Paul Glare
- Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.,Michael J Cousins Pain Management Research Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Claire Ashton-James
- Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Esther Han
- Drug and Alcohol Services, Northern Sydney Local Health District, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Michael Nicholas
- Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia.,Michael J Cousins Pain Management Research Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Jobski K, Dörks M, Bantel C, Hoffmann F. Regional Differences in Opioid Prescribing in Germany - Results of an Analysis of Health Insurance Data of 57 Million Adult People. J Pain Res 2020; 13:2483-2492. [PMID: 33116790 PMCID: PMC7548317 DOI: 10.2147/jpr.s259009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/20/2020] [Indexed: 11/23/2022] Open
Abstract
Background Regional variations of opioid use have been reported from many countries. The objective of this study was to examine opioid prescribing patterns in Germany including low- and high-potency opioids (LPO and HPO) focusing on regional differences. Methods Data source was the "Information system for health care data" comprising statutory health insurance funds data for about 70 million Germans of all ages. For 2010, we received aggregated data (by age, sex, federal state and district) of Germans (18+) who had been prescribed at least one opioid including the number of prescribed packages. For each stratum, we further received the number of insured persons. We calculated LPO and HPO prevalences and the mean number of prescribed packages. Results Among 57 million adult Germans (mean age: 50.2 years, 53.8% female), opioid prevalences were 38.7 per 1000 persons for LPOs and 12.8 for HPOs. Prevalences rose with increasing age and were higher in women than in men. On average, LPO users were prescribed fewer packages than HPO users (3.5 vs 7.0). LPO use was highest in the eastern states ranging from 32.9 per 1000 persons (Hamburg) to 47.2 (Saxony-Anhalt). HPOs were most often prescribed in the North and in the East with prevalences varying between 10.6 per 1000 persons (Baden-Württemberg) and 16.9 (Mecklenburg-Western Pomerania). On the district level, prevalences varied by the factors 2.6 and 3.2 for LPOs and HPOs, respectively. Conclusion We found large regional variations in opioid prescribing which probably cannot only be attributed to differences in patient characteristics.
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Affiliation(s)
- Kathrin Jobski
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Michael Dörks
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Carsten Bantel
- University Department of Anesthesiology, Critical Care, Emergency and Pain Medicine, Klinikum Oldenburg, Oldenburg, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Petzke F, Häuser W. [And the opioid pendulum still swings between uncritical indication and overcritical restriction]. Schmerz 2020; 34:443-446. [PMID: 32880758 DOI: 10.1007/s00482-020-00494-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Frank Petzke
- Schmerzmedizin, Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - Winfried Häuser
- Medizinisches Versorgungszentrum für Schmerzmedizin und seelische Gesundheit Saarbrücken - St. Johann, 66111, Saarbrücken, Deutschland
- Innere Medizin 1, Klinikum Saarbrücken, Winterberg 1, 66119, Saarbrücken, Deutschland
- Klinik für Psychosomatische Medizin und Psychotherapie, Technische Universität München, 81635, München, Deutschland
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[How long does a long-term therapy last?]. Schmerz 2020; 34:438-442. [PMID: 32880757 PMCID: PMC7471546 DOI: 10.1007/s00482-020-00493-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Just JM, Scherbaum N, Specka M, Puth MT, Weckbecker K. Rate of opioid use disorder in adults who received prescription opioid pain therapy-A secondary data analysis. PLoS One 2020; 15:e0236268. [PMID: 32702036 PMCID: PMC7377413 DOI: 10.1371/journal.pone.0236268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 07/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background and aims Data on rates of prescription opioid use disorder (pOUD) in European countries is limited. The aim of this investigation was to analyze a representative population sample regarding the 1-year prevalence of opioid use disorder in patients who received prescription opioid pain therapy and to identify related risk factors. Design Cross-sectional secondary data analysis Setting Secondary data analysis based on data from the 2015 Epidemiological Survey of Substance Abuse (ESA 2015) in Germany Participants German-speaking individuals living in private households aged 18 to 64 years were investigated. A total of 9204 individuals participated in the survey, resulting in a response rate of 52.2%. Primary and secondary outcome measures Primary outcome measure was the weighted prevalence of pOUD in the subgroup of study participants who had received prescription opioids. Secondary outcome measure was an analysis of risk factors connected with pOUD in the same subgroup. Findings A total of n = 9204 participants were included in the study of which n = 275 had received an opioid prescription in the last 12 months of which n = 54 were diagnosed with pOUD. The weighted 1-year prevalence of pOUD was 21.2% (mild: 14.7% | moderate: 3.5% | severe: 2.9%). Participants who had received opioid pain therapy had significantly higher odds of pOUD if they reported signs of depression (OR: 2.69; CI 95%: 1.13–6.38), inexplicable physical complaints (OR: 2.68; CI 95%: 1.14–6.31) or a psychiatric diagnosis (OR: 4.12; CI 95%: 1.36–12.43), and significantly lower odds of pOUD if they reported the use of non-opioid painkillers (OR: 0.27; CI 95%: 0.09–0.81). Conclusions pOUD is a common phenomenon in working-age patients who receive prescription opioid pain therapy in Germany and may be related to the co-existence of psychosomatic and psychiatric disorders such as depression.
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Affiliation(s)
- Johannes M. Just
- Institute of General Practice and Interprofessional Care, Faculty of Health / Department of Medicine, University Witten/Herdecke, Witten, Germany
- * E-mail:
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Michael Specka
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Marie-Therese Puth
- Department of Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Interprofessional Care, Faculty of Health / Department of Medicine, University Witten/Herdecke, Witten, Germany
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Überall MA. A Review of Scientific Evidence for THC:CBD Oromucosal Spray (Nabiximols) in the Management of Chronic Pain. J Pain Res 2020; 13:399-410. [PMID: 32104061 PMCID: PMC7027889 DOI: 10.2147/jpr.s240011] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/15/2020] [Indexed: 12/13/2022] Open
Abstract
The 20% prevalence of chronic pain in the general population is a major health concern given the often profound associated impairment of daily activities, employment status, and health-related quality of life in sufferers. Resource utilization associated with chronic pain represents an enormous burden for healthcare systems. Although analgesia based on the World Health Organization’s pain ladder continues to be the mainstay of chronic pain management, aside from chronic cancer pain or end-of-life care, prolonged use of non-steroidal anti-inflammatory drugs or opioids to manage chronic pain is rarely sustainable. As the endocannabinoid system is known to control pain at peripheral, spinal, and supraspinal levels, interest in medical use of cannabis is growing. A proprietary blend of cannabis plant extracts containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) as the principal cannabinoids is formulated as an oromucosal spray (USAN name: nabiximols) and standardized to ensure quality, consistency and stability. This review examines evidence for THC:CBD oromucosal spray (nabiximols) in the management of chronic pain conditions. Cumulative evidence from clinical trials and an exploratory analysis of the German Pain e-Registry suggests that add-on THC:CBD oromucosal spray (nabiximols) may have a role in managing chronic neuropathic pain, although further precise clinical trials are required to draw definitive conclusions.
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Tan B, Li B, An Y, Ma X, Jiang Y, Song Y, Ge X, Yuan S, Liu L, Dou Y, Yu Y, Ji P, Li X, Cheng Y. A multicentre survey of pain management in cancer patients and physicians attending radiotherapy clinics in Shandong Province, China. J Int Med Res 2019; 47:5711-5722. [PMID: 31588825 PMCID: PMC6862914 DOI: 10.1177/0300060519867168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To obtain a better understanding of the prevalence and management of pain in patients undergoing radiotherapy for cancer in Shandong Province, China. Methods This cross-sectional study used a questionnaire during face-to-face interviews to collect data from physicians and patients regarding the recognition, prevalence and treatment of pain during the waiting period before commencement of radiotherapy and during the radiotherapy period. Physicians and patients were recruited from 10 tertiary Class A hospitals across Shandong Province, China. Results A total of 184 patients and 87 physicians were recruited to the study. During the waiting period, pain was reported by the physicians according to their experience to affect 26.0% of patients, which almost agreed with the patients’ data (36.5%; 160 of 438). During the radiotherapy period, there was a significant difference in the reported prevalence of pain during the radiotherapy period between the physicians’ data (23.0%) based on their experience and the patients’ data (84.1%; 169 of 201 patients). The majority of physicians (98.9%; 86 of 87) agreed to the use opioids for pain management and 90.8% (79 of 87) were satisfied with the analgesic effect, but more than half of the patients who received pain treatment reported inadequate analgesia. Conclusion There was a high incidence of cancer pain, but insufficient assessment, inadequate treatment and inadequate education about pain in both the waiting and radiotherapy periods.
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Affiliation(s)
- Bingxu Tan
- Department of Radiotherapy, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Baosheng Li
- Department of Radiotherapy, Shandong Cancer Hospital, Jinan, Shandong Province, China
| | - Yongheng An
- Department of Radiotherapy, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xuezhen Ma
- Department of Radiotherapy, Qingdao Centre Medical Group, Qingdao, Shandong Province, China
| | - Yuhua Jiang
- Department of Radiotherapy, Second Hospital of Shandong University, Jinan, Shandong Province, China
| | - Yipeng Song
- Department of Radiotherapy, Yantai YuHuangDing Hospital, Yantai, Shandong Province, China
| | - Xingping Ge
- Department of Radiotherapy, Yantaishan Hospital, Yantai, Shandong Province, China
| | - Shengli Yuan
- Department of Radiotherapy, Qingdao Municipal Hospital, Qingdao, Shandong Province, China
| | - Liping Liu
- Department of Radiotherapy, Jining No.1 People's Hospital, Jining, Shandong Province, China
| | - Yan Dou
- Department of Radiotherapy, Jinan Central Hospital, Jining, Shandong Province, China
| | - Yanxia Yu
- Department of Radiotherapy, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Pu Ji
- Mundipharma (China) Pharmaceutical Co., Ltd., Beijing, China
| | - Xia Li
- Mundipharma (China) Pharmaceutical Co., Ltd., Beijing, China
| | - Yufeng Cheng
- Department of Radiotherapy, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
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