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Opioid Treatments for ChronicPain Opioid Treatments for ChronicPain Comparative Effectiveness Review Number 229 R Comparative Effectiveness Review Number 229 Opioid Treatments for ChronicPain Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290-2015-00009-I Prepared by: Pacific Northwest Evidence-based Practice Center Portland, OR Investigators: Roger Chou, M.D. Daniel Hartung (...) , Pharm.D. Judith Turner, Ph.D. Ian Blazina, M.P.H. Brian Chan, M.D. Ximena Levander, M.D. Marian McDonagh, Pharm.D. Shelley Selph, M.D., M.P.H. Rongwei Fu, Ph.D. Miranda Pappas, M.A. AHRQ Publication No. 20-EHC011 April 2020 ii Key Messages Purpose of Review To assess the effectiveness and harms of opioid therapy for chronic noncancer pain, alternative opioid dosing strategies, and risk mitigation strategies Key Messages • Opioids are associated with small improvements versus placebo in pain
Nonopioid Pharmacologic Treatments for ChronicPain Nonopioid Pharmacologic Treatments for ChronicPain Comparative Effectiveness Review Number 228 R Comparative Effectiveness Review Number 228 Nonopioid Pharmacologic Treatments for ChronicPain Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290-2015-00009-I Prepared by: Pacific Northwest Evidence-based Practice Center Portland (...) , OR Investigators: Marian S. McDonagh, Pharm.D. Shelley S. Selph, M.D., M.P.H. David I. Buckley, M.D., M.P.H. Rebecca S. Holmes, M.D., M.S. Kimberly Mauer, M.D. Shaun Ramirez, M.P.H. Frances C. Hsu, M.S. Tracy Dana, M.L.S. Rochelle Fu, Ph.D. Roger Chou, M.D. AHRQ Publication No. 20-EHC010 April 2020 ii Key Messages Purpose of Review Evaluate the benefits and harms of nonopioid drugs in randomized controlled trials of patients with specific types of chronicpain, considering the effects on pain, function
Noninvasive Nonpharmacological Treatment for ChronicPain Noninvasive Nonpharmacological Treatment for ChronicPain: A Systematic Review Update Comparative Effectiveness Review Number 227 R Comparative Effectiveness Review Number 227 Noninvasive Nonpharmacological Treatment for ChronicPain: A Systematic Review Update Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290-2015 (...) for common chronicpain conditions. Key Messages • Interventions that improved function and/or pain for =1 month: o Low back pain: Exercise, psychological therapy, spinal manipulation, low-level laser therapy, massage, mindfulness-based stress reduction, yoga, acupuncture, multidisciplinary rehabilitation (MDR) o Neck pain: Exercise, low-level laser, mind-body practices, massage, acupuncture o Knee osteoarthritis: Exercise, cognitive behavioral therapy (CBT) o Hip osteoarthritis: Exercise, manual
Treatments for ChronicPain Treatments for ChronicPain | Effective Health Care Program Search Effective Health Care website Submit search Toggle navigation Select site to search Search Effective Health Care website Submit search » » » Treatments for ChronicPainChronicpain affects millions of adults in the United States. It is the leading cause of disability and significantly impacts physical and mental functioning and quality of life. Chronicpain is often defined as pain lasting 3 months (...) or longer or persisting past the normal time for tissue healing. HHS is committed to the promotion of evidence-based approaches to safe and appropriate treatment of chronicpain. The AHRQ Evidence-based Practice Center Program, on request from the U.S. Centers for Disease Control and Prevention, has conducted a comprehensive synthesis of the recent evidence from the peer-reviewed literature on the effectiveness and harms of noninvasive treatments for chronic noncancer pain. The current state
Chronic Foot Pain American College of Radiology End User License Agreement ACR Appropriateness Criteria is a registered trademark of the American College of Radiology. By accessing the ACR Appropriateness Criteria®, you expressly agree and consent to the terms and conditions as described at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/TermsandConditions.pdf Personal use of material is permitted for research, scientific and/or information purposes only. You may not modify or create (...) derivative works based on American College of Radiology material. No part of any material posted on the American College of Radiology Web site may be copied, downloaded, stored in a retrieval system, or redistributed for any other purpose without the expressed written permission of American College of Radiology. Date of origin: 1998 Last review date: 2013 ACR Appropriateness Criteria ® 1 ChronicFootPain American College of Radiology ACR Appropriateness Criteria ® Clinical Condition: Chronic Foot Pain
Opioids, chronicpain and the bigger picture OPIOID TAPERING ALGORITHM 1–9 Patient who is taking opioids No meaningful improvement in pain and/or function Cause of pain has resolved Adverse effects are intolerable Risk of harm outweighs potential benefits Signs of aberrant behaviour • Discuss the decision to taper an opioid with the patient • Ask each patient about their treatment goals and their perceived benefits and harms of opioid treatment • Listen to the patient’s beliefs and concerns (...) and preferences Fast taper Appropriate after a short period of opioid treatment (< 3 months) Reduce daily opioid dose each week by 10%–25% of the starting dose Review the patient frequently, emphasise the benefits of tapering and assess response against set goals Tapering progressing well improved function, controlled pain, reduced side effects Taper to the lowest effective dose, which may mean stopping the opioid • Some patients may not entirely stop using opioids but any dose reduction may be beneficial
Recommendations on ChronicPain Practice during the COVID-19 Pandemic Recommendations on ChronicPain Practice during the COVID-19 Pandemic - American Society of Regional Anesthesia and Pain Medicine Search Recommendations on ChronicPain Practice during the COVID-19 Pandemic A Joint Statement by American Society of Regional Anesthesia and Pain Medicine (ASRA) and European Society of Regional Anesthesia and Pain Therapy (ESRA) Authors: Harsha Shanthanna, MBBS, MD, MSc, FRCPC; Steven P. Cohen (...) General Considerations in ChronicPain Patients Susceptibility of chronicpain patients could be higher as many are elderly with multiple comorbidities and potential immune suppression. 4,5 Significant immune changes occur in a patient with COVID-19 disease. 3,6 Chronicpain exerts complex effects on the immune system, including immunosuppression in some individuals. 7 Chronic opioid therapy may cause immune suppression in some patients, and individual opioids differ in their potential. 8,9 Use
10-kHz High-Frequency Spinal Cord Stimulation for Adults With Chronic Noncancer Pain Published March 2020 Volume 20, Number 6 ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 10-kHz High-Frequency Spinal Cord Stimulation for Adults With Chronic Noncancer Pain: A Health Technology Assessment KEY MESSAGES What Is This Health Technology Assessment About? Chronicpain is pain that lasts for a long time, usually more than 3 months. People may develop chronicpain because of an injury, an infection (...) , a disease, or a surgery—or there may be no obvious reason for the pain. Chronicpain has a negative effect on people’s physical, emotional, social, and mental health. People may try a range of treatment options to manage their chronicpain, including physiotherapy, mindfulness practices, and medications. Spinal cord stimulation is typically recommended if these options do not work to relieve a person's pain. It delivers low-voltage electricity to the nerves in the spine to suppress pain signals
The effect of an integrated multidisciplinary rehabilitation programme alternating inpatient interventions with home-based activities for patients with chronic low back pain: a randomized controlled trial To compare the effectiveness of an integrated rehabilitation programme with an existing rehabilitation programme in patients with chronic low back pain.A single-centre, pragmatic, two-arm parallel, randomized controlled trial (1:1 ratio).A rheumatology inpatient rehabilitation centre (...) in Denmark.A total of 165 adults (aged ⩾ 18 years) with chronic low back pain.An integrated rehabilitation programme comprising an alternation of three weeks of inpatient stay and 12 weeks of home-based activities was compared with an existing rehabilitation programme of four weeks of inpatient stay.Patient-reported outcomes were collected at baseline and at the 26-week follow-up. The primary outcome was back-specific disability (Oswestry Disability Index). Secondary outcomes included pain intensity
Long-term safety and efficacy of closed-loop spinal cord stimulation to treat chronic back and leg pain (Evoke): a double-blind, randomised, controlled trial Spinal cord stimulation has been an established treatment for chronic back and leg pain for more than 50 years; however, outcomes are variable and unpredictable, and objective evidence of the mechanism of action is needed. A novel spinal cord stimulation system provides the first in vivo, real-time, continuous objective measure of spinal (...) of chronic back and leg pain.This multicentre, double-blind, parallel-arm, randomised controlled trial was done at 13 specialist clinics, academic centres, and hospitals in the USA. Patients with chronic, intractable pain of the back and legs (Visual Analog Scale [VAS] pain score ≥60 mm; Oswestry Disability Index [ODI] score 41-80) who were refractory to conservative therapy, on stable pain medications, had no previous experience with spinal cord stimulation, and were appropriate candidates for a spinal
Benefits and Harms of Long-term Opioid Dose Reduction or Discontinuation in Patients with ChronicPain Management Briefs eBrief-no166 -- Benefits and Harms of Long-term Opioid Dose Reduction or Discontinuation in Patients with ChronicPain Talk to the Veterans Crisis Line now An official website of the United States government Here's how you know The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're (...) eBrief-no166 -- Benefits and Harms of Long-term Opioid Dose Reduction or Discontinuation in Patients with ChronicPain Health Services Research & Development Management eBrief no. 166 » Issue 166 January 2020 The report is a product of the VA/HSR&D Evidence Synthesis Program. Benefits and Harms of Long-term Opioid Dose Reduction or Discontinuation in Patients with ChronicPain In response to the evolving public health crisis related to opioid use, many providers, health systems, and payers
Effects of open-label placebo on pain, functional disability, and spine mobility in patients with chronic back pain: a randomized controlled trial Chronic back pain (CBP) is a major global health problem, while its treatment is hampered by a lack of efficacy and restricted safety profile of common frontline therapies. The present trial aims to determine whether a 3-week open-label placebo treatment reduces pain intensity and subjective and objective functional disability in patients with CBP (...) . This randomized controlled trial, following a pretest-posttest design, enrolled 127 patients with CBP (pain duration >12 weeks) from the Back Pain Center, Neurology, University Hospital Essen, Germany. Patients randomized to the open-label placebo group received a 3-week open-label placebo treatment. Patients in the treatment as usual (TAU) group received no intervention. Both groups continued TAU. Primary outcome was the change in pain intensity. Secondary outcomes included patient-reported functional
Moderators of Internet-Delivered Cognitive-Behavioral Therapy for Adolescents With ChronicPain: Who Benefits From Treatment at Long-Term Follow-Up? Cognitive behavioral therapy (CBT) is effective for pediatric chronicpain, but little is understood about which youth are most likely to benefit. The current study aimed to identify individual characteristics for which CBT yielded the greatest (and least) clinical benefit among adolescents with chronicpain participating in a multicenter (...) randomized controlled trial of Internet-delivered CBT (WebMAP2). A total of 273 adolescents ages 11 to 17 with chronicpain (M age = 14.7; 75.1% female) were randomly assigned to Internet-delivered CBT or Internet-delivered pain education and evaluated at pretreatment, post-treatment, and 2 longer term follow-up periods (6 and 12 months). Multilevel growth models tested several adolescent- and parent-level moderators of change in pain-related disability including 1) adolescent age, sex, pain
Is a combined programme of manual therapy and exercise more effective than usual care in patients with non-specific chronic neck pain? A randomized controlled trial The aim of this study was to compare the effectiveness of a combined intervention of manual therapy and exercise (MET) versus usual care (UC), on disability, pain intensity and global perceived recovery, in patients with non-specific chronic neck pain (CNP).Randomized controlled trial.Outpatient care units.Sixty-four non-specific (...) CNP patients were randomly allocated to MET (n = 32) or UC (n = 32) groups.Participants in the MET group received 12 sessions of mobilization and exercise, whereas the UC group received 15 sessions of usual care in physiotherapy.The primary outcome was disability (Neck Disability Index). The secondary outcomes were pain intensity (Numeric Pain Rating Scale) and global perceived recovery (Patient Global Impression Change). Patients were assessed at baseline, three weeks, six weeks (end of treatment
Pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common disorder in which the two main clinical features are pelvic pain and lower urinary tract symptoms. There are currently many approaches for its management, using both pharmacological and non-pharmacological interventions. The National Institute of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) score is a validated measure (...) commonly used to measure CP/CPPS symptoms. We considered a 25% decrease of NIH-CPSI baseline score or a six-point reduction as MCID.To assess the effects of pharmacological therapies for chronic prostatitis/chronic pelvic pain syndrome.We performed a comprehensive search using CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, trial registries, grey literature and conference proceedings, with no restrictions on the language of publication or publication status. The date of the latest search of all databases