Browse > Article
http://dx.doi.org/10.3344/kjp.2013.26.1.3

Opioid Pharmacotherapy for Chronic Noncancer Pain: The American Experience  

Chapman, C. Richard (Pain Research Center, Department of Anesthesiology, School of Medicine, University of Utah)
Publication Information
The Korean Journal of Pain / v.26, no.1, 2013 , pp. 3-13 More about this Journal
Abstract
Chronic noncancer pain is a significant and growing public health challenge in the United States. Lacking effective alternative interventions for effective chronic noncancer pain management, many physicians have turned to opioid pharmacotherapy. Increased opioid prescribing brings not only gains in therapeutic benefit but also a higher incidence of adverse drug events including increased medication misuse and opioid related mortality. Currently the United States must confront the dual problems of widespread undertreated chronic noncancer pain and a prescription opioid abuse crisis. Withholding pain relieving drugs from patients in need is unjustifiable, yet drug diversion, abuse and adverse drug events have become major social as well as medical problems. At the heart of this crisis is the lack of definitive evidence about the risk to benefit ratio of opioid pharmacotherapy for chronic noncancer pain both on an individual case and on a population basis. This article describes the extent and severity of the American chronic noncancer pain problem and the history of opioid pharmacotherapy for chronic noncancer pain in the United States. It then discusses the concept of evidence based practice and reviews current evidence supporting opioid pharmacotherapy for chronic noncancer pain as well as adverse drug events related to opioid pharmacotherapy including misuse and abuse. Finally, it considers the conflict of providing pain relief versus protecting society and reviews steps that governmental agencies, industry and others are taking to contain and ultimately resolve the problems of excessive prescribing and conflicting priorities.
Keywords
chronic pain; evidence-based practice; noncancer pain; opioid pharmacotherapy;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Webster L, St Marie B, McCarberg B, Passik SD, Panchal SJ, Voth E. Current status and evolving role of abuse-deterrent opioids in managing patients with chronic pain. J Opioid Manag 2011; 7: 235-45.   DOI
2 Webster LR, Cochella S, Dasgupta N, Fakata KL, Fine PG, Fishman SM, et al. An analysis of the root causes for opioid-related overdose deaths in the United States. Pain Med 2011; 12 Suppl 2: S26-35.   DOI   ScienceOn
3 Chapman CR, Lipschitz DL, Angst MS, Chou R, Denisco RC, Donaldson GW, et al. Opioid pharmacotherapy for chronic non-cancer pain in the United States: a research guideline for developing an evidence-base. J Pain 2010; 11: 807-29.   DOI   ScienceOn
4 International Narcotics Control Board. The Report of the International Narcotics Control Board for 2010. Vienna, Austria, United Nations Press. 2011.
5 Lipton RB. Chronic migraine, classification, differential diagnosis, and epidemiology. Headache 2011; 51 Suppl 2: 77-83.   DOI   ScienceOn
6 McCarthy LH, Bigal ME, Katz M, Derby C, Lipton RB. Chronic pain and obesity in elderly people: results from the Einstein aging study. J Am Geriatr Soc 2009; 57: 115-9.   DOI   ScienceOn
7 Mathus-Vliegen EM. Obesity and the elderly. J Clin Gastroenterol 2012; 46: 533-44.   DOI
8 Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain 2012; 13: 715-24.   DOI   ScienceOn
9 Jeffery MM, Butler M, Stark A, Kane RL. Multidisciplinary pain programs for chronic noncancer pain. Technical brief No. 8. Rockville, Agency for Healthcare Research and Quality. 2011.
10 Portenoy RK, Foley KM. Chronic use of opioid analgesics in non-malignant pain: report of 38 cases. Pain 1986; 25: 171-86.   DOI   ScienceOn
11 The use of opioids for the treatment of chronic pain. A consensus statement from the American Academy of Pain Medicine and the American Pain Society. Clin J Pain 1997; 13: 6-8.   DOI   ScienceOn
12 The Federation of State Medical Boards of The United States, Inc. Model guidelines for the use of controlled substances for the treatment of pain. S D J Med 1999; 52: 25-7.
13 Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ 1996; 312: 71-2.   DOI   ScienceOn
14 Portenoy RK, Farrar JT, Backonja MM, Cleeland CS, Yang K, Friedman M, et al. Long-term use of controlled-release oxycodone for noncancer pain: results of a 3-year registry study. Clin J Pain 2007; 23: 287-99.   DOI   ScienceOn
15 Ballantyne JC, Mao J. Opioid therapy for chronic pain. N Engl J Med 2003; 349: 1943-53.   DOI   ScienceOn
16 Papaleontiou M, Henderson CR Jr, Turner BJ, Moore AA, Olkhovskaya Y, Amanfo L, et al. Outcomes associated with opioid use in the treatment of chronic noncancer pain in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 2010; 58: 1353-69.   DOI   ScienceOn
17 Carson S, Thakurta S, Low A, Smith B, Chou R. Drug class review: long-acting opioid analgesics. Portland, Oregon Evidence-based Practice Center, Oregon Health & Sciences University. 2011.
18 Moore RA, McQuay HJ. Prevalence of opioid adverse events in chronic non-malignant pain: systematic review of randomised trials of oral opioids. Arthritis Res Ther 2005; 7: R1046-51.   DOI   ScienceOn
19 Elliott JA, Opper SE, Agarwal S, Fibuch EE. Non-Analgesic Effects of Opioids: Opioids and The Endocrine System. Curr Pharm Des 2012 [in press].
20 Merza Z. Chronic use of opioids and the endocrine system. Horm Metab Res 2010; 42: 621-6.   DOI   ScienceOn
21 Fishman SM. Responsible opioid prescribing: a clinician's guide. 2nd ed. Washington, D.C., Waterford Life Sciences. 2012.
22 Office of National Drug Control Policy, Epidemic: responding to America's prescription drug abuse crisis. Edited by Office of National Drug Control Policy. Washington, D.C., US Government. 2011, p 10.
23 Gudin J. Risk Evaluation and Mitigation Strategies (REMS) for extended-release and long-acting opioid analgesics: considerations for palliative care practice. J Pain Palliat Care Pharmacother 2012; 26: 136-43.   DOI   ScienceOn
24 Schneider JP, Matthews M, Jamison RN. Abuse-deterrent and tamper-resistant opioid formulations: what is their role in addressing prescription opioid abuse? CNS Drugs 2010; 24: 805-10.   DOI   ScienceOn
25 Raffa RB, Pergolizzi JV Jr. Opioid formulations designed to resist/deter abuse. Drugs 2010; 70: 1657-75.   DOI   ScienceOn
26 Lee M, Silverman SM, Hansen H, Patel VB, Manchikanti L. A comprehensive review of opioid-induced hyperalgesia. Pain Physician 2011; 14: 145-61.
27 Brack A, Rittner HL, Stein C. Immunosuppressive effects of opioids--clinical relevance. J Neuroimmune Pharmacol 2011; 6: 490-502.   DOI
28 Warner M, Chen LH, Makuc DM, Anderson RN, Minino AM. Drug poisoning deaths in the United States, 1980-2008. NCHS Data Brief 2011: 1-8.
29 Manchikanti L, Helm S 2nd, Fellows B, Janata JW, Pampati V, Grider JS, et al. Opioid epidemic in the United States. Pain Physician 2012; 15: ES9-38.
30 Andrews CM, Krantz MJ, Wedam EF, Marcuson MJ, Capacchione JF, Haigney MC. Methadone-induced mortality in the treatment of chronic pain: role of QT prolongation. Cardiol J 2009; 16: 210-7.
31 Committee on Advancing Pain Research, Care, and Education; Institute of Medicine. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Edited by Institute of Medicine. Washington, D.C., The National Academies Press. 2011.
32 Croft P, Blyth FM, Windt D. Chronic pain epidemiology from aetiology to public health. Oxford, Oxford University Press. 2010.
33 Cepeda MS, Fife D, Chow W, Mastrogiovanni G, Henderson SC. Assessing opioid shopping behaviour: a large cohort study from a medication dispensing database in the US. Drug Saf 2012; 35: 325-34.   DOI   ScienceOn
34 Birnbaum HG, White AG, Schiller M, Waldman T, Cleveland JM, Roland CL. Societal costs of prescription opioid abuse, dependence, and misuse in the United States. Pain Med 2011; 12: 657-67.   DOI   ScienceOn
35 Colburn JL, Jasinski DR, Rastegar DA. Long-term opioid therapy, aberrant behaviors, and substance misuse: comparison of patients treated by resident and attending physicians in a general medical clinic. J Opioid Manag 2012; 8: 153-60.   DOI   ScienceOn
36 Von Korff M, Kolodny A, Deyo RA, Chou R. Long-term opioid therapy reconsidered. Ann Intern Med 2011; 155: 325-8.   DOI   ScienceOn
37 Cepeda MS, Fife D, Chow W, Mastrogiovanni G, Henderson SC. Opioid shopping behavior: how often, how soon, which drugs, and what payment method. J Clin Pharmacol 2012 [in press].
38 Fishbain DA, Cole B, Lewis J, Rosomoff HL, Rosomoff RS. What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review. Pain Med 2008; 9: 444-59.   DOI   ScienceOn
39 Boscarino JA, Rukstalis MR, Hoffman SN, Han JJ, Erlich PM, Ross S, et al. Prevalence of prescription opioid-use disorder among chronic pain patients: comparison of the DSM-5 vs. DSM-4 diagnostic criteria. J Addict Dis 2011; 30: 185-94.   DOI   ScienceOn
40 Rigg KK, Kurtz SP, Surratt HL. Patterns of prescription medication diversion among drug dealers. Drugs (Abingdon Engl) 2012; 19: 144-55.
41 Hall AJ, Logan JE, Toblin RL, Kaplan JA, Kraner JC, Bixler D, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA 2008; 300: 2613-20.   DOI   ScienceOn