Journal of pain and symptom management
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J Pain Symptom Manage · May 1996
ReviewLong-term opioid therapy: assessment of consequences and risks.
Medical practice with respect to the use of opioids for the treatment of pain has been heavily influenced by societal perceptions of problems of addiction and by laws governing the use of opioids. To effectively use opioids for the treatment of chronic pain, physicians must recognize pervasive, but clinically often irrelevant societal and legal influences on prescribing, while at the same time respecting opioid properties which may lead to unwanted consequences in the course of opioid therapy. This paper reviews history and legislation that has shaped medical prescribing of opioids, examines the potential risks and consequences of long-term opioid therapy and assesses three models of long-term opioid therapy.
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J Pain Symptom Manage · May 1996
ReviewGovernment regulatory influences on opioid prescribing and their impact on the treatment of pain of nonmalignant origin.
Interpretation of regulations establishing standards for prescribing opioids by government regulatory boards and drug-enforcement agencies is more restrictive for treatment of nonmalignant pain than for malignant pain. Authority to regulate opioids is provided by health practice acts enacted by state governments, and controlled substances acts, enacted by both state and federal governments. The methods used by boards/agencies to determine standards of practice for opioid use result in interpreting the language in these regulations based on myths, prejudices, and misinformation about opioids, and the unexamined belief that mere exposure of patients to these drugs causes psychological dependence (addiction) on them to all patients in all instances. ⋯ Patients with nonmalignant pain who are not relieved if opioids are not provided will continue to suffer until regulatory boards/drug enforcement agencies define the standards of practice for opioid use for nonmalignant pain in clear and unequivocal terms. It is unlikely these standards will be developed until there is a consensus among pain specialists about opioid use for nonmalignant pain because boards/agencies have no consistent, reliable source of expert information. Pain specialists should initiate efforts to develop this consensus.
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A new instrument for measuring pain intensity--the visual analogue thermometer (VAT)--was developed to overcome limitations and disadvantages of the conventional visual analogue scale (VAS). Two studies were performed to assess the validity and utility of the VAT as compared to conventional pain instruments whose psychometric qualities are scientifically recognized. The first study was carried out with a group of 65 chronic pain patients who provided pain intensity ratings using the VAT, a standard VAS, and the McGill Pain Questionnaire. ⋯ When questioned about pain scale preference, a substantial number of participants preferred the VAT to the standard VAS as a means of rating pain intensity. In view of the results obtained in the present studies, it is concluded that the VAT is a valid accurate, and clinically useful tool for measuring pain. Its design makes it suitable and effective for clinical use and as an outcome measure in clinical trials.
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J Pain Symptom Manage · May 1996
Case ReportsOral methadone for managing chronic nonmalignant pain.
Five patients with chronic nonmalignant pain were transferred from other analgesics to oral methadone. The method of transferring to oral methadone is described and issues of cost effectiveness, convenience, improved analgesia, and adverse effects are discussed. Oral methadone may provide a cost-effective alternative to other opioid analgesics and may provide improved pain control in certain patients, even when compared with other opioids administered parenterally.