Abstract:
:The use of long-term opioid therapy for chronic pain remains common, yet data on long-term outcomes, especially after dose escalation, are sparse. This study examined potential benefits and harms associated with prescription opioid dose escalation. Participants from 2 institutions were enrolled in a 2-year prospective cohort study. All participants (n = 517) had a musculoskeletal pain diagnosis and were receiving a stable dose of long-term opioid therapy at baseline. Participants completed self-report measures of pain, disability, depression, and potential adverse effects at baseline and every 6 months for 2 years. We reviewed electronic health record data weekly to identify episodes of prescription opioid dose escalation; participants who had increases in their dose were seen for additional research visits within 1 month of dose escalation. Over 2 years, 19.5% of participants had prescription opioid dose increases. After controlling for covariates, there were no significant changes on any variable after dose escalation. Of those with a dose increase, 3% experienced a clinically meaningful improvement in pain after dose escalation. Participants in the entire sample had small improvements in pain intensity, depressive symptoms, medication-related side effects, and lower risk for prescription opioid misuse during the study period. Sexual functioning worsened over time. There were no significant changes in the full sample on pain disability, sleep functioning, or experiencing a fall. In summary, patients prescribed stable doses of long-term opioid therapy may demonstrate small changes in key pain-related outcomes over time, but prescription opioid dose escalation status is unrelated to clinical outcomes.
journal_name
Painjournal_title
Painauthors
Morasco BJ,Smith N,Dobscha SK,Deyo RA,Hyde S,Yarborough BJHdoi
10.1097/j.pain.0000000000001817subject
Has Abstractpub_date
2020-06-01 00:00:00pages
1332-1340issue
6eissn
0304-3959issn
1872-6623pii
00006396-202006000-00021journal_volume
161pub_type
杂志文章相关文献
PAIN文献大全abstract::Genetic influence on the sensory, motor and histopathological outcome of transient spinal cord ischemia was studied in Sprague-Dawley (SD), spontaneously hypertensive (SH) and Wistar-Kyoto (WKY) rats. Ischemia caused minor motor deficits and no identifiable morphological damage in the spinal cord of the majority of SD...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/0304-3959(93)90152-F
更新日期:1993-11-01 00:00:00
abstract::Migraine is a common and disabling neurologic disorder, with important psychiatric comorbidities. Its pathophysiology involves activation of neurons in the trigeminocervical complex (TCC). Kainate receptors carrying the glutamate receptor subunit 5 (GluK1) are present in key brain areas involved in migraine pathophysi...
journal_title:Pain
pub_type: 杂志文章
doi:10.1097/01.j.pain.0000460325.25762.c0
更新日期:2015-03-01 00:00:00
abstract::The present study describes a new test of tonic pain to be used as an animal model of persistent pain. First, pain responses and edema produced by subcutaneous injection of increasing doses of honey bee venom into the hind paw of the rat were quantified. Second, the effect of morphine and aspirin on the pain responses...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/0304-3959(96)03075-8
更新日期:1996-08-01 00:00:00
abstract::The aim of the present study was to investigate changes in the plasma calcitonin gene-related peptide (CGRP) concentration and platelet serotonin (5-hydroxytriptamine, 5-HT) content during the immediate headache and the delayed genuine migraine attack provoked by nitroglycerin. Fifteen female migraineurs (without aura...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/j.pain.2003.09.008
更新日期:2003-12-01 00:00:00
abstract::In 1864, W. Mitchell and colleagues first described the clinical syndrome which came to be known as 'causalgia'. Since that time, the concept of sympathetically related pain has evolved. There is general agreement that profound emotional and behavioural changes can follow these types of pain. Opinions have varied wide...
journal_title:Pain
pub_type: 杂志文章,评审
doi:10.1016/0304-3959(92)90241-3
更新日期:1992-06-01 00:00:00
abstract::The cell soma of primary afferent neurons in the dorsal root ganglion (DRG) is assigned by classical neurophysiology the role of a metabolic depot, charged with supporting the peripheral sensory ending, the conducting axon, and the central synaptic terminals. However, certain peculiarities of DRG morphology and physio...
journal_title:Pain
pub_type: 杂志文章,评审
doi:10.1016/S0304-3959(99)00135-9
更新日期:1999-08-01 00:00:00
abstract::Painful neuromas can cause severe loss of function and have great impact on the daily life of patients. Surgical management remains challenging; despite improving techniques, success rates are low. To accurately study the success of surgical neuroma treatment and factors predictive of outcome, a prospective follow-up ...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/j.pain.2010.09.032
更新日期:2010-12-01 00:00:00
abstract::Internet-delivered interventions are emerging as a strategy to address barriers to care for individuals with chronic pain. This is the first large multicenter randomized controlled trial of Internet-delivered cognitive-behavioral therapy (CBT) for pediatric chronic pain. Participants included were 273 adolescents (205...
journal_title:Pain
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/j.pain.0000000000000348
更新日期:2016-01-01 00:00:00
abstract::Two hundred and sixty-three ambulatory patients older than 21 years of age who were attending clinics at an oncology hospital in San Juan, Puerto Rico, were studied. They completed a questionnaire (BQ-PR) that measures 8 concerns about reporting pain and using analgesics, such as fears of addiction and tolerance and t...
journal_title:Pain
pub_type: 临床试验,杂志文章
doi:10.1016/0304-3959(94)90203-8
更新日期:1994-08-01 00:00:00
abstract::Cultures differ as to typical linguistic reports and classifications of pain. In some languages upwards of a dozen specific pain terms are in common use, each indicating a particular pain experience. In other languages a single inclusive term is the norm, perhaps with optional qualifiers added to make desired distinct...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/0304-3959(80)90025-1
更新日期:1980-08-01 00:00:00
abstract::To quantify performance differences between patients with low-back pain (LBP) and a control group during their performance of a repetitive isodynamic lifting task. Case-control study was done. LBP patients were recruited and tested at an outpatient ambulatory chronic pain rehabilitation program before treatment was be...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/s0304-3959(03)00247-1
更新日期:2003-09-01 00:00:00
abstract::Medical case management has improved in the past few decades, changing the dynamic interaction between depression and prevalent medical diseases. It is relevant to describe the comorbidity between depression and medical diseases to further improve the effectiveness of case management. We analyzed the data of adults ag...
journal_title:Pain
pub_type: 杂志文章
doi:10.1097/j.pain.0000000000000826
更新日期:2017-04-01 00:00:00
abstract::Blockade of the noradrenergic input to the nucleus raphe magnus (NRM) by the injection of alpha-adrenergic antagonists produces hypoalgesia. Previous studies show that this hypoalgesia is blocked by the intrathecal injection of either phentolamine or methysergide. The present study demonstrates that depletion of spina...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/0304-3959(83)90113-6
更新日期:1983-07-01 00:00:00
abstract::Anecdotal reports suggest that the general anaesthetic drug ketamine, taken orally in low doses, can give rise to some extra analgesia in patients with refractory neuropathic pain. This study was designed to determine the proportion of patients with chronic neuropathic pain responding to oral ketamine, and then to sep...
journal_title:Pain
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0304-3959(99)00117-7
更新日期:1999-11-01 00:00:00
abstract::Metastatic bone cancer causes severe pain that is primarily treated with opioids. A model of bone cancer pain in which the progression of cancer pain and bone destruction is tightly controlled was used to evaluate the effects of sustained morphine treatment. In cancer-treated mice, morphine enhanced, rather than dimin...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/j.pain.2007.06.026
更新日期:2007-11-01 00:00:00
abstract::In order to understand how nociceptive information is processed in the spinal dorsal horn we need to unravel the complex synaptic circuits involving interneurons, which constitute the vast majority of the neurons in laminae I-III. The main limitation has been the difficulty in defining functional populations among the...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/j.pain.2013.05.001
更新日期:2013-12-01 00:00:00
abstract::Treatment of neuropathic pain is a major clinical challenge that has been met with minimal success. After peripheral nerve injury, a decrease in the expression of the K-Cl cotransporter KCC2, a major neuronal Cl(-) extruder, leads to pathologic alterations in GABA(A) and glycine receptor function in the spinal cord. T...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/j.pain.2009.11.015
更新日期:2010-02-01 00:00:00
abstract::Reports of pain during mammography show that there is great variability in both the incidence of reported pain (0.2-62%) and the intensity of that pain. Much of that variability may be due to the measures used to rate mammography pain. This is the first study that has examined the incidence, quality and intensity of m...
journal_title:Pain
pub_type: 临床试验,杂志文章
doi:10.1016/0304-3959(96)03057-6
更新日期:1996-08-01 00:00:00
abstract::Fibromyalgia (FM) is a prevalent and disabling chronic disease. Recent studies have found elevated levels of glutamate in several brain regions, leading to hypotheses about the usefulness of glutamate-blocking drugs such as memantine in the treatment of FM. The aim of this study was to evaluate the efficacy of memanti...
journal_title:Pain
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.pain.2014.09.004
更新日期:2014-12-01 00:00:00
abstract::Pregnant women may take nonsteroidal antiinflammatory drugs (NSAIDs), selective cyclooxygenase (COX)-2 inhibitors, or biological agents to relieve symptoms or manage disease flares in late pregnancy. We aimed to quantify the risk of prematurity associated with late pregnancy exposure to nonselective NSAIDs, selective ...
journal_title:Pain
pub_type: 杂志文章
doi:10.1097/j.pain.0000000000001163
更新日期:2018-05-01 00:00:00
abstract::Venlafaxine hydrochloride (Effexor) is a structurally novel antidepressant that inhibits reuptake of 5-hydroxytryptamine and noradrenaline, but unlike the older antidepressants, has few side-effects. The objective of this study was to determine whether venlafaxine relieves thermal hyperalgesia in rats with neuropathic...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/S0304-3959(96)03223-X
更新日期:1996-11-01 00:00:00
abstract::Many aspects of bilateral presentation or recurrence of reflex sympathetic dystrophy (RSD) are unknown. For this reason 1183 consecutive patients with RSD were analyzed. In 10 patients RSD started in symmetrical limbs. In 34 patients RSD recurred in the same limb after a period of no or few complaints and in 76 patien...
journal_title:Pain
pub_type: 临床试验,杂志文章
doi:10.1016/0304-3959(95)00160-3
更新日期:1996-03-01 00:00:00
abstract:ABSTRACT:Spinal cord stimulation (SCS) is an approved treatment for truncal and limb neuropathic pain. However, pain relief is often suboptimal and SCS efficacy may reduce over time, requiring sometimes the addition of other pain therapies, stimulator revision, or even explantation. We designed and tested a new procedu...
journal_title:Pain
pub_type: 杂志文章
doi:10.1097/j.pain.0000000000002160
更新日期:2020-11-30 00:00:00
abstract::Studies in healthy human subjects and patients with irritable bowel syndrome suggest sex differences in cerebral nociceptive processing. Here we examine sex differences in functional brain activation in the rat during colorectal distention (CRD), a preclinical model of acute visceral pain. [(14)C]-iodoantipyrine was i...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/j.pain.2009.05.025
更新日期:2009-09-01 00:00:00
abstract::Endometriosis affects ∼176 million women worldwide, yet on average, women experience pain ∼10 years from symptom onset before being properly diagnosed. Standard treatments (drugs or surgery) often fail to provide long-term pain relief. Elevated levels of reactive aldehydes such as 4-hydroxynonenal (4-HNE) have been im...
journal_title:Pain
pub_type: 杂志文章
doi:10.1097/j.pain.0000000000001949
更新日期:2021-01-01 00:00:00
abstract::The facial expression of pain plays a crucial role in pain communication and pain diagnostics. Despite its importance, it has remained unknown which dimensions of pain (sensory and/or affective) are encoded in the face. To answer this question, we used a well-established cognitive strategy (suggestions) to differentia...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/j.pain.2011.10.027
更新日期:2012-02-01 00:00:00
abstract::Central antinociceptive effects of cannabinoids have been well documented. However, relatively little is known about the peripheral effects of the cannabinoids on inflammation. In the present study, we evaluated the effects of peripherally administered cannabinoids on three indices of inflammation: carrageenan-induced...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/S0304-3959(97)00213-3
更新日期:1998-03-01 00:00:00
abstract::The associative network theory of memory [2] is outlined along with the concepts of mood congruity and state dependent learning. Two experiments are reported which investigate the occurrence of these effects where memory for pain is concerned. In experiment 1 the performance of 25 chronic pain patients was compared wi...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/0304-3959(90)91072-Q
更新日期:1990-11-01 00:00:00
abstract::The tricyclic antidepressant drugs (TCAs) are commonly used in the treatment of chronic, especially neuropathic, pain. We evaluated their possible effect on a new model of neuropathic pain-related behaviour induced by ligatures tied loosely around the common sciatic nerve. The effects of 3 TCAs with different monoamin...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/0304-3959(92)90152-2
更新日期:1992-05-01 00:00:00
abstract::The purpose of this study was to assess if the functional activation caused by painful stimuli could be detected with arterial spin labeling (ASL), which is a non-invasive magnetic resonance imaging (MRI) technique for measuring cerebral blood flow (CBF). Because ASL directly measures blood flow, it is well suited to ...
journal_title:Pain
pub_type: 杂志文章
doi:10.1016/j.pain.2007.06.021
更新日期:2008-05-01 00:00:00