Review of the effect of opioid-related side effects on the undertreatment of moderate to severe chronic non-cancer pain: tapentadol, a step toward a solution?

  title={Review of the effect of opioid-related side effects on the undertreatment of moderate to severe chronic non-cancer pain: tapentadol, a step toward a solution?},
  author={Keith A Candiotti and Melvin C. Gitlin},
  journal={Current Medical Research and Opinion},
  pages={1677 - 1684}
Abstract Objective: Opioids are among the most effective and potent analgesics currently available. Their utility in the management of pain associated with cancer, acute injury, or surgery is well recognized. However, extending the application of opioids to the management of chronic non-cancer pain has met with considerable resistance. This resistance is due in part to concerns related to gastrointestinal and central nervous system-related adverse events as well as issues pertaining to… 
Recent advances in opioid prescription for chronic non-cancer pain
Despite the widespread use of opioids in the management of chronic non-cancer pain, significant research gaps remain and an improvement in the evidence base for its prescription is required.
Effectiveness of long-term opioid therapy for chronic non-cancer pain.
A paucity of literature exists concerning both controlled and observational literature for multiple drugs and multiple conditions of chronic non-cancer pain, and only one drug, tramadol, is effective for pain relief and improvement of functional status.
Opioid-Induced Constipation: Challenges and Therapeutic Opportunities
  • M. Camilleri
  • Medicine, Biology
    The American Journal of Gastroenterology
  • 2011
Novel patient response outcomes have been developed to facilitate demonstration of efficacy and safety of drugs in development for OIC: prolonged release formulations that contain naloxone and a new class of peripherally restricted μ-opiate receptor antagonists.
Opioid-induced constipation
This review will update the new options and strategies available for treating OIC along with the relevant clinical trials, and provides a recommendation on the preferred way to approach a patient with OIC in the modern era.
Constipations as a side effect of opioid anti-pain therapy – current and future treatment methods
A thorough review of the currently available traditional and pharmacological methods of treating opiod-related constipations is offered, including the PAMORA group, which unlike the previously employed drugs, are unable to interact with the central nervous system.
Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective.
An updated 10-year perspective on therapeutic use, abuse, and non-medical use of opioids and their consequences is provided.
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These guidelines are intended to provide a systematic and standardized approach to this complex and difficult arena of practice, while recognizing that every clinical situation is unique.
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Among adults taking oxycodone CR for chronic noncancer pain (with or without a neuropathic pain component), over three-fourths reported being bothered by side effects, resulting in increased payer costs.
American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I--evidence assessment.
The focus of these guidelines is to curtail the abuse of opioids without jeopardizing non-cancer pain management with opioids, and to reduce the incidence of abuse and drug diversion.


Opioid complications and side effects.
The role of opioids in the treatment of chronic pain is influenced by the fact that these potent analgesics are associated with a significant number of side effects and complications, and these phenomena are the focus of this review.
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Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects
Weak and strong opioids outperformed placebo for pain and function in all types of CNCP and were significantly superior to naproxen and nortriptyline, and only for pain relief.
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Patient education and informed consent, exercise, complementary medicine, and the use of a controlled substance agreement increases the likelihood of patient compliance with treatment guidelines, improving functional capacity and quality of life.
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Opioid therapy can be the safest and most effective treatment measure for quality of life improvement in the chronic pain patient.
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  • B. Sng, S. Schug
  • Medicine
    Annals of the Academy of Medicine, Singapore
  • 2009
The use of opioids for the treatment of chronic non-cancer pain has become more widespread recently. Available data support the short-term use of opioids in clearly defined nociceptive and
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The role of sublingual buprenorphine appears to be an attractive, simple option for the treatment of OIH and is particularly advantageous for a busy interventional pain practice.
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The available data indicate that the outcomes associated with opioid therapy vary markedly across patients experiencing chronic nonmalignant pain, and the main consensus is that a subset of these patients may gain substantial benefit from opioid analgesics without requiring rapidly escalating doses or developing intolerable adverse effects or drug addiction.
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Moderate or low dose opioid therapy in conjunction with or without benzodiazepines, antidepressants, or in combinations are associated with minor side effects.
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Opioids are safe and effective for managing chronic pain and should be initiated after an adequate trial of acetaminophen or nonsteroidal anti-inflammatory drugs for nociceptive pain and of tricyclic antidepressants or anticonvulsants for neuropathic pain.