Multimodal approaches to optimize outcomes of chronic opioid therapy in the management of chronic pain

Kenneth L. Kirsh, Scott M Fishman

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objective. To review clinical strategies for long-term opioid management as well as strategies to assess and monitor patients with moderate to severe chronic pain who may be at risk for aberrant drug-related behaviors.Design. A symposium was held to disseminate a review of opioid use strategies, including use of the Universal Precautions in Pain Medicine as well as the Federation of State Medical Boards Model Policy for Prescribing Controlled Substances (FSMB model policy). These include continual reassessment of pain and risk, treatment agreements, compliance monitoring, urine drug screening, documentation, compliance with the law, and patient education. Additionally, the use of multimodal strategies to treat patients, with techniques such as cognitive-behavioral therapy, is discussed as an essential part of a comprehensive pain management plan.Setting. The review summarizes a continuing medical education (CME)-accredited symposium conducted at the American Pain Society Annual Meeting in Baltimore, Maryland, in May 2010.Results. Recommendations for the management and monitoring of long-term opioid therapy for patients with chronic noncancer pain are rooted in evidence-based clinical guidelines, which also provide guidance for the identification of aberrant behaviors or overt addiction.Conclusions. Vigilance and frequent interactions may sometimes be inadequate to prevent problematic behaviors; therefore, pharmacologic strategies designed to deter abusive behaviors are also discussed. Wiley Periodicals, Inc.

Original languageEnglish (US)
JournalPain Medicine
Volume12
Issue numberSUPPL.1
DOIs
StatePublished - Jan 2011

Fingerprint

Chronic Pain
Opioid Analgesics
Controlled Substances
Universal Precautions
Pain
Continuing Medical Education
Baltimore
Preclinical Drug Evaluations
Cognitive Therapy
Patient Education
Pain Management
Therapeutics
Documentation
Compliance
Medicine
Urine
Guidelines
Pharmaceutical Preparations

Keywords

  • Abuse-Deterrent Formulations
  • Chronic Pain
  • Multimodal Therapy
  • Opioids
  • Universal Precautions

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Multimodal approaches to optimize outcomes of chronic opioid therapy in the management of chronic pain. / Kirsh, Kenneth L.; Fishman, Scott M.

In: Pain Medicine, Vol. 12, No. SUPPL.1, 01.2011.

Research output: Contribution to journalArticle

@article{4ec8abd5377441f6baa0209f823e9f5e,
title = "Multimodal approaches to optimize outcomes of chronic opioid therapy in the management of chronic pain",
abstract = "Objective. To review clinical strategies for long-term opioid management as well as strategies to assess and monitor patients with moderate to severe chronic pain who may be at risk for aberrant drug-related behaviors.Design. A symposium was held to disseminate a review of opioid use strategies, including use of the Universal Precautions in Pain Medicine as well as the Federation of State Medical Boards Model Policy for Prescribing Controlled Substances (FSMB model policy). These include continual reassessment of pain and risk, treatment agreements, compliance monitoring, urine drug screening, documentation, compliance with the law, and patient education. Additionally, the use of multimodal strategies to treat patients, with techniques such as cognitive-behavioral therapy, is discussed as an essential part of a comprehensive pain management plan.Setting. The review summarizes a continuing medical education (CME)-accredited symposium conducted at the American Pain Society Annual Meeting in Baltimore, Maryland, in May 2010.Results. Recommendations for the management and monitoring of long-term opioid therapy for patients with chronic noncancer pain are rooted in evidence-based clinical guidelines, which also provide guidance for the identification of aberrant behaviors or overt addiction.Conclusions. Vigilance and frequent interactions may sometimes be inadequate to prevent problematic behaviors; therefore, pharmacologic strategies designed to deter abusive behaviors are also discussed. Wiley Periodicals, Inc.",
keywords = "Abuse-Deterrent Formulations, Chronic Pain, Multimodal Therapy, Opioids, Universal Precautions",
author = "Kirsh, {Kenneth L.} and Fishman, {Scott M}",
year = "2011",
month = "1",
doi = "10.1111/j.1526-4637.2010.00992.x",
language = "English (US)",
volume = "12",
journal = "Pain Medicine",
issn = "1526-2375",
publisher = "Wiley-Blackwell",
number = "SUPPL.1",

}

TY - JOUR

T1 - Multimodal approaches to optimize outcomes of chronic opioid therapy in the management of chronic pain

AU - Kirsh, Kenneth L.

AU - Fishman, Scott M

PY - 2011/1

Y1 - 2011/1

N2 - Objective. To review clinical strategies for long-term opioid management as well as strategies to assess and monitor patients with moderate to severe chronic pain who may be at risk for aberrant drug-related behaviors.Design. A symposium was held to disseminate a review of opioid use strategies, including use of the Universal Precautions in Pain Medicine as well as the Federation of State Medical Boards Model Policy for Prescribing Controlled Substances (FSMB model policy). These include continual reassessment of pain and risk, treatment agreements, compliance monitoring, urine drug screening, documentation, compliance with the law, and patient education. Additionally, the use of multimodal strategies to treat patients, with techniques such as cognitive-behavioral therapy, is discussed as an essential part of a comprehensive pain management plan.Setting. The review summarizes a continuing medical education (CME)-accredited symposium conducted at the American Pain Society Annual Meeting in Baltimore, Maryland, in May 2010.Results. Recommendations for the management and monitoring of long-term opioid therapy for patients with chronic noncancer pain are rooted in evidence-based clinical guidelines, which also provide guidance for the identification of aberrant behaviors or overt addiction.Conclusions. Vigilance and frequent interactions may sometimes be inadequate to prevent problematic behaviors; therefore, pharmacologic strategies designed to deter abusive behaviors are also discussed. Wiley Periodicals, Inc.

AB - Objective. To review clinical strategies for long-term opioid management as well as strategies to assess and monitor patients with moderate to severe chronic pain who may be at risk for aberrant drug-related behaviors.Design. A symposium was held to disseminate a review of opioid use strategies, including use of the Universal Precautions in Pain Medicine as well as the Federation of State Medical Boards Model Policy for Prescribing Controlled Substances (FSMB model policy). These include continual reassessment of pain and risk, treatment agreements, compliance monitoring, urine drug screening, documentation, compliance with the law, and patient education. Additionally, the use of multimodal strategies to treat patients, with techniques such as cognitive-behavioral therapy, is discussed as an essential part of a comprehensive pain management plan.Setting. The review summarizes a continuing medical education (CME)-accredited symposium conducted at the American Pain Society Annual Meeting in Baltimore, Maryland, in May 2010.Results. Recommendations for the management and monitoring of long-term opioid therapy for patients with chronic noncancer pain are rooted in evidence-based clinical guidelines, which also provide guidance for the identification of aberrant behaviors or overt addiction.Conclusions. Vigilance and frequent interactions may sometimes be inadequate to prevent problematic behaviors; therefore, pharmacologic strategies designed to deter abusive behaviors are also discussed. Wiley Periodicals, Inc.

KW - Abuse-Deterrent Formulations

KW - Chronic Pain

KW - Multimodal Therapy

KW - Opioids

KW - Universal Precautions

UR - http://www.scopus.com/inward/record.url?scp=78651352502&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78651352502&partnerID=8YFLogxK

U2 - 10.1111/j.1526-4637.2010.00992.x

DO - 10.1111/j.1526-4637.2010.00992.x

M3 - Article

VL - 12

JO - Pain Medicine

JF - Pain Medicine

SN - 1526-2375

IS - SUPPL.1

ER -