Category: Articles

PAINS Policy Brief #4: Opioid Treatment Agreements or “Contracts” – Insert

Pain care in the United States presents a complex set of challenges. On the one hand, there is ample documentation that pain, especially chronic pain, is often not well managed, and that as the Institute of Medicine has stated, we need a “cultural transformation in how pain is judged, managed and treated” to advance pain More Info »

A Guide to Optimizing Treatment Through Integrative Health for People Living with Pain

When you break your leg, undergo surgery, or burn your hand, you experience pain – acute pain. With treatment and time, the pain usually disappears. But chronic pain is different. It hangs around even after the original illness or injury has improved, reminding you every day that it has no plans to vacate the premises. More Info »

Maximizing Safety with Methadone & Other Opioids

Opioids provide life-saving analgesia for the millions of Americans who suffer with chronic pain, yet overdose deaths are rising at an alarming rate, with methadone implicated to a disproportionate degree [Paulozzi et al. 2006; Webster 2005; Warner et al. 2009]. Methadone deaths increased almost seven-fold from 790 in 1999 to 5,420 in 2006, rising faster More Info »

Oral Methadone Dosing for Chronic Pain: A Practitioner’s Guide

Methadone has emerged as a good choice for the management of cancer pain and chronic non-cancer pain both as a first-line medication and as a replacement opioid. Particular cautions must be observed as methadone’s pharmacokinetics and pharmacodynamics are unique among opioids. Milligram for milligram, however, methadone is much more powerful than morphine, although there is More Info »

Commonsense Opioid-Risk Management in Chronic Noncancer Pain: A Clinician’s Perspective

Chronic noncancer pain (CNP) is a serious and likely undertreated public health problem. In a 2005 survey, 19% of US adults reported chronic pain and 34% reported recurrent pain [Kuehn 2007]. The annual costs of pain-related healthcare, litigation, and compensation are estimated at $100 billion in the United States alone [Sinatra 2006]. While opioids have More Info »

Pain in Opioid-Addicted Patients Entering Addiction Treatment

Pain and addiction share some common physiologic pathways in the brain, especially those involving opioids, and each may affect the other. That is, the presence of pain may influence the development and course of opioid addiction, and vice versa (Compton and Gebhart 2003). These interactions may complicate therapy for opioid addiction. For example, opioid-addicted persons More Info »

Methadone Cardiac Concerns

Some patients in methadone maintenance treatment (MMT) programs may have conditions or behaviors associated with increased risks of arrhythmia, including: abuse of cardiotoxic substances, cardiovascular disease, electrolyte imbalances, and prescribed medications that may foster cardiac repolarization disturbances. Furthermore, recent data suggest that in some individuals methadone – alone or, more commonly, in combination with other More Info »

Methadone-Drug Interactions (Medications, illicit drugs, & other substances)

Each year in the U.S. there are innumerable adverse drug reactions, broadly defined as any unexpected, unintended, undesired, or excessive response to a medicine. Such reactions may require discontinuing or changing medication therapy. Furthermore, greater than 2 million of those are serious reactions resulting in hospitalization and/or permanent disability, and there are more than 100,000 More Info »

Opioid Tapering: Safely Discontinuing Opioid Analgesics

Severe hurricanes in the Gulf Coast during 2005 caused many hardships for patients and healthcare providers alike. An important concern coming to light during this time of crisis was the inability to obtain prescription medications, including opioid analgesics. Patients with chronic pain and their healthcare providers faced the daunting task of either somehow procuring the More Info »

Commonsense Oxycodone Prescribing & Safety

Oxycodone is FDA-approved for treating moderate to severe pain that is either acute or chronic in nature. It has been widely used in pain management practice for decades but has recently been receiving much negative attention due to abuse, overdose, and deaths associated with the controlled-release formulation. So, in the overall approach to pain management, More Info »