Canadian guideline for safe and effective use of opioids for chronic noncancer pain: clinical summary for family physicians. Part 2: special populations.

نویسندگان

  • Meldon Kahan
  • Lynn Wilson
  • Angela Mailis-Gagnon
  • Anita Srivastava
چکیده

OBJECTIVE To provide family physicians with a practical clinical summary of opioid prescribing for specific populations based on recommendations from the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain. QUALITY OF EVIDENCE Researchers for the guideline conducted a systematic review of the literature, focusing on reviews of the effectiveness and safety of opioids in specific populations. MAIN MESSAGE Family physicians can minimize the risks of overdose, sedation, misuse, and addiction through the use of strategies tailored to the age and health status of patients. For patients at high risk of addiction, opioids should be reserved for well-defined nociceptive or neuropathic pain conditions that have not responded to first-line treatments. Opioids should be titrated slowly, with frequent dispensing and close monitoring for signs of misuse. Suspected opioid addiction is managed with structured opioid therapy, methadone or buprenorphine treatment, or abstinence-based treatment. Patients with mood and anxiety disorders tend to have a blunted analgesic response to opioids, are at higher risk of misuse, and are often taking sedating drugs that interact adversely with opioids. Precautions similar to those for other high-risk patients should be employed. The opioid should be tapered if the patient's pain remains severe despite an adequate trial of opioid therapy. In the elderly, sedation, falls, and overdose can be minimized through lower initial doses, slower titration, benzodiazepine tapering, and careful patient education. For pregnant women taking daily opioid therapy, the opioids should be slowly tapered and discontinued. If this is not possible, they should be tapered to the lowest effective dose. Opioid-dependent pregnant women should receive methadone treatment. Adolescents are at high risk of opioid overdose, misuse, and addiction. Patients with adolescents living at home should store their opioid medication safely. Adolescents rarely require long-term opioid therapy. CONCLUSION Family physicians must take into consideration the patient's age, psychiatric status, level of risk of addiction, and other factors when prescribing opioids for chronic pain.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Canadian guideline for safe and effective use of opioids for chronic noncancer pain: clinical summary for family physicians. Part 1: general population.

OBJECTIVE To provide family physicians with a practical clinical summary of the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain, developed by the National Opioid Use Guideline Group. QUALITY OF EVIDENCE Researchers for the guideline conducted a systematic review of the literature on the effectiveness and safety of opioids for chronic noncancer pain, and dr...

متن کامل

Opioid prescribing is a surrogate for inadequate pain management resources.

The registrar of the College of Physicians and Surgeons of Ontario stated in 2010 that “opioids are an important part of the modern arsenal for treating chronic non-cancer pain.”1 He noted that clear guidance on the prescribing of opioids was needed and that the National Opioid Use Guideline Group had led a project to develop the Canadian Guideline for Safe and Effective Use of Opioids for Chro...

متن کامل

Self-reported practices in opioid management of chronic noncancer pain: a survey of Canadian family physicians.

BACKGROUND In May 2010, a new Canadian guideline on prescribing opioids for chronic noncancer pain (CNCP) was released. To assess changes in family physicians' (FPs) prescribing of opioids following the release of the guideline, it is necessary to know their practices before the guideline was widely disseminated. OBJECTIVES To determine FPs' practices and knowledge in prescribing opioids for ...

متن کامل

Addressing the limitations of the CDC guideline for prescribing opioids for chronic noncancer pain.

The excessive use of opioids for chronic noncancer pain represents a serious public health problem in Canada, and health care regulators face considerable pressure to adopt stricter policies to curb prescribing practices. In March 2016, the United States Centers for Disease Control and Prevention (CDC) issued a guideline for prescribing of opioids for chronic pain.1 Because it raises many cauti...

متن کامل

The opioid epidemic and national guidelines for opioid therapy for chronic noncancer pain: a perspective from different continents

Introduction A marked rise in opioid prescriptions for patients with chronic noncancer pain (CNCP) with a parallel increase in opioid abuse/misuse, and resulting deaths was noted in the Unites states in the past decade (opioid epidemic). In response, the US Center of Diseases Control (CDC) developed a guideline for prescribing of opioids for patients with CNCP. Objectives To assess (1) if the...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Canadian family physician Medecin de famille canadien

دوره 57 11  شماره 

صفحات  -

تاریخ انتشار 2011