Details

Autor(en) / Beteiligte

• Krumova, Elena K
• Bennemann, Philipp
• Kindler, Doris
• Schwarzer, Andreas
• Zenz, Michael
• Maier, Christoph

Titel

Low Pain Intensity After Opioid Withdrawal as a First Step of a Comprehensive Pain Rehabilitation Program Predicts Long-term Nonuse of Opioids in Chronic Noncancer Pain

Ist Teil von

• The Clinical journal of pain, 2013-09, Vol.29 (9), p.760-769

Ort / Verlag

United States: by Lippincott Williams & Wilkins

Erscheinungsjahr

2013

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• OBJECTIVES:In specialized pain clinics there is an increasing number of patients with severe chronic noncancer pain (CNCP) despite long-term opioid medication. Few clinical studies show short-term pain relief after opioid withdrawal (OW). We have evaluated the relation between pain intensity after OW and long-term opioid nonuse. METHODS:One hundred two consecutive patients with severe CNCP despite opioid medication (mean treatment duration, 43 mo) reported pain intensity (numerical rating scale, 0 to 10), Pain Disability Index, mood (CES-D), and quality of life (Short Form 36) before, shortly, and 12 to 24 months after inpatient OW. Total opioid withdrawal (n=78) or significant dose reduction (DR; n=24, mean reduction, 82%) was performed after individual decision. Opioid intake 12 to 24 months later, respectively dose increase ≥100% (DR group), was considered relapse. T tests, multivariable analysis of variance, logistic regression. RESULTS:After OW current pain intensity significantly decreased on an average by 41% (6.4±2.4 vs. 3.8±2.5), maximal and average pain by 18% and 24%, respectively. Twelve to 24 months later 42 patients (41%) relapsed (31 of the total opioid withdrawal group, 6 of the DR group, 5 lost). Patients without later relapse showed significantly lower pain scores than the later relapsed patients already shortly after OW (5.0±2.2 vs. 5.9±2.1) and 12 to 24 months later (5.5±2.4 vs. 6.5±2.0). There was a significant relation between relapse probability and pain intensity immediately after OW. CONCLUSIONS:In many patients with severe CNCP, despite opioid medication, sustainable pain relief can be achieved if OW is included in the rehabilitation program. Consequently, we recommend OW for opioid-resistant CNCP before any opioid escalation. Lower pain intensity shortly after OW may predict the long-term opioid nonuse probability.