Opioid Tapering/Detoxification Protocols, A Compendium: Narrative Review.

Objectives: The opioid epidemic has put pressure on clinicians to taper their chronic pain patients (CPPs) from opioids. This has resulted in rapid or forced tapers and opioid discontinuation. Partially responsible is lack of information on how to taper (tapering protocols).

Can Patient Expectations of Returning to Work Documented Before, During, or at the End of Treatment Predict Actual Return to Work Post-treatment? An Evidence-Based Structured Systematic Review.

Background: There is significant evidence that patient expectations can impact their treatment outcomes. The hypothesis of this systematic review was then the following. There will be significant consistent evidence as specified by the Agency for Health Care Policy and Research (AHCPR) guidelines that chronic pain patient (CPP) expectations for returning to work documented before, during, or at the end of treatment will predict actual return to work post-treatment.

Does Opioid Tapering in Chronic Pain Patients Result in Improved Pain or Same Pain vs Increased Pain at Taper Completion? A Structured Evidence-Based Systematic Review.

Objective: To support or refute the hypothesis that opioid tapering in chronic pain patients (CPPs) improves pain or maintains the same pain level by taper completion but does not increase pain.

Methods: Of 364 references, 20 fulfilled inclusion/exclusion criteria. These studies were type 3 and 4 (not controlled) but reported pre/post-taper pain levels.

Chronic Pain Types Differ in Their Reported Prevalence of Post -Traumatic Stress Disorder (PTSD) and There Is Consistent Evidence That Chronic Pain Is Associated with PTSD: An Evidence-Based Structured Systematic Review.

Objectives: The hypotheses of this systematic review were the following: 1) Prevalence of post-traumatic stress disorder (PTSD) will differ between various types of chronic pain (CP), and 2) there will be consistent evidence that CP is associated with PTSD.

Methods: Of 477 studies, 40 fulfilled the inclusion/exclusion criteria of this review and were grouped according to the type of CP. The reported prevalence of PTSD for each grouping was determined by aggregating all the patients in all the studies in that group.

At Completion of a Multidisciplinary Treatment Program, Are Psychophysical Variables Associated with a VAS Improvement of 30% or More, a Minimal Clinically Important Difference, or an Absolute VAS Score Improvement of 1.5 cm or More?

Objectives: Objectives were to determine at completion of a multidisciplinary pain program: 1) what percentage of chronic low back pain (CLBP) patients had improved at 30% or more (minimal clinically important difference [MCID]) and by 1.5 cm or more (minimal important change [MIC]) on the visual analog scale (VAS) and 2) whether that improvement is associated with pain matching (PM), pain threshold (PTRE), and pain tolerance (PTOL) improvements.

Methods: One hundred and six CLBP patients had admission and discharge scores for VAS, PM, PTRE, and PTOL.

Do Acute and Chronic Pain Patients Differ on Affirmation of One Aspect of Pain Acceptance? Acknowledgement that a Cure Is Unlikely.

Background: Many chronic pain patients (CPPs) cannot be cured of their pain, but can learn to manage it. This has led to research on pain "acceptance" which is defined as a behavior pattern with awareness of pain but not directed at changing pain.

Objective: CPPs who have accepted their pain generally acknowledge that a cure is unlikely.

Does pain interfere with antidepressant depression treatment response and remission in patients with depression and pain? An evidence-based structured review.

Objective: The objective of this evidence-based structured review was to determine if there is consistent evidence that pain interferes with achieving antidepressant treatment response/remission of depression in patients with depression and pain.

Methods: After exclusion criteria were applied, of 2,801 studies/reports, 17 studies addressed this question. They were sorted into the four hypotheses outlined herein after.

Prevalence comparisons of somatic and psychiatric symptoms between community nonpatients without pain, acute pain patients, and chronic pain patients.

Objectives: Somatic/psychiatric symptoms are frequently found in chronic pain patients (CPPs). The objectives of this study were to determine 1) which somatic/psychiatric symptoms are more commonly found in acute pain patients (APPs) and CPPs vs community nonpatients without pain (CNPWPs) and 2) if somatic/psychiatric symptom prevalence differs between APPs and CPPs.

Design: The above groups were compared statistically for endorsement of 15 symptoms: fatigue, numbness/tingling, dizziness, difficulty opening/closing mouth, muscle weakness, difficulty staying asleep, depression, muscle tightness, nervousness, irritability, memory, falling, nausea, concentration, and headaches.

Examination of symptom clusters in acute and chronic pain patients.

Background: Symptom clusters have not been previously explored in acute pain patients (APPs) and chronic pain patients (CPPs) with non-cancer pain.

Objectives: The objectives of this study were to determine in CPPs and APPs which somatic and non-somatic symptoms cluster with each other, the number of clusters, and if cluster number and cluster symptom makeup differ by pain level.

Study Design: Study sample was 326 APPs and 341 CPPs who had completed a pool of questions that had included current symptom questions other than pain.

Exploring the Relationship of Three Medical Entitlement Beliefs and Psychiatric/Psychological Variables for Acute and Chronic Pain Patients.

Objectives: The belief in medical care entitlement has recently resulted in major changes in the medical system in the United States. The objectives of this study were the following: to compare endorsement of three medical entitlement beliefs (I deserve the best medical care no matter what the cost [BMC], I am entitled to all of the medical care I want at no charge [NC], I shouldn't have to wait to see my doctors [W]) in community nonpatients without pain (CNPWP), acute pain patients (APPs), and chronic pain patients (CPPs) and to develop predictor models for these beliefs in APPs and CPPs.

Design: CNPWP, APPs, and CPPs were compared statistically for frequency of endorsement of each belief.

What is the evidence that neuropathic pain is present in chronic low back pain and soft tissue syndromes? An evidence-based structured review.

Objectives: The objectives of this evidence-based review were to review the evidence for whether neuropathic pain (NP) is associated with chronic low back pain (CLBP) and soft tissue syndromes (STS), and review the reported prevalence percentages for NP within these syndromes.

Methods: Of 816 reports, 11 addressed the diagnosis of NP in CLBP and five of NP in STS. Studies were grouped by the method of arrival at an NP diagnosis, e.

Exploration of affirmation of childhood molestation (sexual abuse) in chronic pain patients, acute pain patients, community patients with pain and community nonpatients without pain.

Objectives: To further explore the controversy as to whether childhood molestation is associated with chronic pain in adulthood.

Design: Community nonpatients without pain (CNPWP), community patients with pain (CPWP), acute pain patients (APPs), and chronic pain patients (CPPs) were compared for endorsement of affirmation of childhood molestation by chi-square. Logistic regression was utilized to predict affirmation in male and female CPPs.

The prevalence of smokers within chronic pain patients and highest pain levels versus comparison groups.

OBJECTIVES.: The objectives of this study were to (1) compare the prevalence of smoking within chronic pain patients (CPPs) to community non-patients without pain (CNPWP), community patients with pain (CPWP), and acute pain patients (APPs); and (2) compare smokers to nonsmokers within CPPs, APPs, and CPWP for highest pain level. DESIGN.

Is there significant correlation between self-reported low back pain visual analogue scores and low back pain scores determined by pressure pain induction matching?

The objective of this study was to determine whether self-reported visual analogue scale (VAS) low back pain (LBP) scores are valid against matched psychophysically induced pressure pain scores. Two hundred thirty-six chronic LBP patients (some with neck pain) reported their LBP and neck pain scores on a VAS immediately before psychophysical pressure pain induction used to determine pain threshold (PTHRE), pain tolerance (PTOL), and a psychophysical pressure pain score which matched (PMAT) their current LBP. Pearson Product-Moment correlation coefficients were calculated between reported VAS neck scores, reported VAS LBP scores, and the psychophysically determined LBP PMAT scores.

Is smoking associated with alcohol-drug dependence in patients with pain and chronic pain patients? An evidence-based structured review.

Objective: The objective of this study was to determine if there is consistent evidence for smoking to be considered a red flag for development of opioid dependence during opioid exposure in patients with pain and chronic pain patients (CPPs).

Methods: Six hundred and twenty-three references were found that addressed the areas of smoking, pain, and drug-alcohol dependence. Fifteen studies remained after exclusion criteria were applied and sorted into four groupings addressing four hypotheses: patients with pain and CPPs who smoke are more likely than their nonsmoking counterparts to use opioids, require higher opioid doses, be drug-alcohol dependent, and demonstrate aberrant drug-taking behaviors (ADTBs).

Are psychoactive substance (opioid)-dependent chronic pain patients hyperalgesic?

Objectives: One indirect line of evidence for opioid-induced hyperalgesia (OIH) in humans is decreased pain thresholds (PTREs) and tolerances (PTOLs) in opioid addicts on opioids. There are a number of such studies in opioid maintained addicts, but no such studies in chronic pain patients (CPPs) with current opioid addiction. The objective of this study was to determine if this group demonstrates hyperalgesia.

Medical malpractice allegations of iatrogenic addiction in chronic opioid analgesic therapy: forensic case reports.

Objectives: The objectives for presenting these medico-legal forensic case reports are the following: 1) detail three cases where chronic opioid analgesic therapy (COAT) was alleged to cause iatrogenic addiction and/or re-addiction; 2) detail the plaintiff's and defendant's medical experts' opinions on these allegations; and 3) through analyzing these cases, develop some recommendations for future prevention of such allegations during COAT.

Methods: Case Reports.

Results: Medico-legal issues surrounding the allegation of iatrogenic addiction were identified in each case.

Exploration of anger constructs in acute and chronic pain patients vs. community patients.

Objectives: (1) Determine and compare prevalence of forms of anger (FOA; anger, hostility, aggression, anger-in, anger-out, chronic anger) in community nonpatients (n=478), community patients (n=158), acute pain patients (APPs; n=326), chronic pain patients (CPPs; n=341); and (2) develop FOA predictor models in APPs and CPPs.

Design: A large set of items containing the FOA items was administered to the above groups, who were compared statistically for FOA endorsement. APPs and CPPs affirming the anger and chronic anger items were compared with those not affirming on all available variables including the Battery for Health Improvement (BHI-2) with significant variables (P≤0.

Allegations of medical malpractice in chronic opioid analgesic therapy possibly related to collaborative/split treatment and the P-450 enzyme system: forensic case report.

Objectives: The objectives of this forensic medicolegal case report were the following: 1) present details of a patient on chronic opioid analgesic therapy (COAT) where a disastrous outcome resulted in allegations of malpractice; 2) detail the plaintiff's and defendant's medical experts' opinions on this allegation; and 3) discuss issues potentially related to these allegations, i.e., split treatment and the P450 enzyme system.

Exploration of the illness uncertainty concept in acute and chronic pain patients vs community patients.

Objective: Illness uncertainty (IU) theory proposes that patients with chronic illness may have difficulty adjusting to the illness if there is significant diagnostic or prognostic uncertainty. Two dimensions of IU theory are "lack of information about diagnoses or severity of the illness" (LIDSI) and "complexity regarding the health care system" (CRHCS). The primary objective of this study was then to compare the prevalence of IU in community nonpatients, community patients, and rehabilitation patients without pain/chronic pain patients (CPPs)/acute pain patients (APPs) as represented by two items with possible face validity for LIDSI ("doctors puzzled by my problems,""doctors missed something important") and three items with possible CRHCS face validity ("doctors don't believe me,""I need to prove my problem is real,""doctors think my problems are in my head").