Review ArticleClinical Review
Opioid Analgesics in Primary Care: Challenges and New Advances in the Management of Noncancer Pain
Raymond Sinatra
The Journal of the American Board of Family
Medicine March 2006, 19 (2) 165-177; DOI: https://doi.org/10.3122/jabfm.19.2.165

References
- ↵
- ↵Federation of State Medical Boards of the United States I. Model guidelines for the use of controlled substances for the treatment of chronic pain. Available from: http://www.medsch.wisc.edu/painpolicy/domestic/model.htm. Accessed December 8, 2004.
- ↵Gilson AM, Joranson DE. Controlled substances and pain management: changes in knowledge and attitudes of state medical regulators.J Pain Symptom Manage 2001; 21: 227–37.
- ↵
- ↵Portenoy RK. Opioid therapy for chronic nonmalignant pain: a review of the critical issues.J Pain Symptom Manage 1996; 11: 203–17.
- ↵Portenoy RK, Foley KM. Chronic use of opioid analgesics in non-malignant pain: report of 38 cases.Pain 1986; 25: 171–86.
- ↵Martin TJ, Eisenach JC. Pharmacology of opioid and nonopioid analgesics in chronic pain states.J Pharmacol Exp Ther 2001; 299: 811–7.
- ↵Nicholson B. Responsible prescribing of opioids for the management of chronic pain.Drugs 2003; 63: 17–32.
- ↵
- ↵National Institutes of Health. The NIH Guide: New directions in pain research I. Washington (DC): US Government Printing Office; 1998.
- ↵Mercadante S. Opioid rotation for cancer pain: rationale and clinical aspects.Cancer 1999; 86: 1856–66.
- ↵Chandler S, Payne R. Economics of unrelieved cancer pain. Am J Hosp Palliat Care 1998; 15: 223–6.
- ↵Abernethy AP, Samsa GP, Matchar DB. A clinical decision and economic analysis model of cancer pain management.Am J Manag Care 2003; 9: 651–64.
- ↵
- ↵
- ↵
- ↵Cowan DT, Wilson-Barnett J, Griffiths P, Vaughan DJ, Gondhia A, Allan LG. A randomized, double-blind, placebo-controlled, cross-over pilot study to assess the effects of long-term opioid drug consumption and subsequent abstinence in chronic noncancer pain patients receiving controlled-release morphine.Pain Med 2005; 6: 113–21.
- ↵
- ↵Charatan F. Time release analgesic causes fatal overdoses in United States. BMJ 2001; 322: 1143.
- ↵Kuhlman JJ Jr., McCaulley R, Valouch TJ, Behonick GS. Fentanyl use, misuse, and abuse: a summary of 23 postmortem cases.J Anal Toxicol 2003; 27: 499–504.
- ↵Tharp AM, Winecker RE, Winston DC. Fatal intravenous fentanyl abuse: four cases involving extraction of fentanyl from transdermal patches.Am J Forensic Med Pathol 2004; 25: 178–81.
- ↵Gilson AM, Joranson DE. U.S. policies relevant to the prescribing of opioid analgesics for the treatment of pain in patients with addictive disease.Clin J Pain 2002; 18: S91–8.
- ↵
- ↵Butler SF, Budman SH, Fernandez K, Jamison RN. Validation of a screener and opioid assessment measure for patients with chronic pain.Pain 2004; 112: 65–75.
- ↵Friedman R, Li V, Mehrotra D. Treating pain patients at risk: evaluation of a screening tool in opioid-treated pain patients with and without addiction.Pain Med 2003; 4: 182–5.
- ↵Adams LL, Gatchel RJ, Robinson RC, et al. Development of a self-report screening instrument for assessing potential opioid medication misuse in chronic pain patients.J Pain Symptom Manage 2004; 27: 440–59.
- ↵Portenoy RK. Opioid therapy for chronic nonmalignant pain: a review of critical issues. In: Fields HL, Liebeskind JC, editors. Pharmacological approaches to the treatment of chronic pain: new concepts and critical issues. Seattle (WA): IASP Publications; 1994. p. 247–87.
- ↵Adams D, Royal M, Jenson MG, et al. Retrospective assessment of frequency of dosing of sustained release opiate preparations. American Pain Society 21st Scientific Meeting, March 14–17, 2002. American Pain Society 2002 Abstract Database. Available from: http://www.ampainsoc.org/cgi-bin/abstract2002/search.pl. Accessed September 15, 2004.
- ↵
- ↵American Society of Anesthesiologists. A report by the American Society of Anesthesiologists Task Force on pain management, chronic pain section.Anesthesiology 1997; 86: 995–1004.
- ↵
- ↵Adams MP, Ahdieh H. Pharmacokinetics and dose-proportionality of oxymorphone extended release and its metabolites: results of a randomized crossover study.Pharmacotherapy 2004; 24: 468–76.
- ↵Parris WC, Johnson BW Jr., Croghan MK, et al. The use of controlled-release oxycodone for the treatment of chronic cancer pain: a randomized, double-blind study.J Pain Symptom Manage 1998; 16: 205–11.
- Stambaugh JE, Reder RF, Stambaugh MD, Stambaugh H, Davis M. Double-blind, randomized comparison of the analgesic and pharmacokinetic profiles of controlled- and immediate-release oral oxycodone in cancer pain patients.J Clin Pharmacol 2001; 41: 500–6.
- ↵Hale ME, Fleischmann R, Salzman R, et al. Efficacy and safety of controlled-release versus immediate-release oxycodone: randomized, double-blind evaluation in patients with chronic back pain.Clin J Pain 1999; 15: 179–83.
- ↵Cherny NJ, Chang V, Frager G, et al. Opioid pharmacotherapy in the management of cancer pain: a survey of strategies used by pain physicians for the selection of analgesic drugs and routes of administration.Cancer 1995; 76: 1283–93.
- ↵American Society of Anesthesiologists. Practice guidelines for cancer pain management. A report by the American Society of Anesthesiologists Task Force on pain management, cancer pain section.Anesthesiology 1996; 84: 1243–57.
- ↵Quang-Cantagrel ND, Wallace MS, Magnuson SK. Opioid substitution to improve the effectiveness of chronic noncancer pain control: a chart review.Anesth Analg 2000; 90: 933–7.
- ↵Adams M, Pieniaszek HJ Jr., Gammaitoni AR, Ahdieh H. Oxymorphone extended release does not affect CYP2C9 or CYP3A4 metabolic pathways.J Clin Pharmacol 2005; 45: 337–45.
- ↵Marcus DA, Glick RM. Sustained-release oxycodone dosing survey of chronic pain patients.Clin J Pain 2004; 20: 363–6.
- ↵Liston HL, Markowitz JS, DeVane CL. Drug glucuronidation in clinical psychopharmacology.J Clin Psychopharmacol 2001; 21: 500–15.
- ↵Lotsch J, Skarke C, Tegeder I, Geisslinger G. Drug interactions with patient-controlled analgesia.Clin Pharmacokinet 2002; 41: 31–57.
- ↵Mogil JS. The genetic mediation of individual differences in sensitivity to pain and its inhibition.Proc Natl Acad Sci USA 1999; 96: 7744–51.
- ↵
- ↵Fishman SM, Wilsey B, Yang J, Reisfield GM, Bandman TB, Borsook D. Adherence monitoring and drug surveillance in chronic opioid therapy.J Pain Symptom Manage 2000; 20: 293–307.
- ↵Katz NP, Sherburne S, Beach M, et al. Behavioral monitoring and urine toxicology testing in patients receiving long-term opioid therapy.Anesth Analg 2003; 97: 1097–102.
- ↵Pasero C, Portenoy RK, McCaffery M. Opioid analgesics. In: McCaffery M, Pasero C, editors. Pain clinical manual. St. Louis (MO): Mosby Inc.; 1999. p. 161–299.
- ↵Dews TE, Mekhail N. Safe use of opioids in chronic noncancer pain.Cleve Clin J Med 2004; 71: 897–904.
- ↵Cherny N, Ripamonti C, Pereira J, et al. Strategies to manage the adverse effects of oral morphine: an evidence-based report.J Clin Oncol 2001; 19: 2542–54.
- ↵Coluzzi PH, Schwartzberg L, Conroy JD, et al. Breakthrough cancer pain: a randomized trial comparing oral transmucosal fentanyl citrate (OTFC) and morphine sulfate immediate release (MSIR).Pain 2001; 91: 123–30.
- ↵Mercadante S, Ferrera P, Villari P, Arcuri E. Hyperalgesia: an emerging iatrogenic syndrome.J Pain Symptom Manage 2003; 26: 769–75.
- ↵Mercadante S. The use of anti-inflammatory drugs in cancer pain.Cancer Treat Rev 2001; 27: 51–61.
- ↵Caterina MJ, Julius D. The vanilloid receptor: a molecular gateway to the pain pathway.Annu Rev Neurosci 2001; 24: 487–517.
- Ibrahim MM, Deng H, Zvonok A, et al. Activation of CB2 cannabinoid receptors by AM1241 inhibits experimental neuropathic pain: pain inhibition by receptors not present in the CNS.Proc Natl Acad Sci USA 2003; 100: 10529–33.
- ↵
- ↵Flockhart DA. Cytochrome P450 drug interaction table. Indiana University School of Medicine. Available from: http://medicine.iupui.edu/flockhart/. Accessed September 15, 2004.
- ↵Lalovic B, Phillips B, Risler LL, Howald W, Shen DD. Quantitative contribution of CYP2D6 and CYP3A to oxycodone metabolism in human liver and intestinal microsomes.Drug Metab Dispos 2004; 32: 447–54.
- ↵Compazine (prochlorperazine) [full prescribing information]. Research Triangle Park (NC): GlaxoSmithKline; 2004.
- ↵Zofran (R) (ondansetron hydrochloride) [full prescribing information]. Research Triangle Park (NC): GlaxoSmithKline; 2004.
- ↵Evans DA, Mahgoub A, Sloan TP, Idle JR, Smith RL. A family and population study of the genetic polymorphism of debrisoquine oxidation in a white British population.J Med Genet 1980; 17: 102–5.
- ↵Yeh SY, Gorodetzky CW, Krebs HA. Isolation and identification of morphine-3 and 6-glucuronides, morphine 3,6 diglucuronide, morphine 3 ethereal sulfate, normorphine and normorphine 6-glucuronide as morphine metabolites in humans.J Pharm Sci 1977; 66: 1288–93.
- ↵Sinatra RS, Hyde NH, Harrison DM. Oxymorphone revisited.Semin Anesth 1988; 7: 209–15.
- ↵Pasternak GW. Pharmacological mechanisms of opioid analgesics. Clin Neuropharmacol 1993; 16: 1–18.
- ↵Uhl GR, Sora I, Wang Z. The mu opiate receptor as a candidate gene for pain: polymorphisms, variations in expression, nociception, and opiate responses.Proc Natl Acad Sci USA 1999; 96: 7752–5.
- ↵Ross FB, Smith MT. The intrinsic antinociceptive effects of oxycodone appear to be kappa-opioid receptor mediated.Pain 1997; 73: 151–7.
- ↵
- ↵Gear RW, Miaskowski C, Gordon NC, Paul SM, Heller PH, Levine JD. Kappa-opioids produce significantly greater analgesia in women than in men.Nat Med 1996; 2: 1248–50.
- ↵Cherny NI, Portenoy RK. Cancer pain management. Current strategy.Cancer 1993; 72: 3393–415.
- ↵Galer BS, Coyle N, Pasternak GW, Portenoy RK. Individual variability in the response to different opioids: report of five cases.Pain 1992; 49: 87–91.
- ↵
- ↵Gimbel JS, Richards P, Portenoy RK. Controlled-release oxycodone for pain in diabetic neuropathy: a randomized controlled trial.Neurology 2003; 60: 927–34.
- Rowbotham MC, Twilling L, Davies PS, Reisner L, Taylor K, Mohr D. Oral opioid therapy for chronic peripheral and central neuropathic pain.N Engl J Med 2003; 348: 1223–32.
- ↵Watson CP, Babul N. Efficacy of oxycodone in neuropathic pain: a randomized trial in postherpetic neuralgia.Neurology 1998; 50: 1837–41.
- ↵Mystakidou K, Befon S, Kouskouni E, et al. From codeine to transdermal fentanyl for cancer pain control: a safety and efficacy clinical trial.Anticancer Res 2001; 21: 2225–30.
- ↵Viscusi ER, Reynolds L, Chung F, Atkinson LE, Khanna S. Patient-controlled transdermal fentanyl hydrochloride vs intravenous morphine pump for postoperative pain: a randomized controlled trial.JAMA 2004; 291: 1333–41.
- ↵Farrar JT, Cleary J, Rauck R, Busch M, Nordbrock E. Oral transmucosal fentanyl citrate: randomized, double-blinded, placebo-controlled trial for treatment of breakthrough pain in cancer patients.J Natl Cancer Inst 1998; 90: 611–6.
- ↵Avinza (morphone sulfate extended-release capsules) [full prescribing information]. San Diego (CA): Ligand Pharmaceuticals Incorporated; 2004.
- ↵Groves ES, Shelby SM, Schlosser L. Efficacy and safety of long-term, once-daily morphine sulfate extended-release capsules in camcer patients with chronic, moderate-to-severe pain. J Clin Oncol 2004;22:
- ↵Caldwell JR, Rapoport RJ, Davis JC, et al. Efficacy and safety of a once-daily morphine formulation in chronic, moderate-to-severe osteoarthritis pain: results from a randomized, placebo-controlled, double-blind trial and an open-label extension trial.J Pain Symptom Manage 2002; 23: 278–91.
- ↵Mantripragada S. A lipid based depot (DepoFoam technology) for sustained release drug delivery.Prog Lipid Res 2002; 41: 392–406.
- ↵Gambling D, Hughes T, Martin G, Horton W, Manvelian G. A comparison of Depodur, a novel, single-dose extended-release epidural morphine, with standard epidural morphine for pain relief after lower abdominal surgery.Anesth Analg 2005; 100: 1065–74.
- ↵Carvalho B, Riley E, Cohen SE, et al. Single-dose, sustained-release epidural morphine in the management of postoperative pain after elective cesarean delivery: results of a multicenter randomized controlled study.Anesth Analg 2005; 100: 1150–8.
- ↵Sinatra RS, Lodge K, Sibert K, et al. A comparison of morphine, meperidine, and oxymorphone as utilized in patient-controlled analgesia following cesarean delivery.Anesthesiology 1989; 70: 585–90.
- ↵
- ↵
- ↵Gabrail NY, Dvergsten C, Ahdieh H. Establishing the dosage equivalency of oxymorphone extended release and oxycodone controlled release in patients with cancer pain: a randomized controlled study.Curr Med Res Opin 2004; 20: 911–8.
- ↵
In this issue
The Journal of the American Board of Family
Medicine
Vol. 19, Issue 2
March-April 2006
Opioid Analgesics in Primary Care: Challenges and New Advances in the Management of Noncancer Pain
Raymond Sinatra
The Journal of the American Board of Family
Medicine Mar 2006, 19 (2) 165-177; DOI: 10.3122/jabfm.19.2.165
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