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Journal of Clinical Medicine Aug 2022Background: Neuropathic pain (NP) in head and neck cancer (HNC) patients represents a treatment challenge. Most studies investigating drugs against NP are conducted in... (Review)
Review
Background: Neuropathic pain (NP) in head and neck cancer (HNC) patients represents a treatment challenge. Most studies investigating drugs against NP are conducted in patients suffering with diabetic neuropathy or postherpetic neuralgia, while data are limited in cancer pain management. Additionally, regarding cancer therapy-related NP, most of the studies do not focus on HNC patients. The aim of this review is to identify the studies on systematically administered medication for NP management that included HNC patients under radiotherapy. Methods: A systematic literature search was performed, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, in PubMed, Cochrane Library, Web of Science and ClinicalTrials.gov on 30 October 2021. The medical subject heading (MeSH) terms were (“head and neck cancer” OR “tumor”) AND “neuropathic pain” AND “medication” AND “radiotherapy.” The Cochrane Collaboration tool was used for quality assessment. Results: The search identified 432 articles. Three more articles were identified after searching the reference lists of the retrieved articles. A total of 10 articles met the eligibility inclusion criteria and were included in this review; 6 on gabapentin, 1 on pregabalin, 1 on nortriptyline, 1 on methadone, and 1 on ketamine. Statistically significant results in pain reduction compared to placebo or standard pain medication were found in the studies on pregabalin (p = 0.003), methadone (p = 0.03), ketamine (p = 0.012), and in two out of six gabapentin studies (p < 0.004). Two of the studies (both concerning gabapentin) had no comparison arm. Conclusions: Treatments including pregabalin, methadone, ketamine, and gabapentin were found to provide pain relief against HNC NP. While there is a plethora of pharmacological treatments available for the management of NP, only a few studies have been conducted regarding the pharmacological management of therapy-related NP in HNC patients. More studies should be conducted regarding the pharmacological approaches in HNC therapy-related NP so that specific treatment algorithms can be developed.
PubMed: 36013118
DOI: 10.3390/jcm11164877 -
Journal of Addiction MedicineMultiple substance use is a common but underrecognized problem in patients on opioid agonist treatment (OAT). Co-occurring substance misuse is associated with poor... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
Multiple substance use is a common but underrecognized problem in patients on opioid agonist treatment (OAT). Co-occurring substance misuse is associated with poor clinical and psychosocial outcomes. We aimed ( a ) to determine the effect of screening and brief intervention (SBI) for substance misuse in people on OAT and (b) to qualitatively summarize the implementation of SBI.
METHODS
We performed a systematic review of clinical trials on the efficacy of SBI for alcohol and drug misuse in participants on OAT. We searched 5 electronic databases and included published studies and unpublished trials. We measured the standardized mean difference in substance risk scores before and after intervention. We also estimated the standardized mean difference in alcohol consumption per day before and after intervention.
RESULTS
We included a total of 8 studies; 5 of these were included in the meta-analysis, and all were reviewed for narrative synthesis. We observed a significant change in the pre-post brief intervention substance risk scores with a medium effect size (Hedges g = 0.752, 95% confidence interval, 0.405-1.099). Sensitivity analyses with different pretest-posttest correlations did not change our result. Modest effects of SBI were found in reducing both alcohol and illicit drug risk scores, and among the population on methadone and buprenorphine treatment. We also observed a significant decrease in alcohol consumption per day 3 months after SBI. Studies showed a limited and incomplete screening for substance misuse and delivery of brief intervention in OAT settings.
CONCLUSIONS
Screening and brief intervention may be a potential treatment for co-occurring substance misuse among patients on OAT.
Topics: Humans; Crisis Intervention; Analgesics, Opioid; Substance-Related Disorders; Alcohol Drinking; Drug Users
PubMed: 36001065
DOI: 10.1097/ADM.0000000000001058 -
Journal of Hospital Medicine Sep 2022Hospitalizations related to the consequences of opioid use are rising. National guidelines directing in-hospital opioid use disorder (OUD) management do not exist. OUD...
BACKGROUND
Hospitalizations related to the consequences of opioid use are rising. National guidelines directing in-hospital opioid use disorder (OUD) management do not exist. OUD treatment guidelines intended for other treatment settings could inform in-hospital OUD management.
OBJECTIVE
Evaluate the quality and content of existing guidelines for OUD treatment and management.
DATA SOURCES
OVID MEDLINE, PubMed, Ovid PsychINFO, EBSCOhost CINHAL, ERCI Guidelines Trust, websites of relevant societies and advocacy organizations, and selected international search engines.
STUDY SELECTION
Guidelines published between January 2010 to June 2020 addressing OUD treatment, opioid withdrawal management, opioid overdose prevention, and care transitions among adults.
DATA EXTRACTION
We assessed quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.
DATA SYNTHESIS
Nineteen guidelines met the selection criteria. Most recommendations were based on observational studies or expert consensus. Guidelines recommended the use of nonstigmatizing language among patients with OUD; to assess patients with unhealthy opioid use for OUD using the Diagnostic Statistical Manual of Diseases-5th Edition criteria; use of methadone or buprenorphine to treat OUD and opioid withdrawal; use of multimodal, nonopioid therapy, and when needed, short-acting opioid analgesics in addition to buprenorphine or methadone, for acute pain management; ensuring linkage to ongoing methadone or buprenorphine treatment; referring patients to psychosocial treatment; and ensuring access to naloxone for opioid overdose reversal.
CONCLUSIONS
Included guidelines were informed by studies with various levels of rigor and quality. Future research should systematically study buprenorphine and methadone initiation and titration among people using fentanyl and people with pain, especially during hospitalization.
Topics: Adult; Analgesics, Opioid; Buprenorphine; Hospitalization; Humans; Methadone; Opiate Overdose; Opioid-Related Disorders
PubMed: 35880821
DOI: 10.1002/jhm.12908 -
Substance Use & Misuse 2022Illicit opioid use in pregnancy is associated with adverse maternal, neonatal, and childhood outcomes. Opioid substitution is recommended, but whether methadone or... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Illicit opioid use in pregnancy is associated with adverse maternal, neonatal, and childhood outcomes. Opioid substitution is recommended, but whether methadone or buprenorphine is the optimal agent remains unclear.
METHODS
We searched EMBASE, PubMed, Web of Science, Scopus, Open Gray, CINAHL and the Cochrane Central Registry of Controlled Trials (CENTRAL) from inception to April 2020 for randomized controlled trials (RCTs) and cohort studies comparing methadone and buprenorphine treatment for opioid-using mothers. Included studies assessed maternal and or neonatal outcomes. We used random-effects meta-analyses to estimate summary measures for outcomes and report these separately for RCTs and cohort studies.
RESULTS
Of 408 abstracts screened, 20 papers were included (4 RCTs, 16 cohort, 223 and 7028 participants respectively). All RCTs (4/4) had a high risk of bias and median (IQR) Newcastle Ottawa Scale for cohort studies was 7.5 (6-9). In both RCTs and cohort studies, buprenorphine was associated with; greater offspring birth weight (weighted mean difference [WMD] 343 g (95% CI: 40-645 g) in RCT and 184 g (95% CI: 121-247 g) in cohort studies); body length at birth (WMD 2.28 cm (95% CI: 1.06-3.49 cm) in RCTs and 0.65 cm (95% CI: 0.31-0.98 cm) in cohort studies); and reduced risk of prematurity (risk ratio [RR] 0.41 (95% CI: 0.18-0.93) in RCTs and 0.63 [95% CI: 0.53-0.75] in cohort studies) when compared to methadone. All other clinical outcomes were comparable.
CONCLUSIONS
Compared to methadone, buprenorphine was consistently associated with improved birthweight and gestational age, however given potential biases, results should be interpreted with caution.
Topics: Analgesics, Opioid; Buprenorphine; Child; Female; Humans; Infant, Newborn; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Pregnancy
PubMed: 35758300
DOI: 10.1080/10826084.2022.2083174 -
Frontiers in Pediatrics 2022Pediatric palliative care (PPC) is defined as the prevention and relief from suffering of families and children with life-limiting (LLDs) or life-threatening diseases... (Review)
Review
BACKGROUND
Pediatric palliative care (PPC) is defined as the prevention and relief from suffering of families and children with life-limiting (LLDs) or life-threatening diseases (LTDs). These patients often experience pain, with morphine being the most widely used drug to treat it. Few studies investigated the role of methadone in PPC patients, although it is considered among the most effective and underutilized drugs in PPC.
OBJECTIVES
Our aim was to evaluate the efficacy, safety, and dosage of methadone in PPC.
METHODS
Between August and October 2021 PubMed, Scopus and the Cochrane Library were searched for studies on the use of methadone in children with LLDs and LTDs. Articles were included if they met the following criteria: published in the last 10 years, English language, patients aged 0-23 years; children enrolled in a PPC center or receiving declared support from a PPC service; reporting of specific data on methadone in interventional trials, observational studies, or case series on >10 patients. The reporting of the article was guided by the PRISMA guidelines, and a critical appraisal of the included studies was performed using the JBI-tool.
RESULTS
After duplicates removal and full-text assessment, four studies were included and another one was added after checking the references of the retrieved papers. All were retrospective, and the literature is concordant in documenting the lack of evidence. A total of 116 children received methadone in PPC. From our review emerges the poor quality of data collection: in only one study pain was assessed with standardized scales. All studies documented the effectiveness of methadone in treating complex pain, either nociceptive or neuropathic. No serious adverse events were reported, with no cases of cardiac arrhythmias.
CONCLUSION
Our results suggest that methadone could represent a suitable strategy for treating pain in PPC. However, the evidence base is insufficient, and further research is warranted.
PubMed: 35712616
DOI: 10.3389/fped.2022.874529 -
Exploratory Research in Clinical and... Jun 2021The opioid crisis has left a devastating impact on the United States (U.S.) for over 20 years. The over-prescribing of opioid medications and availability of illicit... (Review)
Review
INTRODUCTION
The opioid crisis has left a devastating impact on the United States (U.S.) for over 20 years. The over-prescribing of opioid medications and availability of illicit opioids have contributed to the U.S. opioid epidemic. Given the complexity of the epidemic, substance use disorder, and its treatment, there is an urgent need for a thorough review of the qualitative literature which has captured the patient's experiences Such patient-derived qualitative data on lived experiences and perspectives may allow researchers, clinicians, and policy makers to glean new insights into addressing this epidemic.
OBJECTIVES
The objective of this paper is to present a systematic literature review of the existing U.S. qualitative research and provide a patient perspective on medications for opioid use disorder (MOUD), including barriers and facilitators to MOUD use.
METHODS
In November 2019, four electronic databases (PubMed, CINAHL, Scopus, and Web of Science) were searched by a medical librarian using a combination of keywords, Medical Subject Headings (MeSH), and/or CINAHL subject headings. 8766 results were imported into EndNote, then duplicate records were removed, leaving a total of 4722 articles. The unique records were imported into Rayyan QCRI an online platform designed to expedite screening. Blinded screening was undertaken in duplicate by four reviewers. Two researchers abstracted all the articles and used thematic analysis.
RESULTS
The screening in the abstract phase excluded 4681 results, leaving 41 studies for full-text screening to determine their eligibility for inclusion in the review. After screening, 21 articles were included in the study and the analysis is based on these articles Common themes across studies included stigmatization, perceived barriers to MOUD, and MOUD treatment deserts and provider shortages.
CONCLUSIONS
Qualitative research studies conducted to date have uncovered substantial MOUD treatment barriers which are both social and structural in nature. Such barriers to treatment may serve to exacerbate the current epidemic and must be taken into consideration in designing policy and treatment solutions for patients with OUD.
PubMed: 35481114
DOI: 10.1016/j.rcsop.2021.100029 -
Adicciones Jul 2023The crisis caused by prescribed opioids and their related side effects are a public health problem worldwide. Most of these are prescribed for coping with chronic pain....
The crisis caused by prescribed opioids and their related side effects are a public health problem worldwide. Most of these are prescribed for coping with chronic pain. The coexistence of opioid use disorder (OUD) in patients with chronic pain represents a complex challenge due to the need for managing both pain and OUD. The aim of this systematic review is to evaluate the efficacy of feasible treatments for this population with OUD and comorbid chronic pain for both conditions. A systematic database search has been performed using Cochrane Library, MEDLINE, PsycINFO and ClinicalTrials.gov in compliance with PRISMA guidelines. Eligible articles addressed the outcomes in chronic pain patients with comorbid opioid use disorder after treatment interventions were applied. Of 593 identified articles, nine were eligible for qualitative review (n = 7 pharmacological interventions; n = 2 psychological interventions). Methadone, buprenorphine, cognitive-behavioral and mindfulness showed promising results, but data were inconclusive (<2 RCT with low risk of bias). It is unclear whether the opioid agonist treatment should be maintained or tapered and which drug should be prescribed for the opioid substitution therapy (methadone or buprenorphine/naloxone). Mindfulness and cognitive behavioral therapy have a discrete effect on improving negative affect but not pain. The therapeutic approach might be individualized under a shared decision-making basis.
Topics: Humans; Chronic Pain; Opioid-Related Disorders; Analgesics, Opioid; Methadone; Buprenorphine; Opiate Substitution Treatment
PubMed: 35472158
DOI: 10.20882/adicciones.1680 -
Archives of Disease in Childhood. Fetal... Nov 2022To conduct a meta-analysis to determine the association between prenatal drug exposure and risk of sudden infant death syndrome (SIDS). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To conduct a meta-analysis to determine the association between prenatal drug exposure and risk of sudden infant death syndrome (SIDS).
DESIGN
Studies were searched using PubMed, Medline and Embase and restricted to English, with no publication date limit. Selected studies included published cohort, population or case studies comparing the incidence of SIDS among drug-exposed with drug-free controls. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. Data were pooled using a random-effects model to evaluate risk ratios (RR).
SETTING
High-income countries.
PATIENTS
Children with a history of prenatal drug exposure.
INTERVENTIONS
None.
MAIN OUTCOME MEASURES
RR of SIDS between drug-exposed and control infants.
RESULTS
Sixteen studies (36 730 infants with any prenatal drug exposure, 21 661 exposed to opioids, 21 571 exposed to cocaine, 5031 exposed to methadone compared with 4 201 955 with no exposure). Any prenatal drug exposure was associated with an increased crude risk of SIDS (RR 7.84, 95% CI 5.21 to 11.81). Prenatal opioid exposure had the highest associative crude risk of SIDS (RR 9.76, 95% CI 5.28 to 18.05), followed by methadone (RR 9.52, 95% CI 4.60 to 19.70) and cocaine (RR 4.40, 95% CI 2.52 to 7.67). Increased crude risk persisted after adjusting for socioeconomic factors (RR 4.24, 95% CI 1.39 to 12.88). The incidence of SIDS for this cohort decreased between 1972 and 2020 but remained significantly higher than controls.
CONCLUSION
Exposure to any drug of dependency during pregnancy is associated with an increased risk of SIDS after controlling for socioeconomic factors. Further study to evaluate mechanisms and contribution of other confounders (eg, smoking) is warranted.
Topics: Female; Humans; Infant; Pregnancy; Analgesics, Opioid; Cocaine; Methadone; Observational Studies as Topic; Risk Factors; Substance-Related Disorders; Sudden Infant Death; Prenatal Exposure Delayed Effects
PubMed: 35396270
DOI: 10.1136/archdischild-2021-323260 -
PloS One 2022Several pharmacotherapeutic interventions are available for maintenance treatment for opioid-related disorders. However, previous meta-analyses have been limited to... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Several pharmacotherapeutic interventions are available for maintenance treatment for opioid-related disorders. However, previous meta-analyses have been limited to pairwise comparisons of these interventions, and their efficacy relative to all others remains unclear. Our objective was to unify findings from different healthcare practices and generate evidence to strengthen clinical treatment protocols for the most widely prescribed medications for opioid-use disorders.
METHODS
We searched Medline, EMBASE, PsycINFO, CENTRAL, and ClinicalTrials.gov for all relevant randomized controlled trials (RCT) from database inception to February 12, 2022. Primary outcome was treatment retention, and secondary outcome was opioid use measured by urinalysis. We calculated risk ratios (RR) and 95% credible interval (CrI) using Bayesian network meta-analysis (NMA) for available evidence. We assessed the credibility of the NMA using the Confidence in Network Meta-Analysis tool.
RESULTS
Seventy-nine RCTs met the inclusion criteria. Due to heterogeneity in measuring opioid use and reporting format between studies, we conducted NMA only for treatment retention. Methadone was the highest ranked intervention (Surface Under the Cumulative Ranking [SUCRA] = 0.901) in the network with control being the lowest (SUCRA = 0.000). Methadone was superior to buprenorphine for treatment retention (RR = 1.22; 95% CrI = 1.06-1.40) and buprenorphine superior to naltrexone (RR = 1.39; 95% CrI = 1.10-1.80). However, due to a limited number of high-quality trials, confidence in the network estimates of other treatment pairs involving naltrexone and slow-release oral morphine (SROM) remains low.
CONCLUSION
All treatments had higher retention than the non-pharmacotherapeutic control group. However, additional high-quality RCTs are needed to estimate more accurately the extent of efficacy of naltrexone and SROM relative to other medications. For pharmacotherapies with established efficacy profiles, assessment of their long-term comparative effectiveness may be warranted.
TRIAL REGISTRATION
This systematic review has been registered with PROSPERO (https://www.crd.york.ac.uk/prospero) (identifier CRD42021256212).
Topics: Analgesics, Opioid; Buprenorphine; Humans; Methadone; Morphine; Naltrexone; Network Meta-Analysis; Opioid-Related Disorders; Randomized Controlled Trials as Topic
PubMed: 35358261
DOI: 10.1371/journal.pone.0266142 -
Neuroscience and Biobehavioral Reviews May 2022Opioid use disorder is a significant global issue and the rate of opioid use in women of childbearing age and pregnant women is on the rise. Whilst the adverse general... (Meta-Analysis)
Meta-Analysis Review
Opioid use disorder is a significant global issue and the rate of opioid use in women of childbearing age and pregnant women is on the rise. Whilst the adverse general health, cognitive, and neurodevelopmental outcomes of in utero exposure to opioids have been explored, there is a lack of prospective, controlled, longitudinal research into the ophthalmic outcomes. Existing research suggests that there is an association between prenatal exposure and future risk of abnormalities in visual functioning. This systematic review and meta-analysis analysed studies that measured eye abnormalities in infants or children exposed to opioid maintenance therapy in utero and compared them to non-opioid exposed controls. After considering the clinical findings, limitations of the studies, confounding factors, and quantitative analysis, a causal relationship between in utero opioid exposure and future eye abnormalities could not be confirmed. The implications of the findings and their clinical relevance, in addition to identified gaps for future research are also discussed in this paper.
Topics: Analgesics, Opioid; Buprenorphine; Child; Female; Humans; Infant; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Pregnancy; Prenatal Exposure Delayed Effects
PubMed: 35263646
DOI: 10.1016/j.neubiorev.2022.104601