Literature Collection | Integration Academy

2441

Chronic opioid therapy for chronic non-cancer pain: a review and comparison of treatment guidelines

Type: Journal Article

Authors: C. W. Cheung, Q. Qiu, S. W. Choi, B. Moore, R. Goucke, M. Irwin

Year: 2014

Publication Place: United States

Abstract: BACKGROUND: Long-term opioid use for chronic non-cancer pain has increased substantially in recent years despite the paucity of strong supporting scientific data and concerns regarding adverse effects and potential misuse. STUDY DESIGN: Review and summary of practice guidelines available on PubMed and Cochrane databases as well as on the Internet on chronic opioid therapy from June 2004 to June 2013. OBJECTIVE: To review expert-developed practice guidelines on chronic opioid therapy, published in different countries over the past decade in order to reveal similar principles of therapy and to provide useful information and references for future development of opioid guidelines to identify adequately supported practice points and areas in need of further scientific evidence. METHOD: Seven guidelines were identified as pertaining specifically to the long-term use of opioids for general chronic non-cancer pain from an initial search of the PubMed/Medline and Cochrane databases using combinations of the search terms "opioid," "chronic opioid therapy," "chronic pain," "chronic non-cancer pain," "chronic non-malignant pain," "guidelines," "practice guidelines," and "clinical practice guidelines," filtered to include only articles on humans published in the English language over the past 10 years. RESULTS: All guidelines espouse an individual approach to management, beginning with a comprehensive patient evaluation, with particular focus on eliciting factors that may indicate potential drug misuse and abuse, and a trial of therapy to determine the course of treatment. Goals of treatment should be adequately discussed with and consented to by the patient. Opioids are generally not recommended as first-line therapy but, when used, clinicians should closely monitor patients for loss of response, adverse effects or aberrant behavior, and revise the treatment plan accordingly. Urine drug testing (UDT) may be used as a tool to monitor for aberrant behavior or drug misuse; opioid rotation may be considered when loss of response or adverse effects are a concern, at a starting dose lower than the calculated equianalgesic dose. LIMITATIONS: Information on some African nations, countries in the Middle-East, and Pacific Islands is not available and therefore was not included in this review. CONCLUSION: There is a growing body of scientific evidence to support opioid use in chronic pain. Future work should focus on continuing to generate good-quality evidence on the long-term benefits of opioid therapy, as well as scientific data to guide drug choice and dosing for specific conditions, populations, and situations.

Topic(s):

Reference Links:

Export Citation: RIS

View details

2442

Chronic opioid therapy for nonmalignant pain: The patient's perspective. Part II--Barriers to chronic opioid therapy

Type: Journal Article

Authors: A. Vallerand, L. Nowak

Year: 2010

Publication Place: United States

Topic(s):

Reference Links:

Export Citation: RIS

View details

2443

Chronic opioid therapy urine drug testing in primary care: prevalence and predictors of aberrant results

Type: Journal Article

Authors: J. A. Turner, K. Saunders, S. M. Shortreed, L. LeResche, K. Riddell, S. E. Rapp, M. Von Korff

Year: 2014

Publication Place: United States

Abstract: BACKGROUND: Urine drug tests (UDTs) are recommended for patients on chronic opioid therapy (COT). Knowledge of the risk factors for aberrant UDT results could help optimize their use. OBJECTIVE: To identify primary care COT patient and opioid regimen characteristics associated with aberrant UDT results. DESIGN: Population-based observational. SAMPLE: 5,420 UDTs for Group Health integrated group practice COT patients. MEASURES: Group Health database measures of patient demographics, medical history, COT characteristics, and UDT results. RESULTS: Thirty percent of UDTs had aberrant results, including prescribed opioid non-detection (12.3%), tetrahydrocannabinol (THC; 11.2%), non-prescribed opioid (5.3%), illicit drug (excluding THC; 0.6%), non-prescribed benzodiazepine (1.7%), and dilute (4.8%). Adjusted odds ratios (95% CI) of any aberrant result were higher for males than females (1.24 [1.07, 1.43]), patients with versus without prior substance use disorder diagnoses (1.42 [1.17, 1.72]), and current smokers versus non-smokers (1.50 [1.30, 1.73]). Odds ratios were lower for patients aged 45-64 (0.77 [0.65, 0.92]) and 65+ (0.40 [0.32, 0.50]) versus patients aged 20-44 and for patients on long-acting opioids only (0.72 [0.55, 0.95]) or long-acting plus short-acting (0.67 [0.54, 0.83]) versus short-acting only. Adjusted odds of prescribed opioid non-detection were lower for patients aged 45-64 (0.79 [0.63, 0.998]) and 65+ (0.44 [0.32, 0.59]) versus patients aged 20-44, for those on 40-<120 mg daily morphine-equivalent dose (0.52 [0.39, 0.70]) or 120+ mg (0.22 [0.11, 0.43]) versus <40 mg, and for patients on long-acting (0.35 [0.21, 0.57]) or long-acting plus short-acting (0.35 [0.24, 0.50]) opioids (versus short-acting only); and odds ratios were higher for patients with versus without prior diagnoses of substance use disorder (1.70 [1.31, 2.20]). CONCLUSIONS: In this primary care setting, results were aberrant for 30% of UDTs of COT patients, largely because of prescribed opioid non-detection and THC. Aberrant results of almost all types were more likely among patients under the age of 45. Other risk factors varied across aberrancies, but commonly included current smoking and prior substance use disorder diagnosis.

Topic(s):

Reference Links:

Export Citation: RIS

View details

2444

Chronic pain and depression among primary care patients treated with buprenorphine

Type: Journal Article

Authors: M. D. Stein, D. S. Herman, G. L. Bailey, J. Straus, B. J. Anderson, L. A. Uebelacker, R. B. Weisberg

Year: 2015

Publication Place: United States

Abstract: BACKGROUND: Pain and depression are each prevalent among opioid dependent patients receiving maintenance buprenorphine, but their interaction has not been studied in primary care patients. OBJECTIVE: We set out to examine the relationship between chronic pain, depression, and ongoing substance use, among persons maintained on buprenorphine in primary care settings. DESIGN: Between September 2012 and December 2013, we interviewed buprenorphine patients at three practice sites. PARTICIPANTS: Opioid dependent persons at two private internal medicine offices and a federally qualified health center participated in the study. MAIN MEASURES: Pain was measured in terms of chronicity, with chronic pain being defined as pain lasting at least 6 months; and in terms of severity, as measured by self-reported pain in the past week, measured on a 0-100 scale. We defined mild chronic pain as pain severity between 0 and 39 and lasting at least 6 months, and moderate/severe chronic pain as severity >/= 40 and lasting at least 6 months. To assess depression, we used the Center for Epidemiologic Studies Depression (CESD) ten-item symptom scale and the two-item Patient Health Questionnaire (PHQ-2). KEY RESULTS: Among 328 participants, 169 reported no chronic pain, 56 reported mild chronic pain, and 103 reported moderate/severe chronic pain. Participants with moderate/severe chronic pain commonly used non-opioid pain medications (56.3%) and antidepressants (44.7%), yet also used marijuana, alcohol, or cocaine (40.8%) to help relieve pain. Mean CESD scores were 7.1 (+/-6.8), 8.3 (+/-6.0), and 13.6 (+/-7.6) in the no chronic, mild, and moderate/severe pain groups, respectively. Controlling for covariates, higher CESD scores were associated with a higher likelihood of moderate/severe chronic pain relative to both no chronic pain (OR = 1.09, p < 0.001) and mild chronic pain (OR = 1.06, p = 0.04). CONCLUSION: Many buprenorphine patients are receiving over-the-counter or prescribed pain medications, as well as antidepressants, and yet continue to have significant and disabling pain and depressive symptoms. There is a clear need to address the pain-depression nexus in novel ways.

Topic(s):

,

Reference Links:

Export Citation: RIS

View details

2445

Chronic pain and distress in the primary care setting: Implementing a digital pain and distress screener to optimize integrated psychological treatment

Type: Journal Article

Authors: Erin T. Tobin, Minerva So, Chloe Sutlick, Jan Mooney, David Willens, Jordan M. Braciszewski, Lisa R. Miller-Matero

Year: 2026

Topic(s):

Access Resource

Reference Links: Access Resource

Export Citation: RIS

View details

2446

Chronic Pain and Opioids in the Elderly: Treating the Brain, Not Just the Body

Type: Journal Article

Authors: M. G. Carbone, I. Maremmani, L. Mazzetto, A. Bellini, R. Miccichè, R. Rizzato, G. Gastaldello, C. Tagliarini, Della Rocca, A. G. I. Maremmani

Year: 2026

Abstract:

BACKGROUND: Chronic pain, opioid use, and mental health disorders frequently co-occur in older adults, forming a complex and mutually reinforcing triad. Neurobiological ageing processes-such as neuroinflammation, dopaminergic decline, and impaired top-down regulation-may increase vulnerability to maladaptive coping strategies, including opioid misuse. This review aims to integrate neurobiological, affective, and clinical evidence to propose a unified neuropsychiatric framework for understanding the intersection between chronic pain, emotional distress, and opioid vulnerability in later life, while highlighting implications for integrated treatment and opioid stewardship. METHODS: This structured narrative review synthesised interdisciplinary evidence from neuroscience, geriatric psychiatry, and pain medicine. The literature was thematically organised to examine shared neurobiological and psychosocial mechanisms underlying chronic pain, affective disorders, and opioid use disorder (OUD) in older adults, with attention to treatment strategies and stewardship principles. RESULTS: Converging evidence suggests a neuroprogressive continuum linking chronic pain, emotional distress, opioid misuse, and cognitive decline. Key mechanisms include frontolimbic dysfunction, impaired reward processing, and chronic allostatic load. Therapeutic approaches that integrate analgesia with emotional regulation-such as buprenorphine, serotonin-noradrenaline reuptake inhibitors (SNRIs), and multimodal tapering strategies-may offer neuroprotective benefits. Effective opioid stewardship appears to require integrated functional, cognitive, and affective monitoring. CONCLUSIONS: Pain management in older adults may benefit from moving beyond symptom-focused approaches toward a neuropsychiatric model of care aimed at preserving homeostatic balance across sensory, emotional, and motivational domains. Within this framework, opioid therapy can be conceptualised as a potential means of functional and neuroaffective restoration, rather than solely as a strategy for risk reduction.

Topic(s):

,

Reference Links:

Export Citation: RIS

View details

2447

Chronic Pain Management Therapies in Medicaid: Policy Considerations for Non-Pharmacological Alternatives to Opioids

Type: Report

Authors: Hannah Dorr, Charles Townley

Year: 2016

Publication Place: Portland, ME

Topic(s):

, ,

Disclaimer:

This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

Access Resource

Reference Links: Access Resource

Export Citation: RIS

View details

2448

Chronic pain severity in opioid-dependent patients

Type: Journal Article

Authors: J. S. Potter, S. J. Shiffman, R. D. Weiss

Year: 2008

Publication Place: England

Abstract: Treatment-seeking opioid-dependent patients present frequently with chronic pain (CP). This pilot study examined the feasibility and utility of a single-item rapid screening tool for identifying CP with implications for substance use disorder (SUD) treatment in a sample of patients presenting for inpatient opioid detoxification (n = 110). Most respondents (91.2%) reported pain in the past week. Forty-seven (42.8%) had CP. Individuals with severe CP had significantly greater depressive symptom severity, pain-related functional interference, and were more likely to be on disability than individuals with mild to moderate CP or no CP. The relationships were supported in a multivariate model. The results suggest it is feasible and important to assess for CP severity in SUD treatment settings.

Topic(s):

,

Reference Links:

Export Citation: RIS

View details

2449

Chronic prescription opioid use in pregnancy in the United States

Type: Journal Article

Authors: L. Straub, K. F. Huybrechts, S. Hernandez-Diaz, Y. Zhu, S. Vine, R. J. Desai, K. J. Gray, B. T. Bateman

Year: 2021

Publication Place: England

Topic(s):

,

Reference Links:

Export Citation: RIS

View details

2450

Chronic Treatment with Opiate Agonists in Bulgaria - Assessing the Quality of Life Using SF 36 v. 2

Type: Journal Article

Authors: S. V. Petrov, M. M. Orbetzova, Y. T. Iliev, D. T. Boyadzhiev

Year: 2016

Publication Place: Germany

Abstract: INTRODUCTION: Drug addictions to psychoactive substances are disorders with a complex bio-psycho-social genesis, which are characterized with chronic relapses. Substance addiction causes multifactorial damage to the normal functioning of individuals and requires a multicenter approach for the treatment process. AIM: The aim of the study was to assess the quality of life of patients undergoing chronic treatment with the opiate agonist methadone using a standardized questionnaire method in Bulgarian. MATERIAL AND METHODS: The study included patients aged 18 to 40 years undergoing chronic treatment with methadone for at least six months. The study included 100 subjects. Seventy-six patients were from 5 clinical programs in Bulgaria; twenty- four clinically healthy age-matched subjects with no history of drug abuse, psychiatric and somatic diseases were the control group. RESULTS: We found significant differences between patients and controls in all components of the survey (P<0.05). The patients had lower scores than the control group in the SF-36 in terms of all eight components and both the physical and mental component summaries of the SF-36-survey. Patients compared between the groups by dose, duration of treatment with methadone and period of heroin abuse before initiating treatment did not show significant differences. There were no significant differences between patients with and without hepatitis C virus. CONCLUSIONS: Opiate addiction is a state associated with poor quality of life. The duration of treatment, the methadone dose, period of heroin abuse before initiating treatment and illness of hepatitis C virus does not correlate with lower results.

Topic(s):

Reference Links:

Export Citation: RIS

View details

2451

Chronicity of Suicidality: Youth Suicide Prevention in Primary Care

Type: Journal Article

Authors: Marcus D. Henderson, Anne Batchelder, Tamar Rodney, Catherine Ling

Year: 2026

Topic(s):

Access Resource

Reference Links: Access Resource

Export Citation: RIS

View details

2452

Citalopram for treatment of cocaine use disorder: A Bayesian drop-the-loser randomized clinical trial

Type: Journal Article

Authors: Robert Suchting, Charles E. Green, Constanza de Dios, Jessica Vincent, F. G. Moeller, Scott D. Lane, Joy M. Schmitz

Year: 2021

Topic(s):

Reference Links:

Export Citation: RIS

View details

2453

City streetscapes and neighborhood characteristics of fatal opioid overdoses among people experiencing homelessness who use drugs in New York City, 2017–2019

Type: Journal Article

Authors: Elizabeth D. Nesoff, Douglas J. Wiebe, Silvia S. Martins

Year: 2022

Topic(s):

Reference Links:

Export Citation: RIS

View details

2454

Civil commitment for opioid misuse: Do shortterm benefits outweigh long-term harms?

Type: Journal Article

Authors: John C. Messinger, Daniel J. Ikeda, Ameet Sarpatwari

Year: 2022

Topic(s):

Reference Links:

Export Citation: RIS

View details

2455

Civilian Health Care Systems Must Recognize and Study Military Service as a Social Determinant of Health

Type: Report

Authors: Margaret Chamberlain Wilmoth, Mona Pearl Treyball, Andrew Gettinger, Linda McCauley

Year: 2025

Publication Place: Washington, D.C.

Topic(s):

,

Disclaimer:

This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

Access Resource

Reference Links: Access Resource

Export Citation: RIS

View details

2456

Civilian Primary Care Prescribing Psychologist in an Army Medical Center

Type: Journal Article

Authors: David S. Shearer

Year: 2012

Topic(s):

Reference Links:

Export Citation: RIS

View details

2457

CKD quality improvement intervention with PCMH integration: health plan results

Type: Journal Article

Authors: J. A. Vassalotti, R. DeVinney, S. Lukasik, S. McNaney, E. Montgomery, C. Voss, D. Winn

Year: 2019

Publication Place: United States

Abstract: OBJECTIVES: To execute a chronic kidney disease (CKD) intervention to assess feasibility and preliminary outcomes for a health plan. STUDY DESIGN: This CKD quality improvement study was incorporated into an existing CareFirst primary care patient-centered medical home cohort with a pre- and postintervention assessment from July 1, 2015, to June 30, 2017. METHODS: The study targeted the population at risk for CKD with diabetes and/or hypertension by implementing a care plan according to the stratification by estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (uACR) or CKD heat map class. RESULTS: The population included 7420 individuals (51.8% female) with a mean age of 55.9 years; 19.1% had diabetes only, 42.2% had hypertension only, and 38.2% had both conditions. Overall, there was no change in eGFR testing among risk groups (84.8%), but a small significant increase in uACR testing occurred (from 31.3% to 33.0%; P = .0020). Reductions in admissions per 1000 patients were from 362.5 to 249.0 for class 3, 311.7 to 219.2 for class 4, and 590.9 to 323.5 for class 5. Lastly, there were reductions in 30-day readmissions per 1000 patients, from 51.9 to 13.7 for class 4 and 45.5 to 0 for class 5. Although there were increases in many of the per-member per-month costs assessed pre- versus post intervention, net savings in medical costs were $276.80 and $480.79 for CKD classes 3 and 5, respectively. CONCLUSIONS: This scalable CKD intervention demonstrated feasibility. For advanced CKD, decreased hospitalization and a reduction in several important costs were observed. These preliminary results support the stratification of laboratory data for CKD population health innovation in commercial health plans.

Topic(s):

,

Reference Links:

Export Citation: RIS

View details

2458

CKD quality improvement intervention with PCMH integration: health plan results

Type: Journal Article

Authors: J. A. Vassalotti, R. DeVinney, S. Lukasik, S. McNaney, E. Montgomery, C. Voss, D. Winn

Year: 2019

Publication Place: United States

Abstract: OBJECTIVES: To execute a chronic kidney disease (CKD) intervention to assess feasibility and preliminary outcomes for a health plan. STUDY DESIGN: This CKD quality improvement study was incorporated into an existing CareFirst primary care patient-centered medical home cohort with a pre- and postintervention assessment from July 1, 2015, to June 30, 2017. METHODS: The study targeted the population at risk for CKD with diabetes and/or hypertension by implementing a care plan according to the stratification by estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (uACR) or CKD heat map class. RESULTS: The population included 7420 individuals (51.8% female) with a mean age of 55.9 years; 19.1% had diabetes only, 42.2% had hypertension only, and 38.2% had both conditions. Overall, there was no change in eGFR testing among risk groups (84.8%), but a small significant increase in uACR testing occurred (from 31.3% to 33.0%; P = .0020). Reductions in admissions per 1000 patients were from 362.5 to 249.0 for class 3, 311.7 to 219.2 for class 4, and 590.9 to 323.5 for class 5. Lastly, there were reductions in 30-day readmissions per 1000 patients, from 51.9 to 13.7 for class 4 and 45.5 to 0 for class 5. Although there were increases in many of the per-member per-month costs assessed pre- versus post intervention, net savings in medical costs were $276.80 and $480.79 for CKD classes 3 and 5, respectively. CONCLUSIONS: This scalable CKD intervention demonstrated feasibility. For advanced CKD, decreased hospitalization and a reduction in several important costs were observed. These preliminary results support the stratification of laboratory data for CKD population health innovation in commercial health plans.

Topic(s):

,

Reference Links:

Export Citation: RIS

View details

2459

Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention

Type: Journal Article

Authors: J. J. Petersen, J. Hartig, M. A. Paulitsch, M. Pagitz, K. Mergenthal, S. Rauck, A. Reif, F. M. Gerlach, J. Gensichen

Year: 2018

Publication Place: United States

Abstract: PURPOSE: Collaborative care is effective in improving symptoms of patients with depression. The aims of this study were to characterize symptom trajectories in patients with major depression during one year of collaborative care and to explore associations between baseline characteristics and symptom trajectories. METHODS: We conducted a cluster-randomized controlled trial in primary care. The collaborative care intervention comprised case management and behavioral activation. We used the Patient Health Questionnaire-9 (PHQ-9) to assess symptom severity as the primary outcome. Statistical analyses comprised latent growth mixture modeling and a hierarchical binary logistic regression model. RESULTS: We included 74 practices and 626 patients (310 intervention and 316 control recipients) at baseline. Based on a minimum of 12 measurement points for each intervention recipient, we identified two latent trajectories, which we labeled 'fast improvers' (60.5%) and 'slow improvers' (39.5%). At all measurements after baseline, 'fast improvers' presented higher PHQ mean values than 'slow improvers'. At baseline, 'fast improvers' presented fewer physical conditions, higher health-related quality of life, and had made fewer suicide attempts in their history. CONCLUSIONS: A notable proportion of 39.5% of patients improved only 'slowly' and probably needed more intense treatment. The third follow-up in month two could well be a sensible time to adjust treatment to support 'slow improvers'.

Topic(s):

Reference Links:

Export Citation: RIS

View details

2460

Classes of depression symptom trajectories in patients with major depression receiving a collaborative care intervention

Type: Journal Article

Authors: J. J. Petersen, J. Hartig, M. A. Paulitsch, M. Pagitz, K. Mergenthal, S. Rauck, A. Reif, F. M. Gerlach, J. Gensichen

Year: 2018

Publication Place: United States

Abstract: PURPOSE: Collaborative care is effective in improving symptoms of patients with depression. The aims of this study were to characterize symptom trajectories in patients with major depression during one year of collaborative care and to explore associations between baseline characteristics and symptom trajectories. METHODS: We conducted a cluster-randomized controlled trial in primary care. The collaborative care intervention comprised case management and behavioral activation. We used the Patient Health Questionnaire-9 (PHQ-9) to assess symptom severity as the primary outcome. Statistical analyses comprised latent growth mixture modeling and a hierarchical binary logistic regression model. RESULTS: We included 74 practices and 626 patients (310 intervention and 316 control recipients) at baseline. Based on a minimum of 12 measurement points for each intervention recipient, we identified two latent trajectories, which we labeled 'fast improvers' (60.5%) and 'slow improvers' (39.5%). At all measurements after baseline, 'fast improvers' presented higher PHQ mean values than 'slow improvers'. At baseline, 'fast improvers' presented fewer physical conditions, higher health-related quality of life, and had made fewer suicide attempts in their history. CONCLUSIONS: A notable proportion of 39.5% of patients improved only 'slowly' and probably needed more intense treatment. The third follow-up in month two could well be a sensible time to adjust treatment to support 'slow improvers'.

Topic(s):

Reference Links:

Export Citation: RIS

View details