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Pharmacological Management of Chronic Pain
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Pharmacological Management of Chronic Pain

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pharmacology".

Deadline for manuscript submissions: closed (28 February 2023) | Viewed by 42957

Special Issue Editors

Dr. Andrea D. Furlan

E-Mail Website
Guest Editor
Toronto Rehabilitation Institute University Health Network 550 University Avenue, 7-141 Toronto, ON M5G 2A2, Canada
Interests: chronic pain; opioids; health services; clinical epidemiology; clinical; practice guidelines; knowledge transfer; implementation science
Special Issues, Collections and Topics in MDPI journals
Dr. Laura Murphy

E-Mail Website
Guest Editor
Department of Pharmacy, University Health Network, Toronto, ON, Canada
Interests: chronic pain; pharmacotherapy; opioids; substance use; pharmacy practice; medication therapy management; clinical; practice guidelines

Special Issue Information

Dear Colleagues,

The Journal of Clinical Medicine is planning a Special Issue, “Pharmacological Management of Chronic Pain”. Pharmacological management is important as part of a multi-modal approach to improve the lives of people living with chronic pain, impacting 1 in 5 individuals. In the last 30 years, pharmacotherapy in many countries, and particularly in North America, has been largely dominated by opioids. This use has made significant contributions to the ongoing global opioid crisis, and has prompted a need to ensure the rational use of opioid and other pharmacological therapy. It has also created an urgent need for novel pharmacological strategies, and new approaches to therapy management.

High-quality scientific studies are needed to explore current and new approaches to pharmacological management of chronic pain. We are delighted that the Journal of Clinical Medicine is dedicating a Special Issue to this topic. The Journal of Clinical Medicine's impact factor is 3.303; ranked 36 out of 154 journals (Q1) in 'Medicine, General & Internal'

For this Special Issue, we are interested in clinical, epidemiological studies and systematic reviews with a focus on pharmacotherapy, pharmacology, pharmacokinetics, pharmacoepidemiology, pharmacogenomics, drug efficacy and safety, related education for healthcare professionals, policy and program research.

Dr. Andrea D. Furlan
Dr. Laura Murphy
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • chronic pain
  • pharmacotherapy
  • opioids
  • novel therapies
  • evidence-based medicine
  • drug efficacy
  • drug safety
  • pharmacoepidemiology
  • pharmacogenomics
  • rational polypharmacy

Published Papers (5 papers)

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Research

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13 pages, 581 KiB  
Article
Opioids for Osteoarthritis: Cross-Sectional Survey of Patient Perspectives and Satisfaction
by Thomas J. Schnitzer, Rebecca L. Robinson, Lars Viktrup, Joseph C. Cappelleri, Andrew G. Bushmakin, Leslie Tive, Mia Berry, Chloe Walker and James Jackson
J. Clin. Med. 2023, 12(7), 2733; https://doi.org/10.3390/jcm12072733 - 06 Apr 2023
Viewed by 1628
Abstract
Patients often take opioids to relieve osteoarthritis (OA) pain despite limited benefits and potential harms. This study aimed to compare cross-sectional perspectives of patients that were taking prescription opioid (N = 471) or nonopioid medications (N = 185) for OA in terms of [...] Read more.
Patients often take opioids to relieve osteoarthritis (OA) pain despite limited benefits and potential harms. This study aimed to compare cross-sectional perspectives of patients that were taking prescription opioid (N = 471) or nonopioid medications (N = 185) for OA in terms of satisfaction, expectations of effectiveness, and concerns. Patients prescribed opioids (>7 days) reported more prior treatments (2.47 vs. 1.74), greater mean pain intensity (5.47 vs. 4.11), and worse quality of life (EQ-5D-5L index value mean 0.45 vs. 0.71) than patients prescribed nonopioid medications (all p < 0.0001). Based on linear regression models adjusting for demographics and pain intensity, patients prescribed opioids were less satisfied with overall regimen (3.40 vs. 3.67, p = 0.0322), had less belief that medications were meeting effectiveness expectations (2.72 vs. 3.13, p < 0.0001), and had more concerns about treatments being “not very good” (3.66 vs. 3.22, p = 0.0026) and addiction (3.30 vs. 2.65, p < 0.0001) than patients prescribed nonopioid regimens. When the models were replicated for subgroups with ≥30 days’ medication regimen duration, the findings were consistent with the main analyses. Patients have concerns about the risk of opioid addiction, but those with greater disease burden and more prior treatments continue taking opioid regimens. Full article
(This article belongs to the Special Issue Pharmacological Management of Chronic Pain)
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14 pages, 1638 KiB  
Article
Opioid Prescribing for Osteoarthritis: Cross-Sectional Survey among Primary Care Physicians, Rheumatologists, and Orthopaedic Surgeons
by Thomas J. Schnitzer, Rebecca L. Robinson, Lars Viktrup, Joseph C. Cappelleri, Andrew G. Bushmakin, Leslie Tive, Mia Berry, Chloe Walker and James Jackson
J. Clin. Med. 2023, 12(2), 589; https://doi.org/10.3390/jcm12020589 - 11 Jan 2023
Cited by 1 | Viewed by 1530
Abstract
Opioids are often prescribed for osteoarthritis (OA) pain, despite recommendations to limit use due to minimal benefits and associated harms. This study aimed to assess physicians’ practice patterns and perceptions regarding opioids by specialty one year following the Centers for Disease Control and [...] Read more.
Opioids are often prescribed for osteoarthritis (OA) pain, despite recommendations to limit use due to minimal benefits and associated harms. This study aimed to assess physicians’ practice patterns and perceptions regarding opioids by specialty one year following the Centers for Disease Control and Prevention (CDC) published guidance on opioid prescribing. The 139/153 (90.8%) physicians who reported prescribing opioids in the previous year reported decreased prescribing for mild OA (51.3%, 26.5% and 33.3% of primary care physicians, rheumatologists, and orthopaedic surgeons, respectively), moderate OA (50.0%, 47.1% and 48.1%) and severe OA (43.6%, 41.2% and 44.4%). Prescribing changes were attributed to the CDC guidelines for 58.9% of primary care physicians, 59.1% of rheumatologists, and 73.3% of orthopaedic surgeons. Strong opioids were mostly reserved as third-line treatment. Although treatment effectiveness post-CDC guidelines was not assessed, perceptions of efficacy and quality of life with opioids significantly differed across specialties, whereas perceptions of safety, convenience/acceptability and costs did not. Physicians generally agreed on the barriers to opioid prescribing, with fear of addiction and drug abuse being the most important. Across specialties, physicians reported decreased opioid prescribing for OA, irrespective of OA severity, and in most cases attributed changes in prescribing to the CDC guideline. Full article
(This article belongs to the Special Issue Pharmacological Management of Chronic Pain)
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Review

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27 pages, 1894 KiB  
Review
Combination Therapy for Neuropathic Pain: A Review of Recent Evidence
by Ancor Serrano Afonso, Thiago Carnaval and Sebastià Videla Cés
J. Clin. Med. 2021, 10(16), 3533; https://doi.org/10.3390/jcm10163533 - 11 Aug 2021
Cited by 18 | Viewed by 8427
Abstract
Pharmacological treatment is not very effective for neuropathic pain (NP). A progressive decrease in the estimated effect of NP drugs has been reported, giving rise to an increase in the use of the multimodal analgesic approach. We performed a new independent review to [...] Read more.
Pharmacological treatment is not very effective for neuropathic pain (NP). A progressive decrease in the estimated effect of NP drugs has been reported, giving rise to an increase in the use of the multimodal analgesic approach. We performed a new independent review to assess whether more and better-quality evidence has become available since the last systematic review. We evaluated the efficacy, tolerability, and safety of double-blinded randomized controlled trials involving only adult participants and comparing combination therapy (CT: ≥2 drugs) with a placebo and/or at least one other comparator with an NP indication. The primary outcome assessed was the proportion of participants reporting ≥50% pain reductions from baseline. The secondary outcome assessed was the proportion of drop-outs due to treatment-emergent adverse events. After removing duplicates, 2323 citations were screened, with 164 articles assessed for eligibility, from which 16 were included for qualitative analysis. From the latter, only five lasted for at least 12 weeks and only six complied with the required data for complete analysis. CT has been adopted for years without robust evidence. Efforts have been made to achieve better-quality evidence, but the quality has not improved over the years. In this regard, guidelines for NP should attempt to make recommendations about CT research, prioritizing which combinations to analyze. Full article
(This article belongs to the Special Issue Pharmacological Management of Chronic Pain)
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22 pages, 690 KiB  
Review
Paracetamol: A Review of Guideline Recommendations
by Ulderico Freo, Chiara Ruocco, Alessandra Valerio, Irene Scagnol and Enzo Nisoli
J. Clin. Med. 2021, 10(15), 3420; https://doi.org/10.3390/jcm10153420 - 31 Jul 2021
Cited by 65 | Viewed by 23123
Abstract
Musculoskeletal pain conditions are age-related, leading contributors to chronic pain and pain-related disability, which are expected to rise with the rapid global population aging. Current medical treatments provide only partial relief. Furthermore, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are effective in young and [...] Read more.
Musculoskeletal pain conditions are age-related, leading contributors to chronic pain and pain-related disability, which are expected to rise with the rapid global population aging. Current medical treatments provide only partial relief. Furthermore, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are effective in young and otherwise healthy individuals but are often contraindicated in elderly and frail patients. As a result of its favorable safety and tolerability record, paracetamol has long been the most common drug for treating pain. Strikingly, recent reports questioned its therapeutic value and safety. This review aims to present guideline recommendations. Paracetamol has been assessed in different conditions and demonstrated therapeutic efficacy on both acute and chronic pain. It is active as a single agent and is additive or synergistic with NSAIDs and opioids, improving their efficacy and safety. However, a lack of significant efficacy and hepatic toxicity have also been reported. Fast dissolving formulations of paracetamol provide superior and more extended pain relief that is similar to intravenous paracetamol. A dose reduction is recommended in patients with liver disease or malnourished. Genotyping may improve efficacy and safety. Within the current trend toward the minimization of opioid analgesia, it is consistently included in multimodal, non-opioid, or opioid-sparing therapies. Paracetamol is being recommended by guidelines as a first or second-line drug for acute pain and chronic pain, especially for patients with limited therapeutic options and for the elderly. Full article
(This article belongs to the Special Issue Pharmacological Management of Chronic Pain)
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13 pages, 281 KiB  
Review
Fixed-Dose Combination of NSAIDs and Spasmolytic Agents in the Treatment of Different Types of Pain—A Practical Review
by Magdalena Janczura, Małgorzata Kobus-Moryson, Szymon Sip, Marcin Żarowski, Agnieszka Wareńczak and Judyta Cielecka-Piontek
J. Clin. Med. 2021, 10(14), 3118; https://doi.org/10.3390/jcm10143118 - 15 Jul 2021
Cited by 7 | Viewed by 6687
Abstract
This review presents the most common disease entities in which combinations of NSAIDs and spasmolytic drugs are used to reduce pain. The benefits of fixed-dose combination products (FDCs) are that they improve the response in people with insufficient monotherapy. Using the synergy or [...] Read more.
This review presents the most common disease entities in which combinations of NSAIDs and spasmolytic drugs are used to reduce pain. The benefits of fixed-dose combination products (FDCs) are that they improve the response in people with insufficient monotherapy. Using the synergy or additive effect of drugs, it is possible to obtain a significant therapeutic effect and faster action with the use of smaller doses of individual drugs. In addition, one active ingredient may counteract adverse reactions from the other. Another essential aspect of the use of FDCs is the improvement of medical adherence due to the reduction in the pill burden on patients. It is also possible to develop a fixed-dosed combination product de novo to address a new therapeutic claim and be protected by patents so that the manufacturer can obtain exclusive rights to sell a particular FDC or a formulation thereof. The proposed fixed-dose combinations should always be based on valid therapeutic principles and consider the combined safety profile of all active substances included in the medicinal product. This review aims to identify which combinations of NSAIDs and spasmolytics have been developed and tested and which combinations are still under development. Full article
(This article belongs to the Special Issue Pharmacological Management of Chronic Pain)
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