Document Detail

Chronic back pain with possible prescription opioid misuse.
MedLine Citation:
PMID:  23462788     Owner:  NLM     Status:  MEDLINE    
IMPORTANCE: Data on the effectiveness and safety of long-term opioid therapy for chronic pain are limited. Opioid adherence monitoring includes urine drug testing. Determining whether a patient's opioid prescription should be discontinued after an unexpected urine test result can be clinically complex.
OBJECTIVE: To review safe opioid prescribing practices and appropriate interpretation and management of unexpected urine drug test results.
EVIDENCE REVIEW: Systematic reviews of the effectiveness and safety of long-term opioid therapy for chronic noncancer pain. Clinical management recommendations are derived from clinical guidelines generated by several professional medical organizations including the American Pain Society, the American Academy of Pain Medicine, and the Federation of State Medical Boards.
FINDINGS: Informed consent and patient-prescriber agreements are important strategies to ensure that patients understand treatment goals and potential opioid risks. Monitoring for benefit and opioid misuse is accomplished by having frequent face-to-face assessments, performing urine drug tests, monitoring pill counts, and reviewing prescription drug monitoring program data, when available.
CONCLUSIONS AND RELEVANCE: The underlying causes for worrisome behaviors such as urine drug test results that are negative for the prescribed opioid should be fully investigated. Subsequent opioid prescriptions should be based on the revised risk and benefit assessment.
Daniel P Alford
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Publication Detail:
Type:  Clinical Conference; Journal Article; Review    
Journal Detail:
Title:  JAMA     Volume:  309     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-06     Completed Date:  2013-03-08     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  919-25     Citation Subset:  AIM; IM    
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MeSH Terms
Analgesics, Opioid / therapeutic use*,  urine
Back Pain / drug therapy*
Chronic Disease
Informed Consent
Medication Adherence
Monitoring, Physiologic
Opioid-Related Disorders / diagnosis,  prevention & control*
Practice Guidelines as Topic
Reg. No./Substance:
0/Analgesics, Opioid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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