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Per Sjogren - One of the best experts on this subject based on the ideXlab platform.

  • addiction to opioids in Chronic Pain patients a literature review
    European Journal of Pain, 2007
    Co-Authors: Jette Hojsted, Per Sjogren
    Abstract:

    Opioids have proven very useful for treatment of acute Pain and cancer Pain, and in the developed countries opioids are increasingly used for treatment of Chronic Non-Malignant Pain patients as well. This literature review aims at giving an overview of definitions, mechanisms, diagnostic criteria, incidence and prevalence of addiction in opioid treated Pain patients, screening tools for assessing opioid addiction in Chronic Pain patients and recommendations regarding addiction problems in national and international guidelines for opioid treatment in cancer patients and Chronic Non-Malignant Pain patients. The review indicates that the prevalence of addiction varied from 0% up to 50% in Chronic Non-Malignant Pain patients, and from 0% to 7.7% in cancer patients depending of the subpopulation studied and the criteria used. The risk of addiction has to be considered when initiating long-term opioid treatment as addiction may result in poor Pain control. Several screening tools were identified, but only a few were thoroughly validated with respect to validity and reliability. Most of the identified guidelines mention addiction as a potential problem. The guidelines in cancer Pain management are concerned with the fact that Pain may be under treated because of fear of addiction, and the guidelines in management of Non-Malignant Pain patients include warnings of addiction. According to the literature, it seems appropriate and necessary to be aware of the problems associated with addiction during long-term opioid treatment, and specialised treatment facilities for Pain management or addiction medicine should be consulted in these cases.

  • neuropsychological assessment of Chronic non malignant Pain patients treated in a multidisciplinary Pain centre
    European Journal of Pain, 2005
    Co-Authors: Per Sjogren, Lona L Christrup, Morten Petersen, Jette Hojsted
    Abstract:

    The aim of the study was to investigate the influence of Pain, sedation, Pain medications and socio-demographics on cognitive functioning in Chronic Non-Malignant Pain patients. Chronic Non-Malignant Pain patients (N = 91) treated in a multidisciplinary Pain centre were compared with age and sex matched healthy volunteers (N = 64). Furthermore four subgroups of patients were examined: Group 1 (N = 21) received no Pain medications, group 2 (N = 19) were in long-term oral opioid treatment, group 3 (N = 18) were treated with antidepressants and/or anticonvulsants and group 4 (N = 33) were treated with a combination of long-term oral opioids and antidepressants and/or anticonvulsants. Assessments comprised Pain (PVAS) and sedation (SVAS), Continuous Reaction Time (CRT) testing for sustained attention, Finger Tapping Test (FTT) testing for psychomotor speed, Paced Auditory Serial Addition Task (PASAT) testing for information processing and working memory and Mini Mental State Examination (MMSE). CRT and FTT were impaired in the total patient sample. Treatment with opioids was associated with poorer performance of PASAT. High scores of PVAS and SVAS were associated with poor performance of PASAT and CRT, respectively. MMSE seems to be too insensitive for detecting the milder forms of cognitive impairment found in Chronic Non-Malignant patients.

  • treatment outcome of Chronic non malignant Pain patients managed in a danish multidisciplinary Pain centre compared to general practice a randomised controlled trial
    Pain, 2000
    Co-Authors: N Becker, Per Sjogren, Alf Kornelius Olsen, Per Bech, Jorgen Eriksen
    Abstract:

    This randomised controlled study investigated the effect of outpatient multidisciplinary Pain centre treatment (MPT) compared with treatment by a general practitioner after initial supervision by a Pain specialist (GP-group) and with a group of patients waiting for 6 months before treatment was initiated (WL-group). One-hundred-and-eighty-nine Chronic Non-Malignant Pain patients were studied. At referral, and after 3 and 6 months patients filled in questionnaires evaluating Pain intensity, health related quality of life (HRQL) and use of analgesics. HRQL was evaluated using the Medical Outcome Study-Short Form (SF-36), the Hospital Anxiety and Depression scale (HAD) and the Psychological General Well-being Scale (PGWB). After 6 months patients allocated to MPT (n=63) reported statistically significant reduction in Pain intensity (VAS-score, P<0.001), improvement in psychological well-being (PGWB, P<0.001), quality of sleep (P<0.05) and physical functioning (SF-36-Phycical Functioning, P<0.05). No improvements were seen in the GP-group (n=63). In the WL-group (n=63) a statistically significant deterioration was observed in PGWB-scores, HAD-scores and in 6 of 8 SF-36-subscores (P ≤ 0.05). A reduction in use of opioids administered on demand was obtained in the group receiving MPT (P<0.001). In the MPT- and GP-groups a decrease in the use of short acting opioids was observed (P<0.01). No change in use of analgesics was seen in the WL-group. The study showed that (i) in the MPT-group there was a significant reduction in Pain intensity and improvement of HRQL compared to the WL-group, and (ii) the mere establishment of a Pain diagnosis and a Pain management plan by a Pain specialist was not sufficient to enable the referring GP to manage severely Chronic Pain patients.

  • Pain epidemiology and health related quality of life in Chronic non malignant Pain patients referred to a danish multidisciplinary Pain center
    Pain, 1997
    Co-Authors: N Becker, Per Sjogren, Annemarie Bondegaard Thomsen, Alf Kornelius Olsen, Per Bech, Jorgen Eriksen
    Abstract:

    This paper presents the results of a detailed study of the Pain epidemiology and health related quality of life (HRQL) in 150 Chronic Non-Malignant Pain patients consecutively referred to a Danish multidisciplinary Pain center. Mean Pain severity was 71.6 (SD = 18.5) on the VAS scale. Forty-two percent reported poor quality of sleep. HRQL was evaluated with the Medical Outcome Study-Short Form (SF-36), the Hospital Anxiety and Depression scale (HAD) and the Psychological General Well-Being Scale (PGWB). Compared with the normal population (NP) both SF-36 scores and PGWB scores were significantly reduced (P < 0.001) indicating that physical, psychological and social well-being were severely reduced. On the HAD scale 58% were found to have a depressive or anxiety disorder. Statistically significant but modest correlations were found between Pain severity and HRQL. Psychological and social well-being was closely correlated. Sixty-three percent of the referred patients had neurogenic Pain conditions. Of these, only 25% were treated with antidepressants or anticonvulsants at referral. Seventy-three percent were treated with opioids at referral. Mean opioid consumption was 64 mg of morphine per day (range 1-280 mg). Compared with the NP the Chronic Pain patients had used the health care system five times more often in the years prior to referral (P < 0.001). The study confirms the severe multidimensional impact of Chronic Pain and demonstrates that HRQL of Chronic Non-Malignant Pain patients is among the lowest observed for any medical condition.

Jorgen Eriksen - One of the best experts on this subject based on the ideXlab platform.

  • treatment outcome of Chronic non malignant Pain patients managed in a danish multidisciplinary Pain centre compared to general practice a randomised controlled trial
    Pain, 2000
    Co-Authors: N Becker, Per Sjogren, Alf Kornelius Olsen, Per Bech, Jorgen Eriksen
    Abstract:

    This randomised controlled study investigated the effect of outpatient multidisciplinary Pain centre treatment (MPT) compared with treatment by a general practitioner after initial supervision by a Pain specialist (GP-group) and with a group of patients waiting for 6 months before treatment was initiated (WL-group). One-hundred-and-eighty-nine Chronic Non-Malignant Pain patients were studied. At referral, and after 3 and 6 months patients filled in questionnaires evaluating Pain intensity, health related quality of life (HRQL) and use of analgesics. HRQL was evaluated using the Medical Outcome Study-Short Form (SF-36), the Hospital Anxiety and Depression scale (HAD) and the Psychological General Well-being Scale (PGWB). After 6 months patients allocated to MPT (n=63) reported statistically significant reduction in Pain intensity (VAS-score, P<0.001), improvement in psychological well-being (PGWB, P<0.001), quality of sleep (P<0.05) and physical functioning (SF-36-Phycical Functioning, P<0.05). No improvements were seen in the GP-group (n=63). In the WL-group (n=63) a statistically significant deterioration was observed in PGWB-scores, HAD-scores and in 6 of 8 SF-36-subscores (P ≤ 0.05). A reduction in use of opioids administered on demand was obtained in the group receiving MPT (P<0.001). In the MPT- and GP-groups a decrease in the use of short acting opioids was observed (P<0.01). No change in use of analgesics was seen in the WL-group. The study showed that (i) in the MPT-group there was a significant reduction in Pain intensity and improvement of HRQL compared to the WL-group, and (ii) the mere establishment of a Pain diagnosis and a Pain management plan by a Pain specialist was not sufficient to enable the referring GP to manage severely Chronic Pain patients.

  • Pain epidemiology and health related quality of life in Chronic non malignant Pain patients referred to a danish multidisciplinary Pain center
    Pain, 1997
    Co-Authors: N Becker, Per Sjogren, Annemarie Bondegaard Thomsen, Alf Kornelius Olsen, Per Bech, Jorgen Eriksen
    Abstract:

    This paper presents the results of a detailed study of the Pain epidemiology and health related quality of life (HRQL) in 150 Chronic Non-Malignant Pain patients consecutively referred to a Danish multidisciplinary Pain center. Mean Pain severity was 71.6 (SD = 18.5) on the VAS scale. Forty-two percent reported poor quality of sleep. HRQL was evaluated with the Medical Outcome Study-Short Form (SF-36), the Hospital Anxiety and Depression scale (HAD) and the Psychological General Well-Being Scale (PGWB). Compared with the normal population (NP) both SF-36 scores and PGWB scores were significantly reduced (P < 0.001) indicating that physical, psychological and social well-being were severely reduced. On the HAD scale 58% were found to have a depressive or anxiety disorder. Statistically significant but modest correlations were found between Pain severity and HRQL. Psychological and social well-being was closely correlated. Sixty-three percent of the referred patients had neurogenic Pain conditions. Of these, only 25% were treated with antidepressants or anticonvulsants at referral. Seventy-three percent were treated with opioids at referral. Mean opioid consumption was 64 mg of morphine per day (range 1-280 mg). Compared with the NP the Chronic Pain patients had used the health care system five times more often in the years prior to referral (P < 0.001). The study confirms the severe multidimensional impact of Chronic Pain and demonstrates that HRQL of Chronic Non-Malignant Pain patients is among the lowest observed for any medical condition.

N Becker - One of the best experts on this subject based on the ideXlab platform.

  • treatment outcome of Chronic non malignant Pain patients managed in a danish multidisciplinary Pain centre compared to general practice a randomised controlled trial
    Pain, 2000
    Co-Authors: N Becker, Per Sjogren, Alf Kornelius Olsen, Per Bech, Jorgen Eriksen
    Abstract:

    This randomised controlled study investigated the effect of outpatient multidisciplinary Pain centre treatment (MPT) compared with treatment by a general practitioner after initial supervision by a Pain specialist (GP-group) and with a group of patients waiting for 6 months before treatment was initiated (WL-group). One-hundred-and-eighty-nine Chronic Non-Malignant Pain patients were studied. At referral, and after 3 and 6 months patients filled in questionnaires evaluating Pain intensity, health related quality of life (HRQL) and use of analgesics. HRQL was evaluated using the Medical Outcome Study-Short Form (SF-36), the Hospital Anxiety and Depression scale (HAD) and the Psychological General Well-being Scale (PGWB). After 6 months patients allocated to MPT (n=63) reported statistically significant reduction in Pain intensity (VAS-score, P<0.001), improvement in psychological well-being (PGWB, P<0.001), quality of sleep (P<0.05) and physical functioning (SF-36-Phycical Functioning, P<0.05). No improvements were seen in the GP-group (n=63). In the WL-group (n=63) a statistically significant deterioration was observed in PGWB-scores, HAD-scores and in 6 of 8 SF-36-subscores (P ≤ 0.05). A reduction in use of opioids administered on demand was obtained in the group receiving MPT (P<0.001). In the MPT- and GP-groups a decrease in the use of short acting opioids was observed (P<0.01). No change in use of analgesics was seen in the WL-group. The study showed that (i) in the MPT-group there was a significant reduction in Pain intensity and improvement of HRQL compared to the WL-group, and (ii) the mere establishment of a Pain diagnosis and a Pain management plan by a Pain specialist was not sufficient to enable the referring GP to manage severely Chronic Pain patients.

  • Pain epidemiology and health related quality of life in Chronic non malignant Pain patients referred to a danish multidisciplinary Pain center
    Pain, 1997
    Co-Authors: N Becker, Per Sjogren, Annemarie Bondegaard Thomsen, Alf Kornelius Olsen, Per Bech, Jorgen Eriksen
    Abstract:

    This paper presents the results of a detailed study of the Pain epidemiology and health related quality of life (HRQL) in 150 Chronic Non-Malignant Pain patients consecutively referred to a Danish multidisciplinary Pain center. Mean Pain severity was 71.6 (SD = 18.5) on the VAS scale. Forty-two percent reported poor quality of sleep. HRQL was evaluated with the Medical Outcome Study-Short Form (SF-36), the Hospital Anxiety and Depression scale (HAD) and the Psychological General Well-Being Scale (PGWB). Compared with the normal population (NP) both SF-36 scores and PGWB scores were significantly reduced (P < 0.001) indicating that physical, psychological and social well-being were severely reduced. On the HAD scale 58% were found to have a depressive or anxiety disorder. Statistically significant but modest correlations were found between Pain severity and HRQL. Psychological and social well-being was closely correlated. Sixty-three percent of the referred patients had neurogenic Pain conditions. Of these, only 25% were treated with antidepressants or anticonvulsants at referral. Seventy-three percent were treated with opioids at referral. Mean opioid consumption was 64 mg of morphine per day (range 1-280 mg). Compared with the NP the Chronic Pain patients had used the health care system five times more often in the years prior to referral (P < 0.001). The study confirms the severe multidimensional impact of Chronic Pain and demonstrates that HRQL of Chronic Non-Malignant Pain patients is among the lowest observed for any medical condition.

Paul Benfield - One of the best experts on this subject based on the ideXlab platform.

  • transdermal fentanyl a review of its pharmacological properties and therapeutic efficacy in Pain control
    Drugs, 1997
    Co-Authors: Wendy Jeal, Paul Benfield
    Abstract:

    Fentanyl is a synthetic opioid with short-acting analgesic activity after intravenous or subcutaneous administration. The low molecular weight, high potency and lipid solubility of fentanyl make it suitable for delivery via the transdermal therapeutic system (TTS). These systems are designed to release the drug into the skin at a constant rate ranging from 25 to 100 micrograms/h, multiple systems can be applied to achieve higher delivery rates. Initially, much of the clinical experience with fentanyl TTS was obtained in patients with acute postoperative Pain. However, because of the increased risk of respiratory complications, fentanyl TTS is contraindicated in this setting. Fentanyl TTS is recommended for use in Chronic cancer Pain. Moreover, in 11 countries worldwide including the US, its use is not restricted to Chronic cancer Pain; the drug is also available for treatment of general Chronic Pain, including that of nonmalignant origin. At the start of fentanyl TTS treatment, depot accumulation of the drug within skin tissue results in a significant delay (17 to 48 hours) before maximum plasma concentration is achieved. Approximately half of the cancer patients converted to transdermal fentanyl from other opioid agents required increased dosages after initial application of the patch. However, concomitant use of short-acting morphine maintained Pain relief during the titration period, and the use of such supplementary medication decreased with the duration of fentanyl TTS treatment. In patients with Chronic cancer Pain, changes in visual analogue scale (VAS) Pain scores ranged from a 10% increase (worse Pain) to > 50% decrease (less Pain) during transdermal fentanyl therapy compared with previous opioid treatment. In addition, patient preference for fentanyl TTS was indicated by the number of patient requests (up to 95%) for continued use of the drug at the end of the study. Although fentanyl TTS is contraindicated in patients postoperatively, the efficacy of fentanyl via the transdermal route was investigated in this patient group. Supplementary patient controlled analgesia was significantly reduced in patients who received fentanyl TTS 75 micrograms/h compared with placebo, although this was not apparent until > or = 12 hours after application. Data evaluating Pain relief, which was assessed by VAS Pain scores, were inconclusive. Preliminary data, although from relatively small numbers of patients, indicate that transdermal fentanyl may be useful in the management of Chronic Non-Malignant Pain. Indeed, some patients whose Pain was previously uncontrolled became completely Pain free. The most frequently occurring adverse events during fentanyl TTS therapy (as with other opioid agents) included vomiting, nausea and constipation, although vomiting and nausea were not clearly associated with the drug. The most serious adverse event was hypoventilation, which occurred more frequently in postoperative (4%) than in cancer patients (2%). In surgical patients, fentanyl-associated respiratory events (reduced respiratory rate and apnoea) generally occurred within 24 hours of patch application; however, there were isolated reports of late onset (> or = 36 hours postsurgery) fentanyl-associated respiratory depression. In cancer patients, the incidence of constipation was reduced by up to two-thirds after switching from oral morphine to transdermal fentanyl. Transient skin irritation associated with the plastic patch or the adhesive, rather than the drug, was reported in a maximum 3% of patients. In summary, transdermal fentanyl is a useful alternative to other opioid agents, which are also recommended on the third step of the WHO analgesic ladder, in the management of Chronic malignant Pain. Preliminary data indicate that it may be useful in the management of Chronic nonmalignant Pain. The advantages offered by fentanyl TTS over traditional methods of Chronic Pain control include its ease of administration, less constipation and the 3-

Jette Hojsted - One of the best experts on this subject based on the ideXlab platform.

  • addiction to opioids in Chronic Pain patients a literature review
    European Journal of Pain, 2007
    Co-Authors: Jette Hojsted, Per Sjogren
    Abstract:

    Opioids have proven very useful for treatment of acute Pain and cancer Pain, and in the developed countries opioids are increasingly used for treatment of Chronic Non-Malignant Pain patients as well. This literature review aims at giving an overview of definitions, mechanisms, diagnostic criteria, incidence and prevalence of addiction in opioid treated Pain patients, screening tools for assessing opioid addiction in Chronic Pain patients and recommendations regarding addiction problems in national and international guidelines for opioid treatment in cancer patients and Chronic Non-Malignant Pain patients. The review indicates that the prevalence of addiction varied from 0% up to 50% in Chronic Non-Malignant Pain patients, and from 0% to 7.7% in cancer patients depending of the subpopulation studied and the criteria used. The risk of addiction has to be considered when initiating long-term opioid treatment as addiction may result in poor Pain control. Several screening tools were identified, but only a few were thoroughly validated with respect to validity and reliability. Most of the identified guidelines mention addiction as a potential problem. The guidelines in cancer Pain management are concerned with the fact that Pain may be under treated because of fear of addiction, and the guidelines in management of Non-Malignant Pain patients include warnings of addiction. According to the literature, it seems appropriate and necessary to be aware of the problems associated with addiction during long-term opioid treatment, and specialised treatment facilities for Pain management or addiction medicine should be consulted in these cases.

  • neuropsychological assessment of Chronic non malignant Pain patients treated in a multidisciplinary Pain centre
    European Journal of Pain, 2005
    Co-Authors: Per Sjogren, Lona L Christrup, Morten Petersen, Jette Hojsted
    Abstract:

    The aim of the study was to investigate the influence of Pain, sedation, Pain medications and socio-demographics on cognitive functioning in Chronic Non-Malignant Pain patients. Chronic Non-Malignant Pain patients (N = 91) treated in a multidisciplinary Pain centre were compared with age and sex matched healthy volunteers (N = 64). Furthermore four subgroups of patients were examined: Group 1 (N = 21) received no Pain medications, group 2 (N = 19) were in long-term oral opioid treatment, group 3 (N = 18) were treated with antidepressants and/or anticonvulsants and group 4 (N = 33) were treated with a combination of long-term oral opioids and antidepressants and/or anticonvulsants. Assessments comprised Pain (PVAS) and sedation (SVAS), Continuous Reaction Time (CRT) testing for sustained attention, Finger Tapping Test (FTT) testing for psychomotor speed, Paced Auditory Serial Addition Task (PASAT) testing for information processing and working memory and Mini Mental State Examination (MMSE). CRT and FTT were impaired in the total patient sample. Treatment with opioids was associated with poorer performance of PASAT. High scores of PVAS and SVAS were associated with poor performance of PASAT and CRT, respectively. MMSE seems to be too insensitive for detecting the milder forms of cognitive impairment found in Chronic Non-Malignant patients.