Monitoring Pharmacological Treatment in Patients With Chronic Noncancer Pain.

Grisell Vargas-Schaffer,Allen Steverman,Veronique Potvin

doi:10.7759/cureus.20358

Abstract

Chronic pain has been not recognized as a chronic illness, and its far-reaching impacts are often ignored. Chronic noncancer pain (CNCP) is a chronic disease and health care professionals need recommendations on how to monitor treatments, patients and long-term side effects of the different medications used to control CNCP.CNCP patients make up a vulnerable population due to the various associated pathologies and the challenging socio-economic conditions experienced by many of these patients. CNCP is more common among older adults, females, cancer survivors, indigenous peoples, veterans, and populations affected by social inequities and discrimination. These social determinants can lead to a complex interplay between chronic pain, mental illness, and substance use disorders. Given these realities, long-term pharmacological and side effect surveillance is more complex.Follow-up of patients with CNCP is a challenge for physicians, and thus it is important to provide recommendations on how to monitor treatments and long-term side effects of the different medications used to control CNCP.

Highlights

BackgroundPain continues to be one of the main reasons for medical consultation worldwide
Chronic noncancer pain (CNCP) patients make up a vulnerable population due to the various associated pathologies and the challenging socio-economic conditions experienced by many of these patients
Taking into consideration that multimodal analgesia is the most used for the treatment of CNCP, we propose that the most important factors to monitor from the pharmacological point of view in the long-term followup of patients treated for CNCP are the following: oral hygiene, chronic constipation, and narcotic bowel syndrome (NBS), cardiovascular opioids effects, effects on the immune system, sleep and somnolence, respiratory depression, substance use disorders, and addiction, HPA axis and hypothalamic-pituitarygonadal axis (HPGA) axis dysregulation, mental health and lack of exercise (Figure 1)

Summary

Introduction

Pain continues to be one of the main reasons for medical consultation worldwide. Chronic noncancer pain (CNCP) is a common condition considered to be an epidemic with major social and economic impacts [1,2,3,4]. Taking into consideration that multimodal analgesia is the most used for the treatment of CNCP, we propose that the most important factors to monitor from the pharmacological point of view in the long-term followup of patients treated for CNCP are the following: oral hygiene, chronic constipation, and narcotic bowel syndrome (NBS), cardiovascular opioids effects, effects on the immune system, sleep and somnolence, respiratory depression, substance use disorders, and addiction, HPA axis and hypothalamic-pituitarygonadal axis (HPGA) axis dysregulation, mental health and lack of exercise (Figure 1). The mechanism of opioid-induced respiratory depression involves Mu opioid receptor inhibition of the brainstem respiratory control centers impacting both rate and depth of respiration, eventually resulting in increased arterial partial pressure of carbon dioxide and reduced partial pressure of oxygen [21] This risk of respiratory depression is a major limiting factor for dose escalation in providing effective analgesia.

Conclusions

Disclosures

Vargas-Schaffer G and Cogan J

Findings

21. Albert D