We use cookies to improve your experience. By continuing to browse this site, you accept our cookie policy.×
Skip main navigation
Aging Health
Bioelectronics in Medicine
Biomarkers in Medicine
Breast Cancer Management
CNS Oncology
Colorectal Cancer
Concussion
Epigenomics
Future Cardiology
Future Medicine AI
Future Microbiology
Future Neurology
Future Oncology
Future Rare Diseases
Future Virology
Hepatic Oncology
HIV Therapy
Immunotherapy
International Journal of Endocrine Oncology
International Journal of Hematologic Oncology
Journal of 3D Printing in Medicine
Lung Cancer Management
Melanoma Management
Nanomedicine
Neurodegenerative Disease Management
Pain Management
Pediatric Health
Personalized Medicine
Pharmacogenomics
Regenerative Medicine
Special ReportFree Access

Latin-American guidelines for opioid use in chronic nononcologic pain

    Argelia Lara-Solares

    *Author for correspondence:

    E-mail Address: argelia.lara@dolorypaliativos.org

    Instituto Nacional de Ciencias Médicas y Nutrición ‘Salvador Zubirán’, Mexico City, Mexico

    ,
    Carlos Aguayo Zamora

    Hospital Clinico FUSAT, Rancagua, Chile

    , ,
    João Batista Santos Garcia

    Pain & Palliative Care, Federal University of Maranhao, Brazil

    , ,
    Patricia Bonilla Sierra

    Instituto Oncológico ‘Luis Razetti’, Pain clinic & Palliative Care, Instituto Médico La Floresta, Caracas, Venezuela

    ,
    Durval Campos Kraychete

    Federal University of Bahia, Coordinator of the Pain Outpatient Clinic, Brazilian Society for the Study of Pain, Brazil

    ,
    José Alberto Flores Cantisani

    Programa Regional de Cuidados Paliativos, Unidad Médica de Alta Especialidad No. 25, IMSS, Monterrey NL, Mexico

    ,
    Carlos Guerrero

    Hospital Universitario Fundación Santa Fe, Bogotá. Universidad de los Andes, Colombia

    ,
    María del Rocío Guillén Núñez

    Medicina del Dolor y Cuidados Paliativos, Hospital Médica Sur, Mexico City, Mexico

    ,
    John Jairo Hernández Castro

    Pain Medicine & Palliative Care, Universidad del Rosario – MEDERI, Bogotá, Colombia

    ,
    Andrés Hernández Ortíz

    Instituto Nacional de Ciencias Médicas y Nutrición ‘Salvador Zubirán’, Mexico City, Mexico

    ,
    Aziza Jreige Iskandar

    Rehabilitation Residency Program, UCV, Unidad de Rehabilitación DM, Maracay, Venezuela

    ,
    Osvandré Lech

    Orthopaedic Residency Program, UFFS-HSVP-IOT, Passo Fundo, Brazil

    ,
    Jacqueline Macías Guerra

    Hospital ‘Luis Vernaza’, Universidad Católica Santiago de Guayaquil, Guayaquil, Ecuador

    ,
    Gerardo Ramírez Samayoa

    Hospital General San Juan de Dios, Universidad de San Carlos de Guatemala, HUMANA, Centro de Tratamiento e Investigación de Epilepsia en Guatemala

    ,
    Edwin Rangel Morillo

    Physical Medicine & Rehabilitation, Panama

    ,
    María Antonieta Rico Pazos

    Clínica Alemana, Universidad del Desarrollo, Santiago, Chile

    &
    Manuel Sempértegui Gallegos

    Pain Clinic, Hospital Metropolitano, Quito, Ecuador

    Published Online:https://doi.org/10.2217/pmt-2016-0065

    Aim: Latin-American experts in the use of opioids in patients with chronic nononcologic pain (CNOP) have updated existing recommendations to current Latin-American reality. Methods: Several key opinion leaders from Latin America participated in a face-to-face meeting in Guatemala (April 2015) to discuss the use of opioids in CNOP. Subgroups of experts worked on specific topics, reviewed the literature and shaped the final manuscript. Results: The expert panel developed guidelines taking into consideration the utility of both opioid and nonopioid analgesics and factors pertaining to their efficacy, safety, adherence, administration and risks for abuse/addiction. Conclusion: Latin-American guidelines for the use of opioids in CNOP should improve pain relief and patients’ quality of life by increasing access to these effective agents.

    Papers of special note have been highlighted as: • of interest

    References

    • 1 Cousins MJ, Lynch ME. The Declaration Montreal: access to pain management is a fundamental human right. Pain 152, 2673–2674 (2011). • This publication was a milestone in the history of contemporary medicine, as it established that pain relief was an important unmet need, as well as human right, a concept endorsed by highly relevant institutions, such as WHO, International Association for the Study of Pain and European Pain Federation.
    • 2 Brennan F, Carr DB, Cousins M. Pain management: a fundamental human right. Anesth. Analg. 105, 205–221 (2007).
    • 3 Treede R, Rief W, Barke A et al. A classification of chronic pain for ICD-11. Pain 156, 1003–1007 (2015).
    • 4 Henschke N, Kamper S, Maher Ch. The epidemiology and economic consequences of pain. Mayo Clin. Proc. 90, 139–147 (2015).
    • 5 Garcia JBS. Change Pain Latin America -new initiative established to enhance management of patients with chronic pain in Latin America. Rev. Bras. Anestesiol. 64, 140–142 (2014). • A group of opinion leaders, who are also renowned specialists in pain management, have developed an initiative called Change Pain aimed at improving pain management in Latin-American patients through education, research, and diffusion of best practices.
    • 6 Wynne-Jones G, Vande Windt D, Ong BN et al. Perceptions of health professionals towards the management of back pain in the context of work: a qualitative study. BMC Musculoskelet. Disord. 15, 210 (2014).
    • 7 Cicad Plan Nacional de Prevención Integral de Drogas. 2012–2013. www.cicad.oas.org/fortalecimiento_institucional/savia/PDF/2012_plan_prevenci%C3%B3n.pdf.
    • 8 Lohman D, Schleifer R, Amon J. Access to pain treatment as a human right. BMC Med. 8, 8 (2010).
    • 9 Rico M, Kraychete C, Iskandar J et al. Use of opioids in Latin America: the need of an evidence-based change. Pain Med. 17, 704–716 (2016). • Recent publication by Change Pain Latin-American group, in which the need to change clinical practices on the use of opioids is established on the basis of the best evidence available.
    • 10 Kahan M, Mailis-Gagnon A, Wilson L, Srivastava A; National Opioid Use Guideline Group. Canadian guideline for safe and effective use of opioids for chronic noncancer pain: clinical summary for family physicians. Part 1: general population. Can. Fam. Physician 57, 1257–1266 (2011). • One of the first and more complete guidelines aimed at promoting rational and safe prescription of opioids for noncancer pain, and which set the scene for further publications on this topic.
    • 11 Häuser W, Bock F, Engeser P, Tölle T, Willweber-Strumpfe A, Petzke F. Clinical practice guideline: Long-term opioid use in non-cancer pain. Dtsch Arztebl. Int. 111, 732–740 (2014).
    • 12 Kalso E, Edwards JE, Moore RA, McQuay HJ. Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain 112, 372–380 (2004).
    • 13 O'Neil Ch, Hanlon J, Marcum ZA. Adverse effects of analgesics commonly used by older adults with osteoarthritis: focus on non-opioid and opioid analgesics. Am. J. Geriatr. Pharmacother. 10(6), 331–342 (2012).
    • 14 Singh BK, Haque SE, Pillai KK. Assessment of nonsteroidal anti-inflammatory drug-induced cardiotoxicity. Expert Opin. Drug Metab. Toxicol. 10, 143–156 (2014).
    • 15 Trescot A, Helm S, Hansen H et al. Opioids in the management of chronic non cancer pain: an update of American Society of the Interventional Pain Physicians’ (ASIPP) Guidelines. Pain Physician 11, S5–S62 (2008).
    • 16 Cheatle MD, Savage SR. Informed consent in opioid therapy: a potential obligation and opportunity. J. Pain Symptom Manage. 44(1), 105–116 (2012).
    • 17 Bruera E, Paice JA. Cancer pain management: safe and effective use of opioids. Am. Soc. Clin. Oncol. Educ. Book 2015, e593–e599 (2015).
    • 18 Tzschentke TM, Christoph T, Kögel BY. The mu-opioid receptor agonist/noradrenaline reuptake inhibition (MOR-NRI) concept in analgesia: the case of tapentadol. CNS Drugs 28(4), 319–29 (2014).
    • 19 Cheung CH, Qui Q, Choi SW, Moore B, Goucke R, Irwin M. Chronic opioid therapy for chronic non cancer pain: a review and comparison of treatment guidelines. Pain Phys. 17, 401–414 (2014).
    • 20 Chou R, Fanciullo GJ, Fine PG et al. Clinical guidelines for use of chronic opioid therapy in chronic noncancer pain. J. Pain 10, 113–130 (2009).
    • 21 Passik SD, Squire P. Current risk assessment and management paradigms: snapshots in the life of the pain specialist. Pain Med. 10(Suppl. 2), S101–S114 (2009).
    • 22 Khanna IK, Pillariserri S. Buprenorphine -an attractive opioid with underutilized potential in treatment of chronic pain. J. Pain Res. 4, 859–870 (2015).
    • 23 VA/DoD Opioid Therapy for Chronic Pain Working Group (2010). The management of opioid therapy for chronic pain. www.healthquality.va.gov/Chronic_Opioid_Therapy_COT.asp.
    • 24 Ho KY, Chua NH, George JM et al. Evidence-based guidelines on the use of opioids in chronic non-cancer pain-a consensus statement by the Pain Association of Singapore Task Force. Ann. Acad. Med. Singapore 42(3), 138–152 (2013).
    • 25 Manchikanti L, Abdi S, Atluri S et al. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: part 2–guidance. Pain Physician 15(3), S67–S116 (2012). • A publication in which interventional experts in the field of pain management put forward their perspective on the responsible use of opioids in chronic noncancer pain.
    • 26 Webster L, Fine PG. Review and critique of opioid rotation practices and associated risks of toxicity. Pain Med. 13, 562–570 (2012). • A review of the methods for opioid rotation, their utility and associated risks.
    • 27 McPherson ML. Desmistifying opioid conversion calculations. American Society of Health System. USA (2009). www.ashp.org/doclibrary/bookstore/p1985firstpages.aspx.
    • 28 Deyo RA, Von Korff M, Duhrkoop D. Opioids for low back pain. BMJ 350, g6830 (2015).
    • 29 Gordon DB, Dahl JL, Miaskowski C et al. American Pain Society recommendations for improving the quality of acute and cancer pain management. American Pain Society Quality of Care Task Force. Arch. Intern. Med. 165, 1574–1580 (2005).
    • 30 Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain 2010 National Opioid Use Guideline Group (NOUGG). http://nationalpaincentre.mcmaster.ca/opioid/.
    • 31 Labianca R, Sarzi-Puttini P, Zuccaro SM, Cherubino P, Vellucci R, Fornasari D. Adverse effects associated with non-opioid and opioid treatment in patients with chronic pain. Clin. Drug Investig. 32(1), 53–63 (2012). • Review of side effects of commonly used drugs in patients with chronic pain, including a critical appraisal of the analgesic groups most frequently prescribed for this condition, along with their potential effects, prevention and management. Previous comorbidity is also considered.
    • 32 Díaz P, Tamayo A. Efectos gastrointestinales. In: Uso de opioides en Tratamiento del Dolor. Manual para Latinoamérica. Bonilla P, De Lima L, Díaz P, León MX, González M (Eds). TIPS Imagen y Comunicación 1967 CA, Caracas, Venezuela, 100–113 (2011).
    • 33 Al-Hashimi M, Scott SW, Thompson JP, Lambert DG. Opioids and immune modulation: more questions than answers. Br. J. Anaesth. 111, 80–88 (2013).
    • 34 Garcia JB, Cardoso MGM, Dos-Santos MC. Opioids and the immune system: clinical relevance. Rev. Bras. Anaestesiol. 62(5), 709–718 (2012).
    • 35 Pain and substance misuse: improving the patient experience. A consensus statement prepared by The British Pain Society in collaboration with The Royal College of Psychiatrists, The Royal College of General Practitioners and The Advisory Council on the Misuse of Drug. The British Pain Society, 2010. www.britishpainsociety.org/static/uploads/resources/misuse_0307_v13_FINAL.pdf.
    • 36 Juurlink DN, Dhalla IA. Dependence and addiction during chronic opioid therapy. J. Med. Toxicol. 8(4), 393–399 (2012).
    • 37 Noble M, Tregear SJ, Treadwell JR, Schoelles K. Long-term opioid therapy for chronic noncancer pain: a systematic review and meta-analysis of efficacy and safety. J. Pain Symptom Manage. 35, 214–228 (2008).
    • 38 United Nations Economic and Social Council (ECOSOC). Resolution 2005/25. Treatment of pain using opioid analgesics. www.un.org/en/ecosoc/docs/2005/resolution%202005-25.pdf.
    • 39 Acceso y uso racional de los medicamentos Departamento de Medicamentos Esenciales y Políticas Farmacéuticas Sistemas y servicios de salud, Organización Mundial de la Salud. www.who.int/medicines/areas/quality_safety/ACMP_BrNoteGenrl_SP_Feb09.pdf. • This highly relevant article establishes that the program on the access to controlled drugs represents the first and only worldwide initiative in this field. National mechanisms are assessed by providing scientifically based guidelines, policy analyses, qualification and practical help measures in an attempt to furnish national governments with universal, worldwide-recognized norms on the clinical use of controlled drugs.
    • 40 Duthey B, Scholten W. Adequacy of opioid analgesic consumption at country, global, and regional levels in 2010, its relationship with development level, and changes compared with 2006. J. Pain Symptom Manage. 47, 283–297 (2014). • A publication that advocates the use of Adequacy of Opioid Analgesic Consumption to define needs at country, region and global levels, as well as changes introduced between 2006 and 2010.
    • 41 International Narcotics Control Board: WHO population data by: pain & policy studies group. University of Wisconsin/WHO collaboration center (2014). http://www.painpolicy.wisc.edu/.
    • 42 Lamas D, Rosenbaum L. Painful inequities – palliative care in developing countries. N. Engl. J. Med. 366, 199–201 (2012).
    • 43 Ryan K, De Lima L, Maurer M. Disponibilidad acceso y políticas sanitaria en medicamentos opioides en latinoamérica. In: Uso de opioides en Tratamiento del Dolor. Manual para Latinoamérica. Bonilla P, De Lima L, Díaz P, León MX, González M (Eds). IAHPC Press, Caracas, Venezuela, 20–41 (2011).