Open Access Open Access  Restricted Access Subscription or Fee Access

Tapering chronic opioid therapy in neuropathic facial pain: An interdisciplinary approach

Brijesh P. Chandwani, BDS, FOP, Ronald J. Kulich, PhD, Lainie Andrew, PhD, Steven Scrivani, DDS, DMedSc

Abstract


This case report presents a patient with chronic orofacial pain who was considered to be an appropriate candidate for chronic opioid therapy, a treatment uncommonly considered at most facial pain centers. Her opioid treatment proved ineffectual, and conservative approaches were addressed. She was successfully tapered off the use of a long-acting opioid within a relatively short time, using an interdisciplinary approach involving an aggressive biobehavioral approach.

Keywords


neuropathic face pain, opioid therapy, behavioral therapy, psychological treatment, opioid taper, appliance therapy

Full Text:

PDF

References


Stewart WF, Ricci JA, Chee E, et al.: Lost productive time and cost due to common pain conditions in the US workforce. JAMA. 2003; 290(18): 2443-2454.

Watson CP: Management issues of neuropathic trigeminal pain from a medical perspective. J Orofac Pain. 2004; 18(4): 366-373.

Merskey H, Bogduk N (ed.): Classification of Chronic Pain. Description of Chronic Pain Syndromes and Definitions of Pain Terms. Seattle: IASP Press, 1994.

Henry JL: Future basic science directions into mechanisms of neuropathic pain. J Orofac Pain. 2004; 18(4): 306-310.

Furlan AD, Sandoval JA, Mailis-Gagnon A, et al.: Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects. Can Med Assoc J. 2006; 174(11): 1589-1594.

Savage SR: Opioid therapy of chronic pain: Assessment of consequences. Acta Anaesthesiol Scand. 1999; 43(9): 909-917.

Gamsa A: The role of psychological factors in chronic pain. Pain. 1994; 57(1): 5-15.

Linton SJ, Gotesam KG: Relations between pain, anxiety, mood and muscle tension in chronic pain patients. Psychother Psychosom. l985; 43: 95-98.

Muse M: Stress-related, post-traumatic chronic pain syndrome: Criteria for diagnosis, and preliminary report on prevalence. Pain. l985; 23: 295-300.

Lee MHM: Physical therapy and rehabilitation medicine. In Bonica JJ (ed.): The Management of Pain. Philadelphia: Lea and Febiger, 1990; 1769-1788.

Bruera E, Kim HN: Cancer pain. JAMA. 2003; 290: 2476-2479.

Deshpande A, Furlan A, Mailis-Gagnon A, et al.: Opioids for chronic low-back pain. Cochrane Database Sys Rev. 2007; 3: CD004959.

Gimbel JS. Richards P, Portenoy RK: Controlled-release oxycodone for pain in diabetic neuropathy: A randomized controlled trial. Neurology. 2003; 60(6): 927-934.

Eisenberg E, McNicol E, Carr DB: Opioids for neuropathic pain. Cochrane Database Sys Rev. 2006; 3: CD006146.

Xu XJ, Colpaert F, Wiesenfeld-Hallin Z: Opioid hyperalgesia and tolerance versus 5-HT1A receptor-mediated inverse tolerance. Trends Pharmacol Sci. 2003; 24(12): 634-639.

Dworkin SF, LeResche L: Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandibular Disord. 1992; 6(4): 301-355. [Review] [152 refs].

Akbik H, Butler SF, Budman SH, et al.: Validation and clinical application of the Screener and Opioid Assessment for Patients with Pain (SOAPP). J Pain Symptom Manage. 2006; 32(3): 287-293.

Belgrade MJ, Schamber CD, Lindgren BR.: The DIRE score: Predicting outcomes of opioid prescribing for chronic pain. Pain. 2006; 7(9): 671-681.

Ekberg E, Vallon, N: Occlusal appliance therapy in patients with temporomandibular disorders: A double blind controlled study in a short-term perspective. Acta Odontol Scand. 1998; 56(2): 122-128.

Kavan MG, Guck TP, Barone EJ: A practical guide to crisis management. Am Family Physician. 2006; 74(7): 1159-1164.

Ware JE, Kosinski M: SF-36 Physical & Mental Health Summary Scales: A Manual for Users of Version 1. 2nd ed. Lincoln, RI: Quality Metric Incorporated, 2001.

Chu L, Clark DJ, Angst M: Opioid tolerance and hyperalgesia in chronic pain patients after one month of oral morphine therapy: A preliminary prospective study. J Pain. 2006; 7: 43-48.

Angst M, Clark JD: Opioid induced hyperalgesia. Anesthesiology. 2006; 104: 570-587.

Charlton EJ (ed.): Core Curriculum for Professional Education in Pain. Seattle: IASP Press, 2005; Chapter 39: 198.

Gilron I, Watson CP, Cahill CM, et al.: Neuropathic pain: A practical guide for the clinician. Can Med Assoc J. 2006; 175(3): 265-275.

Dworkin RH, Backonja M, Rowbotham MC, et al.: Advances in neuropathic pain: Diagnosis, mechanisms, and treatment recommendations. Arch Neurol. 2003; 60(11): 1524-1534.

Rome JD, Townsend CO, Bruce BK, et al.: Chronic non cancer pain rehabilitation with opioid withdrawal: Comparison of treatment outcomes based on opioid use status at admission. Mayo Clinic Proc. 2004; 79(6): 759-768.

McCracken LM, Eccleston C.: Coping or acceptance: What to do about chronic pain? Pain. 2003; 105(1/2): 197-204.




DOI: https://doi.org/10.5055/jom.2008.0022

Refbacks

  • There are currently no refbacks.