Case Studies of Long-Acting, Extended-Release, and Sustained-Release Opioids for the Treatment of Chronic Nonmalignant Pain

Paul A. Sloan, MD

doi:10.5055/jom.2014.0231

Authors

Paul A. Sloan, MD

DOI:

https://doi.org/10.5055/jom.2014.0231

Keywords:

chronic pain, opioids, long-acting opioids, extended-release opioids, REMS, pain management

Abstract

Chronic pain of nonmalignant nature (CNMP) is often treated with chronic opioid therapy (COT). Although many guidelines exist to help the clinician use COT in a safe and effective manner, many controversies surrounding the exact prescribing practices
remain. The purpose of these following brief case studies is to help the practicing clinician consider real patient scenarios and help further understanding of the principles outlined by the US FDA REMS document. The patient case scenarios presented in this article do not represent any one real patient. However, each case scenario is entirely plausible and has presented themselves in some like
manner to the author. These discussion and recommendations following each case scenario represent the opinion of the author alone, based on the author’s 30-year experience, a review of common published guidelines, review of the US FDA REMS paper, and a review of the literature concerning COT for CNMP. Some of the discussion points remain controversial and recommendations for therapy are based on a low level of evidence.

Author Biography

Paul A. Sloan, MD

Department of Anesthesiology, University of Kentucky Medical Center, Lexington, Kentucky

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