Table of Contents

Opioid Treatment Guidelines 

113Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain

Roger Chou, Gilbert J. Fanciullo, Perry G. Fine, Jeremy A. Adler, Jane C. Ballantyne, Pamela Davies, Marilee I. Donovan, David A. Fishbain, Kathy M. Foley, Jeffrey Fudin, Aaron M. Gilson, Alexander Kelter, Alexander Mauskop, Patrick G. O'Connor, Steven D. Passik, Gavril W. Pasternak, Russell K. Portenoy, Ben A. Rich, Richard G. Roberts, Knox H. Todd, and Christine Miaskowski, for the American Pain Society–American Academy of Pain Medicine Opioids Guidelines Panel

Use of chronic opioid therapy for chronic noncancer pain has increased substantially. The American Pain Society and the American Academy of Pain Medicine commissioned a systematic review of the evidence on opioid therapy for noncancer pain and convened a research committee to review the evidence and formulate recommendations. Although evidence is limited in many areas related to use of opioids for chronic noncancer pain, this expert panel concluded that ongoing opioid therapy can be effective for carefully selected and monitored patients with noncancer pain. The recommendations offered in this 3-report presentation cover a broad area, including guidance on patient selection and risk, treatment management plans, monitoring of patients, dosing issues, safety concerns, and other opioid-related policies.

131Opioids for Chronic Noncancer Pain: Prediction and Identification of Aberrant Drug-Related Behaviors: A Review of the Evidence for an American Pain Society and American Academy of Pain Medicine Clinical Practice Guideline

Roger Chou, Gilbert J. Fanciullo, Perry G. Fine, Christine Miaskowski, Steven D. Passik, and Russell K. Portenoy

147Research Gaps on Use of Opioids for Chronic Noncancer Pain: Findings From a Review of the Evidence for an American Pain Society and American Academy of Pain Medicine Clinical Practice Guideline

Roger Chou, Jane C. Ballantyne, Gilbert J. Fanciullo, Perry G. Fine, and Christine Miaskowski

Original Reports 

160Assessing Controlled Substance Prescribing Errors in a Pediatric Teaching Hospital: An Analysis of the Safety of Analgesic Prescription Practice in the Transition From the Hospital to Home

Benjamin H. Lee, Christoph U. Lehmann, Eric V. Jackson, Sabine Kost-Byerly, Sharon Rothman, Lori Kozlowski, Marlene R. Miller, Peter J. Pronovost, and Myron Yaster

Iatrogenic errors producing serious and preventable injury occur frequently in hospitalized patients, particularly in children. This study describes the epidemiology of such errors by physicians-in-training for children being discharged from the hospital. The report concludes that discharge prescription errors for children are common and nearly 3% could cause significant harm.

167A Prolonged Nitric Oxide-Dependent, Opioid-Mediated Antinociceptive Effect of Hyperbaric Oxygen in Mice

Lisa M. Zelinski, Yusuke Ohgami, Eunhee Chung, Donald Y. Shirachi, and Raymond M. Quock

Hyperbaric oxygen therapy is reported to cause pain relief in several conditions of chronic pain. In this study, a single 60-minute treatment session produced an effect in mice that persisted for 90 minutes. This article presents evidence of a persistent antinociceptive effect of hyperbaric oxygen treatment that is mediated by opioid and nitric oxide mechanisms.

173Computer Face Scale for Measuring Pediatric Pain and Mood

Padma Gulur, Scott W. Rodi, Tabitha A. Washington, Joseph P. Cravero, Gilbert J. Fanciullo, Gregory J. McHugo, and John C. Baird

This study reports on the psychometric properties and acceptability of an animated face scale presented on a hand-held computer as a means to measure pediatric pain and mood. The authors conclude that the Computer Face Scale allows the health provider to obtain reliable and valid measures of pain and mood. The method can be understood and used by children as young as three years, and is also appropriate for use with adults.

180Associations Between Catastrophizing and Endogenous Pain-Inhibitory Processes: Sex Differences

Burel R. Goodin, Lynanne McGuire, Mark Allshouse, Laura Stapleton, Jennifer A. Haythornthwaite, Noel Burns, Lacy A. Mayes, and Robert R. Edwards

This research supports the hypothesis that heightened pain described by individuals who report higher pain catastrophizing may be related to a disruption in the endogenous modulation of pain, operationalized by assessing diffuse noxious inhibitory controls (DNIC). Whether interventions that reduce pain catastrophizing affect pain outcomes via effects on DNIC is in need of investigation.

191Diclofenac Potassium Attenuates Dysmenorrhea and Restores Exercise Performance in Women With Primary Dysmenorrhea

Ingrid Chantler, Duncan Mitchell, and Andrea Fuller

In women with primary dysmenorrhea, menstrual pain—if untreated—decreases laboratory-assessed exercise performance. This research assessed the efficacy of diclofenac potassium, a non-steroidal anti-inflammatory drug, in alleviating menstrual pain and restoring exercise performance to that measured in the late-follicular phase of the menstrual cycle. A recommended daily dose of a readily-available diclofenac potassium is effective in relieving menstrual pain, and restoring physical performance.

201Differential Roles of Peripheral Mitogen-Activated Protein Kinase Signal Transduction Pathways in Bee Venom–Induced Nociception and Inflammation in Conscious Rats

Hui-Sheng Chen, Xiang He, Fang Qu, Shuang-Ming Kang, Yan Yu, Dan Liao, and Su-Jie Lu

This study shows that injection of different mitogen-activated protein kinase (MAPK) inhibitors produces differential effects on bee venom-induced nociception and inflammation, suggesting that the peripheral MAPK signal transduction pathways have differential roles. Targeting specific peripheral MAPKs might prove effective in the treatment of persistent pain and inflammation.

208A Single-Blind, Placebo Run-in Study of Duloxetine for Activity-Limiting Osteoarthritis Pain

Mark D. Sullivan, Susan Bentley, Ming-Yu Fan, and Greg Gardner

Osteoarthritis pain is a significant problem for the aging population. Antidepressants that are serotonin-norepinephrine reuptake inhibitors are effective for other forms of chronic pain and may provide a new treatment option for osteoarthritis pain. In this single-blind placebo study, results conclude that duloxetine did not significantly reduce pain intensity on the Brief Pain Inventory scale, but did improve pain intensity and self-reported function on the The Western Ontario McMaster Osteoarthritis Index.

214Does the Neonatal Facial Coding System Differentiate Between Infants Experiencing Pain-Related and Non-Pain-Related Distress?

Sara Ahola Kohut and Rebecca Pillai Riddell

The Neonatal Facial Coding System (NFCS) is widely accepted as a measure of infant pain-related distress in known pain-specific contexts. This study sought to explore whether NFCS differentiates between pain-related and non-pain-related distress. Results suggest that NFCS has the ability to discriminate between intensities of distress but not between pain-related and non-pain-related distress.

221Contralateral High or a Combination of High- and Low-Frequency Transcutaneous Electrical Nerve Stimulation Reduces Mechanical Allodynia and Alters Dorsal Horn Neurotransmitter Content in Neuropathic Rats

David L. Somers and F. Richard Clemente

The authors examined the effect of three different application strategies for transcutaneous electrical nerve stimulation (TENS) on neuropathy-induced allodynia and dorsal horn neurotransmitter content. The findings support a contralateral approach to the application of TENS and suggest that distinct strategies for TENS application may differentially alter neurotransmission in the central nervous system.