2022
Complex Persistent Opioid Dependence—an Opioid-induced Chronic Pain Syndrome
Manhapra A. Complex Persistent Opioid Dependence—an Opioid-induced Chronic Pain Syndrome. Current Treatment Options In Oncology 2022, 23: 921-935. PMID: 35435616, DOI: 10.1007/s11864-022-00985-x.Peer-Reviewed Original ResearchConceptsChronic pain syndromeOpioid dependenceOpioid taperingPain syndromeClinical conundrumLong-term opioid useWorse pain controlNon-cancer painOpioid use disorderPoor patient acceptanceSeparate clinical entityAnti-reward systemsOpioid doseOpioid therapyPain providersPain controlOpioid usePain mechanismsClinical entityMore painIatrogenic problemsPatient acceptanceTreatment choiceChronic cancerPain experience
2020
Complex Persistent Opioid Dependence with Long-term Opioids: a Gray Area That Needs Definition, Better Understanding, Treatment Guidance, and Policy Changes
Manhapra A, Sullivan MD, Ballantyne JC, MacLean RR, Becker WC. Complex Persistent Opioid Dependence with Long-term Opioids: a Gray Area That Needs Definition, Better Understanding, Treatment Guidance, and Policy Changes. Journal Of General Internal Medicine 2020, 35: 964-971. PMID: 33159241, PMCID: PMC7728942, DOI: 10.1007/s11606-020-06251-w.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyOpioid taperingOpioid dependenceChronic pain refractoryUtilization of buprenorphineLong-term opioidsSevere chronic painOpioid use disorderMultitude of treatmentsLimited supportive evidenceOpioid therapyPain refractoryBuprenorphine treatmentChronic painClinical instabilityRecent guidelinesClinical definitionUS adultsUse disordersDiagnosis/Treatment guidancePainComplicationsTreatmentSupportive evidence
2018
The Conundrum of Opioid Tapering in Long-Term Opioid Therapy for Chronic Pain: A Commentary
Manhapra A, Arias A, Ballantyne J. The Conundrum of Opioid Tapering in Long-Term Opioid Therapy for Chronic Pain: A Commentary. Substance Abuse 2018, 39: 152-161. PMID: 28929914, PMCID: PMC6129223, DOI: 10.1080/08897077.2017.1381663.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyOpioid taperingChronic painOpioid therapyOpioid dependencePsychiatric symptomsHigher-dose long-term opioid therapyClinical scenariosPoor pain controlTerm opioid therapyUse of opioidsDifficult clinical scenariosUnique clinical challengesOpioid needsPain controlNeuroplasticity effectsAbstinence syndromeFunctional statusOpioid epidemicClinical challengeFunctional declinePainAffective symptomsPsychiatric instabilityAvailable evidence