Importantly, however, recent guidelines developed by the National Pain Centre in Canada attempt to eliminate this ambiguity by issuing clear directives about when and how to prescribe opioids for chronic pain [ 79 ]. These guidelines include: optimizing non-opioid pharmacotherapy and non-pharmacological therapy as first-line treatment for patients; avoiding the use of opioids in patients with an active or prior history of substance abuse; and, stabilizing psychiatric disorders prior to initiating a trial of opioid analgesics, among other recommendations. Nevertheless, the first Canadian guidelines for prescribing opioids in the management of non-cancer chronic pain were released in , and demonstrated only a limited impact on prescribing rates in British Columbia, at least in the short term [ 39 ].
It is important to consider the limitations of this study. First, the study was unable to control for several exogenous factors which may act as confounding variables, including: factors that affect pain tolerance; and medications and conditions which create contraindications for use of pain medications [ 80 ]. The control group in this study is intended to address this by establishing a baseline group against which the affected group can be compared; that is, the only variable putatively separating each group is the presence or absence of having experienced a toothache within the past month.
As well, the study was able to identify and control for several other confounding variables in the regression model, including the age and sex of respondents, potential pain-generating conditions, such as fibromyalgia, arthritis, rheumatism, and back pain, as well as recent injuries or repetitive strain injuries. Moreover, we successfully identified and controlled for several psychosocial variables, including self-reported mental health, life satisfaction, and self-reported daily stress.
The second limitation of the study is that its design is cross-sectional in nature, limiting our ability to draw conclusions about causal relationships.
Non-Opioids in Pain Management | SpringerLink
Provided with adequate data, a longitudinal study design would better allow for social and economic influences on prescription opioid use to be assessed, while also providing more insight into a causal relationship between the dependent and independent variables. Future research examining this topic may also benefit from using more direct metrics to assess opioid use to alleviate tooth pain, as well as exploring the issue in other Canadian jurisdictions experiencing public health challenges [ 17 , 23 ] related to prescription opioid use. In this study, we identified particular social and economic factors that are associated with using opioid analgesics to potentially alleviate tooth pain among those living in BC.
Conceptualization: JM CQ. Data curation: JM JF. Formal analysis: JM JF. Funding acquisition: JM CQ. Investigation: JM. Project administration: CQ. Resources: JM. Software: JM JF. Supervision: CQ. Validation: JM JF. Visualization: JM.
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Writing — original draft: JM. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract The use of prescription opioids has increased dramatically in Canada in recent decades.
Non-Opioids in Pain Management
Introduction The use of prescription opioids has increased dramatically during the past two decades in Canada. Download: PPT. Fig 1. Data source We used data from the Canadian Community Health Survey CCHS , a geographically-representative survey that collects demographic and socioeconomic information of respondents, as well as self-reported information pertaining to health status and health behaviours.
Variables and data analysis This analysis focuses on two specific questions asked to participants: 1 recent experience of a toothache; and 2 recent use of analgesics within the same time frame. Results In total, 13, respondents answered questions pertaining to both their medication use within the past month and their history of a toothache during the same time period.
Distribution of respondents, as well as proportion of respondents who report using Demerol, codeine, or morphine within the past month, using conventional painkillers such as Tylenol within the past month according to a variety of demographic, socioeconomic, and oral health indicators. Table 2. Results of bivariate logistic regression analysis for the odds of using conventional painkillers such as aspirin or Tylenol among 1 those who do not report experiencing a toothache in the past month; and, 2 and those who report experiencing a toothache in the past month using a variety of demographic, socioeconomic, and oral health indicators.
Table 3. Table 4. Conclusion In this study, we identified particular social and economic factors that are associated with using opioid analgesics to potentially alleviate tooth pain among those living in BC. References 1. Pasternak GW. Opioid Receptors: The Early Years. In: The Opiate Receptors, 2 nd Edition.
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