Evidence-based guidelines on the use of opioids in chronic non-cancer pain--a consensus statement by the Pain Association of Singapore Task Force

Item does not contain fulltextINTRODUCTION: While opioids are effective in carefully selected patients with chronic non-cancer pain (CNCP), they are associated with potential risks. Therefore, treatment recommendations for the safe and effective use of opioids in this patient population are needed. MATERIALS AND METHODS: A multidisciplinary expert panel was convened by the Pain Association of Singapore to develop practical evidence-based recommendations on the use of opioids in the management of CNCP in the local population. This article discusses specific recommendations for various common CNCP conditions. RESULTS: Available data demonstrate weak evidence for the long-term use of opioids. There is moderate evidence for the short-term benefit of opioids in certain CNCP conditions. Patients should be carefully screened and assessed prior to starting opioids. An opioid treatment agreement must be established, and urine drug testing may form part of this agreement. A trial duration of up to 2 months is necessary to determine efficacy, not only in terms of pain relief, but also to document improvement in function and quality of life. Regular reviews are essential with appropriate dose adjustments, if necessary, and routine assessment of analgesic efficacy, aberrant behaviour and adverse effects. The reasons for discontinuation of opioid therapy include side effects, lack of efficacy and aberrant drug behaviour. CONCLUSION: Due to insufficient evidence, the task force does not recommend the use of opioids as first-line treatment for various CNCP. They can be used as secondor third-line treatment, preferably as part of a multimodal approach. Additional studies conducted over extended periods are required

25 Years of Self-Organized Criticality: Solar and Astrophysics

Shortly after the seminal paper “Self-Organized Criticality: An explanation of 1/fnoise” by Bak et al. (1987), the idea has been applied to solar physics, in “Avalanches and the Distribution of Solar Flares” by Lu and Hamilton (1991). In the following years, an inspiring cross-fertilization from complexity theory to solar and astrophysics took place, where the SOC concept was initially applied to solar flares, stellar flares, and magnetospheric substorms, and later extended to the radiation belt, the heliosphere, lunar craters, the asteroid belt, the Saturn ring, pulsar glitches, soft X-ray repeaters, blazars, black-hole objects, cosmic rays, and boson clouds. The application of SOC concepts has been performed by numerical cellular automaton simulations, by analytical calculations of statistical (powerlaw-like) distributions based on physical scaling laws, and by observational tests of theoretically predicted size distributions and waiting time distributions. Attempts have been undertaken to import physical models into the numerical SOC toy models, such as the discretization of magneto-hydrodynamics (MHD) processes. The novel applications stimulated also vigorous debates about the discrimination between SOC models, SOC-like, and non-SOC processes, such as phase transitions, turbulence, random-walk diffusion, percolation, branching processes, network theory, chaos theory, fractality, multi-scale, and other complexity phenomena. We review SOC studies from the last 25 years and highlight new trends, open questions, and future challenges, as discussed during two recent ISSI workshops on this theme.Fil: Aschwanden, Markus J.. Lockheed Martin Corporation; Estados UnidosFil: Crosby, Norma B.. Belgian Institute For Space Aeronomy; BélgicaFil: Dimitropoulou, Michaila. University Of Athens; GreciaFil: Georgoulis, Manolis K.. Academy Of Athens; GreciaFil: Hergarten, Stefan. Universitat Freiburg Im Breisgau; AlemaniaFil: McAteer, James. University Of New Mexico; Estados UnidosFil: Milovanov, Alexander V.. Max Planck Institute For The Physics Of Complex Systems; Alemania. Russian Academy Of Sciences. Space Research Institute; Rusia. Enea Centro Ricerche Frascati; ItaliaFil: Mineshige, Shin. Kyoto University; JapónFil: Morales, Laura Fernanda. Canadian Space Agency; Canadá. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Nishizuka, Naoto. Japan National Institute Of Information And Communications Technology; JapónFil: Pruessner, Gunnar. Imperial College London; Reino UnidoFil: Sanchez, Raul. Universidad Carlos Iii de Madrid. Instituto de Salud; EspañaFil: Sharma, A. Surja. University Of Maryland; Estados UnidosFil: Strugarek, Antoine. University Of Montreal; CanadáFil: Uritsky, Vadim. Nasa Goddard Space Flight Center; Estados Unido