Postgraduate education and years of medical practice affect rate of opioid-prescription among physicians treating cancer pain

The Postgraduate Education and Training Board (PMETB) was established by the General and Specialist Medical Practice (Education and Qualifications) Order, approved by parliament on 4 April 2003 to develop a single, unifying framework for postgraduate medical education and training across the UK. The Order placed a duty on the Board to establish, maintain and develop standards and requirements relating to all aspects of postgraduate medical education and training in the UK.

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The Role of Opioid Prescription in Incident Opioid Abuse and Dependence Among Individuals with Chronic Non-cancer Pain

Clinical Journal of Pain ◽

10.1097/ajp.0000000000000021 ◽

2013 ◽

pp. 1 ◽

Cited By ~ 33

Author(s):

Mark J. Edlund ◽

Bradley C. Martin ◽

Joan E. Russo ◽

Andrea Devries ◽

Jennifer Brennan Braden ◽

...

Keyword(s):

Cancer Pain ◽

Opioid Abuse ◽

Opioid Prescription

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Interns’ Attitudes on Cancer Pain and Its Management

Songklanagarind Medical Journal ◽

10.31584/smj.2017.35.3.735 ◽

2017 ◽

Vol 35 (3) ◽

pp. 255

Author(s):

Sasikaan Nimmaanrat ◽

Chatchai Prechawai ◽

Maliwan Oofuvong

Keyword(s):

Cancer Pain ◽

Clinical Judgment ◽

Low Dose ◽

Morphine Injection ◽

Negative Attitudes ◽

Opioid Prescription ◽

Analgesic Treatment ◽

Pain Medications ◽

To Receive ◽

Pain Patients

Objective: This study was designed to evaluate interns’ attitudes in terms of cancer pain and its management, including opioid prescription.Material and Method: Questionnaires consisting of 2 parts (attitudes toward cancer pain and its management as well as attitudes toward opioid prescription), were completed by 125 out of 165 interns (75.8%).Result: The majority of them thought that maximum analgesic treatment should be commenced when patients’ life expectancy was not more than 1 year (76.0%). They rated the patients’ requirement for pain medications as average (73.6%) and supposed that the demand for higher analgesic doses indicating increased pain level (60.8%). Almost seventy percent would cautiously regulate the dosage and frequency of opioids to avoid tolerance and addiction. Two thirds did not agree to provide too low dose of opioid to prevent tolerance. Over 80.0% did not agree that they should inform patients, as well as their relatives, that opioids were bad, nor did they reassure them that trying to bear pain may be a better alternative. Over half would discourage patients who were willing to stand the pain and refused to receive a morphine injection. None strongly agreed not to prescribe opioids due to a fear of respiratory depression.Conclusion: Although the minority of the participated interns had negative attitudes towards cancer pain and its management, these negative attitudes may influence their clinical judgment and practice, which lead to inadequate pain management being provided to cancer pain patients, who are in need for optimal pain relief.

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Genetics and Opioids: Towards More Appropriate Prescription in Cancer Pain

Cancers ◽

10.3390/cancers12071951 ◽

2020 ◽

Vol 12 (7) ◽

pp. 1951

Author(s):

Dario Bugada ◽

Luca F. Lorini ◽

Roberto Fumagalli ◽

Massimo Allegri

Keyword(s):

Adverse Events ◽

Cancer Pain ◽

Genetic Variants ◽

Drug Prescription ◽

Gene Variants ◽

Opioid Prescription ◽

New Approach ◽

Patients With Cancer ◽

Patient’S Outcome ◽

Complex Scenario

Opioids are extensively used in patients with cancer pain; despite their efficacy, several patients can experience ineffective analgesia and/or side effects. Pharmacogenetics is a new approach to drug prescription based on the “personalized-medicine” concept, i.e., the ability of tailoring treatments to each individual’s genetic/genomic profile. Pharmacogenetics aims to identify specific genetic variants that influence pharmacokinetics and pharmacodynamics of drugs, better determining their effectiveness/safety profile. Opioid response is a complex scenario, but some gene variants have shown a correlation with pain sensitivity, as well as with opioid metabolism and clinical efficacy/adverse events. Although questions remain unanswered, some of these gene variants may already be used to identify specific patients’ phenotypes that are more prone to experience better clinical response (i.e., better analgesia and/or less adverse events). Once adopted, this approach to opioid prescription may improve a patient’s outcome. This review summarizes the available data on genetic variants and opioid response: we will focus on basic pharmacogenetic and its impact in the clinical scenario discussing how they may lead to more appropriate opioid prescription in cancer patients.

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A systematic review of the evidence for the efficacy of opioids for chronic non-cancer pain in community-dwelling older adults

Age and Ageing ◽

10.1093/ageing/afz175 ◽

2020 ◽

Vol 49 (2) ◽

pp. 175-183

Author(s):

Michael David Cory O’Brien ◽

Anne Pamela Frances Wand

Keyword(s):

Systematic Review ◽

Older People ◽

Cancer Pain ◽

Activities Of Daily Living ◽

Social Engagement ◽

Daily Living ◽

Nursing Home Residents ◽

Community Dwelling ◽

Opioid Use ◽

Opioid Prescription

Abstract Introduction the ageing global population and concomitant increase in the use of opioid analgesia have highlighted the need to evaluate the effectiveness of opioids for chronic pain in older people. Methods a systematic review of the evidence for the efficacy of opioids for chronic non-cancer pain in community-dwelling people aged 65 years or more was conducted using PRISMA guidelines. The databases MEDLINE, EMBASE, Pubmed and PsychINFO were searched. The quality of studies was assessed. Secondary aims were to assess correlates of opioid use and the decision-making processes of prescribers. Results seven studies were identified of low to high quality. The majority of older people experienced ongoing pain despite continuing opioid therapy. There were mixed results regarding benefits of opioids in terms of activities of daily living and social engagement. In nursing home residents, opioid use at baseline was associated with severe pain, severe impairment in activities of daily living and a diagnosis of depression. Fear of causing harm to older people was common amongst opioid prescribers, limiting prescription. Facilitators of opioid prescription included educational interventions and access to an evidence base for opioid use. Conclusion there is limited evidence supporting the use of long-term opioid use in older people for chronic non-cancer pain and a lack of trials in this age group. Age-specific guidelines are required addressing initial assessment, indications, monitoring and de-prescribing.

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Postgraduate Education in Ufa Eye Research Institute

POINT OF VIEW EAST – WEST ◽

10.25276/2410-1257-2021-2-28-31 ◽

2021 ◽

pp. 28-31

Author(s):

N.M. Sagadatova ◽

◽

G.K. Zaynutdinova ◽

M.S. Absalyamov ◽

◽

...

Keyword(s):

Medical Practice ◽

Professional Education ◽

Modern Science ◽

Postgraduate Education ◽

Medical Personnel ◽

Republic Of Bashkortostan ◽

The Republic ◽

Academy Of Sciences ◽

Research Institute

The article presents the results of the work of the Scientific and Educational department of the Ufa Eye Research Institute of the Academy of Sciences of the Republic of Bashkortostan for 2016-2020. The activities of the Scientific and Educational department allowed us to create a system of training qualified medical personnel, improve the quality of postgraduate professional education of ophthalmologists, which will contribute to improving the efficiency of using the achievements of modern science and technology in everyday medical practice when providing medical care to the population. Key words: Ufa Eye Research Institute, postgraduate education, Scientific and Educational department, results of work, WETLAB.

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The McGill University Health Centre interdisciplinary approach to cancer pain management: Description of treatments and outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.190 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 190-190

Author(s):

Sara Olivier ◽

Jordi Perez ◽

Yoram Shir ◽

Manuel Borod ◽

Rosemary O'Grady

Keyword(s):

Cancer Pain ◽

Symptom Management ◽

Health Centre ◽

Interdisciplinary Approach ◽

Palliative Radiotherapy ◽

Interdisciplinary Teams ◽

Pain Clinic ◽

Symptom Improvement ◽

Opioid Prescription ◽

Edmonton Symptom Assessment Scale

190 Background: Cancer-related symptom management is best achieved by interdisciplinary teams. In 2011, the MUHC launched an interdisciplinary Cancer Pain Clinic including palliative care, anesthesia, radiation oncology and nursing with rapid access to physiotherapy, occupational therapy and psychosocial oncology. Methods: We retrospectively analysed all new outpatients completing two subsequent visits since March 2013. Variables included a) symptom severity with the Edmonton Symptom Assessment Scale (ESAS), b) pain with the Brief Pain Inventory (BPI) and c) treatment including medication (type, formulation, dose of opioids) of non-pharmacological approaches. Results: 71 patients were analysed. Symptom management: Severity of pain and other five symptoms decreased significantly at V2 or V3 (Table). Pain significantly decreased in all four BPI categories. One third of patients had ≥50% pain relief at V2 or V3. Number of severe pain cases decreased (45% at V1 to 18% at V3) in parallel to an increase of mild pain cases (11% at V1, 41% at V3). Treatments: Acetaminophen, anticonvulsants and NSAIDs were the most common non-opioid drugs. Opioid prescription remained constant at an 80% yet the ratio between short acting (SA) and long acting (LA) changed at V3 compared to V1 (V1: SA/LA=76/44; V3: SA/LA=48/58) and the morphine equivalent daily doses decreased (V1: 100±194 mg, V2: 84±158mg and V3: 65±80mg). Among non-pharmacological methods, 28% of patients received interventional procedures, 18% psychotherapy and 12% palliative radiotherapy. Conclusions: We believe that the pain and other symptom improvement observed after three visits along with a lower opioid consumption is a result of the interdisciplinary approach offered. [Table: see text]

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(449) Pediatric opioid prescription rates for non-cancer pain: 2005-2014

Journal of Pain ◽

10.1016/j.jpain.2016.01.426 ◽

2016 ◽

Vol 17 (4) ◽

pp. S86-S87 ◽

Cited By ~ 1

Author(s):

M. Pielech ◽

W. Rivers ◽

R. Bailey ◽

K. Vowles

Keyword(s):

Cancer Pain ◽

Opioid Prescription ◽

Prescription Rates

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African Americans With Cancer Pain Are More Likely to Receive an Analgesic With Toxic Metabolite Despite Clinical Risks: A Mediation Analysis Study

Journal of Clinical Oncology ◽

10.1200/jco.2013.54.7992 ◽

2014 ◽

Vol 32 (25) ◽

pp. 2773-2779 ◽

Cited By ~ 28

Author(s):

Salimah H. Meghani ◽

Youjeong Kang ◽

Jesse Chittams ◽

Erin McMenamin ◽

Jun J. Mao ◽

...

Keyword(s):

African American ◽

Adverse Effects ◽

Cancer Pain ◽

Strong Predictor ◽

Private Insurance ◽

Toxic Metabolite ◽

Opioid Prescription ◽

Insurance Type ◽

To Receive ◽

White Patients

Purpose Renal impairment is highly prevalent among patients with cancer, and many patients have undiagnosed chronic kidney disease (CKD) from underlying disease, treatment, or both. African American individuals have disproportionate risk factors (diabetes, hypertension) predisposing them to CKD. We investigated whether African American patients are more likely than white patients to receive morphine with 3- and 6-glucuronide metabolites, which are known to be neurotoxic and accumulate in CKD; whether insurance type mediates the relationship between race and the prescriber's opioid selection; and whether the chosen opioid has a resultant negative effect according to race. Patients and Methods Patients (N = 182) were recruited from oncology clinics within the University of Pennsylvania Health System. Inclusion was based on self-identified African American or white race, age older than 18 years, and the presence of cancer-related pain plus a prescription for morphine or oxycodone. Kidney function was estimated using the abbreviated Modification of Diet in Renal Disease formula. Results Patients with CKD who received morphine reported a greater severity of analgesic-related adverse effects than patients with CKD who received oxycodone (P = .010). Controlling for health insurance type, African American patients had 71% lower odds of receiving a prescription of oxycodone than white patients (P < .001). Limiting analysis to those with CKD, the effect of private insurance became insignificant. However, race still remained a significant predictor of the prescribed opioid selection. Race was a strong predictor of adverse effect severity in the presence of CKD, and the type of opioid selection partially mediated this relationship. Conclusion Reducing racial disparities in the type of opioid prescription and understanding mechanisms of disproportionate opioid-related adverse effects in African American patients might decrease the clinical disparities in cancer pain outcomes.

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