Postoperative Pain Management and Perceived Patient Outcomes Following Endoscopic Pituitary Surgery

2021 ◽  
Author(s):  
Austin Thomas-Kim Hoke ◽  
Madison J Malfitano ◽  
Adam M Zanation ◽  
Brian D Thorp ◽  
Adam J Kimple ◽  
...  
Keyword(s):  
Pain Management ◽  
Patient Outcomes ◽  
Opioid Analgesics ◽  
Pituitary Surgery ◽  
Postoperative Pain Management ◽  
Prescribing Patterns ◽  
Opioid Prescription ◽  
Patient Reported ◽  
Pain Outcomes ◽  
Opioid Users

Objectives: Pain management remains a point of emphasis given the ongoing opioid crisis. There are no studies in the literature interrogating opioid prescribing and use following endoscopic pituitary surgery. This study investigate provider prescribing tendency, patient utilization of analgesics, and patient outcomes regarding pain management after endoscopic pituitary surgery. Methods: We identified 100 patients undergoing endoscopic pituitary surgery at one institution from 2016 – 2018 in the electronic medical record (EMR) and state narcotic database to determine postoperative analgesic regimens. A telephone survey was used to characterize postoperative analgesic use and satisfaction with prescribed regimens. Results: 52 different pain control regimens were prescribed to study patients. 93% of study patients were prescribed an opioid postoperatively. The average quantity of opioids prescribed per patient in morphine milligram equivalents (MME) was 625 (equivalent 83 oxycodone 5 mg tablets) with an average MME/day of 59 (equivalent 8 oxycodone 5 mg tablets). Average total MME, MME/day, and pills/tablets per opioid prescription decreased significantly over the study period. 71% of survey respondents who used opioids reported using <25% of their prescription. The majority of prescription narcotic users consumed >50% of their postoperative opioid intake in the first 24-48 hours after discharge. There were no significant differences in pain outcome between opioid users and non-opioid users. Conclusions: Vast heterogeneity exists in narcotic prescribing by providers at our institution following endoscopic pituitary surgery. Narcotic prescribing patterns exceeded most patients’ analgesic needs. Opioid analgesics were not superior to non-opioids regimens in patient-reported pain outcomes in this study population.

scholarly journals An Interactive Pain Application (MServ) Improves Postoperative Pain Management

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Richard Gordon-Williams ◽  
Andreia Trigo ◽  
Paul Bassett ◽  
Amanda Williams ◽  
Stephen Cone ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Nursing Staff ◽  
Pain Control ◽  
Standard Care ◽  
Severe Pain ◽  
Postoperative Pain Management ◽  
Pain Scale ◽  
Opioid Prescription ◽  
Patient Reported

Background. Most patients have moderate or severe pain after surgery. Opioids are the cornerstone of treating severe pain after surgery but cause problems when continued long after discharge. We investigated the efficacy of multifunction pain management software (MServ) in improving postoperative pain control and reducing opioid prescription at discharge. Methods. We recruited 234 patients to a prospective cohort study into sequential groups in a nonrandomised manner, one day after major thoracic or urological surgery. Group 1 received standard care (SC, n = 102), group 2 were given a multifunctional device that fed back to the nursing staff alone (DN, n = 66), and group 3 were given the same device that fed back to both the nursing staff and the acute pain team (DNPT, n = 66). Patient-reported pain scores at 24 and 48 hours and patient-reported time in severe pain, medications, and satisfaction were recorded on trial discharge. Findings. Odds of having poor pain control (>1 on 0–4 pain scale) were calculated between standard care (SC) and device groups (DN and DNPT). Patients with a device were significantly less likely to have poor pain control at 24 hours (OR 0.45, 95% CI 0.25, 0.81) and to report time in severe pain at 48 hours (OR 0.62, 95% CI 0.47–0.80). Patients with a device were three times less likely to be prescribed strong opioids on discharge (OR 0.35, 95% CI 0.13 to 0.95). Interpretation. Using an mHealth device designed for pain management, rather than standard care, reduced the incidence of poor pain control in the postoperative period and reduced opioid prescription on discharge from hospital.

Postoperative Pain Management and Perceived Patient Outcomes following Endoscopic Pituitary Surgery

2020 ◽  
Author(s):  
Austin T. Hoke ◽  
Madison Malfitano ◽  
Lucas Frickey ◽  
Adam J. Kimple ◽  
Adam M. Zanation ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Patient Outcomes ◽  
Pituitary Surgery ◽  
Postoperative Pain Management

Opioid Reduction Through Postoperative Pain Management in Pediatric Orthopedic Surgery

PEDIATRICS ◽  
2021 ◽  
Author(s):  
Kerwyn Jones ◽  
Laurie Engler ◽  
Elizabeth Fonte ◽  
Ibrahim Farid ◽  
Michael T. Bigham
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Control Charts ◽  
Postoperative Pain Management ◽  
Prescribing Practices ◽  
Opioid Prescription ◽  
Orthopedic Surgical Procedures ◽  
Pediatric Orthopedic ◽  
Over Time ◽  
Order Set

OBJECTIVES Our goal with this initiative was to reduce discharge opioid prescriptions while maintaining optimal pain management through the use of standardized pain prescribing guidelines for pediatric patients after orthopedic surgical procedures. METHODS Through analysis of established yet inconsistent prescribing practices, we created a 4-tiered guideline for pediatric orthopedic postoperative pain management prescription ordering. Following the Model for Improvement methodology including iterative plan-do-study-act cycles, the team created an electronic medical record order set to be used at discharge from the hospital. The provider compliance with this order set was monitored and analyzed over time by using provider-level and aggregate control charts. A secondary measure of opioid prescriptions (morphine milligram Eq [MME] dosage per patient) was tracked over time. The balancing measure was the analysis of unanticipated opioid prescription refills. RESULTS Greater than 90% compliance with the guidelines was achieved and sustained for 20 months. This resulted in a 54% reduction in opioids prescribed during the improvement period (baseline = 71 MME per patient; postintervention = 33 MME per patient) and has been sustained for 12 months. The percentage of unanticipated opioid prescription refills did not significantly change from the period before the institution of the guidelines and after institution of the guidelines (2017 = 3%; 2019 = 3%). CONCLUSIONS The creation of these guidelines has led to a significant reduction in the number of opioids prescribed while maintaining effective postoperative pain management.

Less is more: Postoperative pain management using restrictive opioid protocols in all surgical services in a comprehensive cancer center.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 103-103
Author(s):  
Jason Ricciuti ◽  
Steven Gallo ◽  
Deanna Argentieri ◽  
Paul Visco ◽  
Kristopher Attwood ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Patient Experience ◽  
Postoperative Pain Management ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Control Group ◽  
Prescription Database ◽  
Opioid Prescription ◽  
Surgical Services

103 Background: Opioids are routinely given for postoperative pain management with limited evidence on the amount needed to be dispensed. Prescribed opioids increase the risk of chronic use, abuse, and diversion, which contribute to the opioid epidemic. We sought to demonstrate that postsurgical acute pain can be effectively managed across different surgical specialties with a markedly reduced number of opioids. Methods: A prospective case-control study of restrictive opioid prescription protocol (ROPP) was implemented in all surgical services from February 2019 through July 2019 at a tertiary comprehensive cancer center for all patients undergoing a surgery for which opioids would be routinely prescribed at discharge (n = 2,015). Data from surgeries performed by the same services from August 2018 through January 2019 were used for comparison (n = 2,051). At discharge, patients did not routinely receive opioids unless they had a maximally invasive procedure or if they required multiple doses of opioids during hospitalization (maximum 3-day supply). Compliance with the protocol was tracked by pharmacists daily. Patient demographics and surgical details were collected. State-run opioid prescription database was used to determine the number of opioids prescribed to all surgical patients within a 120-day surgical window. Validated patient satisfaction surveys were used at postoperative visits to assess patient experience. Results: After implementation of the ROPP, 45% less opioids were prescribed after surgery for all participating patients (323,674 morphine milligram equivalents (MME) vs 179,458 MME, p < 0.001). The majority of services complied with the ROPP in more than 95% of cases. There was no difference in postsurgical pain intensity between cohorts. Patients in the ROPP cohort had less refill requests compared to the control group (20.9% vs 17.9%, p value = 0.016). Surveys were completed by 338 patients in the control group (16.5%) and 360 in the ROPP group (17.9%). There was no significant difference in patient reported satisfaction with postoperative pain control or on the impact of pain on daily activities between the cohorts. Conclusions: Implementation of a ROPP by multiple surgical services at a tertiary cancer center was feasible and resulted in substantial decrease in the number of opioids prescribed while not compromising patient experience. Patients did not require more prescription refills despite being provided no opioids or a limited supply. This study provides evidence to support reducing the number of opioids routinely prescribed after surgery.[Table: see text]

Remifentanil and worse patient-reported outcomes regarding postoperative pain management after thyroidectomy

2016 ◽  
Vol 31 ◽  
pp. 27-33 ◽  
Author(s):  
Filippo Sanfilippo ◽  
Caren Conticello ◽  
Cristina Santonocito ◽  
Carmelo Minardi ◽  
Filippo Palermo ◽  
...  
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Patient Reported Outcomes ◽  
Postoperative Pain Management ◽  
Patient Reported

scholarly journals Positive affect skills may improve pain management in people with HIV

2018 ◽  
Vol 25 (10-11) ◽  
pp. 1784-1795 ◽  
Author(s):  
Elizabeth L Addington ◽  
Elaine O Cheung ◽  
Judith T Moskowitz
Keyword(s):  
Pain Management ◽  
Positive Affect ◽  
Controlled Trial ◽  
Management Strategies ◽  
Secondary Analysis ◽  
Opioid Analgesics ◽  
Future Research ◽  
People Living With Hiv ◽  
Pain Outcomes ◽  
Pain Prevalence

Non-opioid pain management strategies are critically needed for people with HIV. We therefore conducted a secondary analysis of pain-related outcomes in a randomized controlled trial of a positive affect skills intervention for adults newly diagnosed with HIV ( N = 159). Results suggest that, even if pain prevalence rises, positive affect skills may reduce pain interference and prevent increased use of opioid analgesics by people living with HIV. Future research should replicate and extend these findings by conducting trials that are specifically designed to target pain outcomes.

Opioid prescription patterns among patients with fibromyalgia

2019 ◽  
Vol 15 (6) ◽  
pp. 469-477 ◽  
Author(s):  
Caio V. M. Sarmento, PT, PhD ◽  
Mehrdad Maz, MD ◽  
Taylor Pfeifer, DPT ◽  
Marco Pessoa, PhD ◽  
Wen Liu, PhD
Keyword(s):  
Prescribing Patterns ◽  
Chi Square ◽  
Opioid Prescription ◽  
Healthcare Enterprise ◽  
The Us ◽  
Chi Square Test ◽  
Opioid Medications ◽  
Chronic Pain Conditions ◽  
Opioid Users ◽  
Harmful Effects

Objectives: To investigate opioid prescribing patterns among patients with fibromyalgia (FM) in terms of age, gender, race, type of opioids, and to examine changes in opioid prescription over the past 8 years compared to the US Food and Drug Administration (FDA)-approved FM medications.Design: Retrospective review of data using the Healthcare Enterprise Repository for Ontological Narration database. The collected data were analyzed descriptively and a chi-square test for trend was used to analyze a possible linear relationship between the proportions of opioid and non-opioid users along the time.Participants: Patients with a diagnosis of FM who had received opioid prescriptions from January 1, 2010 to December 31, 2017, and FM patients who had received prescriptions of FDA-approved FM medications in the same period. Main outcome measure: Trends in opioid and non-opioid prescriptions in patients with FM.Results: The opioid medications were prescribed more frequently in 2010 (40 percent) and 2011 (42 percent), but the percentages have decreased since 2012 and reached the lowest numbers in 2016 (27 percent). The chi-square test for trend shows that from 2010 to 2017 the prescriptions of opioids had a statistically significant (p 0.0001) decrease.Conclusion: This study suggests that the frequency of prescribed opioids in FM patients has decreased since 2012. This decline could be attributed to (1) FDA monitoring programs, (2) national efforts to increase awareness of the addictive and harmful effects of opioids, and (3) the growing research on the efficacy of non-opioid therapies to treat chronic pain conditions including FM.

Academic family medicine physicians' confidence and comfort with opioid analgesic prescribing for patients with chronic nonmalignant pain

2014 ◽  
Vol 10 (4) ◽  
pp. 255 ◽  
Author(s):  
Allison A. Macerollo, MD ◽  
Donald O. Mack, MD ◽  
Rupal Oza, MD, MPH ◽  
Ian M. Bennett, MD, PhD ◽  
Lorraine S. Wallace, PhD
Keyword(s):  
Pain Management ◽  
Family Medicine ◽  
Family Physicians ◽  
Opioid Analgesics ◽  
Comfort Level ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain ◽  
Level Of Concern

Objective: To examine academic family medicine physicians' current practices, experiences, beliefs, level of concern about negative outcomes, and confidence and comfort when prescribing opioid analgesics for chronic nonmalignant pain management. Design: Electronic cross-sectional survey.Participants: This study was part of the Council of Academic Family Medicine (CAFM) Educational Research Alliance omnibus survey of active academic US family physicians.Main outcome measures: Respondents completed survey items addressing their 1) sociodemographic and practice characteristics, 2) current opioid prescribing practices, 3) experiences and beliefs toward prescribing opioid analgesics for chronic nonmalignant pain management, 4) level of concern about negative opioid-related outcomes, and 5) confidence and comfort when prescribing opioid analgesics.Results: The majority of the sample (n = 491) were male (57.8 percent) with 84.1 percent identifying themselves as non-Hispanic white. Nearly all respondents (91.0 percent) reported currently prescribing opioids to patients with chronic nonmalignant pain. Most respondents reported being confident (88.4 percent) and comfortable (76.2 percent) in their prescribing for patients with chronic nonmalignant pain. Family physicians who were comfortable in their opioid prescribing skills were more likely to report satisfaction in prescribing opioids to patients with chronic pain (ρ = 0.494, p < 0.001), while those who were confident in their opioid prescribing skills were more likely to identify pain management as high priority (ρ = -0.287, p < 0.001).Conclusions: Most academic family physicians currently prescribed opioid analgesics to patients with chronic nonmalignant pain. There was a strong inverse relationship between confidence regarding opioid prescription and concern about negative consequences. Similarly, comfort level was tied to increased satisfaction with the overall process of opioid prescription.

Use of multidomain management strategies by community dwelling adults with chronic pain: evidence from a systematic review

2019 ◽  
Vol 19 (1) ◽  
pp. 9-23 ◽  
Author(s):  
David R. Axon ◽  
Mira J. Patel ◽  
Jennifer R. Martin ◽  
Marion K. Slack
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Pain Management ◽  
Adverse Events ◽  
Management Strategies ◽  
Community Dwelling ◽  
Controlled Vocabulary ◽  
Self Management ◽  
Patient Reported ◽  
Pain Outcomes

AbstractBackground and aimsMultidomain strategies (i.e. two or more strategies) for managing chronic pain are recommended to avoid excessive use of opioids while producing the best outcomes possible. The aims of this systematic review were to: 1) determine if patient-reported pain management is consistent with the use of multidomain strategies; and 2) identify the role of opioids and non-steroidal anti-inflammatory drugs (NSAIDs) in patient-reported pain management.MethodsBibliographic databases, websites, and reference lists of included studies were searched to identify published articles reporting community-based surveys of pain self-management from January 1989 to June 2017 using controlled vocabulary (and synonyms): pain; self-care; self-management; self-treatment; and adult. Two independent reviewers screened studies and extracted data on subject demographics, pain characteristics, pain self-management strategies, and pain outcomes. Pain self-management strategies were organized according to our conceptual model. Included studies were assessed for risk of bias. Differences between the researchers were resolved by consensus.ResultsFrom the 3,235 unique records identified, 18 studies published between 2002 and 2017 from 10 countries were included. Twenty-two types of pharmacological strategies were identified (16 prescription, six non-prescription). NSAIDs (15 studies, range of use 10–72%) and opioids (12 studies, range of use 5–72%) were the most commonly reported prescription pharmacological strategies. Other prescription pharmacological strategies included analgesics, acetaminophen, anticonvulsants, antidepressants, anxiolytics, salicylates, β-blockers and calcium channel blockers, disease-modifying anti-rheumatic drugs and steroids, muscle relaxants, topical products, triptans, and others. Twenty-two types of non-pharmacological strategies were identified: four medical strategies (10 studies), 10 physical strategies (15 studies), four psychological strategies (12 studies), and four self-initiated strategies (15 studies). Medical strategies included consulting a medical practitioner, chiropractic, and surgery. Physical strategies included exercise, massage, hot and cold modalities, acupuncture, physical therapy, transcutaneous electrical nerve stimulation, activity modification or restriction, assistive devices, and altering body position/posture. Psychological strategies included relaxation, prayer or meditation, therapy, and rest/sleep. Self-initiated strategies included dietary or herbal supplements, dietary modifications, and complementary and alternative medicine. Overall, the number of strategies reported among the studies ranged from five to 28 (out of 44 identified strategies). Limited data on pain outcomes was reported in 15 studies, and included satisfaction with pain management strategies, pain interference on daily activities, adverse events, lost work or restricted activity days, emergency department visits, and disabilities.ConclusionsA wide variety and large number of pharmacological and non-pharmacological strategies to manage chronic pain were reported, consistent with the use of multidomain strategies. High levels of use of both NSAIDs and opioids also were reported.ImplicationsComprehensive review and consultation with patients about their pain management strategies is likely needed for optimal outcomes. Additional research is needed to determine: how many, when, and why multidomain strategies are used; the relationship between opioid use, multidomain management strategies, and level of pain; how multidomain strategies relate to outcomes; and if adding strategies to a pain management plan increases the risk of adverse events or interactions, and increases an individuals pain management burden.

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