scholarly journals Attitudes Toward Opioid Use for Chronic Pain: A Canadian Physician Survey

2003 ◽  
Vol 8 (4) ◽  
pp. 189-194 ◽  
Author(s):  
Patricia K Morley-Forster ◽  
Alexander J Clark ◽  
Mark Speechley ◽  
Dwight E Moulin
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Pain Management ◽  
Physician Education ◽  
Care Practice ◽  
Pain Patient ◽  
Computer Assisted ◽  
Opioid Use ◽  
Severe Chronic Pain ◽  
Noncancer Pain

OBJECTIVES: To measure chronic pain patient volumes seen in primary care practice; to determine what medications physicians choose for the treatment of moderate to severe chronic pain; to identify barriers to the use of opioids in the treatment of chronic pain; and to assess physicians' attitudes toward the current management of chronic pain in Canada.DESIGN: A computer-assisted telephone survey of 100 regionally representative Canadian physicians with a defined interest in palliative care (PC, n=30) or noncancer pain (GP, n=70).SETTING: A survey was conducted by Ipsos-Reid in June 2001. Only physicians who met the eligibility criteria of having written 20 or more prescriptions for moderate to severe pain in the preceding four weeks or having devoted 20% of time to palliative care were eligible to participate.RESULTS: In one month, the average number of patients with moderate to severe chronic pain seen by PCs was 94.2; the average seen by GPs was 44.7. The pain experienced by 83.3% of GP patients was noncancer related. For chronic cancer pain, an opioid analgesic was the treatment of choice of 79% of physicians (48% preferred morphine, 21% codeine, 10% other). For moderate to severe chronic noncancer pain, opioids were the first-line treatment of only 32% of physicians (16% preferred codeine, 16% major opioids) because a significant number preferred either nonsteriodal anti-inflammatory drugs (29%) or acetaminophen (16%). Thirty-five per cent of GPs and 23% of PCs would never use opioids for noncancer pain, even when described as severe. Chronic pain was deemed by 68% of physicians to be inadequately managed. Almost 60% thought that pain management could be enhanced by improved physician education. Identified barriers to opioid use included addiction potential (37%) and side effects (25%). Seventeen per cent of GPs and 10% of PCs thought that regulatory sanctions limited opioid prescribing.CONCLUSIONS: Even among physicians experienced in chronic pain treatment, there is a reluctance to use opioids for severe nonmalignant pain. One-half of the survey participants believed that there was a need for improved physician education in pain management, including the use of opioids.

Opioid use disorder and chronic pain: challenges for palliative care practice

2019 ◽  
Vol 25 (9) ◽  
pp. 453-457
Author(s):  
Brenda Peters-Watral
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Substance Use ◽  
Pain Management ◽  
Cancer Pain ◽  
Opioid Use Disorder ◽  
Care Practice ◽  
Care Providers ◽  
Opioid Use ◽  
Multiple Cancer

Along with a well-documented increase in opioid use disorder (OUD) and a rapidly escalating rate of fatal overdose in North America, inadequate management of chronic pain remains a pervasive problem. The increasing number of individuals living with OUD also experience multiple cancer risk factors, which are related to their substance use, while people with cancer diagnoses have similar risks of current or past addiction as the general population. Recent pain guidelines focus on chronic non-cancer pain and do not include recommendations for cancer pain management. Managing cancer pain at the end of life is more challenging in people with current or past substance use disorder (SUD), especially OUD. Addressing these challenges requires confronting stigmas and stereotypes, building knowledge among palliative care providers and assessing the risks and benefits of opioids for pain management on an individual basis in order to continue to provide the holistic care.

Pain management

2019 ◽  
pp. 237-316
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Pain Management ◽  
Cancer Pain ◽  
Care Practice ◽  
Total Pain ◽  
Holistic Understanding ◽  
Central Tenet ◽  
The Common ◽  
Palliative Setting

This chapter covers the theoretical and practical basis of managing patients with pain in the palliative setting. It includes a review of the common pharmacological, non-pharmacological and anaesthetic approaches to managing pain as well as emphasizing that all good care must be based on a holistic understanding. The concept of total pain has become a central tenet of palliative care practice. It recognizes that cancer pain is often a complex, chronic pain with multiple, coexisting causes. Effective management of cancer pain requires a multidisciplinary approach that addresses the patient’s concerns and fears, as well as treating the physical aspects of pain. As a result, the provision of analgesics should be combined with the provision of emotional, social, and spiritual supports.

Chronic Pain Management as a Barrier to Pediatric Palliative Care

2013 ◽  
Vol 30 (8) ◽  
pp. 764-767 ◽  
Author(s):  
Lindsay A. Thompson ◽  
Elizabeth Meinert ◽  
Kimberly Baker ◽  
Caprice Knapp
Keyword(s):  
Chronic Pain ◽  
Palliative Care ◽  
Pain Management ◽  
Pediatric Palliative Care ◽  
Chronic Pain Management

Principles of Assessment and Pain Management and Procedures in Pain Management

2018 ◽  
Author(s):  
Francisco A. Loaiciga ◽  
Suresh Reddy
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Interdisciplinary Approach ◽  
Care Practice ◽  
Clear Understanding ◽  
Pain Mechanisms ◽  
Single Presentation ◽  
Basic Concepts ◽  
Outpatient Settings ◽  
Real Challenge

Pain has been a major concern in both inpatient and outpatient settings, particularly in patients with advanced diseases. In recent years, considerable progress has been made in the understanding of both acute and chronic pain mechanisms. The bio psychosocial experience of pain, whether it is a mixture or a single presentation of it’s different components, physical, psychological, social, or spiritual, may present a real challenge to both the patient and the treating team, and thus a clear understanding of it’s complexity, is of prime importance. Effective pain management involves an interdisciplinary approach using multimodal techniques, with the goal being to relieve the patient’s suffering. This chapter discusses basic concepts related to pain and its approach in routine palliative care practice.

Online group pain management for chronic pain: Preliminary results of a novel treatment approach to teletherapy

2019 ◽  
pp. 1357633X1987036
Author(s):  
Timothy Y Mariano ◽  
Limeng Wan ◽  
Robert R Edwards ◽  
Asimina Lazaridou ◽  
Edgar L Ross ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Group Discussion ◽  
Preliminary Investigation ◽  
Skills Training ◽  
Chronic Pain Patient ◽  
Behavioural Therapy ◽  
Pain Patient ◽  
Cognitive Behavioural ◽  
Online Group

Objective This pilot study was designed to determine the feasibility, tolerability, safety, and efficacy of group teletherapy for persons with chronic pain. The aim was to present preliminary outcomes of an open trial of group cognitive behavioural therapy (CBT) teletherapy compared with an in-person chronic pain patient group. Methods We recruited 47 chronic pain patients to participate in an 8-session, 2-hour-per-week, online, structured, CBT-oriented pain management group using WebEx and compared them with 46 subjects who participated in a parallel, content-matched, in-person, weekly group. Both groups included goal setting, skills training, relaxation exercises, group discussion, and practice assignments. All subjects completed baseline measures, which were repeated post-treatment. Those in the online group participated in weekly telephone interviews and rated the perceived helpfulness of the remote group. Results The average age of the online group participants was 54.5 ( ± 14.3) years and 70.2% were female, compared with 59.7 ( ± 13.0) years of age and 57.8% females among the in-person group members. On follow-up, both CBT groups showed modest improvements on the outcome measures. Results of this preliminary investigation comparing online teletherapy with in-person CBT suggest similar benefit. Many participants in the online group rated their experience as very helpful (62.5%; 7–10/10) and most would recommend this programme to others (93.7%; 7–10/10). Discussion Preliminary findings suggest that online group CBT may be as effective in improving coping among persons with chronic pain as in-person groups. More rigorous controlled trials are needed to adequately assess the outcome benefit of online teletherapy for chronic pain.

scholarly journals Using information and communication technologies to improve the management of pain from advanced cancer in the community: Qualitative study of the experience of implementation for patients and health professionals in a trial

2020 ◽  
Vol 26 (4) ◽  
pp. 2435-2445
Author(s):  
Julia Hackett ◽  
Matthew J Allsop ◽  
Sally Taylor ◽  
Michael I Bennett ◽  
Bridgette M Bewick
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Qualitative Study ◽  
Information And Communication Technology ◽  
Communication Technology ◽  
Health Professionals ◽  
Randomised Control Trial ◽  
Care Practice ◽  
Technology System ◽  
Information And Communication

In cancer care, there are emerging information and communication technology systems being developed, enabling real-time information sharing between patients and health professionals. This study explored health professionals’ and patients’ perceptions of their engagement with an information and communication technology system for pain management to understand the mechanisms that could support implementation into routine palliative care practice. This was a qualitative study, embedded within a randomised control trial, using semi-structured face-to-face interviews. Data were analysed using thematic analysis. The role of health professionals was a key component to patient engagement with the information and communication technology system. Where patients engaged with the information and communication technology system, both patients and health professionals reported benefits to system use in addition to usual care. Implementation issues were identified that can be used to guide future system development to support pain management in the context of routine clinical care in palliative care services. Where interventions are dependent on multiple providers, collaborative working and consideration of the context within which they are set are needed.

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