scholarly journals Risk Assessment of Opioid Misuse in Italian Patients with Chronic Noncancer Pain

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Renata Ferrari ◽  
Genni Duse ◽  
Michela Capraro ◽  
Marco Visentin
Keyword(s):  
Predictive Validity ◽  
Psychological Intervention ◽  
Opioid Therapy ◽  
Self Report ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Chronic Noncancer Pain ◽  
Good Internal Consistency ◽  
Noncancer Pain ◽  
Pain Patients

Objective. Opioid therapy in patients with chronic noncancer pain must be preceded by evaluation of the risk of opioid misuse. The aim of this study was to evaluate the predictive validity of the Italian translation of the Pain Medication Questionnaire (PMQ) and of the Diagnosis Intractability Risk and Efficacy Score (DIRE) in chronic pain patients. Design. 75 chronic noncancer pain patients treated with opioids were enrolled and followed longitudinally. Risk of opioid misuse was evaluated through PMQ, DIRE, and the physician’s clinical evaluation. Pain experience and psychological characteristics were assessed through specific self-report instruments. At follow-ups, pain intensity, aberrant drug behaviors, and presence of the prescribed opioid and of illegal substances in urine were also checked. Results. PMQ demonstrated good internal consistency (Cronbach’s α=0.77) and test-retest reliability (r=0.86). Significant correlations were found between higher PMQ scores and the number of aberrant drug behaviors detected at 2-, 4-, and 6-month follow-ups (P<0.01). Also the DIRE demonstrated good predictive validity. Conclusions. The results obtained with specific tools are more reliable than the clinician’s evaluation alone in predicting the risk of opioid misuse; regular monitoring and psychological intervention will contribute to improving compliance and outcome of long-term opioid use.

scholarly journals Efficacy and Practicality of Opioid Therapy in Japanese Chronic Noncancer Pain Patients

2019 ◽  
Vol 20 (3) ◽  
pp. 222-231 ◽  
Author(s):  
Yukari Shindo ◽  
Soushi Iwasaki ◽  
Michiaki Yamakage
Keyword(s):  
Opioid Therapy ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain ◽  
Pain Patients

scholarly journals Health care resource use and cost differences by opioid therapy type among chronic noncancer pain patients

2017 ◽  
Vol Volume 10 ◽  
pp. 1713-1722 ◽  
Author(s):  
Pamela Landsman-Blumberg ◽  
Nathaniel Katz ◽  
Kavita Gajria ◽  
Anna D’Souza ◽  
Sham L Chaudhari ◽  
...  
Keyword(s):  
Health Care ◽  
Resource Use ◽  
Opioid Therapy ◽  
Health Care Resource ◽  
Chronic Noncancer Pain ◽  
Health Care Resource Use ◽  
Noncancer Pain ◽  
Pain Patients ◽  
Cost Differences

Opioid Misuse and Addiction Among Patients With Chronic Pain

2019 ◽  
pp. 339-354
Author(s):  
Marc O. Martel ◽  
Robert N. Jamison
Keyword(s):  
Chronic Pain ◽  
Opioid Therapy ◽  
Screening Tools ◽  
Prescription Opioid ◽  
Opioid Misuse ◽  
Chronic Noncancer Pain ◽  
Medication Misuse ◽  
Opioid Medications ◽  
Noncancer Pain

Chapter 20 provides an introduction to understanding the prevalence and risk factors as well as screening tools for assessing opioid misuse and addiction in patients with chronic pain. In the era of the opioid epidemic in North America and beyond, the use of prescription opioid medications to help improve function in chronic noncancer pain is frequently debated. Out of fear of iatrogenic addiction, litigation, and/or potential medication misuse, some clinicians are refusing to prescribe opioids for chronic pain. Evidence indicates that rates of opioid misuse and addiction are fairly high among chronic pain patients prescribed long-term opioid therapy, but there is consensus that opioids can be safe and effective for carefully selected and monitored patients.

A Two-Year Prospective Multicenter Study of Opioid Therapy for Chronic Noncancer Pain: Prescription Trends and Predictors

Pain Medicine ◽  
2018 ◽  
Vol 20 (11) ◽  
pp. 2166-2178 ◽  
Author(s):  
Dalila R Veiga ◽  
Liliane Mendonça ◽  
Rute Sampaio ◽  
José M Castro-Lopes ◽  
Luís F Azevedo
Keyword(s):  
Chronic Pain ◽  
Clinical Outcomes ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain ◽  
Opioid Users

Abstract Objectives Opioid use in chronic pain has increased worldwide in recent years. The aims of this study were to describe the trends and patterns of opioid therapy over two years of follow-up in a cohort of chronic noncancer pain (CNCP) patients and to assess predictors of long-term opioid use and clinical outcomes. Methods A prospective cohort study with two years of follow-up was undertaken in four multidisciplinary chronic pain clinics. Demographic data, pain characteristics, and opioid prescriptions were recorded at baseline, three, six, 12, and 24 months. Results Six hundred seventy-four CNCP patients were recruited. The prevalence of opioid prescriptions at baseline was 59.6% (N = 402), and 13% (N = 86) were strong opioid prescriptions. At 24 months, opioid prescription prevalence was as high as 74.3% (N = 501), and strong opioid prescription was 31% (N = 207). Most opioid users (71%, N = 479) maintained their prescription during the two years of follow-up. Our opioid discontinuation was very low (1%, N = 5). Opioid users reported higher severity and interference pain scores, both at baseline and after two years of follow-up. Opioid use was independently associated with continuous pain, pain location in the lower limbs, and higher pain interference scores. Conclusions This study describes a pattern of increasing opioid prescription in chronic pain patients. Despite the limited improvement of clinical outcomes, most patients keep their long-term opioid prescriptions. Our results underscore the need for changes in clinical practice and further research into the effectiveness and safety of chronic opioid therapy for CNPC.

Attributes, Attitudes, and Practices of Clinicians Concerned with Opioid Prescribing

Pain Medicine ◽  
2018 ◽  
Vol 20 (10) ◽  
pp. 1934-1941 ◽  
Author(s):  
Zayd Razouki ◽  
Bushra A Khokhar ◽  
Lindsey M Philpot ◽  
Jon O Ebbert
Keyword(s):  
Monitoring Program ◽  
Program Review ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Attitudes And Practices ◽  
Urine Drug ◽  
Noncancer Pain

Abstract Background Many clinicians who prescribe opioids for chronic noncancer pain (CNCP) express concerns about opioid misuse, addiction, and physiological dependence. We evaluated the association between the degree of clinician concerns (highly vs less concerned), clinician attributes, other attitudes and beliefs, and opioid prescribing practices. Methods A web-based survey of clinicians at a multispecialty medical practice. Results Compared with less concerned clinicians, clinicians highly concerned with opioid misuse, addiction, and physiological dependence were more confident prescribing opioids (risk ratio [RR] = 1.34, 95% confidence interval [CI] = 1.08–1.67) but were more reluctant to do so (RR = 1.13, 95% CI = 1.03–1.25). They were more likely to report screening patients for substance use disorder (RR = 1.18, 95% CI = 1.01–1.37) and to discontinue prescribing opioids to a patient due to aberrant opioid use behaviors (RR = 1.30, 95% CI = 1.13–1.50). They were also less likely to prescribe benzodiazepines and opioids concurrently (RR = 0.40, 95% CI = 0.25–0.65). Highly concerned clinicians were more likely to work in clinics which engage in “best practices” for opioid prescribing requiring urine drug screening (RR = 4.65, 95% CI = 2.51–8.61), prescription monitoring program review (RR = 2.90, 95% CI = 1.84–4.56), controlled substance agreements (RR = 4.88, 95% CI = 2.64–9.03), and other practices. Controlling for clinician concern, prescribing practices were also associated with clinician confidence, reluctance, and satisfaction. Conclusions Highly concerned clinicians are more confident but more reluctant to prescribe opioids. Controlling for clinician concern, confidence in care and reluctance to prescribe opioids were associated with more conservative prescribing practices.

scholarly journals ADHERENCE TO OPIOID THERAPY IN PATIENTS WITH CHRONIC NON-CANCER PAIN ATTENDING A PAIN CLINIC IN MALAYSIA

2018 ◽  
Vol 11 (15) ◽  
pp. 4 ◽  
Author(s):  
Hussam Mizher ◽  
Che S Zin ◽  
Asween R Sani ◽  
Abdul Hadi Bin Mohamed ◽  
Tan H Ling ◽  
...  
Keyword(s):  
Medication Possession Ratio ◽  
Opioid Therapy ◽  
Pain Clinic ◽  
Pain Intensity Score ◽  
Opioid Use ◽  
Chronic Noncancer Pain ◽  
Number Of Patients ◽  
Noncancer Pain ◽  
Opioid Users

Objectives: This study examined the adherence to opioid therapy in patients with chronic noncancer pain (CNCP). The prevalence of opioid use and pain scores was also explored.Methods: This cross-sectional study was conducted among patients with noncancer pain attending a pain clinic at a tertiary hospital in Malaysia from August 2016 to February 2017. All patients prescribed with any of the five available opioids (morphine, oxycodone, fentanyl, buprenorphine, and dihydrocodeine) were included in the study, and their medical and prescription records were assessed for further information on opioid use such as the type of opioid, dose, frequency, and duration. The prevalence of opioid use was calculated by dividing the number of opioid users and the total number of patients attending the pain clinic during the study. Adherence was calculated for patients with long-term opioid therapy (>90 days/ year) and measured using the medication possession ratio (MPR). This was derived by sum up the total days covered with medication in the last 365 days; and then divide that by the total days, the medication was prescribed over the same period. A cutoff point of 80% or more was considered as adherence. The pain intensity score was assessed through a numerical scale from 0 (no pain) to 10 (worst possible pain) at four different points (now, on average, least in the last 24 h, and worst in the last 24 h).Results: A total of 555 patients with various noncancer pain conditions attended the pain clinic during the study. The prevalence of opioid use among these patients was 13.5% (n=74/555). Of these, 24.3% (n=18/74) of patients using opioids for long term (>90 days) and were included in the adherence measure. 78% (n=14/18) of these long-term opioid users were adherent to opioid therapy with a reported MPR >80%. 22% (n=4/18) of patients showed nonadherence to opioid therapy with a reported MPR <80%. The mean pain score for both adherent and nonadherent groups was 5/10, and there was no statistical difference between the two groups.Conclusion: The preliminary results of this study demonstrated that the majority of patients with chronic opioid use adhered to their prescribed opioids. The prevalence of opioid use among patients with noncancer pain was low, and the number of patients using opioid for the long term was ~20% which is similar to the finding from the previous study. The future research is required to evaluate the clinical outcomes in patients with CNCP using opioid for long term particularly in nonadherent patients.

scholarly journals Consensus-based approach to managing opioids, including opioid misuse and opioid use disorder, in patients with serious illness: protocol for a modified Delphi process

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045402
Author(s):  
Caroline King ◽  
Robert Arnold ◽  
Emily Dao ◽  
Jennifer Kapo ◽  
Jane Liebschutz ◽  
...  
Keyword(s):  
Palliative Care ◽  
Opioid Therapy ◽  
Opioid Use Disorder ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Serious Illness ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Institutional Review ◽  
Management Guidance

IntroductionManagement of opioid misuse and opioid use disorder (OUD) among individuals with serious illness is an important yet understudied issue. Palliative care clinicians caring for individuals with serious illness, many of whom may live for months or years, describe a complex tension between weighing the benefits of opioids, which are considered a cornerstone of pain management in serious illness, and serious opioid-related harms like opioid misuse and OUD. And yet, little literature exists to inform the management of opioid misuse and OUDs among individuals with serious illness. Our objective is to provide evidence-based management guidance to clinicians caring for individuals with serious illness who develop opioid misuse or OUD.Methods and analysisWe chose a modified Delphi approach, which is appropriate when empirical evidence is lacking and expert input must be used to shape clinical guidance. We sought to recruit 60 clinicians with expertise in palliative care, addiction or both to participate in this study. We created seven patient cases that capture important management challenges in individuals with serious illness prescribed opioid therapy. We used ExpertLens, an online platform for conducting modified Delphi panels. Participants completed three rounds of data collection. In round 1, they rated and commented on the appropriateness of management choices for cases. In round 2, participants reviewed and discussed their own and other participants’ round 1 numerical responses and comments. In round 3 (currently ongoing), participants again reviewed rounds 1 and 2, and are allowed to change their final numerical responses. We used ExpertLens to automatically identify whether there is consensus, or disagreement, among responses in panels. Only round 3 responses will be used to assess final consensus and disagreement.Ethics and disseminationThis project received ethical approval from the University of Pittsburgh’s Institutional Review Board (study 19110301) and the RAND Institutional Research Board (study 2020-0142). Guidance from this work will be disseminated through national stakeholder networks to gain buy-in and endorsement. This study will also form the basis of an implementation toolkit for clinicians caring for individuals with serious illness who are at risk of opioid misuse or OUD.

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