Differences in pain, symptom burden, and opioid use among cancer pain patients with active versus non-active disease.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20568-e20568
Author(s):  
Karina J Bouffard ◽  
Lakshmi Koyyalagunta ◽  
Salahardin Abdi ◽  
Mike Hernandez ◽  
Diane M. Novy
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Symptom Burden ◽  
Disease Status ◽  
Pain Medication ◽  
Categorical Variables ◽  
Opioid Use ◽  
Poor Appetite ◽  
Pain Patients ◽  
Active Disease

e20568 Background: Many cancer survivors with non-active disease suffer with pain and other symptoms. This study investigated differences in symptoms and opioid use among cancer pain patients with active versus non-active disease. Methods: Data were obtained from 518 consecutive new patients seen at the Pain Management Center of MD Anderson Cancer Center from 01/01/09 to 06/30/09. Measures: Usual pain was rated on the Brief Pain Inventory. The Edmonton Symptom Assessment Scale (ESAS) was used for ratings of fatigue, shortness of breath, poor appetite, depression, anxiety, drowsiness, difficulty thinking clearly and insomnia. Opioid use was calculated in morphine equivalency daily dose (MEDD) milligrams based on the sum of long- and short-acting opioids used per day. Analyses of Data: Independent samples t-tests were used to make comparisons between patients with active versus non-active disease on continuous variables. Chi-square tests were used to make comparisons across disease status on categorical variables. Results: 349 patients had active disease; 169 patients had non-active disease. Patients with active disease received significantly higher MEDD (125.6 ± 158.8 mg) versus patients with non-active disease (74.4 ± 87.0 mg). Patients with active disease reported significantly higher mean scores on fatigue, poor appetite, and drowsiness. Average weekly pain scores were comparable and moderately high for both groups of patients. Other symptoms and clinical characteristics were not significantly different across disease status. Conclusions: Plausible explanations for the higher opioid use and symptom burden among patients with active disease are cancer treatments and disease progression. A higher level of pain medication is often needed to achieve pain management during active treatment or following recent surgery. The finding of higher fatigue, poor appetite, and drowsiness among those with active disease is also consistent with the symptom burden expected from treatment. Although patients with active disease have a greater symptom burden and need for pain medication, there is a need for pain and symptom management among patients in the non-active disease phase of survivorship.

869 Opioid Utilization in Pediatric Burn Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S273-S274
Author(s):  
Niti Shahi ◽  
Maxene Meier ◽  
Ryan Phillips ◽  
Gabrielle Shirek ◽  
Ashley Banks ◽  
...  
Keyword(s):  
Parent Education ◽  
Multimodal Therapy ◽  
Medication Use ◽  
Pain Medication ◽  
Categorical Variables ◽  
Burn Patients ◽  
Opioid Use ◽  
Over The Counter ◽  
Pain Medications ◽  
Opioid Administration

Abstract Introduction Childhood burns are extremely common and distressing for children and their parents. Pain is the most common complaint and often thought to be undertreated, disrupting care and increasing the risk of post-traumatic stress disorder. There is limited literature on the role of opioids and multimodal therapy in the treatment of burns in pediatric patients. We sought to evaluate the current use of multimodal therapy as well as the use, storage, and disposal of opioids in this patient population. Methods We prospectively surveyed parents of pediatric burn patients (0–18 years old) who presented to the burn clinic within two weeks of burn injury. Parents were surveyed regarding over-the-counter pain medication use and opioid medication use, storage, and disposal in the treatment of their child. Medians and interquartile ranges were used to describe continuous variables and frequencies and percentages were used for categorical variables. Results A total of 92 parents of burn-injured children were surveyed at a single institution in the outpatient burn clinic. The median age of burn-injured children was 3.1 years old, and 50% of patients were male. The majority had a TBSA of 1%. The hand was the most frequently burned location (45.7%). Acetaminophen (58.7%) and ibuprofen (69.6%) were the most common treatments for both constant and breakthrough pain. Approximately 28% (26/92) of patients were prescribed opioids, of which 18.5% (17/92) filled their prescription. Only 29% of patients (5/17) consumed their entire prescription, and a median of 3 doses of opioids remained for those who did not finish the entire prescription. Parents most commonly decided to give their children opioid pain medications because “my child is in severe pain” or “I give my child pain medications as scheduled (written on prescription).” Approximately 40% (7/17) of patients who filled opioid prescriptions stored them in a locked area, and only 35.3% (6/17) were educated on how to dispose of excess opioid pain medication. Conclusions Presently, multimodal therapy with over-the-counter pain medications is used to treat the majority of pediatric burns. This study demonstrates an increased need for education on opioid administration, storage, and disposal for parents of burn-injured children. Applicability of Research to Practice We aimed to evaluate what current trends in opioid use are in pediatric burn patients and areas for improvement in parent education for over-the-counter pain medication use, opioid use, opioid storage, and disposal. From the study, we were able to glean that the majority of patients are successfully managed with over-the-counter pain medications. However, parents and patients managed with opioids need additional education on appropriate administration of opioid pain medications, safe locked storage of opioids, and opioid disposal. This demonstrates an area for quality improvement inpatient and outpatient.

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.

A physician's practice, attitude and approach for the management of palliative care for cancer.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 112-112
Author(s):  
Shijian Feng ◽  
Qiongwen Zhang ◽  
Chunhua Yu ◽  
Huashan Shi ◽  
Wenxiu Yao ◽  
...  
Keyword(s):  
Pain Management ◽  
Cancer Pain ◽  
Professional Education ◽  
Physician Education ◽  
Dose Titration ◽  
Categorical Variables ◽  
Cancer Pain Management ◽  
Patients With Cancer ◽  
Knowledge Of Cancer ◽  
Chi Square Analysis

112 Background: Pain is the most frequent and persistent symptom experienced by cancer patients. Thus, exploring how to achieve the best outcome of cancer pain management in China is clearly extremely important. Our study focuses on the Chinese physicians' current clinical practice, attitudes, toward and barriers to opioid use, and knowledge of cancer pain management. Methods: A face to face survey include 23 items was designed and conducted to the doctors working with cancer pain managements (oncologists, internists, hematologists, et al) responsible for the care of patients with cancer in 11 tertiary hospitals in China. Descriptive statistics were used to characterize the total sample and for multiple choice questions and each item. Chi-square analysis was used to examine the difference between categorical variables. Results: 500 questionnaires were received out of 550. Most (62.2%) physicians assessed patients’ cancer pain every day, but 85.5% never or occasionally treated patients’ cancer pain together with psychologists. Most respondents appreciated that > 50% of patients with cancer experience severe chronic pain warranting analgesic therapy (73.5%), and that this therapy could control pain adequately in > 50% of patients (77.2%). More than half of physicians indicated that opioid dose titration in patients with poor pain control and assessment of the cause and severity of pain were urgently needed knowledge for cancer pain management. A majority (65.0%) of physicians responded incorrectly (60.0% agreed and 5.0% had no opinion) that they would increase the dosage of a potent opioid and administer it every 4 h as needed (q4h PRN). Inadequate assessment of pain and pain management (63.0%), patients' reluctance to take opioids (62.2%), and inadequate staff knowledge of pain management (61.4%) were the three most frequently barriers to physicians’ pain management. Conclusions: Our results revealed that physician education in cancer pain management in China does not currently provide the necessary levels of knowledge and skills. Therefore, effective strategies and professional education are still needed to encourage physicians’ concern with, experience in, and knowledge of cancer pain management in China.

scholarly journals Cancer Pain Management Insights and Reality in Southeast Asia: Expert Perspectives From Six Countries

2016 ◽  
Vol 2 (4) ◽  
pp. 235-243 ◽  
Author(s):  
Francis O. Javier ◽  
Cosphiadi Irawan ◽  
Marzida Binti Mansor ◽  
Wimonrat Sriraj ◽  
Kian Hian Tan ◽  
...  
Keyword(s):  
Pain Management ◽  
Southeast Asia ◽  
Cancer Pain ◽  
Management Practices ◽  
Southeast Asian ◽  
Asian Countries ◽  
Opioid Use ◽  
Cancer Pain Management ◽  
The Status ◽  
Southeast Asian Countries

This expert opinion report examines the current realities of the cancer pain management landscape and the various factors that hinder optimal pain control in six countries in Southeast Asia, describes ongoing efforts to advance patient care, and discusses approaches for improving cancer pain management. Information was gathered from leading experts in the field of cancer pain management in each country through an initial meeting and subsequent e-mail discussions. Overall, there are vast disparities in cancer pain management practices and access to opioids in the Southeast Asian countries. The experts considered cancer pain as being generally undermanaged. Access to opioids is inadequate in most countries, and opioid use for analgesia remains inadequate in the region. Several system-, physician-, and patient-related barriers to adequate pain relief were identified, including widespread over-regulation of opioid use, shortage of trained health care workers, inadequacies in pain assessment and knowledge about managing pain, and widespread resistance among patients and physicians toward opioid treatment. According to the experts, many of the ongoing initiatives in the Southeast Asian countries are related to educating patients and physicians on cancer pain management and opioid use. Efforts to improve opioid availability and reduce regulatory barriers in the region are limited, and much work is still needed to improve the status of cancer pain management in the region. Enacting necessary change will require recognition of the unique needs and resources of each country and collaboration across interdisciplinary professional teams to improve cancer pain care in this region.

scholarly journals Evaluating health and well-being outcomes following the South Gloucestershire Pain Review pilot for patients on long-term opioids for chronic non-cancer pain

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703445
Author(s):  
Jo Kesten ◽  
Lauren Scott ◽  
Kevin Bache ◽  
Rosie Closs ◽  
Sabi Redwood ◽  
...  
Keyword(s):  
Primary Care ◽  
Pain Management ◽  
Cancer Pain ◽  
Management Strategies ◽  
Well Being ◽  
Service Users ◽  
Opioid Use ◽  
The South ◽  
Health And Well Being

BackgroundThe South Gloucestershire Pain Review pilot is an individually-tailored service to help primary care patients on long-term (>3 months) treatment with opioid painkillers for chronic non-cancer pain understand their relationship with opioids and support alternative non-drug-based pain management strategies. The pilot was based in two GP practices in South Gloucestershire.AimTo evaluate the health and well-being outcomes and perceived impact of the pilot service to inform future service development.MethodQuantitative data were collected for all enrolled patients on demographics; opioid use, misuse and dose; and pre-post intervention changes in health, well-being, quality of life (QoL), pain intensity/relief, and interference with life measures. Twenty-five semi-structured interviews (18 service users, seven service providers) explored experiences of the pilot including perceived impacts.ResultsFifty-nine patients were invited to use the service and 34 (58%) enrolled. The median prescribed opioid dose reduced from 90 mg (interquartile range [IQR] 60–240) at baseline to 72 mg (IQR 30–160) at follow-up (P<0.001). On average, service users showed improvement on all health, well-being, and QoL outcomes except pain relief. The service was received positively. Perceived benefits related to well-being and QoL, use of pain management strategies (for example pacing), changes in medication use and changes in primary care use.ConclusionThe pilot has shown promising results. The service was viewed as acceptable and health and well-being outcomes suggest a benefit. Following further development of the service, a randomised controlled trial is needed to formally test the effects of this type of care pathway on pain management and reducing long-term opioid use.

Pain in children

2018 ◽  
Author(s):  
Julia Wager ◽  
Boris Zernikow
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Cancer Pain ◽  
Acute Pain ◽  
Pain Assessment ◽  
Education For All ◽  
Special Focus ◽  
Assessment And Treatment ◽  
Specialized Service ◽  
Pain Patients

Pain management in children is a specialized service. Pain aetiology, assessment, and treatment vary at every age from pre-term foetuses at 23 weeks gestation to adolescence. In this chapter of European Pain Management advances in our understanding of pain assessment are reviewed, particularly in the use of developmentally relevant technology. Advances in acute pain, cancer pain, and in chronic pain are also reviewed, with a special focus on innovations in multidisciplinary treatments for chronic pain. There is a need to raise awareness and understanding of the needs of paediatric pain patients, and their family members. Education for all professionals who interact with pain patients is essential, as is the need to invest in specialized pain management services, and professionals, across Europe.

scholarly journals 2-Week Post-Operative Opioid Use after Primary Hallux Valgus Correction

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0046
Author(s):  
Zachary T. Thier ◽  
Kenna C. Altobello ◽  
Tyler A. Gonzalez ◽  
J. Ben Jackson
Keyword(s):  
Body Weight ◽  
Pain Management ◽  
Hallux Valgus ◽  
The United States ◽  
Pain Medication ◽  
Clinic Visit ◽  
Objective Data ◽  
Opioid Use ◽  
Adductor Canal ◽  
Post Operative Pain

Category: Bunion; Other Introduction/Purpose: More than 200,000 surgeries for hallux valgus correction occur annually in the United States. Due to the post-operative pain associated with the procedure, opioids are often prescribed to help manage pain. The opioid epidemic has led to a 78-billion-dollar economic impact. Given the lack of objective data on opioid use and the difficulty of addressing a patient’s post-operative pain, we sought to quantify, through a prospective analysis, patient’s narcotic use after hallux valgus surgery. Objective data may help guide the surgeon in the type and number of opioids utilized after surgery. Methods: Adult patients undergoing primary hallux valgus surgery were recruited from two surgeon’s institution. At the pre- operative visit, patients were consented and completed a demographical questionnaire. Data was collected from the operative and PACU record, as well as the 2-week post-operative visit. A simple statistical analysis was performed to determine average quantity and type of opioid and non-opioid pain medication used in the PACU and for post-operative pain management. Results: 33 subjects were prospectively enrolled and followed. The average time until the first post-operative clinic visit was 13.53 days. The average opioid pain medication consumption during this period was 20.766 (0-66) pills, with a morphine milligram equivalents (MME)/kg of body weight at 1.69. (78.8%) were prescribed hydrocodone/acetaminophen 5/325mg and 7 subjects (21.2%) were prescribed oxycodone/acetaminophen 5/325 for post-operative pain management. 84.8% of subjects (28/33) received a local block, including 2 femoral, 2 ankle, 13 popliteal, 3 sciatic, 3 adductor canal, 4 popliteal and saphenous, and 1 popliteal and adductor canal. 24.2% (8/33) of subjects received opioid pain medication in the PACU post-operatively with a MME/kg of body weight at 0.135 per subject. Conclusion: Based on our prospective study, we recommend an initial prescription of 30 5mg hydro/oxycodone pain pills, as this represents the 3rd quartile of consumption.

scholarly journals Perspectives of pain specialists, patients, and family members on long-term opioid use for chronic non-cancer pain: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rattaphol Seangrung ◽  
Thongchai Tempeetikul ◽  
Supasit Pannarunothai ◽  
Supalak Sakdanuwatwong
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Qualitative Study ◽  
Adverse Events ◽  
Cancer Pain ◽  
Family Members ◽  
Opioid Therapy ◽  
Functional Improvement ◽  
Opioid Use

Abstract Background Opioids are currently prescribed for chronic non-cancer pain (CNCP), and some patients use opioids continuously for long-term treatment. Stakeholders’ awareness about long-term opioid therapy is essential for improving the safety and effectiveness of pain treatment. The purpose of this study is to explore the perspectives of pain specialists, patients, and family caregivers about long-term opioid use in CNCP management. Methods This study was a qualitative study and adhered to the COREQ guidelines. Pain specialists (n = 12), patients (n = 14), and family members (n = 9) were recruited to the study by purposive sampling at the Pain Clinic of Ramathibodi Hospital. Semi-structured interviews were recorded, verbatim transcribed, conceptually coded, and analyzed using Atlas.ti 8.0. Results All groups of participants described opioids as non-first-line drugs for pain management. Opioids should be prescribed only for severe pain, when non-opioid pharmacotherapy and non-pharmacological therapies are not effective. Patients reported that the benefits of opioids were for pain relief, while physicians and most family members highlighted that opioid use should improve functional outcomes. Physicians and family members expressed concerns about opioid-related side effects, harm, and adverse events, while patients did not. Patients confirmed that they would continue using opioids for pain management under supervision. However, physicians stated that they would taper off or discontinue opioid therapy if patients’ pain relief or functional improvement was not achieved. Both patients and family members were willing to consider non-pharmacological therapies if potential benefits existed. Patient education, doctor–patient/family relationships, and opioid prescription policies were proposed to enhance CNCP management. Conclusion Long-term opioid therapy for CNCP may be beneficial in patients who have established realistic treatment goals (for both pain relief and functional improvement) with their physicians. Regular monitoring and evaluation of the risks and benefits, adverse events, and drug-related aberrant behaviors are necessary. Integrated multimodal multidisciplinary therapies and family member collaborations are also important for improving CNCP management.

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