scholarly journals Multimodal Local Opioid Prescribing Intervention Outcomes in Chronic Noncancer Pain Management

2019 ◽  
Vol 32 (4) ◽  
pp. 559-566
Author(s):  
Natalia P. Arizmendez ◽  
Fabiana Kotovicz ◽  
Jessica J. F. Kram ◽  
Dennis J. Baumgardner
Keyword(s):  
Pain Management ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Noncancer Pain

scholarly journals What are Future Pain Physicians Learning? A Survey of Opioid Prescribing Practices Among US Pain Fellowship Programs

2019 ◽  
Vol 6 (22;6) ◽  
pp. 549-554 ◽  
Author(s):  
Ferdinand Iannaccone
Keyword(s):  
United States ◽  
Pain Management ◽  
Clinical Training ◽  
The United States ◽  
Prescribing Practices ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Prescribe Opioid ◽  
Fellowship Programs ◽  
Noncancer Pain

Background: Pain physicians have long been seen as subspecialists that commonly prescribe opioid medications, but the reality exists that primary care, oncologists, and surgical subspecialists find themselves embroiled in these clinical decisions just as frequently. It is a reasonable hope that pain physicians emerge as leaders in navigating these muddy waters, and the most important time to engrave practice standards is during clinical training. Objectives: It was our hope to survey Accreditation Council for Graduate Medical Education (ACGME) pain fellowship programs throughout the United States in regard to practice behaviors for opioid prescribing in chronic noncancer pain (CNCP), and to assess what future pain physicians are learning during their training. Study Design: We developed a succinct, 8-question survey that attempted to gauge several aspects of opioid prescribing practices for CNCP. A survey was prepared in electronic format and e-mailed to each program director or chair of every ACGME accredited pain program in the United States. Methods: Our results were anonymously collected and percentage of response to each question was presented in bar graph format. The survey was prepared and initially sent out in November 2017 and intermittently redistributed through April 2018. Results: Of the 117 surveys sent through Survey Monkey, 42 responses were returned and collected, 39 fully completed surveys, and 3 partial completions, an estimate of roughly one-third of US ACGME pain fellowship programs. Limitations: Completion of our survey was voluntary, roughly 35% of ACGME programs submitted a response. Conclusions: Data displayed in collected responses illustrate that although there is variance in opioid prescribing practices for CNCP, many programs are limiting what they use opioids for and have substantial nonopioid pharmacologic and or interventional aspects to their practice. Future pain physicians throughout the country are learning diverse methods of pain management, with opioids being only a part of their toolbox. Key words: Opioids, ACGME, pain management fellowship, guidelines, teaching

How opioid prescribing policies influence primary care clinicians’ treatment decisions and conversations with patients with chronic pain

2021 ◽  
Vol 17 (6) ◽  
pp. 499-509
Author(s):  
Elizabeth C. Danielson, PhD ◽  
Christopher A. Harle, PhD ◽  
Sarah M. Downs, MPH ◽  
Laura Militello, MA ◽  
Olena Mazurenko, MD, PhD
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Treatment Decisions ◽  
Healthcare Organizations ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Prevention Guideline ◽  
Multistep Process ◽  
Primary Care Clinicians ◽  
Noncancer Pain

Objective: The 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain aimed to assist primary care clinicians in safely and effectively prescribing opioids for chronic noncancer pain. Individual states, payers, and health systems issued similar policies imposing various regulations around opioid prescribing for patients with chronic pain. Experts argued that healthcare organizations and clinicians may be misapplying the federal guideline and subsequent opioid prescribing policies, leading to an inadequate pain management. The objective of this study was to understand how primary care clinicians involve opioid prescribing policies in their treatment decisions and in their conversations with patients with chronic pain.Design: We conducted a secondary qualitative analysis of data from 64 unique primary care visits and 87 post-visit interviews across 20 clinicians from three healthcare systems in the Midwestern United States. Using a multistep process and thematic analysis, we systematically analyzed data excerpts addressing opioid prescribing policies.Results: Opioid prescribing policies influenced clinicians’ treatment decisions to not initiate opioids, prescribe fewer opioids overall (theme #1), and begin tapering and discontinuation of opioids (theme #2) for most patients with chronic pain. Clinical precautions, described in the opioid prescribing policies to monitor use, were directly invoked during visits for patients with chronic pain (theme #3).Conclusions: Opioid prescribing policies have multidimensional influence on clinician treatment decisions for patients with chronic pain. Our findings may inform future studies to explore mechanisms for aligning pressures around opioid prescribing, stemming from various opioid prescribing policies, with the need to deliver individualized pain care.

Interventions to Influence Opioid Prescribing Practices for Chronic Noncancer Pain: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 60 (1) ◽  
pp. e15-e26
Author(s):  
Michael Asamoah-Boaheng ◽  
Oluwatosin A. Badejo ◽  
Louise V. Bell ◽  
Norman Buckley ◽  
Jason W. Busse ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Prescribing Practices ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Noncancer Pain

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.

Impact of a pharmacist-developed protocol on the cardiac monitoring of methadone in chronic noncancer pain management

2009 ◽  
Vol 49 (5) ◽  
pp. e102-e109
Author(s):  
Emily Weidman-Evans ◽  
Tibb F. Jacobs ◽  
Philip Isherwood ◽  
Jeffery D. Evans ◽  
Tara Jenkins
Keyword(s):  
Pain Management ◽  
Cardiac Monitoring ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain

The Evolving Role of Long-Term Pharmacotherapy for Opioid-Induced Constipation in Patients Being Treated for Noncancer Pain

2017 ◽  
Vol 32 (5) ◽  
pp. 558-567 ◽  
Author(s):  
Brandi L. Bowers ◽  
Andrew J. Crannage
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Adverse Effects ◽  
Chronic Pain Management ◽  
Unique Challenge ◽  
Chronic Noncancer Pain ◽  
Long Term Treatment ◽  
Noncancer Pain

Nationally, the prescription of opioids for acute and chronic pain is increasing. As opioid use continues to expand and become of increased concern for health-care practitioners, so do the adverse effects and long-term management of those effects. Opioid-induced constipation (OIC) presents a unique challenge because tolerance does not develop to this particular adverse effect, making chronic pain management a delicate balance between relieving pain and preventing long-term adverse effects such as constipation and dependence. Several agents have been developed for the treatment of OIC in patients with chronic noncancer pain on the basis of short-term studies of 12 weeks or less. However, chronic pain management often extends beyond this 12-week boundary, resulting in health-care professionals questioning the safety and efficacy of continued treatment with OIC agents. This review evaluates available literature on long-term treatment of OIC in patients with chronic noncancer pain with lubiprostone, naloxegol, and methylnaltrexone as well as preliminary results of the recently completed naldemedine long-term trial, COMPOSE-3.

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