scholarly journals Opioid Prescriptions in Chronic Pain Rehabilitation. A Prospective Study on the Prevalence and Association between Individual Patient Characteristics and Opioids

2021 ◽  
Vol 10 (10) ◽  
pp. 2130
Author(s):  
Mikael Svanberg ◽  
Britt-Marie Stålnacke ◽  
Patrick D. Quinn ◽  
Katja Boersma
Keyword(s):  
Chronic Pain ◽  
Depressive Symptoms ◽  
Patient Characteristics ◽  
Opioid Therapy ◽  
Pain Coping ◽  
Opioid Prescription ◽  
Target Period ◽  
Specialist Rehabilitation ◽  
Unique Predictor ◽  
A Prospective Study

While against recommendations, long-term opioid therapy (LTOT) for chronic pain is common. This study aimed to describe the prevalence of opioid prescriptions and to study the association of patient characteristics (demographics, pain characteristics, anxiety, depressive symptoms and pain coping) with future LTOT. The sample included N = 1334 chronic musculoskeletal pain patients, aged 18–65, who were assessed for Interdisciplinary Multimodal Pain Rehabilitation (IMMR) in Swedish specialist rehabilitation. Prescriptions were tracked across a two-year target period after assessment. In total, 9100 opioid prescriptions were prescribed to 55% of the sample (Mmedian = 6, IQR = 14). Prediction of LTOT was analyzed separately for those who did (24%) and did not (76%) receive IMMR. The odds of receiving opioids was similar for these subsamples, after controlling for differences in baseline characteristics. In both samples, there were significant associations between patient characteristics and future opioid prescriptions. Dysfunctional pain coping was a unique predictor of LTOT in those who received IMMR while pain intensity and depressive symptoms were unique predictors in those who did not receive IMMR. The results underscore that opioid treatment is common among patients in chronic pain rehabilitation and relates to pain and psychological factors. Understanding in detail why these factors relate to opioid prescription patterns is an important future study area as it is a prerequisite for better management and fundamental for preventing overuse.

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.

scholarly journals Opioid Dosage Levels, Concurrent Risk Factors and Self-Perceptions among Chronic Pain, Opioid-Managed Individuals at Elevated Risk for Opioid Overdose

2021 ◽  
Vol 14 (12) ◽  
pp. 1279
Author(s):  
Matthew S. Ellis ◽  
Zachary A. Kasper ◽  
Mark Gold ◽  
Theodore J. Cicero
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Medical Condition ◽  
Opioid Therapy ◽  
Opioid Overdose ◽  
Provider Communication ◽  
Online Questionnaire ◽  
Opioid Prescription ◽  
Organizational Policies ◽  
The Relationship

While current opioid prescribing guidelines highlight a dose-response relationship between therapeutic management and overdose risk, other concurrent risk factors have also been identified. However, there is little data in assessing the relationship between risk factor prevalence, associated provider communication, and subsequent perceptions of overdose risk among chronic pain, opioid-managed (CPOM) patients. An online questionnaire was distributed in June 2020 to a sample of CPOM individuals (n = 190) treated with an opioid prescription at or above 50 daily MME, or any dosage alongside benzodiazepines. CPOM individuals reported a mean daily MME of 470, with half (52.6%) receiving a concurrent benzodiazepine prescription. All patients reported past month alcohol use, and 67.4% indicated a risk-elevating diagnosed medical condition. In assessing provider communication, 41.6% reported no discussion focusing on the risks of one’s opioid therapy. Subsequently, 62.1% perceived themselves as having “no risk”, and 60.0% were “not at all concerned” (60.0%) about experiencing an opioid overdose. Organizational policies should focus on implementing consistent methods of patient education regarding overdose risk, as well as assessments of behaviors or characteristics that my increase an individual’s risk of opioid overdose. These policies should also include other forms of evidence-based overdose risk prevention such as co-prescriptions of naloxone.

scholarly journals Opioid Therapy in the Treatment of Chronic Pain Conditions in Germany

2015 ◽  
Vol 3;18 (3;5) ◽  
pp. E323-E331 ◽  
Author(s):  
Andreas Werber
Keyword(s):  
Chronic Pain ◽  
Health Insurance ◽  
Opioid Therapy ◽  
Health Insurance Company ◽  
Insurance Company ◽  
Opioid Prescription ◽  
Opioid Medication ◽  
Chronic Pain Conditions ◽  
Strong Opioids ◽  
Tumor Pain

Background: Primarily used for treating malignant pain, opioids are recently applied for chronic non-tumor pain. For the lack of evidence based strategies from long-term studies, opioids are discussed controversially, esp. considering cost-benefit. Objectives: The purpose of this study is to evaluate characteristics in prescribing opioids for tumor and non-tumor pain conditions. Study design: Cost effectiveness study/observational study Setting/Methods: Health insurance data of a German statutory health insurance company (N = 6.800.000, data acquisition from 2006 to 2010) was evaluated by assigning opioid prescriptions to certain pain related diagnoses using CART (Classification And Regression Tree) segmentation analysis. Age- and gender-specific characteristics of prescriptions were calculated. Results: The number of prescriptions of opioid prescriptions increased linearly. Prescriptions of mild opioids were decreasing for non-tumor pain, but increasing for tumor pain, while the number of prescriptions of strong opioids was increasing both for tumor and nontumor pain. Differences occurred in terms of duration and kind of the preferred substances, including the considerations of common contraindications (e.g. somatoform disorders). The majority of strong opioids being prescribed for non-tumor pain were fentanyl pain patches for 40 to 45 year old males with average annual costs of 1833 Euros per patient. Out of 21000 patients with somatoform pain disorder, 44.4% were treated with opioids (20.7% with mild, 23.7% with strong opioids). Limitations: The results did not consider if the opioid medication was actually taken by the patients. Another difference in terms of representativeness might occur since the gender distribution varies between the official statistical data and data collected by the health insurance company. Because of the acquisition of the data, no conclusions about possible correlation of pain syndromes and educational and social classes are possible. Tumor patients who received an opioid prescription for non-tumor pain could not be excluded. Conclusions: While the overall expenditure of the health insurance companies increased, it remains unknown which patient is receiving a particular opioid medication. Prescribing behavior was often not consistent with common indications and contraindications. Key words: Opioid therapy, chronic pain conditions

Review article. Opioid analgesics: Does potency matter?

2014 ◽  
Vol 10 (4) ◽  
pp. 263 ◽  
Author(s):  
Steven D. Passik, PhD ◽  
Lynn Webster, MD
Keyword(s):  
Chronic Pain ◽  
Opioid Analgesics ◽  
Patient Characteristics ◽  
Immediate Release ◽  
Opioid Therapy ◽  
Abuse Liability ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Wide Range ◽  
Effective Analgesia

Prescription opioid analgesics with a wide range of potencies are currently used for the treatment of chronic pain. Yet understanding the clinical relevance and therapeutic consequences of opioid potency remains ill defined. Both patients and clinicians alike have misperceptions about opioid potency, expecting that lesspotent opioids will be less effective or fearing that more-potent opioids are more dangerous or more likely to be abused. In this review, common myths about the potency of opioid analgesics will be discussed. Clinicians should understand that pharmacologic potency per se does not necessarily imply more effective analgesia or higher abuse liability. Published dose conversion tables may not accurately calculate the dose for effective and safe rotation from one opioid to another in patients receiving long-term opioid therapy because they are based on limited data that may not apply to chronic pain. Differences in pharmacologic potency are largely accounted for by the actual doses prescribed, according to individualized patient need. Factors for achieving effective analgesia and reducing the risks involved with opioid use include careful medication selection based on patient characteristics, appropriate dosing titration and opioid rotation practices, knowledge of product formulation characteristics (eg, extended release, immediate release, and tamper-resistant features), and an awareness of differences in opioid pharmacokinetics and metabolism. Clinicians should remain vigilant in monitoring patients on any opioid medication, regardless of classification along the opioid potency continuum.

scholarly journals Opioids in the treatment of non-specific acute and chronic pain

Pain medicine ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 22-36
Author(s):  
D V Dmytriiev ◽  
O A Zaletska ◽  
D I Bortnik
Keyword(s):  
Chronic Pain ◽  
Opioid Analgesics ◽  
Opioid Therapy ◽  
Opioid Antagonists ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Opioid Prescription ◽  
Economic Problems ◽  
Partial Agonists ◽  
Prescription Form ◽  
Effective Use

After reading this article, the reader will be familiar with the general classes of opioid agonists and partial agonists, the basics of the pharmacokinetics and pharmacodynamics of opioids, the risks of opioid therapy and the requirements for the safe and effective use of opioids in acute and chronic pain. The use of opioids during surgical procedures or anesthesia is not discussed. Also, there is no discussion about various available opioid antagonists that are used to treat overdose and the various disorders associated with their use (including naloxone and naltrexone). Opioids are available, the most powerful and effective analgesics, and have become acceptable drugs for the treatment of acute and cancerous pain. However, there is concern about their use in case of chronic pain, if there is no cancer, because they are long-range ineffective but best suited for stopping this pain. Opioid prescription must be monitored for better use. Chronic pain creates discomfort for these patients, reducing their productivity and efficiency, which, in turn, can lead to economic problems in the country. The choice of Nalbuphine is due to the following reasons: the opioid, which is comparable to morphine by its analgesic potential, but has a better safety profile for nausea, vomiting and respiratory depression; not subject to strict quantitative accounting (extract on prescription form 1); the choice of opioid analgesics is significantly limited in Ukraine.

Chronic Pain Coping Inventory

1995 ◽  
Author(s):  
Mark P. Jensen ◽  
Judith A. Turner ◽  
Joan M. Romano ◽  
Susan E. Strom
Keyword(s):  
Chronic Pain ◽  
Pain Coping

Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711581
Author(s):  
Charlotte Greene ◽  
Alice Pearson
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Practice Guidelines ◽  
Best Practice ◽  
Evidence Base ◽  
High Dose ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Best Practice Guidelines

BackgroundOpioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.AimAn audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.MethodA search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine’s best-practice guidelines were used.ResultsDemographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. Indications: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. Review: 56% 4-week, 70% past year.ConclusionOpioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

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