scholarly journals Pharmacogenomic Testing and Patient Perception Inform Pain Pharmacotherapy

2021 ◽  
Vol 11 (11) ◽  
pp. 1112
Author(s):  
Feng-Hua Loh ◽  
Brigitte Azzi ◽  
Alexander Weingarten ◽  
Zvi G. Loewy
Keyword(s):  
Chronic Pain ◽  
Retrospective Study ◽  
Pain Management ◽  
Pain Scale ◽  
Pain Medication ◽  
Intense Pain ◽  
Pain Medications ◽  
Scale Category ◽  
The Impact ◽  
To Receive

(1) Background: Chronic pain is one of the most common reasons for individuals to seek medications. Historically, opioids have been the mainstay of chronic pain management. However, in some patient populations, opioids fail to demonstrate therapeutic efficacy, whereas in other populations, opioids may cause toxic effects, even at lower doses. Response to pain medication is affected by many factors, including an individual’s genetic variations. Pharmacogenomic testing has been designed to help achieve optimal treatment outcomes. This study aimed at assessing the impact of CYP2D6 pharmacogenomic testing on physicians’ choice in prescribing chronic pain medications and patient pain control. (2) Methods: This retrospective study reviewed 107 patient charts from a single site pain management center. All 107 patients received pharmacogenomic testing. The outcomes of interest were confirmation that the optimal pain medication is being administered or a change in the chronic pain medication is warranted as a result of the pharmacogenomic testing. The main independent variable was the pharmacogenomic test result. Other independent variables included patient gender, race, and comorbidities. The retrospective study was reviewed and approved by the Touro College and University System IRB, HSIRB1653E. (3) Results: Patients self-reported pain intensity on a scale of 1–10 before and after pharmacogenomic testing. Then, 100% of patients in the retrospective study were tested for their pain pharmacogenomic profile. Of the 107 patients participating in the study, more than 50% had their medications altered as a result of the pharmacogenomic testing. The percentage of patients with intense pain were decreased post-pharmacogenomic testing (5.6%) as compared to pre-pharmacogenomic testing (10.5%). Patients with intense, moderate, and mild pain categories were more likely to receive changes in pain medications. In contrast, patients with severe pain were less likely to receive a change in pain medication. Hispanic ethnicity was associated with a statistically significantly decrease in a pain scale category. Illegal drug abuse was associated with a decrease in pain scale category. Change in medication dose was associated with a decrease in pain scale category. (4) Conclusion: In this retrospective study, implementation of pharmacogenomic testing demonstrated significant benefits to patients with intense pain undergoing treatment.

scholarly journals An Innovative Electronic Health Toolkit (Our Whole Lives for Chronic Pain) to Reduce Chronic Pain in Patients With Health Disparities: Open Clinical Trial

10.2196/14768 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e14768
Author(s):  
Paula Gardiner ◽  
Salvatore D'Amico ◽  
Man Luo ◽  
Niina Haas
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Low Income ◽  
Self Efficacy ◽  
Medication Use ◽  
Pain Medication ◽  
Chronic Pain Management ◽  
Management Platform ◽  
Electronic Health ◽  
The Impact

Background Chronic pain affects millions of Americans. Our Whole Lives, an electronic health (eHealth) toolkit for Chronic Pain (Our Whole Lives for Chronic Pain [OWLCP]), is a mind-body chronic pain management platform that teaches self-management strategies to reduce pain impact and pain medication use. Objective The primary goal of this study was to evaluate the feasibility of OWLCP in reducing pain impact and pain-related outcomes. Methods We conducted a pre-post clinical study (2 cohorts) to assess the feasibility of OWLCP usage among low-income patients with chronic pain. Outcome data, collected at baseline and 9 weeks, included Patient-Reported Outcomes Measurement Information System (PROMIS-29), pain self-efficacy, and pain medication use. In the statistical analysis, we used descriptive statistics, logistic regression, linear regression, and qualitative methods. Results Among the enrolled 43 participants, the average age was 50 years, (39/43) 91% were female, (16/43) 37% were black, and (7/43) 16% were Hispanic. From baseline to follow-up, the PROMIS measures showed a reduction in depression (P=.02), pain interference (P=.003), and average pain impact score (P=.007). Pain self-efficacy increased ((P<.001), whereas opioid use had a 13% reduction (P=.03). Conclusions The eHealth chronic pain management platform, OWLCP, is a potential tool to reduce the impact of chronic pain for low-income racially diverse populations.

Interdisciplinary management for chronic pain in central neurological disorders: a retrospective study

2020 ◽  
Vol 27 (1) ◽  
pp. 1-7
Author(s):  
Jamie Young ◽  
Steven Mantopoulos ◽  
Megan Blanchard ◽  
Hilarie Tardif ◽  
Malcolm Hogg ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Retrospective Study ◽  
Pain Management ◽  
Outcome Measures ◽  
Neurological Disorders ◽  
Neurological Disorder ◽  
Persistent Pain ◽  
Interdisciplinary Management ◽  
Management Service ◽  
Pain Outcomes

Background/aims Chronic pain in central neurological disorders is common and the current management of chronic pain is through an interdisciplinary approach. The aim of this study was to compare outpatient interdisciplinary-based treatment for chronic pain in patients with central neurological disorders to those without central neurological disorders. Methods This was a retrospective study and pain-related outcome measures were collected from a clinical outcomes registry (electronic Persistent Pain Outcomes Collaboration). This registry contained data on people who attended a pain management service who, for the purpose of this study, were categorised into those with a central neurological disorder and those without a central neurological disorder. The two sample t-test was used to determine the significance of the difference between the groups and statistical significance was defined as P<0.05. Outcome measures compared included the Brief Pain Inventory, Depression, Anxiety and Stress Scale 21, Patient Self-efficacy Questionnaire and Patient Catastrophisation Scale. Results There was a total of 1924 participants with a central neurological disorder. The electronic Persistent Pain Outcomes Collaboration registry shows that after engagement with an interdisciplinary pain management service, there was a reduction in pain severity scores, interference, mean depression, anxiety and stress in both groups at end of an episode of care compared to referral. There was a significant difference in mean changes for pain catastrophising between those with a central neurological disorder (−10.3) and those without (−7.8). Conclusions This study shows that people with central neurological disorders can also benefit from interdisciplinary management and have similar results to those without these conditions.

The Neverending Ouch

2020 ◽  
pp. 171-180
Author(s):  
Julianne Hughes ◽  
Isabel A. Barata
Keyword(s):  
Chronic Pain ◽  
Rating Scale ◽  
Pain Scale ◽  
Pain Medication ◽  
Sociocultural Factors ◽  
Evidence Based ◽  
Pain Rating ◽  
Older Children ◽  
Children's Pain ◽  
Pain Rating Scale

Chronic pain is defined as pain that is either persistent (ongoing) or recurrent (episodic) and is thought to be multifactorial, involving biological, psychological, and sociocultural factors. Generally, pain is considered chronic when the pain itself or recurrent episodes of pain persist greater than 3 to 6 months. Assessing children’s pain can be challenging, and validated tools should be used such as the Wong-Baker FACES Pain Rating Scale or the OUCHER Pain Scale (younger children) and verbal numerical scales (older children). Following assessment, treatment can be initiated based on the severity, nature, and presumed etiology of the pain. Management of acute or chronic pain episodes should follow evidence-based recommendations, which include both pharmacological and nonpharmacological principle. A stepwise escalation in pain medication may be required to adequately control the patient’s pain.

Pain

2018 ◽  
pp. 463-484
Author(s):  
Maria Flynn ◽  
Dave Mercer
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Assessment Tools ◽  
Acute Injury ◽  
Summary Table ◽  
Pain Medications ◽  
Key Features ◽  
The Individual ◽  
Chronic Pain Conditions ◽  
Dressing Change

It is widely recognized that the experience of pain is unique to the individual, which makes caring for people in pain a challenge. The general hospital nurse is most likely to see people in pain due to an acute injury, an episode of ill health, following surgery, or at a wound dressing change. People living with chronic pain conditions will most often be in the care of community nurses or specialist pain management teams. In both acute and chronic pain conditions, it is important that general nurses can accurately assess, monitor, and treat pain. This chapter identifies the key features of acute and chronic pain and describes pain assessment tools which are in widespread use. It outlines common pharmacological and non-pharmacological approaches to pain management, along with a summary table of frequently prescribed pain medications. Key considerations in nursing practice and decision-making are outlined.

scholarly journals Efficacy of the Thoracolumbar Interfascial Plane Block for Lumbar Laminoplasty: A Retrospective Study

2017 ◽  
Vol 11 (5) ◽  
pp. 722-725 ◽  
Author(s):  
Hironobu Ueshima ◽  
Tomoyuki Ozawa ◽  
Tomoaki Toyone ◽  
Hiroshi Otake
Keyword(s):  
Retrospective Study ◽  
Pain Management ◽  
General Anesthesia ◽  
Pain Scale ◽  
Primary Outcome Measure ◽  
Lumbar Region ◽  
Regional Analgesia ◽  
Canal Stenosis ◽  
Number Of Patients ◽  
Perioperative Pain Management

<sec><title>Study Design</title><p>This paper was a single center-based retrospective study with prospective data collection.</p></sec><sec><title>Purpose</title><p>Compared with other surgeries, limited options are available for perioperative pain management in spinal surgery. Therefore, we aimed to identify new pain management in this study.</p></sec><sec><title>Overview of Literature</title><p>The thoracolumbar interfascial plane (TLIP) block has been reported to provide effective regional analgesia in the lumbar region. This study investigated the efficacy of the TLIP block for pain management in lumbar laminoplasty.</p></sec><sec><title>Methods</title><p>We investigated patients who underwent lumbar laminoplasty for the treatment of lumbar spinal canal stenosis from April to October 2015. Patients with secondary surgery or surgery involving more than four intervertebral spaces were excluded. The primary outcome measure was the pain scale score within 48 hours after the surgery. The secondary outcomes were the number of additional analgesic drugs used and the number of patients complaining of complications, such as nausea and vomiting, within 24 hours after the surgery.</p></sec><sec><title>Results</title><p>We retrospectively assessed the data of 44 patients who underwent lumbar laminoplasty. Of these, 25 patients received only general anesthesia (G group), whereas 19 patients received the TLIP block along with general anesthesia (T group). Compared with the G group, the T group reported lower pain scores for pain at 1, 2, 4, and 24 hours postoperatively. Moreover, the number of patients who received the additional analgesic pentazocine was lower in the T group than in the G group. The two groups showed no significant differences in the incidence of complications.</p></sec><sec><title>Conclusions</title><p>The TLIP block provides effective analgesia for 24 hours postoperatively in patients undergoing lumbar laminoplasty.</p></sec>

Pharmacist’s Role in Dispensing Opioids for Acute and Chronic Pain

2011 ◽  
Vol 25 (5) ◽  
pp. 497-502 ◽  
Author(s):  
Karen F. Marlowe ◽  
Richard Geiler
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Health Care Providers ◽  
Family Relationships ◽  
Health Care Professionals ◽  
The United States ◽  
Care Providers ◽  
Economic Productivity ◽  
The Impact

Pain continues to be a serious health care concern in the United States. Patients with chronic pain experience the impact of the disease throughout their lives including their social interactions, family relationships, and in many cases economic productivity. Multiple surveys have found that many pharmacists hold misconceptions regarding opioids, pain disease states, and their understandings of current regulations. Multiple barriers affect the ability of pharmacists to deliver care to patients' prescribed opioid therapy. Inadequate communication between health care professionals and patients is one of the hurdles, which prevents quality care. Increased communication between health care providers including access to health information is one step, which is crucial to improving provision of pharmacotherapy. Finally, the quality of educational opportunities relative to opioids and pain management specifically for pharmacists needs to be increased, and consideration needs to be given for making appropriate pain management education mandatory.

scholarly journals Transition from Compounded to Monotherapy Intrathecal Pain Medication Reduces Drug Costs: Retrospective Analysis of Patient Billing Data

2021 ◽  
Vol 24 (6) ◽  
pp. 489-494
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Financial Burden ◽  
The United States ◽  
Pain Scale ◽  
Control Group ◽  
Billing Data ◽  
Medication Therapy ◽  
Significant Difference ◽  
Before And After

BACKGROUND: Chronic pain accounts for several hundred billion dollars in total treatment costs, and lost productivity annually. Selecting cost-effective pain treatments can reduce the financial burden on both individuals and society. Targeted drug delivery (TDD), whereby medications used to treat pain are delivered directly to the intrathecal space, remains an important treatment modality for chronic pain refractory to oral medication management. These medications can be administered alone (monotherapy), or in conjunction with other medications to give a synergistic affect (compounded therapy). While compounded therapy is often prescribed for pain refractory to both oral management and intrathecal monotherapy, compounded administration has not been approved by the United States Food and Drug Administration (FDA), and is thought to be more expensive. In this study, we hypothesized that TDD delivering monotherapy vs compounded therapy would differ significantly in cost. OBJECTIVES: In 2015, a pharmacy-led initiative resulted in an institution-wide policy requiring that all TDD patients, being treated with compounded therapy, be transitioned to FDA-approved intrathecal monotherapy. The intent of this new policy was to eliminate use of non-FDA approved, “off-label” medications. During this transition, our practice used the opportunity to retrospectively analyze and compare the costs of monotherapy vs compounded therapy. STUDY DESIGN: Billing, drug dosing, and pain data were collected from 01/2015 to 01/2019, and reviewed retrospectively for patients originally on compounded intrathecal medication therapy, and compared before and after transition to monotherapy. SETTING: A multidisciplinary hospital-based spine center within an academic tertiary care facility. METHODS: Electronic medical records from the institutional TDD program were retrospectively reviewed to identify all patients on compounded drug therapy before the transition period (2015-2016). Patients were excluded from the study if they chose to switch their care to another practice rather than transitioning from compounded therapy to monotherapy. Cost per medications refill, cost per year, and reported pain scale before and after the transition were computed, and differences were compared using unpaired t tests. Refill costs of individual drugs were also compared. RESULTS: Of 46 patients originally on compounded therapy, 26 patients met inclusion criteria. The most common pre-transition drugs administered as compounded therapy were bupivacaine (n = 17), morphine (n = 15), and clonidine (n = 14), while hydromorphone (n = 10), baclofen (n = 5), and fentanyl (n = 1) were less common. There was a 51.3% decrease in cost per refill (P = 0.135) and a 50.0% decrease in cost per year (P = 0.283) after transition. Morphine and clonidine were both significantly more expensive than hydromorphone and bupivacaine (P < 0.05). After removing cases in which hydromorphone was the baseline opiate, there was a 64.8% decrease in cost per refill (P = 0.041) and a 66.8% decrease in cost per year (P = 0.190). There was no significant difference in the average reported pain scale across the transition (P = 0.323), suggesting stable pain management efficacy. LIMITATIONS: This retrospective study is limited by its small cohort size and lack of a control group. CONCLUSIONS: Based on single-institutional billing data, transition from compounded therapy to monotherapy TDD resulted in cost savings, dependent on the specific combination of drugs initially used for therapy. A larger multi-institutional study is indicated. KEY WORDS: Low back pain, intrathecal pain management, implantable drug pump, cost analysis, morphine, hydromorphone, fentanyl, clonidine, baclofen, bupivacaine

scholarly journals Moving towards a molecular understanding of pain management

2018 ◽  
Vol 87 (1) ◽  
pp. 49-51
Author(s):  
Logan Van Nynatten ◽  
Shafaz Veettil
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Molecular Medicine ◽  
Prescription Opioids ◽  
Pharmaceutical Treatment ◽  
Pharmacological Interventions ◽  
Drug Effectiveness ◽  
Pain Medications ◽  
Great Pressure ◽  
Promising Avenue

The management of chronic pain remains a challenging area in the practise of medicine. As our population ages, the incidence and prevalence of those living with chronic pain continues to increase. Hence, there is need for methods that promote optimal pain management. One promising avenue is that of “personalized and molecular pain management”. Indeed, a variety of genetic and molecular factors have been shown to impact metabolism of narcotics, limiting drug effectiveness. Furthermore, the prominence of polypharmacy can complicate the action of pain medications. Additional laboratory and diagnostic tests may be of benefit for risk stratifying patients at high risk of abusing pain medications from those at lower risk. Combining this with physician worry of worsening the opioid addiction crisis in North America via prescribing narcotics, there remains great pressure on physicians to limit their use of narcotics. Unfortunately, this may result in patients who are suitable candidates for prescription opioids receiving inadequate pharmaceutical treatment to complement non-pharmacological interventions. Moving forward, the implementation of molecular medicine approaches to pain management may provide unique solutions to these challenges.

scholarly journals Pain scores among ED patients: correlation with desire for pain medication

2014 ◽  
Vol 1 ◽  
pp. 1-4
Author(s):  
Catherine A. Marco ◽  
Megan McGervey ◽  
Joan Gekonde ◽  
Caitlin Martin
Keyword(s):  
Emergency Department ◽  
Pain Scale ◽  
Pain Medication ◽  
Survey Study ◽  
Insurance Status ◽  
Pain Scores ◽  
Pain Medications ◽  
Lower Pain ◽  
Ed Visits ◽  
Emergency Department Patients

Introduction: Pain has been identified as the most common reason for Emergency Department (ED) visits. The verbal numeric rating pain scale (VNRS) is commonly used to assess pain in the ED. This study was undertaken to determine whether VNRS pain scores correlate with desire for pain medication among ED patients. Methods: In this prospective survey study, eligible patients included Emergency Department patients over 18 with painful conditions.  The primary outcome measures included self-reported VNRS, ED diagnosis, number of ED visits and number of ED admissions within the past year, and the self-reported desire for pain medication. Results: Among 482 participants in 2012, the median triage pain score was 8 (IQR 6-10); the most frequently occurring score was 10. Overall, there were significant differences in pain scores with patient desire for analgesics. 67% reported desire for pain medications. Patients who did not want pain medications had significantly lower pain scores (median 6; IQR 4-8) compared to those who wanted medication (median 8; IQR 7-10) (p<0.001) and compared to those who were ambivalent about medication (median 7; IQR 6-10) (p=0.01). There was no association between desire for pain medication and demographics including age, gender, race, or insurance status. Conclusions: ED patients who did not desire pain medication had significantly lower pain scores than patients who desired pain medication. Pain scores usually effectively predicted which patients desired pain medications.  Desire for pain medication was not associated with age, gender, race, or insurance status. 

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