<p>Use of a Long-Acting Opioid Microsphere Formulation to Overcome Difficulties in Swallowing Pain Medication</p>

The Use of Long Acting Opioids to Prevent Rebound Pain Following Peripheral Nerve Blocks for Outpatient Foot and Ankle Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00248 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0024

Author(s):

Leah Herzog ◽

Sylvia H. Wilson ◽

Christopher E. Gross

Keyword(s):

Peripheral Nerve ◽

Nerve Block ◽

Peripheral Nerve Block ◽

Pain Medication ◽

Nerve Blocks ◽

Peripheral Nerve Blocks ◽

Pain Scores ◽

Ankle Surgery ◽

Patient Reported ◽

Long Acting

Category: Ankle; Bunion Introduction/Purpose: Peripheral nerve blocks have become an integral part of orthopedic surgery to assist with postoperative pain. However, 40% of patients who undergo a peripheral nerve block will experience rebound pain, which in turn, long-acting narcotics may be able to block. Unfortunately, this rebound pain can cancel out the potential benefits of decreased opioid medication use. Therefore, this study seeks to compare the difference in patient reported pain scores in those patients whom received long-acting opioid pain medication and those who did not. Methods: This is a retrospective review of patient-reported pain scores for 96 patients who underwent a peripheral nerve block for outpatient foot and ankle surgery. 48 patients either received three days of long-acting opioids or did not. Each patient was asked to fill out and return a pain diary as well as fill out a pain catastrophizing survey (PCS) at their postoperative appointment. The pain diary discussed their Visual Analogue Scale pain scores, amount of pain medication, and time they took the medicine. This data was then collected and compared via paired student t-tests for evaluation of significance. Results: Pain diaries were completed by 69 patients (72%). There were no significant differences between those comorbidities, types of procedures, age, or BMI between the groups. Mean postoperative pain scores did not differ between patients that did and did not receive postoperative extended release opioid medications (p = 0.226). Mean opioid consumption did not differ between groups (p = 0.945). There were no correlations between daily reported pain scores or the postoperative day with the highest pain score for those who received long acting opioid pain medication versus those who did not (r=0.336, p=0.550). Conclusion: Rebound pain is a difficult potential side effect of peripheral nerve blocks that currently does not have a preventative measure. This study was an attempted effort to help eliminate rebound pain, but there did not appear to be a significant benefit to adding long-acting opioid pain medication in addition to the peripheral nerve block and short-acting pain medication

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Opioid Utilization in Adults Hospitalized with Sickle Cell Pain Crises: An Understudied Population

Blood ◽

10.1182/blood-2018-99-111386 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5884-5884

Author(s):

Angie Mae Rodday ◽

Kimberly S Esham ◽

Nicole S Savidge ◽

Daqin Mao ◽

Ruth Ann Weidner ◽

...

Keyword(s):

Neuropathic Pain ◽

Sickle Cell ◽

Medical Center ◽

Academic Medical Center ◽

Pain Medication ◽

Acute Chest Syndrome ◽

Opioid Prescription ◽

Medication Prescription ◽

Pain Scores ◽

Long Acting

Abstract Background: Vaso-occlusive crises (VOC), also known as painful crises, are the hallmark of sickle cell disease (SCD) and adults hospitalized with VOC are among the most severe cases. In the midst of the opioid epidemic, appropriate pain management must be available for these patients when they develop VOC. We describe patient, disease, and treatment characteristics at the time of hospitalization for patients with SCD experiencing VOC. Methods: This retrospective cohort study includes 449 consecutive hospitalizations for VOC among 63 adult patients (≥18 years) with SCD from 2013-2016 at Tufts Medical Center, an academic medical center in Boston, MA. For the current analysis, one hospitalization was randomly selected for each patient (median hospitalizations per patient=4, range=1-45). Demographics, SCD characteristics and complications, pain scores (0-10), and pain medication regimens (pre-admission, inpatient, discharge) were abstracted from electronic medical records (EMR) by trained study staff. History of SCD complications (e.g., acute chest syndrome, avascular necrosis), modeled after the 9-item ASCQ-Me SCD Medical History Checklist (Keller et al. Health and Quality of Life Outcomes, 2017), were obtained from the EMR and subsequently reviewed by two hematologists. Data were described using summary statistics, including means, standard deviations (SD) medians, quartiles (q1, q3), frequencies, and percentages. Results: Mean age was 27.6 years (SD=8.1), 44.4% were male, 77.8% were black, and 19.1% were Hispanic. The majority of patients (92.1%) were publicly insured (27.0% Medicare; 65.1% Medicaid); only 7.9% were privately insured. Patients had a median of 3 medical complications of SCD. Affective disorders were documented for 33.3%; substance use disorders for 6.4%. Median pain scores were 9 (8, 10) at admission and 4 (2, 6) at discharge; the median length of stay was 8 days (5, 11). Prior to admission, 87.3% of patients had a home opioid prescription and 20.6% had a neuropathic pain medication prescription (Table). During the hospitalization, 100% received opioids with 36.5% delivered via patient-controlled analgesia (PCA). Neuropathic pain medication was given to 28.6% of hospitalized patients. At discharge, nearly all (98.4%) were prescribed home opioids and 24.6% were discharged with neuropathic pain medication. With regards to treatment combinations across phases of care, approximately half of patients received both short- and long-acting opioids and less than 20% received long-acting opioids and neuropathic pain medication. Conclusions: All patients with SCD hospitalized with VOC were admitted with significant pain and treated with opioids. Pain decreased during the hospitalization, but did not fully resolve by discharge. Treatment combinations of short- and long-acting opioids and neuropathic pain medication suggest complex acute-on-chronic SCD pain with mixed pain types among this cohort of patients with high-severity SCD. Opioids are an integral component of treatment regimens for patients suffering from debilitating acute-on-chronic pain, such as those with SCD. Disclosures Parsons: Seattle Genetics: Research Funding.

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Establishment of Personalized Pain Goals in Oncology Patients to Improve Care and Decrease Costs

Journal of Oncology Practice ◽

10.1200/jop.2016.017616 ◽

2017 ◽

Vol 13 (3) ◽

pp. e266-e272 ◽

Cited By ~ 3

Author(s):

Dylan Zylla ◽

Amber Larson ◽

Gladys Chuy ◽

Lisa Illig ◽

Adina Peck ◽

...

Keyword(s):

Medication Use ◽

Opioid Analgesics ◽

Pain Medication ◽

Management Information ◽

Lower Treatment ◽

Patient Reported ◽

Pain Intervention ◽

Long Acting ◽

Reported Data

Purpose: Cancer-related pain is common, negatively affects quality of life and survival, and often requires treatment with opioid analgesics. Patient-reported data that describe the incidence and severity of pain, medication use, and patient satisfaction with care are lacking. Methods: We analyzed 18 months of outpatient oncology clinic encounters from the electronic medical record to obtain data on pain levels and opioid and nonopioid treatments. In June 2014, we instituted a pain intervention by creating a pain management information handout for patients, educating clinicians on opioid cost-effectiveness, and implementing a nursing protocol to document personalized pain goals (PPGs). Results: Moderate to severe pain was reported in nearly 15% of patient encounters. We observed an increase in the percentage of encounters with a documented PPG of 16% to 71% ( P < .001). On average, PPG was achieved in 84% of patients. Rates of high-cost long-acting opioid prescriptions (oxycodone controlled release and fentanyl patches), as a total of all long-acting opioids, declined from 45% preintervention to 33% postintervention ( P = .005). Conclusion: Our intervention improved rates of PPG documentation and decreased the number of prescriptions for high-cost long-acting opioids. Oncology clinics can implement simple quality improvement methods, such as asking patients about their PPG and educating clinicians about opioid costs, to improve outcomes and lower treatment costs.

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