Academic family medicine physicians' confidence and comfort with opioid analgesic prescribing for patients with chronic nonmalignant pain

2014 ◽  
Vol 10 (4) ◽  
pp. 255 ◽  
Author(s):  
Allison A. Macerollo, MD ◽  
Donald O. Mack, MD ◽  
Rupal Oza, MD, MPH ◽  
Ian M. Bennett, MD, PhD ◽  
Lorraine S. Wallace, PhD
Keyword(s):  
Pain Management ◽  
Family Medicine ◽  
Family Physicians ◽  
Opioid Analgesics ◽  
Comfort Level ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain ◽  
Level Of Concern

Objective: To examine academic family medicine physicians' current practices, experiences, beliefs, level of concern about negative outcomes, and confidence and comfort when prescribing opioid analgesics for chronic nonmalignant pain management. Design: Electronic cross-sectional survey.Participants: This study was part of the Council of Academic Family Medicine (CAFM) Educational Research Alliance omnibus survey of active academic US family physicians.Main outcome measures: Respondents completed survey items addressing their 1) sociodemographic and practice characteristics, 2) current opioid prescribing practices, 3) experiences and beliefs toward prescribing opioid analgesics for chronic nonmalignant pain management, 4) level of concern about negative opioid-related outcomes, and 5) confidence and comfort when prescribing opioid analgesics.Results: The majority of the sample (n = 491) were male (57.8 percent) with 84.1 percent identifying themselves as non-Hispanic white. Nearly all respondents (91.0 percent) reported currently prescribing opioids to patients with chronic nonmalignant pain. Most respondents reported being confident (88.4 percent) and comfortable (76.2 percent) in their prescribing for patients with chronic nonmalignant pain. Family physicians who were comfortable in their opioid prescribing skills were more likely to report satisfaction in prescribing opioids to patients with chronic pain (ρ = 0.494, p < 0.001), while those who were confident in their opioid prescribing skills were more likely to identify pain management as high priority (ρ = -0.287, p < 0.001).Conclusions: Most academic family physicians currently prescribed opioid analgesics to patients with chronic nonmalignant pain. There was a strong inverse relationship between confidence regarding opioid prescription and concern about negative consequences. Similarly, comfort level was tied to increased satisfaction with the overall process of opioid prescription.

Select practice behaviors of clinicians on the use of opioids for adolescents with subacute and chronic nonmalignant pain

2018 ◽  
Vol 7 (2) ◽  
pp. 123-134 ◽  
Author(s):  
John M. Saroyan, MD ◽  
Wendy Y. Cheng, MPH ◽  
Damani C. Taylor, BA ◽  
Amna Afzal, MD ◽  
Nomita Sonty, MPhil, PhD ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Reference Group ◽  
Self Report ◽  
Prescribing Practices ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Practice Behaviors ◽  
Scoliosis Correction ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

Objectives: To characterize the opioid prescribing and monitoring practices of providers for chronic nonmalignant pain (CNP) and subacute postoperative pain (SAPOP) in adolescents.Design: Web-based cross-sectional self-report survey.Setting: Free-standing pediatric tertiary academic center.Participants: A total of 183 physicians and nurse practitioners were eligible. Of 115 (62.8 percent) participants who responded, 108 (93.9 percent) completed the survey.Main outcome measures: Self-reported frequency of opioid prescription for SAPOP and CNP conditions and frequency of associated monitoring practices.Results: For 10 of the 13 pain conditions included, some participants endorsed “monthly or more opioid prescriptions” while others endorsed “opioids do not represent appropriate management.” Opioid prescribing is present for almost all pain conditions but is substantially more common for nonacute vaso-occlusive-related sickle cell disease, scoliosis correction, and video-assisted pectus excavatumrelated pains. When compared with the reference group, CNP with no identifiable pathology, the odds ratio (OR) of an opioid being prescribed for CNP states with identifiable pathology was not significantly higher. The OR for SAPOP was significantly higher (p 0.0001). None of the opioid prescribers reported collecting urine toxicology before or during opioid therapy.Conclusions: This survey identifies a diversity of self-reported clinician opioid prescribing practices for adolescents with CNP and SAPOP. Urine collection for drug toxicology screening is not utilized by opioid prescribers. Surveys of similar clinician practice behaviors at other institutions are warranted to replicate this finding and to establish common clinical practice for usage and monitoring of opioids in conditions where guidelines do not yet exist.

scholarly journals Evaluation of an Educational Outreach Campaign (IMPACT) on Pain Management Delivered to General Practices in Walsall

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i48-i49
Author(s):  
S Visram ◽  
J Saini ◽  
R Mandvia
Keyword(s):  
Data Analysis ◽  
Pain Management ◽  
Cancer Pain ◽  
Educational Intervention ◽  
Opioid Analgesics ◽  
Educational Outreach ◽  
Opioid Prescribing ◽  
Prescribing Trends ◽  
The Impact

Abstract Introduction Opioid class drugs are a commonly prescribed form of analgesic widely used in the treatment of acute, cancer and chronic non-cancer pain. Up to 90% of individuals presenting to pain centres receive opioids, with doctors in the UK prescribing more and stronger opioids (1). Concern is increasing that patients with chronic pain are inappropriately being moved up the WHO ‘analgesic ladder’, originally developed for cancer pain, without considering alternatives to medications, (2). UK guidelines on chronic non-cancer pain management recommend weak opioids as a second-line treatment, when the first-line non-steroidal anti-inflammatory drugs / paracetamol) ineffective, and for short-term use only. A UK educational outreach programme by the name IMPACT (Improving Medicines and Polypharmacy Appropriateness Clinical Tool) was conducted on pain management. This research evaluated the IMPACT campaign, analysing the educational impact on the prescribing of morphine, tramadol and other high-cost opioids, in the Walsall CCG. Methods Standardised training material was delivered to 50 practices between December 2018 and June 2019 by IMPACT pharmacists. The training included a presentation on pain control, including dissemination of local and national guidelines, management of neuropathic, low back pain and sciatica as well as advice for prescribers on prescribing opioids in long-term pain, with the evidence-base. Prescribing trends in primary care were also covered in the training, and clinicians were provided with resources to use in their practice. Data analysis included reviewing prescribing data and evaluating the educational intervention using feedback from participants gathered via anonymous questionnaires administered at the end of the training. Prescribing data analysis was conducted by Keele University’s Medicines Management team via the ePACT 2 system covering October 2018 to September 2019 (two months before and three months after the intervention) were presented onto graphs to form comparisons in prescribing trends of the Midland CCG compared to England. Results Questionnaires completed at the end of sessions showed high levels of satisfaction, with feedback indicating that participants found the session well presented, successful at highlighting key messages, and effective in using evidence-based practice. 88% of participants agreed the IMPACT campaign increased their understanding of the management and assessment of pain, and prescribing of opioids and other resources available to prescribers. The majority (85%) wished to see this form of education being repeated regularly in the future for other therapeutic areas. Analysis of the prescribing data demonstrated that the total volume of opioid analgesics decreased by 1.7% post-intervention in the Midlands CCG in response to the pharmacist-led educational intervention. As supported by literature, the use of educational strategies, including material dissemination and reminders as well as group educational outreach was effective in engaging clinicians, as demonstrated by the reduction in opioid prescribing and high GP satisfaction in this campaign. Conclusion The IMPACT campaign was effective at disseminating pain-specific guidelines for opioid prescribing to clinicians, leading to a decrease in overall prescribing of opioid analgesics. Educational outreach as an approach is practical and a valuable means to improve prescribing by continuing medical education. References 1. Els, C., Jackson, T., Kunyk, D., Lappi, V., Sonnenberg, B., Hagtvedt, R., Sharma, S., Kolahdooz, F. and Straube, S. (2017). Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. This provided the statistic of percentage receiving opioids that present to pain centres. 2. Heit, H. (2010). Tackling the Difficult Problem of Prescription Opioid Misuse. Annals of Internal Medicine, 152(11), p.747. Issues with prescriptions and inappropriate moving up the WHO ladder.

scholarly journals A Systematic Review of Interventions and Programs Targeting Appropriate Prescribing of Opioids

2019 ◽  
Vol 3 (22;3) ◽  
pp. 229-240 ◽  
Author(s):  
Yola Moride
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Evaluation Studies ◽  
The United States ◽  
Opioid Prescription ◽  
Overdose Death ◽  
Opioid Prescribing ◽  
Gray Literature ◽  
Prescription Monitoring ◽  
Monitoring Programs

Background: Canada and the United States have the highest levels of prescription opioid consumption in the world. In an attempt to curb the opioid epidemic, a variety of interventions have been implemented. Thus far, evidence regarding their effectiveness has not been consolidated. Objectives: The objectives of this study were to: 1) identify interventions that target opioid prescribing; 2) assess and compare the effectiveness of interventions on opioid prescription and related harms; 3) determine the methodological quality of evaluation studies. Study Design: The study involved a systematic review of the literature including bibliographical databases and gray literature sources. Setting: Systematic review including bibliographical databases and gray literature sources. Methods: We searched MEDLINE, Embase, and LILACS databases from January 1, 2005 to September 23, 2016 for any intervention that targeted the prescription of opioids. We also examined websites of relevant organizations and scanned bibliographies of included articles and reviews for additional references. The target population was that of all health care providers (HCPs) or users of opioids with no restriction on indication. Endpoints were those related to process (implementation), outcomes (effectiveness), or impact. Sources were screened independently by 2 reviewers using pre-defined eligibility criteria. Synthesis of findings was qualitative; no pooling of results was conducted. Results: Literature search yielded 12,278 unique sources. Of these, 142 were retained. During full-text review, 75 were further excluded. Searches of the gray literature and bibliographies yielded 49 additional sources. Thus, a total of 95 distinct interventions were identified. Over half consisted of prescription monitoring programs (PMPs) and mainly targeted HCPs. Evaluation studies addressed mainly opioid prescription rate (30.6%), opioid use (19.4%), or doctor shopping or diversion (9.7%). Fewer studies considered overdose death (9.7%), abuse (9.7%), misuse (4.2%), or diversion (5.6%). Study designs consisted of cross-sectional surveys (23.3%), pre-post intervention (26.7%), or time series without a comparison group (13.3%), which limit the robustness of the evidence. Although PMPs and policies have been associated with a reduction in opioid prescription, their impact on appropriateness of use according to clinical guidelines and restriction of access to patients in need is inconsistent. Continuing medical education (CME) and pain management programs were found effective in improving chronic pain management, but studies were conducted in specific settings. The impact of interventions on abuse and overdose-death is conflicting. Limitations: Due to the very large number of publications and programs found, it was difficult to compare interventions owing to the heterogeneity of the programs and to the methodologies of evaluation studies. No assessment of publication bias was done in the review. Conclusions: Evidence of effectiveness of interventions targeting the prescription of opioids is scarce in the literature. Although PMPs have been associated with a reduction in the overall prescription rates of Schedule II opioids, their impact on the appropriateness of use taking into consideration benefits, misuse, legal and illegal use remains elusive. Our review suggests that existing interventions have not addressed all determinants of inappropriate opioid prescribing and usage. A well-described theoretical framework would be the backdrop against which targeted interventions or policies may be developed. Key words: Opioid, prescription, abuse, misuse, diversion, interventions, prescription monitoring programs

Opioid Prescribing in Patients Undergoing Neck Dissections With Short Hospitalizations

2020 ◽  
pp. 019459982095798
Author(s):  
Grace L. Banik ◽  
Kristen L. Kraimer ◽  
Maisie L. Shindo
Keyword(s):  
Pain Management ◽  
Head And Neck ◽  
Neck Dissection ◽  
Opioid Prescription ◽  
Multidisciplinary Collaboration ◽  
Opioid Prescribing ◽  
The Mean ◽  
Preoperative Counseling ◽  
Group 2 ◽  
Group 1

Objective To evaluate postoperative opioid prescribing in patients undergoing neck dissections with short hospitalizations. Study Design Retrospective cohort study. Setting Tertiary academic hospital. Methods The study population included patients who underwent lateral neck dissections with or without an associated head and neck procedure and required hospitalization for ≤3 days from 2012 to 2019. Interventions to decrease opioid utilization, including preoperative counseling, multimodality pain management, and multidisciplinary collaboration, were implemented in September 2016. Patients were divided into 2 groups: preintervention (group 1) and postintervention (group 2). The mean quantity of opioids prescribed during hospitalization, at discharge, and in refills was calculated in morphine milligram equivalents (MME). Results A total of 407 patients were included in the analysis: 223 patients in group 1 and 184 patients in group 2 (42.3% female, 89.4% white; average age, 55.2 years [95% CI, 53.6-56.9]). The mean opioid quantity prescribed in unilateral neck dissection alone decreased from 353.9 MME (95% CI, 266.7-441.2) in group 1 to 113.3 MME (95% CI, 87.8-138.7) in group 2 ( P < .001; effect size, 1.0). Statistically significant decreases in mean opioid quantity prescribed were also observed in unilateral neck dissection in combination with thyroidectomy, parotidectomy, glossectomy, or tonsillectomy. The percentage of patients requiring opioid prescription refills was not statistically different between the groups. Conclusion This study demonstrates that the quantity of opioids prescribed in patients undergoing neck dissections and associated head and neck procedures with short hospitalizations can be reduced to as low as 100 to 125 MME with preoperative counseling, multimodality pain management, and multidisciplinary collaboration.

scholarly journals Relationship Between Opioid Analgesic Prescription and Unemployment in Patients Seeking Acupuncture for Chronic Pain in Urban Primary Care

Pain Medicine ◽  
2018 ◽  
Vol 20 (8) ◽  
pp. 1528-1533 ◽  
Author(s):  
Elizabeth Chuang ◽  
Eric N Gil ◽  
Qi Gao ◽  
Benjamin Kligler ◽  
M Diane McKee
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Pain Treatment ◽  
Opioid Analgesic ◽  
Opioid Analgesics ◽  
Baseline Survey ◽  
Patient Reported ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain ◽  
Analgesic Use

Abstract Objective The widespread use of opioid analgesics to treat chronic nonmalignant pain has contributed to the ongoing epidemic of opioid-related morbidity and mortality. Previous studies have also demonstrated a relationship between opioid analgesic use and unemployment due to disability. These studies have been limited to mainly white European and North American populations. The objective of this study is to explore the relationship between opioid analgesic use for chronic nonmalignant pain in an urban, mainly black and Hispanic, low-income population. Design This is a cross-sectional observational study. Setting Subjects were recruited from six urban primary care health centers. Subjects Adults with chronic neck, back, or osteoarthritis pain participating in an acupuncture trial were included. Methods Survey data were collected as a part of the Acupuncture Approaches to Decrease Disparities in Pain Treatment two-arm (AADDOPT-2) comparative effectiveness trial. Participants completed a baseline survey including employment status, opioid analgesic use, the Brief Pain Inventory, the global Patient Reported Outcomes Measurement Information Systems quality of life measure, the Patient Health Questionnaire-9 (PHQ-9), and demographic information. A multivariable logistic regression model was built to examine the association between opioid analgesic use and unemployment. Results Opioid analgesic use was associated with three times the odds of unemployment due to disability while controlling for potential confounders, including depression, pain severity, pain interference, global physical and mental functioning, and demographic characteristics. Conclusions This study adds to the growing body of evidence that opioid analgesics should be used with caution in chronic nonmalignant pain.

Health Care Providers' Liability Exposure for Inappropriate Pain Management

1996 ◽  
Vol 24 (4) ◽  
pp. 360-364 ◽  
Author(s):  
Robyn S. Shapiro
Keyword(s):  
Health Care ◽  
Pain Management ◽  
Cancer Patients ◽  
Health Care Providers ◽  
Nursing Home Residents ◽  
Hospitalized Patients ◽  
Care Providers ◽  
Experienced Pain ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

Recent studies have exposed the startling inadequacy of health care providers knowledge about and practice of effective pain management. For example, in one study, it was reported that 79 percent of a random sample of 454 medical-surgical inpatients experienced pain during hospitalization, and that 58 percent of patients with pain considered the pain horrible or excruciating. In another study, 67 percent of 2,415 randomly selected hospitalized patients had pain during the twenty-four hours prior to being interviewed, and 50 percent reported pain at the time of the interview. In a study of seriously ill hospitalized patients reported in 1996, half of the patients complained of pain, and one-sixth reported that they experienced extremely severe pain at least half the time. According to one literature review, 75 percent of cancer patients have reported suffering pain, and one study estimates that 25 percent of cancer patients die with severe unrelieved pain. Chronic nonmalignant pain has been described as an extremely prevalent problem, and over two-thirds of nursing home residents experience serious pain.

scholarly journals Opioid Analgesic Prescription in French Children: A National Population-Based Study

2021 ◽  
Vol 18 (24) ◽  
pp. 13316
Author(s):  
Samira Choufi ◽  
Simon Mounier ◽  
Etienne Merlin ◽  
Emmanuelle Rochette ◽  
Jessica Delorme ◽  
...  
Keyword(s):  
Health Insurance ◽  
Pain Management ◽  
Small Proportion ◽  
Opioid Analgesic ◽  
Opioid Analgesics ◽  
Population Based ◽  
Opioid Prescription ◽  
Population Based Study ◽  
Number Of Children ◽  
Strong Opioids

Codeine use was restricted in 2013 and is currently contraindicated for children below the age of 12 years. We examined how the prescription of opioid analgesics in children in France evolved between 2012 and 2018. Our population-based study from the SNIIRAM database (National System of Health Insurance Inter-Regime Information) was designed to determine trends in opioid prescription from 2012 to 2018 in all French children. The number of children who received at least one opioid prescription gradually declined from 452,665 in 2012 (347.5 children per 10,000) to 169,338 in 2018 (130.3 children per 10,000). This decrease was especially marked for codeine (36 children per 10,000 in 2018 vs. 308.5 children per 10,000 in 2012), whereas the number of tramadol prescriptions increased by 171% in 2018 (94.6 children per 10,000). Despite the increase, strong opioids still formed only a small proportion of prescriptions (2.6 children per 10,000 given opioids in 2018). Overall opioid prescriptions in French children dramatically decreased between 2012 and 2018, probably owing to restrictions on the use of codeine. Codeine has been partly replaced by tramadol. Morphine is still probably underused. This suggests that opioids are being used less often for pain management in children.

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