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Opioid Screening Practices in the Cancer Pain Patient.

ABSTRACT: BACKGROUND:Despite the growing use of opioids to treat cancer pain and the probability of opioid aberrancy in the cancer setting, clinical practice guidelines (CPGs) or recommendations for active screening and monitoring of opioid compliance are lacking. OBJECTIVES:To evaluate the current practices and attitudes clinicians have toward monitoring and prescribing opioids in patients with cancer; to describe the current practice of screening and monitoring opioid compliance in the cancer setting; to provide insight into the role that CPGs may have in addressing opioid aberrancy in the oncologic population. HYPOTHESIS:Clinicians adopt diverse clinical practices and attitudes toward opioid screening and monitoring based on cancer status. DESIGN:A 24-question survey that evaluated the practices and attitudes that clinicians have when screening, monitoring, and prescribing opioids in patients with active cancer and history of cancer was completed by 105 pain management physicians. A comprehensive literature review was completed, evaluating the current state of available literature regarding opioid aberrancy and opioid risk in the cancer setting and CPGs for opioid monitor compliance in the cancer setting. SETTING:Multicenter, survey-based study to clinicians regarding pain management strategies in patients with active cancer, patients with a history of cancer, and patients with no history of cancer. RESULTS:Cancer status plays a role in the clinician's decision to screen and monitor opioid compliance in the oncologic population. For patients with active cancer, clinicians are more likely to prescribe opioids despite patient refusal for toxicology screen as well as history of substance abuse. For patients with no history of cancer, clinicians are more likely to refuse a prescription refill and eliminate opioids from treatment regimen. CONCLUSIONS:Based upon the results of our study and evidence from current literature provided, the authors advocate for further investigation and development of CPGs to ensure the safe and prudent screening, monitoring, and prescribing of opioids in the oncologic population.

SUBMITTER: Liebling D

PROVIDER: S-EPMC7476372 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Opioid Screening Practices in the Cancer Pain Patient.

Liebling Dustin D Mehta Neel N Gulati Amitabh A

Journal of palliative medicine 20180828 1

<h4>Background</h4>Despite the growing use of opioids to treat cancer pain and the probability of opioid aberrancy in the cancer setting, clinical practice guidelines (CPGs) or recommendations for active screening and monitoring of opioid compliance are lacking.<h4>Objectives</h4>To evaluate the current practices and attitudes clinicians have toward monitoring and prescribing opioids in patients with cancer; to describe the current practice of screening and monitoring opioid compliance in the ca ...[more]

PMID: 30153080

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Project description:BACKGROUND:This is an updated version of the original Cochrane review published in Issue 4, 2006. Patients may control postoperative pain by self administration of intravenous opioids using devices designed for this purpose (patient controlled analgesia or PCA). A 1992 meta-analysis by Ballantyne et al found a strong patient preference for PCA over non-patient controlled analgesia, but disclosed no differences in analgesic consumption or length of postoperative hospital stay. Although Ballantyne's meta-analysis found that PCA did have a small but statistically significant benefit upon pain intensity, a 2001 review by Walder et al did not find statistically significant differences in pain intensity or pain relief between PCA and groups treated with non-patient controlled analgesia. OBJECTIVES:To evaluate the efficacy and safety of patient controlled intravenous opioid analgesia (termed PCA in this review) versus non-patient controlled opioid analgesia of as-needed opioid analgesia for postoperative pain relief. SEARCH METHODS:We ran the search for the previous review in November 2004. For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL 2014, Issue 12), MEDLINE (1966 to 28 January 2015), and EMBASE (1980 to 28 January 2015) for randomized controlled trials (RCTs) in any language, and reference lists of reviews and retrieved articles. SELECTION CRITERIA:We selected RCTs that assessed pain intensity as a primary or secondary outcome. These studies compared PCA without a continuous background infusion with non-patient controlled opioid analgesic regimens. We excluded studies that explicitly stated they involved patients with chronic pain. DATA COLLECTION AND ANALYSIS:Two review authors independently extracted data, which included demographic variables, type of surgery, interventions, efficacy, and adverse events. We graded each included study for methodological quality by assessing risk of bias and employed the GRADE approach to assess the overall quality of the evidence. We performed meta-analysis of outcomes that included pain intensity assessed by a 0 to 100 visual analog scale (VAS), opioid consumption, patient satisfaction, length of stay, and adverse events. MAIN RESULTS:Forty-nine studies with 1725 participants receiving PCA and 1687 participants assigned to a control group met the inclusion criteria. The original review included 55 studies with 2023 patients receiving PCA and 1838 patients assigned to a control group. There were fewer included studies in our updated review due to the revised exclusion criteria. For the primary outcome, participants receiving PCA had lower VAS pain intensity scores versus non-patient controlled analgesia over most time intervals, e.g., scores over 0 to 24 hours were nine points lower (95% confidence interval (CI) -13 to -5, moderate quality evidence) and over 0 to 48 hours were 10 points lower (95% CI -12 to -7, low quality evidence). Among the secondary outcomes, participants were more satisfied with PCA (81% versus 61%, P value = 0.002) and consumed higher amounts of opioids than controls (0 to 24 hours, 7 mg more of intravenous morphine equivalents, 95% CI 1 mg to 13 mg). Those receiving PCA had a higher incidence of pruritus (15% versus 8%, P value = 0.01) but had a similar incidence of other adverse events. There was no difference in the length of hospital stay. AUTHORS' CONCLUSIONS:Since the last version of this review, we have found new studies providing additional information. We reanalyzed the data but the results did not substantially alter any of our previously published conclusions. This review provides moderate to low quality evidence that PCA is an efficacious alternative to non-patient controlled systemic analgesia for postoperative pain control.

Project description:IntroductionProfessional societies have urged providers to reduce opioid use for pain management. Accordingly, the objective of this study was to assess patient experiences related to postpartum pain management in an effort to better understand potential paths to achieve such a reduction.MethodsThis is a planned secondary analysis of a prospective observational study of opioid use following birth. In the primary study, women who received opioids as inpatients were queried about their pain management, including questions about pain experience, pain satisfaction, perceived areas for practice improvement, and the opportunity to leave additional comments. Participants who were prescribed opioids upon discharge completed postdischarge surveys with a similar opportunity for qualitative input. Data were analyzed using the constant comparative method to identify themes and subthemes.ResultsOf the 493 women enrolled in the primary analysis, 125 provided qualitative data. Three overarching themes regarding pain management were identified: positive experiences (n = 22), negative experiences (n = 19), and beliefs and preferences on opioid use and pain management (n = 28). Women with positive experiences reported satisfaction with timely pain medication administration and appreciation of open dialogue with their care team. In contrast, several negative experiences centered on tardy administration of pain medications, resulting in increased pain. Patients also perceived judgment, accusation, and excessive lecturing by staff when requesting opioid medications. Finally, participants expressed the necessity for opioids for postpartum pain management, as well as their desires for limiting opioid use, improved options for multimodal pain management, and increased communication with providers about pain regimens.DiscussionUnderstanding women's perspectives and experiences regarding postpartum pain control is essential to improving care. Amid growing research on the role of maternity care providers in addressing the opioid crisis, women's voices are rarely solicited. These findings stress the importance of open and frequent dialogue between patients and providers and a need for multimodal pain management options.

Dataset Information

Opioid Screening Practices in the Cancer Pain Patient.

Publications

Opioid Screening Practices in the Cancer Pain Patient.

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