Cautionary Guidelines for the Use of Opioids in Chronic Pain

Streltzer, Jon; Ziegler, Penelope P.; Johnson, Brian

doi:10.1080/10550490802544508

Cited by 16 publications

(17 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…11–13 However, far less is known regarding appropriate prescribing practices following routine elective surgery. 14 Inadequately managed perioperative pain causes difficulty with postoperative rehabilitation, prolonged length of stay, and may be associated with the development of chronic post-surgical pain.…”

mentioning

confidence: 99%

The Use of Opioid Analgesics following Common Upper Extremity Surgical Procedures

Waljee

Zhong

Hou

et al. 2016

Plastic and Reconstructive Surgery

153

105

View full text Add to dashboard Cite

Background The misuse of opioid analgesics is a major public health concern, and guidelines regarding postoperative opioid use are sparse. We examined the use of opioids following outpatient upper extremity procedures. We hypothesized that opioid use varies widely by procedure and patient factors. Methods We studied opioid prescriptions among 296,452 adults ages ≥ 18 years who underwent carpal tunnel release, trigger finger release, cubital tunnel release, and thumb carpometacarpal (CMC) arthroplasty from 2009 to 2013. We analyzed insurance claims drawn using Truven Health MarketScan Commercial Claims and Encounters, which encompasses over 100 health plans in the United States. Using multivariable regression, we compared the receipt of opioids, number of days supplied, indicators of inappropriate prescriptions, and number of refills by patient factors. Results In this cohort, 59% filled a postoperative prescription for opioid medication, and 8.8% patients had an indicator of inappropriate prescribing. The probability of filling an opioid prescription declined linearly with advancing age. In multivariate analysis, patients who had previously received opioids were more likely to fill a postoperative opioid prescription (66% vs. 59%), receive longer prescriptions (24 vs. 5 days), receive refills following surgery (24% vs. 5%), and have at least one indicator of potentially inappropriate prescribing (19% vs 6%). Conclusions Current opioid users are more likely to require postoperative opioid analgesics for routine procedures, and more likely to receive inappropriate prescriptions. More evidence is needed to identify patients who derive the greatest benefit from opioids in order to curb opioids prescriptions when alternative analgesics may be equally effective and available.

show abstract

mentioning

confidence: 99%

The Use of Opioid Analgesics following Common Upper Extremity Surgical Procedures

Waljee

Zhong

Hou

et al. 2016

Plastic and Reconstructive Surgery

153

105

View full text Add to dashboard Cite

show abstract

“…[24,25] This study represents one of the first systematic attempts to understand the thought processes that physicians use when evaluating patients initially complaining of pain and requesting pain medications. By combining quantitative and qualitative analyses in a mixed methods approach, we are able to statistically identify factors associated with physician suspicion of drug-seeking behavior by patients and understand physicians’ strategies for assessing whether a patient is drug seeking.…”

Section: Discussionmentioning

confidence: 99%

“…Some guidelines for managing patients requesting pain medications have been proposed,[24,25,34,36,37] but they have not yet been widely taken up by practitioners. Our findings provide important insights into how primary care clinicians approach decisions about drug-seeking related to narcotic pain medications and highlight the need for further work in this clinical area and for the development of tools to help clinicians work together with patients to manage pain without overusing potentially harmful medications.…”

Section: Discussionmentioning

confidence: 99%

Physician assessments of drug seeking behavior: A mixed methods study

et al. 2017

View full text Add to dashboard Cite

BackgroundPain complaints are common, but clinicians are increasingly concerned about overuse of opioid pain medications. This may lead patients with actual pain to be stigmatized as “drug-seeking,” or attempting to obtain medications they do not require medically. We assessed whether patient requests for specific opioid pain medication would lead physicians to classify them as drug-seeking and change management decisions.Methods and findingsMixed-methods analysis of interviews with 192 office-based primary care physicians after viewing video vignettes depicting patients presenting with back pain. For each presentation physicians were randomly assigned to see either an active request for a specific medication or a more general request for help with pain. The main outcome was assignment by the physician of “drug-seeking” as a potential diagnosis among patients presenting with back pain. Additional outcomes included other actions the physician would take and whether the physician would prescribe the medication requested.A potential diagnosis of drug-seeking behavior was included by 21% of physicians seeing a specific request for oxycodone vs. 3% for a general request for help with back pain(p<0.001). In multivariable models an active request was most strongly associated with a physician-assigned diagnosis of drug-seeking behavior(OR 8.10; 95% CI 2.11–31.15;p = 0.002); other major patient and physician characteristics, including gender and race, did not have strong associations with drug-seeking diagnosis. Physicians described short courses of opioid medications as a strategy for managing patients with pain while avoiding opioid overuse.ConclusionsWhen patients make a specific request for opioid pain medication, physicians are far more likely to suspect that they are drug-seeking. Physician suspicion of drug-seeking behavior did not vary by patient characteristics, including gender and race. The strategies used to assess patients further varied widely. These findings indicate a need for the development of better clinical tools to support the evaluation and management of patients presenting with pain.

show abstract

“…Opioid medications are effective analgesics, yet need to be used with caution because of the risks associated with them. 38 BPD patients may be particularly vulnerable to these risks due to their general impulsivity and reactivity to interpersonal disappointments.…”

Section: Discussionmentioning

confidence: 99%

The Use of Prescription Opioid Medication by Patients With Borderline Personality Disorder and Axis II Comparison Subjects

Frankenburg

Fitzmaurice²,

Zanarini³

2014

J. Clin. Psychiatry

View full text Add to dashboard Cite

Objective-The first purpose of this study was to determine the rate of use of prescription opioid medication reported by patients with borderline personality disorder (BPD) and to compare that to the rate reported by axis II comparison subjects during a 10-year period of prospective follow-up. The second purpose of this study was to determine the most clinically relevant predictors of prescription opioid use among borderline patients.Method-The medical conditions and axis I disorders of 264 borderline patients and 63 axis II comparison subjects were assessed at six-year follow-up and five contiguous follow-up waves that were two years apart. These assessments were conducted between July 1998 and December 2010. Family history of psychiatric disorder had been assessed at baseline by interviewers blind to the diagnostic status of the subjects. All three areas were assessed using semistructured interviews with proven psychometric properties: the Medical History and Services Utilization Interview (MHSUI), the Structured Clinical Interview for DSM-III-R Axis I disorders (SCID I), and the Revised Family History Questionnaire (FHQ-R).Results-Borderline patients were significantly more likely to report the use of prescription opioid medication over time than axis II comparison subjects (OR=1.79; 95%CI, 1.01-3.17). The best predictors of opioid use among borderline patients were the time-varying presence of back pain (OR=1.95; 95%CI, 1.41-2.70), fibromyalgia (OR=3.29; 95%CI, 1.70-6.36), and osteoarthritis (OR=3.32; 95%CI, 2.08-5.29) as well as a baseline history of drug abuse (OR=1.89; 95%CI, 1.27-2.81).Conclusions-The sustained use of prescription opioids is common among and discriminating for patients with BPD. The results also suggest that these borderline patients may be particularly sensitive to physical pain-mirroring their well-known heightened sensitivity to emotional pain.Address correspondence to Dr. Frankenburg, McLean Hospital, 115 Mill Street, Belmont, Massachusetts 02478; phone: 781-687-3004; fax: 617-855-3580; Frances.Frankenburg@med.va Other problems with opioid medications include side effects such as constipation, drowsiness, and decreased libido. Over time, the analgesic efficacy may not be maintained. 4 Chronic opioid use can also increase sensitivity to pain. 5,6 Ever since the work of Portenoy and Foley, the rates of opioid addiction among pain patients have been thought to be very low. Fishbain et al. 7 reviewed over 67 studies of opioid treatment of nonmalignant pain and found that of 2500 patients just over 3% developed abuse or addiction. The rates were lower if subjects were not treated if they had any current or previous history of abuse or addiction. Urine toxicology, however, revealed a higher number of problems. For example, some patients had no opioids in their urine suggesting possible diversion of these medications. In general, the rates of addiction to prescription opioids are higher if the patient has a history of substance abuse, comorbid mental illness, or somatization, or i...

show abstract

Cautionary Guidelines for the Use of Opioids in Chronic Pain

Cited by 16 publications

References 20 publications

The Use of Opioid Analgesics following Common Upper Extremity Surgical Procedures

The Use of Opioid Analgesics following Common Upper Extremity Surgical Procedures

Physician assessments of drug seeking behavior: A mixed methods study

The Use of Prescription Opioid Medication by Patients With Borderline Personality Disorder and Axis II Comparison Subjects

Contact Info

Product

Resources

About