Clinical indications associated with opioid initiation for pain management in Ontario, Canada: a population-based cohort study

Pasricha, Sachin V.; Tadrous, Mina; Khuu, Wayne; Juurlink, David N.; Mamdani, Muhammad; Paterson, J. Michael; Gomes, Tara

doi:10.1097/j.pain.0000000000001242

Cited by 65 publications

(53 citation statements)

References 21 publications

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“…The median starting daily dose was 38 mg and 30 mg MEDD for cancer and palliative care, respectively. 75 As patients deteriorate and approach their end-of-life, their mean opioid dose can be more than 300 mg MEDD, sometimes even greater than 1800 mg MEDD. 76 If an interventional procedure is successful, excessive sedation from the previously prescribed opioids may occur.…”

Section: Discussion: Interdisciplinary Collaboration and Pragmatic Comentioning

confidence: 99%

Interventional anesthesia and palliative care collaboration to manage cancer pain: a narrative review

Lau

Flamer

Murphy-Kane

2019

Can J Anesth/J Can Anesth

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Section: Discussion: Interdisciplinary Collaboration and Pragmatic Comentioning

confidence: 99%

Interventional anesthesia and palliative care collaboration to manage cancer pain: a narrative review

Lau

Flamer

Murphy-Kane

2019

Can J Anesth/J Can Anesth

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“…The primary outcome was a postoperative opioid prescription filled for oral tablet forms of any of codeine, fentanyl, hydromorphone, meperidine, morphine, oxycodone, pentazocine, tapentadol, or tramadol, filled within 7 days (ie, on the hospital discharge date or within 6 days subsequent). The secondary outcomes, defined only for the subset who filled a postoperative opioid prescription, were the characteristics of the first prescription(s) filled during these 7 days: (a) total MME, treated as continuous and categorized as ≤150 or >150 to reflect dose and duration guidance for opioid prescribing for people with acute pain (ie, ≤50 MME/day for 3 days or less) and (b) type of opioid (categorized as whether the prescription(s) included the most commonly dispensed opioids: codeine, oxycodone, hydromorphone, or tramadol) . Among those who filled a postoperative opioid prescription, we also assessed whether they filled a subsequent opioid prescription(s) within 30 days of the hospital discharge date.…”

Section: Methodsmentioning

confidence: 99%

“…Pain after surgery is one of the most common indications for initiating opioids, yet there is relatively little evidence to guide opioid prescribing in this setting. Guidelines on the management of postoperative pain recommend individualized care but acknowledge gaps in evidence and offer no recommendations specific to older adults .…”

Section: Introductionmentioning

confidence: 99%

Age and postoperative opioid prescriptions: a population‐based cohort study of opioid‐naïve adults

Bethell

Neuman

Bateman

et al. 2020

Pharmacoepidemiology and Drug

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Purpose: Opioids are commonly prescribed for acute pain after surgery. However, it is unclear whether these prescriptions are usually modified to account for patient age and, in particular, opioid-related risks among older adults. We therefore sought to describe postoperative opioid prescriptions filled by opioid-naïve adults undergoing four common surgical procedures.Methods: This retrospective cohort study used individually linked surgery and prescription opioid dispensing data from Ontario, Canada to create a population-based sample of 135 659 opioid-naïve adults who underwent one of four surgical procedures (laparoscopic cholecystectomy, laparoscopic appendectomy, knee meniscectomy, or breast excision) between 2013 and 2017. Patient age, in years, was categorized as 18 to 64, 65 to 69, 70 to 74, and 75 and over. Postoperative opioid prescriptions were identified as those filled on or within 6 days of surgical discharge date. For those who filled a prescription, we assessed the total morphine milligram equivalent (MME) dose, types of opioids, and any subsequent opioid prescriptions We have not presented or published these results.

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“…[8][9][10] Many of these children experience moderate to severe pain after trauma, and opioids are one way that pain is treated. [11][12][13][14][15][16][17] Inadequately managed pain can lead to significant long-term consequences, such as post-traumatic stress and substance abuse 7,[18][19][20][21][22] ; however, early exposure to opioids has also been linked to similar outcomes. 4,23,24 Opioids are often first-line treatment for moderate and acute pain after trauma, yet many trauma centers lack clear guidelines for when opioids are indicated in the pediatric trauma population and for the maximum cumulative amount of opioid to administer to pediatric patients.…”

mentioning

confidence: 99%

Who Hurts More? A Multicenter Prospective Study of In-Hospital Opioid Use in Pediatric Trauma Patients in the Midwest

Peláez

Davis

Spilman

et al. 2019

Journal of the American College of Surgeons

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BACKGROUND: Despite increased national attention on misuse of prescription and nonprescription opioids for adolescents and children, little is known about opioid use in a pediatric population during hospitalization for injury. The purpose of this investigation is to describe opioid administration and magnitude of opioid exposure in the first 48 hours of hospitalization in a pediatric trauma population. STUDY DESIGN: This is a secondary analysis of data collected for a randomized, prospective intervention study at 4 Midwestern children's trauma centers. Participants included children ages 10 to 17 years old, admitted to the hospital for unintentional injury. Descriptive statistics and multivariable modeling were used to characterize demographic factors and measure prevalence and magnitude of opioid use within the first 48 hours of hospitalization. RESULTS: Among 299 participants, 82% received at least 1 opioid administration. Children had increased odds of receiving an opioid (odds ratio [OR] 4.25; 95% CI 2.16 to 8.35) for every log increase of Injury Severity Scores (ISS), yet the majority of children with minor injury (61%) also received an opioid. Children with fractures and older children had higher odds of receiving an opioid. Amount of opioid, expressed as morphine milligrams equivalent (MME), significantly increased with child age, ISS, and fracture. CONCLUSIONS: Most pediatric trauma patients received an opioid in the first 48 hours of hospitalization, although prevalence and exposure varied by age, injury, and acuity. Aggressive pain management can be appropriate for injured pediatric patients; however, study results indicate areas for improvement, specifically for children with minor injuries and those receiving excessive opioid amounts.

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Clinical indications associated with opioid initiation for pain management in Ontario, Canada: a population-based cohort study

Abstract: Opioid initiation for postsurgical and musculoskeletal pain is associated with the highest dose and duration at initiation, respectively, relative to other indications.

Cited by 65 publications

References 21 publications

Interventional anesthesia and palliative care collaboration to manage cancer pain: a narrative review

Interventional anesthesia and palliative care collaboration to manage cancer pain: a narrative review

Age and postoperative opioid prescriptions: a population‐based cohort study of opioid‐naïve adults

Who Hurts More? A Multicenter Prospective Study of In-Hospital Opioid Use in Pediatric Trauma Patients in the Midwest

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