Evaluation of Emergency Department Management of Opioid-Tolerant Cancer Patients With Acute Pain

Patel, Pina; Goodman, Lauren; Knepel, Sheri A.; Miller, Charles C.; Azimi, Asma; Phillips, Gary; Gustin, Jillian; Hartman, Amber

doi:10.1016/j.jpainsymman.2017.07.013

Cited by 19 publications

(13 citation statements)

References 29 publications

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“…However, no statistically significant decrease was observed in the median pain scores of the patients who used NSAIDs and opioids together in their daily life after the treatment. In some studies, the causes of failure in the treatment of acute cancer pain in patients using opioids include advanced disease, development of intolerance to opioid drugs, or patient's non-compliance with treatment [1,11]. In addition, opioid abuse and the use of drugs for psychological and physiological pleasure are among the reasons affecting the treatment [6,13].…”

Section: Discussionmentioning

confidence: 99%

Analgesic choice in patients presenting to emergency department with cancer pain: a prospective study

et al. 2022

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Background. Acute onset pain is one of the common reasons for cancer patients to present to the emergency department. In our study, we compared painkillers used in cancer patients admitted to the emergency department with pain complaints and their effectiveness and the superiorities of these painkillers in pain relief and their superiorities over each other. Materials and methods. The pain scores of the patients were asked at the time of admission by showing a visual analogue scale. Before treatment, pain scores were recorded. The patients were divided into four different groups according to the type of given treatment: non-steroidal anti-inflammatory drugs; opioid painkillers; paracetamol; paracetamol and opioid therapy. After the treatment, we asked which painkiller written in the treatment form was administered to the patient and recorded the pain score. Results. It was observed that the median pain score before and after treatment of the patients in all painkiller groups differed statically. When the median scores before and after treatment were compared according to drug types, no difference was found between the decrease in pain scores (p = 0.956 and p = 0.705, respectively). It was concluded that the pre-treatment and post-treatment median pain scores of patients who are using non-steroid anti-inflammatory drugs and opioids at home did not differ statistically (p = 0.063). Conclusions. The use of non-steroidal anti-inflammatory drugs, paracetamol or opioids was not found to be superior to each other in patients with acute severe cancer pain.

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Section: Discussionmentioning

confidence: 99%

Analgesic choice in patients presenting to emergency department with cancer pain: a prospective study

et al. 2022

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“…We de ned a high ECOG as those with a score of 3 or 4, representing those with very limited functional status. We categorized pain based on the numerical scale as: none (0), mild (1-4), moderate (5-6), and severe (7)(8)(9)(10). Cancer type and pain were both grouped according to primary organ system involvement.…”

Section: Methods Of Measurementmentioning

confidence: 99%

“…Despite pain being one of the most common chief complaints in the ED, analgesics are often underutilized and delays in treatment are common [9]. These problems are further ampli ed among minority populations [10]. The effects of insu cient analgesic use are likely ampli ed in patients with active cancer, who are already at high-risk for poor pain control.…”

Section: Introduction/ Backgroundmentioning

confidence: 99%

Cancer Pain Presentation, Management, and Outcomes in the Emergency Department

Gupta

Resley

Khan

et al. 2021

Preprint

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Purpose: To describe the experience of patients with cancer presenting to the emergency department (ED) with pain and to identify patient and treatment factors that may affect patient outcomes. Methods: We conducted a retrospective cohort study to evaluate adult patients with active cancer, who presented to one of two academic EDs with a chief complaint of pain between June 1st, 2012 and December 31st, 2015. Variables analyzed included disease and demographic characteristics, pain character, treatment methods, ED disposition, and revisit rate. We utilized multivariable logistic regression to evaluate the association of our exposure variables on ED disposition. Results: We included 483 patients with active cancer with a chief complaint of pain. Patients with severe pain on arrival tended to be younger than those who did not present with severe pain (median: 58 vs 62 respectively, OR 8.0 p<0.01). Patients with high ECOG statuses (3-4) with severe pain on arrival (≥ 7 out of 10) had less improvement in their pain (OR 8.4, p<.01). Long delays in initial analgesic administration were associated with increased rates of subsequent admission (OR 3.4) [p = 0.14]. Although opioid analgesics led to greater decreases in pain than non-opioid analgesics, patients treated with opioids were more likely to be admitted (43% vs 34.5% AOR 1.51, p =.048).Conclusion: Several factors appear to play a role in the effectiveness of ED cancer pain management including patient and treatment characteristics. We hope that these findings will inform future studies and best-practice initiatives targeting ED cancer pain.

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“…Tolerance (ie, muted therapeutic response) to a previously effective dose frequently develops, such that dose escalation is necessary to maintain adequate pain control. Patients who are receiving a daily oral morphine equivalency >200 mg per day may be at higher risk for undertreatment of their cancer pain 188 . Because it is common for patients to either underuse an as‐needed prescription or to develop confusion regarding their correct schedule, confirming compliance with the prescribed regimen coupled with ED‐facilitated re‐education and supervised administration of scheduled oral pain medications can promote a straightforward, same‐day safe discharge to home.…”

Section: Cancer Pain Managementmentioning

confidence: 99%

Oncologic emergencies and urgencies: A comprehensive review

Rothberg

Quest

Yeung

et al. 2022

CA A Cancer J Clinicians

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Patients with advanced cancer generate 4 million visits annually to emergency departments (EDs) and other dedicated, high‐acuity oncology urgent care centers. Because of both the increasing complexity of systemic treatments overall and the higher rates of active therapy in the geriatric population, many patients experiencing acute decompensations are frail and acutely ill. This article comprehensively reviews the spectrum of oncologic emergencies and urgencies typically encountered in acute care settings. Presentation, underlying etiology, and up‐to‐date clinical pathways are discussed. Criteria for either a safe discharge to home or a transition of care to the inpatient oncology hospitalist team are emphasized. This review extends beyond familiar conditions such as febrile neutropenia, hypercalcemia, tumor lysis syndrome, malignant spinal cord compression, mechanical bowel obstruction, and breakthrough pain crises to include a broader spectrum of topics encompassing the syndrome of inappropriate antidiuretic hormone secretion, venous thromboembolism and malignant effusions, as well as chemotherapy‐induced mucositis, cardiomyopathy, nausea, vomiting, and diarrhea. Emergent and urgent complications associated with targeted therapeutics, including small molecules, naked and drug‐conjugated monoclonal antibodies, as well as immune checkpoint inhibitors and chimeric antigen receptor T‐cells, are summarized. Finally, strategies for facilitating same‐day direct admission to hospice from the ED are discussed. This article not only can serve as a point‐of‐care reference for the ED physician but also can assist outpatient oncologists as well as inpatient hospitalists in coordinating care around the ED visit.

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Evaluation of Emergency Department Management of Opioid-Tolerant Cancer Patients With Acute Pain

Abstract: Patients with daily home use less than 200 OMEs generally received adequate initial PRN opioid doses during their ED visit. However, patients with higher home opioid usage were at increased likelihood of being undertreated.

Cited by 19 publications

References 29 publications

Analgesic choice in patients presenting to emergency department with cancer pain: a prospective study

Analgesic choice in patients presenting to emergency department with cancer pain: a prospective study

Cancer Pain Presentation, Management, and Outcomes in the Emergency Department

Oncologic emergencies and urgencies: A comprehensive review

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