Opioid tolerance impacts compliance with enhanced recovery pathway after major abdominal surgery

Owodunni, Oluwafemi P.; Zaman, Mohammad H.; Ighani, Mehrnaz; Grant, Michael C.; Bettick, Dianne; Sateri, Sara; Magnuson, Thomas; Gearhart, Susan L.

doi:10.1016/j.surg.2019.08.001

Cited by 10 publications

(7 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, a patient was deemed "opioid-tolerant" if he or she was taking an opioid regimen equivalent to 60 mg of daily oral morphine for at least one week prior to surgery. The consequences of opioid tolerance include poorly-controlled pain, which in itself, can lead to decreased compliance with ERAS protocols [8].…”

Section: Review the Chronic Pain Patientmentioning

confidence: 99%

“…This early intervention during follow up has the potential to reduce the healthcare burden associated with unnecessary visits to urgent care and emergency rooms [2]. The recommendation is promising given studies that have shown that poor compliance may be one of the factors contributing to less favorable outcomes in chronic pain patients [8]. In fact, it has been demonstrated that appropriate adherence to an ERAS protocol can alone significantly reduce postoperative complications and risk of readmission [3].…”

Section: Approach To Carementioning

confidence: 99%

“…Chronic pain is highly prevalent and has historically been managed with daily opioid regimens [ 8 ]. It is estimated that as many as 30% of patients presenting for elective surgery are on long-term opioid doses [ 9 ].…”

Section: Reviewmentioning

confidence: 99%

“…It is estimated that as many as 30% of patients presenting for elective surgery are on long-term opioid doses [ 9 ]. These patients are at heightened risk for not only opioid tolerance but also hyperalgesia - not ideal given the inherent risks of acute and subacute pain associated with surgery [ 8 ]. Chronic opioid use has been consistently associated with difficult-to-manage pain, increased length of postoperative stay, increased readmission rates, and increased economic costs [ 10 ].…”

Section: Reviewmentioning

confidence: 99%

See 3 more Smart Citations

Management of Patients With Chronic Pain in Ambulatory Surgery Centers

Charipova¹,

Gress²,

Urits³

et al. 2020

Cureus

View full text Add to dashboard Cite

In the setting of increasingly streamlined surgical techniques and perioperative care, the United States healthcare system is seeing a steady rise in the number of procedures being carried out at ambulatory surgery centers. Concurrently, awareness and diagnosis of both chronic pain conditions and substance use disorders have also improved in recent years. As a result of these two shifts, the demographic characteristics of patients undergoing procedures at ambulatory surgery centers are actively evolving. Chronic pain and substance use disorders are difficult to manage in both the outpatient and inpatient settings and present unique challenges in the context of perioperative planning. Both conditions are associated with worsened postoperative outcomes, including refractory pain, decreased functional status, increased length of stay, increased readmission rates, and increased economic costs. There has been a recent movement to include a preoperative risk stratification calculation for these patients, followed by the implementation of enhanced recovery after surgery (ERAS) protocols in these patient cohorts. Taking a step further, patients benefit when standard ERAS protocols are augmented by integrating designated pain specialists into the ambulatory surgery team. This multimodal and multidisciplinary approach must be assessed in the context of the human and financial resources of a given institution and surgery center, but has been shown to improve the quality and safety of perioperative care effectively.

show abstract

Section: Review the Chronic Pain Patientmentioning

confidence: 99%

Section: Approach To Carementioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Management of Patients With Chronic Pain in Ambulatory Surgery Centers

Charipova¹,

Gress²,

Urits³

et al. 2020

Cureus

View full text Add to dashboard Cite

show abstract

“…Pain control and treatment adherence in opioid-tolerant patients (defined as those who have received at least 60 morphine milligram equivalents (MME) for at least 1 week) [ 12 ], are particularly challenging [ 13 , 14 ]. Whether pharmacist-led management can increase treatment adherence in opioid-tolerant patients with cancer pain is unclear.…”

Section: Introductionmentioning

confidence: 99%

Pharmacist-Led Management Improves Treatment Adherence and Quality of Life in Opioid-Tolerant Patients With Cancer Pain: A Randomized Controlled Trial

Zheng

Ding

et al. 2022

Pain Ther

View full text Add to dashboard Cite

Introduction Opioid-tolerant patients are more likely to deviate from recommended treatments and to experience inadequate analgesia than opioid-naive ones. The aim of this study was to examine whether pharmacist-led management could help improve treatment adherence and quality of life. Methods Eligible patients were randomized in a 1:1 ratio to control group and intervention group. The control group received routine education and support, while the intervention group received additional individualized pharmacist-led care. The primary endpoint was treatment adherence in the per-protocol analysis, as evaluated by blinded assessors. An interim analysis was planned when 30% patients completed the study. Alpha was divided into the interim analysis (0.015) and the final analysis (0.035). Results In the interim analysis (97 and 87 patients in the control and intervention groups, respectively), the primary endpoint was met. Pharmacist-led intervention significantly increased treatment adherence (93.3 vs. 79.8%; OR: 2.25; 95% CI 1.02, 4.94; P = 0.013), quality of life (0.81 ± 0.17 vs. 0.72 ± 0.25; P = 0.008), and reporting of adverse events (82.7 vs. 61.9%; OR: 1.88; 95% CI 1.16, 3.07; P = 0.004). The two groups did not differ in pain control rate (66.7 vs. 57.1%; OR: 1.25; 95% CI 0.87, 1.78; P = 0.218), breakthrough pain-free rate (66.7 vs. 61.9%; OR: 1.12; 95% CI 0.78, 1.59; P = 0.532) and pain score (1.97 ± 1.04 vs. 2.15 ± 1.24; P = 0.522). Conclusions Pharmacist-led management improved treatment adherence, quality of life, and the reporting of adverse events in opioid-tolerant patients with cancer pain. Trial Registration ClinicalTrials.gov, NCT03455023. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-021-00342-0.

show abstract

Perioperative Care of the Opioid-Tolerant Patient

Rudin

2024

Perioperative Pain Management

View full text Add to dashboard Cite

Opioid tolerance impacts compliance with enhanced recovery pathway after major abdominal surgery

Cited by 10 publications

References 11 publications

Management of Patients With Chronic Pain in Ambulatory Surgery Centers

Management of Patients With Chronic Pain in Ambulatory Surgery Centers

Pharmacist-Led Management Improves Treatment Adherence and Quality of Life in Opioid-Tolerant Patients With Cancer Pain: A Randomized Controlled Trial

Perioperative Care of the Opioid-Tolerant Patient

Contact Info

Product

Resources

About