102 -Strong opioid treatment for persistent non-cancer painpainresearch.co.uk › Posters_files ›...
Transcript of 102 -Strong opioid treatment for persistent non-cancer painpainresearch.co.uk › Posters_files ›...
Background
Aims
Methods
Results
Conclusions
References
• Opioid prescribing for persistent non-cancer pain is increasing• Negative physiological and psychological associations with
their use are well documented1, 2
• Evidence is lacking that these potential risks are outweighed by their ability at either reducing pain or increasing function and quality 3, 4
• Anecdotally, a significant proportion of our patients are on long-term strong opioids for their chronic pain conditions
• Our outpatient pain service operates within the model of a multi-professional, multi-disciplinary team and its clinicians are committed to responsible opioid prescribing2
• To evaluate a cross-section of our patient population, identifying the number of patients on strong opioids
• To better delineate the features associated with their pain management strategy and strong opioid use
• To make comparisons to those not taking strong opioids to guide the need for further service development
• To institute service changes if necessary and to re-evaluate their effects in the future
• We see a significant proportion of patients on strong opioids for the treatment of their persistent non-cancer pain• Evidence lacks as to the efficacy of opioids in this patient population and there is risk for serious adverse effects• Patients taking strong opioids might be more effectively served with a specific and focused clinic• This will help us better manage the complex issues they present:
• By addressing problematic opioid use such as narcotic bowel and opioid-induced hyperalgesia• By reducing over-medication• By exploring issues around addiction
• Future development will focus on further integration of allied professionals such as clinical psychology and addiction services to create an Integrated Care Pathway
• Prospective audit registered and permissions sought via the Trust’s Clinical Effectiveness Unit
• Consecutive patients attending secondary care pain clinic (Consultant or CNS led clinic, both new and follow-upincluded)
• Data collection tool: 20 point questionnaire• Data collection format: Structured interview at outpatient
consultation with pain management team• Cross-site data collection, two-week window, November 2015
(1) Ballantyne et al.. Opioid Therapy for Chronic Pain. N Engl J Med 2003;349:1943-53, (2) www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware, (3) American Pain Society and American Academy of Pain Medicine. Consensus statement: The use of opioids for the treatment of chronic pain. February 2009, (4) M. Von Korff, R.A. Deyo. Potent opioids for chronic musculoskeletal pain: flying blind? Pain 109 (2004)207–209.
102 - Strong opioid treatment for persistent non-cancer pain:A Prospective evaluation of prevalence from a secondary care multidisciplinary pain clinic
Dr P. Keogh1 MB BCh, Dr K. Ullrich1 MD & Dr J Gallagher MB BCh1 - 1Barts Health NHS Trust, United Kingdom
142 outpatient encounters recorded
36% 37%
27%
0
5
10
15
20
25
30
35
40
Noopioid Weakopioidonly Strongopioid
Percen
tage
38 patients (27%) were on a strong opioid
37% male63% female
Median oral morphine equivalent daily dose 67.5mg
Range 10mg to 500mg
3.5 yearsmedian strong
opioid use
(n=16)58%
(n=22)42%
0 10 20 30 40 50 60 70
Onan
Anti-
neurop
athic
Notonan
Anti-
neurop
athic
Percentage
OpioidRotation12% Increase
OpoiodDose3%
NoChangeinOpioidDose
36%
DecreaseOpioidDose
5%
Injection13%
Physio/Psychology/PMP
15%
Change,Add,TitrateAnti-neuropathic
16%
Concurrent anti-neuropathic therapy
Clinic outcomes for those on strong opioids
31%
21%
8%
18%
11% 11%
0% 0%
38%
32%
6%
12%
1%
7%
2% 2%
0
5
10
15
20
25
30
35
40
Neu
roaxial
Mecha
nical
Neu
roaxial
Radicular
Neu
ropa
thi
cOther
Widesprea
d/
Fibrom
yalgi
a
Abdo
minal
/Pe
lvic
Perip
heral
Joint
Head
ache
Other/
Unk
nown
Percen
tage
StrongOpioidTakers
Non-StrongOpioidTakers
Diagnosis – predominant type of pain
Other demographics comparable