Acute pain management in dermatology

Glass, Jonathan; Hardy, C; Meeks, Natalie M.; Carroll, Bryan T.

doi:10.1016/j.jaad.2015.04.050

Cited by 37 publications

(21 citation statements)

References 112 publications

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“…12 Current dermatology guidelines recommend oral opioids as second-line agents after a trial of nonsteroidal anti-inflammatory drugs and/or acetaminophen after surgical excisions and Mohs microsurgery (MMS). 13 Prior studies on opioid prescribing practices in dermatology suggest limited use of opioids after MMS but are derived from observational studies with limited cohorts of dermatologists and patients. 14,15 In this study, we sought to broaden this evaluation by examining the use and potential complications associated with opioid prescriptions within the US Medicare population.…”

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confidence: 99%

Opioid Prescribing Patterns and Complications in the Dermatology Medicare Population

Cao

Karmouta

et al. 2018

JAMA Dermatol

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IMPORTANCEThe ongoing opioid epidemic in the United States has been fueled by prescription opioids. Increases in opioid-related deaths and complications mandate clinicians in all fields to scrutinize their prescribing patterns. OBJECTIVE To characterize the current status and potential complications of opioid prescribing practices among dermatologists for Medicare beneficiaries. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study used Medicare Part D prescriber data to evaluate opioid prescriptions by dermatologists from January 1 to December 31, 2014. The number of prescribers, opioid claims, beneficiaries, and days supplied as well as the type of opioid and geographic location of prescribers were extracted and analyzed. The top 1% of dermatologists prescribing opioids were identified and compared with a random sample of the same size among the remaining dermatologists based on sex, geographic location, type of practice, and time in practice. A systematic literature review was conducted to estimate the outcome of opioid prescribing practices on the exposed population.MAIN OUTCOME AND MEASURES Practice characteristics, epidemiologic factors, and consequences of opioids prescribed by dermatologists. RESULTSOf the 12 537 dermatologists in the study, 5305 (42.3%) prescribed no opioid claims, 5408 (43.1%) prescribed 1 to 10 opioid claims, and 1824 (14.5%) prescribed more than 10 opioid claims. Among dermatologists prescribing at least 10 opioid claims, a mean of 1.0 opioid claims was given to each beneficiary, with a supply lasting a mean of 4.4 days. A total of 108 dermatologists (93.9%) in the top 1% of opioid prescribers (n = 115) work in a surgical practice. Estimates suggest that opioids prescribed by dermatologists could annually lead to 3877 to 7602 beneficiaries continuing to use opioids at 1 year and 1825 to 4209 continuing to use opioids at 3 years. A total of 9882 to 22 806 beneficiaries could experience gastrointestinal tract or central nervous system adverse effects and 588 to 999 could experience fractures. CONCLUSIONS AND RELEVANCE Opioid prescribing among dermatologists is limited and concentrated in the surgical setting, but it may be associated with a substantial number of adverse events that serve as a reminder to emphasize nonopioid pain medications in the postoperative setting.Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. 30.Sniezek PJ, Brodland DG, Zitelli JA. A randomized controlled trial comparing acetaminophen, acetaminophen and ibuprofen, and acetaminophen and codeine for postoperative pain relief after Mohs surgery and cutaneous reconstruction.

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confidence: 99%

Opioid Prescribing Patterns and Complications in the Dermatology Medicare Population

Cao

Karmouta

et al. 2018

JAMA Dermatol

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“…7 Higher overall patient satisfaction after outpatient orthopedic procedures has been associated with low levels of postoperative pain and the perception that nurses and physicians showed concern for the patients’ pain levels. 8 Even patients who do experience continued pain despite interventions have been shown to report increased satisfaction when their providers attempted to address the pain.…”

Section: Discussionmentioning

confidence: 99%

Assessment of intraoperative pain during Mohs micrographic surgery (MMS): An opportunity for improved patient care

Connolly

Nehal

Dusza

et al. 2016

Journal of the American Academy of Dermatology

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Background Intraoperative pain during Mohs micrographic surgery (MMS) has not been characterized. However, many patients report postoperative pain on the day of MMS. Objective We sought to determine if patients experience pain during their MMS visit. Methods In phase I of this study, patients were asked to report intraoperative pain level using the verbal numerical rating scale (0–10) at discharge. In phase II, pain levels were assessed before each Mohs layer and at discharge, to determine whether pain was experienced throughout the day. Results Pain was reported at some point during the MMS day for 32.8% of patients (n = 98). The mean pain number reported was 3.7 (range 1–8) out of 10. Pain was more commonly reported by patients who spent a longer time in the office, had 3 or more Mohs layers, and had a flap or graft repair. Patients most frequently reported pain with surgical sites of the periorbital area and nose. Limitations Time between Mohs layers was not measured. There was nonstandardized use of intraoperative local anesthesia volume and oral pain medications. Conclusion Some patients experience pain during MMS. However, the majority of patients report a low level of pain. Additional preventative measures could be considered in patients at higher risk.

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“…Although the concentrations of NSAIDs tested in the frog sciatic nerve are generally much higher than those for voltage-gated Na + -channel inhibition, such high concentrations are likely when NSAIDs are used at high concentrations in the direct vicinity of nerve fibers. At least a part of analgesia caused by NSAIDs used as a dermatological drug for antinociception may be due to a nerve conduction inhibition through their inhibitory action on voltage-gated Na + channels [122].…”

Section: Nsaidsmentioning

confidence: 99%

Inhibition of Fast Nerve Conduction Produced by Analgesics and Analgesic Adjuvants—Possible Involvement in Pain Alleviation

Kumamoto

2020

Pharmaceuticals

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Nociceptive information is transmitted from the periphery to the cerebral cortex mainly by action potential (AP) conduction in nerve fibers and chemical transmission at synapses. Although this nociceptive transmission is largely inhibited at synapses by analgesics and their adjuvants, it is possible that the antinociceptive drugs inhibit nerve AP conduction, contributing to their antinociceptive effects. Many of the drugs are reported to inhibit the nerve conduction of AP and voltage-gated Na+ and K+ channels involved in its production. Compound action potential (CAP) is a useful measure to know whether drugs act on nerve AP conduction. Clinically-used analgesics and analgesic adjuvants (opioids, non-steroidal anti-inflammatory drugs, α2-adrenoceptor agonists, antiepileptics, antidepressants and local anesthetics) were found to inhibit fast-conducting CAPs recorded from the frog sciatic nerve by using the air-gap method. Similar actions were produced by antinociceptive plant-derived chemicals. Their inhibitory actions depended on the concentrations and chemical structures of the drugs. This review article will mention the inhibitory actions of the antinociceptive compounds on CAPs in frog and mammalian peripheral (particularly, sciatic) nerves and on voltage-gated Na+ and K+ channels involved in AP production. Nerve AP conduction inhibition produced by analgesics and analgesic adjuvants is suggested to contribute to at least a part of their antinociceptive effects.

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Acute pain management in dermatology

Cited by 37 publications

References 112 publications

Opioid Prescribing Patterns and Complications in the Dermatology Medicare Population

Opioid Prescribing Patterns and Complications in the Dermatology Medicare Population

Assessment of intraoperative pain during Mohs micrographic surgery (MMS): An opportunity for improved patient care

Inhibition of Fast Nerve Conduction Produced by Analgesics and Analgesic Adjuvants—Possible Involvement in Pain Alleviation

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