Clinical and neuroscience evidence supports the critical importance of patient expectations and agency in opioid tapering

Darnall, Beth D.

doi:10.1097/j.pain.0000000000002443

Cited by 11 publications

(10 citation statements)

References 32 publications

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“…We suggest that forced tapering is not only counterproductive, it risks grave harm. We agree with Agnoli et al 1 and others (cited in our publication) 3 who have called for tapering cautions. The significant potential harm with taper makes nonconsensual tapering generally unjustified clinically and ethically.…”

Section: Letter To the Editorsupporting

confidence: 92%

“…Sullivan's perspective implied that we have proposed a binary categorization of opioid tapering as being either voluntary or involuntary. In fact, we clearly advocated for assessing patient autonomy with tapering “as a continuous variable [to] provide data essential for determining the relationship between degree of patient agency and tapering outcomes.” 3…”

Section: Letter To the Editormentioning

confidence: 99%

“…Here, we address several points that Dr. Sullivan raised in his critique 7 of our published perspective on factors that influence the success of opioid taper. 3…”

Section: Letter To the Editormentioning

confidence: 99%

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A multicenter, randomized, double-blind, placebo-controlled, comparative study to evaluate the efficacy and safety of newly developed diclofenac patches in patients with cancer pain

Yamaguchi¹,

Terahara²,

Okawa³

et al. 2021

Pain

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This phase III multicenter randomized double-blind placebo-controlled comparative study evaluated the efficacy and safety of diclofenac sodium patches for the treatment of cancer pain. The study consisted of a 2-week to 4-week open-label dose-titration phase and a 4-week double-blind phase. In the double-blind phase, patients who were expected to continue treatment of cancer pain with nonopioid analgesics alone were randomized to the diclofenac sodium patch or placebo group. Once-daily diclofenac sodium patches were started at 150 mg/day (2 patches) and could be increased up to 225 mg/day (3 patches). The primary efficacy endpoint was the time to insufficient analgesic response. Statistical analysis of the double-blind phase included data from 120 patients of the diclofenac sodium patch group and 118 patients of the placebo group. Time to insufficient analgesic response was significantly longer with diclofenac sodium patches than with placebo (P 5 0.0016). The hazard ratio for insufficient response for diclofenac sodium patch vs placebo was 0.459 (95% confidence interval, 0.275-0.768). Regarding sleep quality during the doubleblind phase, the proportion of patients with "very good sleep" or "good sleep" in the diclofenac sodium patch and placebo groups was 90.8% and 88.1% at the start of the double-blind phase and 81.4% and 78.6% at the final assessment, respectively. The incidence of adverse events was 60.8% (73/120) in the diclofenac sodium patch group and 60.2% (71/118) in the placebo group. Once-daily diclofenac sodium patches are effective in treating cancer pain and are well tolerated.

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Section: Letter To the Editorsupporting

confidence: 92%

Section: Letter To the Editormentioning

confidence: 99%

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A multicenter, randomized, double-blind, placebo-controlled, comparative study to evaluate the efficacy and safety of newly developed diclofenac patches in patients with cancer pain

Yamaguchi¹,

Terahara²,

Okawa³

et al. 2021

Pain

View full text Add to dashboard Cite

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“…Pharmacists often work in interdisciplinary care teams and make recommendations to both providers and patients about pharmacologic and non-pharmacologic interventions, including pain management ( 64 – 66 ). Given an important role of pharmacists in opioid stewardship and prevention of future opioid crisis ( 67 , 68 ), we hypothesize here that pharmacists recommendations to integrate digital therapeutics with opioid-based analgesia will improve outcomes of opioid tapering programs ( 69 – 73 ). Recently, the Academy of Managed Care Pharmacy convened a forum that brought digital therapeutic innovators, payers, pharmacy benefit managers, and other key stakeholders to discuss the role of digital interventions as therapeutic options ( 74 ).…”

Section: Discussionmentioning

confidence: 99%

Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care

Giravi

Biskupiak

Tyler

et al. 2022

Front. Digit. Health

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Digital therapeutics (DTx, mobile medical apps, software as a medical device) are rapidly emerging as clinically effective treatments for diverse chronic diseases. For example, the Food and Drug Administration (FDA) has recently authorized a prescription virtual reality (VR) app for treatment of moderate to severe low back pain. The FDA has also approved an adjunct digital therapy in conjunction with buprenorphine for opioid use disorder, further illustrating opportunities to integrate digital therapeutics with pharmacotherapies. There are ongoing needs to disseminate knowledge about advances in digital interventions among health care professionals, policymakers, and the public at large. This mini-review summarizes accumulating clinical evidence of digital interventions delivered via virtual reality and mobile apps to improve opioid-based analgesia. We identified relevant randomized controlled trials (RCTs) using Embase and PubMed databases which reported pain scores with a validated pain scale (e.g., visual analog scales, graphic rating scale, numeric rating scale) and use of a digital intervention in conjunction with opiates. Among identified RCTs, the majority of studies reported improved pain scores in the digital intervention group, as compared to “treatment as usual” group. Our work suggests that VR and mobile apps can be used as adjunct digital therapies for pain management. We discuss these findings in the context of how digital health technologies can transform patient-centered pharmacy care.

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“…Increasingly, state laws require clinicians to consult the PDMP when prescribing opioids with penalties for noncompliance 33 . These laws may ultimately harm patients because clinicians may choose to stop prescribing opioids to avoid such penalties, or to taper patients off of opioid medications, even when patients demonstrate improved quality of life and pain stability on opioid therapy 34 . A PDMPEHR integration program could reduce the time and effort required by clinicians to access PDMP data while simultaneously tracking patient’s PDMP data for unexpected opioid or benzodiazepine fills or aberrancies.…”

Section: Discussionmentioning

confidence: 99%

The Impact of a PDMP-EHR Data Integration Combined With Clinical Decision Support on Opioid and Benzodiazepine Prescribing Across Clinicians in a Metropolitan Area

et al. 2022

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IntroductionDespite inconclusive evidence that prescription drug monitoring programs (PDMP) reduce opioid-related mortality, guidelines recommend PDMP review with opioid prescribing. Some reported barriers to use include time-consuming processes to obtain data and workflow disruptions.MethodsWe provided access to a PMDP-electronic health record (EHR) integrated program to 123 clinicians in one healthcare system. Remaining clinicians within the healthcare system and metropolitan area did not receive PDMP-EHR integration program access. We identified changes in opioid prescribing by linking prescription data available in the state PMDP database to individual clinicians. The primary outcome was change in receipt of high dose opioid prescriptions (>90 mg morphine equivalents) by Colorado residents before and after program integration. Secondary outcomes included changes in long-acting opioid receipt and overlapping opioid and benzodiazepine prescription days. Next, we surveyed clinicians to assess their perspectives on PDMP data acquisition before and after PDMP-EHR integration program access.ResultsHigh-dose opioid receipt decreased significantly across all 3 clinician groups [PDMP-EHR integration program access (27.6%, to 6.9%, P < 0.001); no program access in the same healthcare system (4.8% to 2.9%, P < 0.001), and no program access across the metropolitan area (13.5% to 6.1%, P < 0.001)]. Clinicians reported improved access to PDMP data using the PDMP-EHR integrated program compared to the state PDMP website (98.6%).ConclusionsFurther study of PDMP-EHR integration programs on patient and clinician outcomes may illuminate the role of this technology in public health and in clinical practice.

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Clinical and neuroscience evidence supports the critical importance of patient expectations and agency in opioid tapering

Cited by 11 publications

References 32 publications

A multicenter, randomized, double-blind, placebo-controlled, comparative study to evaluate the efficacy and safety of newly developed diclofenac patches in patients with cancer pain

A multicenter, randomized, double-blind, placebo-controlled, comparative study to evaluate the efficacy and safety of newly developed diclofenac patches in patients with cancer pain

Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care

The Impact of a PDMP-EHR Data Integration Combined With Clinical Decision Support on Opioid and Benzodiazepine Prescribing Across Clinicians in a Metropolitan Area

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