Opioid Prescribing in an Opioid Crisis: What Basic Skills Should an Oncologist Have Regarding Opioid Therapy?

Arthur, Joseph; Reddy, Akhila

doi:10.1007/s11864-019-0636-3

Cited by 9 publications

(3 citation statements)

References 76 publications

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“…These findings underscore the importance of additional measures to reduce the risk of long-term opioid use. The use of validated screening tools in all patients using prescription opioids [34,35], and the targeting of psychosocial issues to combat 'chemical coping' [36,37] are examples of additional measures that may be used in conjunction with opioid-sparing approaches.…”

Section: Discussionmentioning

confidence: 99%

Patterns and predictors of outpatient opioid use after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Owusu-Agyemang

Cata

Kapoor

et al. 2019

International Journal of Hyperthermia

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2019) Patterns and predictors of outpatient opioid use after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy, International ABSTRACT Background: Long-term opioid use is a well-known complication after surgery. In this retrospective study of adults who had undergone cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), we sought to determine the rates and factors associated with outpatient opioid use within the sixth and twelfth postoperative months. Methods: Records of 288 opioid-naïve patients were included. Logistic regression models were used to determine factors prognostic of outpatient opioid use. Results: The median patient age was 54 years, and 63% were female. Rates of outpatient opioid use within the sixth and twelfth postoperative months were 21 and 13%, respectively. In the multivariate analysis, every doubling in the amount of in-hospital postoperative opioid consumption was associated with a 44% increase in odds of opioid use within the sixth postoperative month (OR 1.44, 95% CI 1.11-1.87, p ¼ .006) and a 70% increase within the twelfth postoperative month (OR 1.70, 95% CI 1.70-2.37, p ¼ .001). Other factors associated with opioid use within the sixth postoperative month included physical status (OR 5.26, 95% CI 1.08-25.55, p ¼ .039) and recent additional surgery (OR 23.02, 95% CI 2.03-261.30, p ¼ .011). Age (OR 4.39, 95% CI 1.77-10.89, p ¼ .001) and tumor grade (OR 3.31, 95% CI 1.31-8.41, p ¼ .012) were associated with opioid use within the twelfth postoperative month. Conclusion: In this study, the amount of in-hospital postoperative opioid consumption was an important contributory factor to outpatient opioid use in the sixth and twelfth postoperative months. SYNOPSISIn this study of adults who had undergone CRS-HIPEC, higher postoperative opioid consumption during hospitalization was associated with higher odds of opioid use within the sixth and twelfth postoperative months. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

Patterns and predictors of outpatient opioid use after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Owusu-Agyemang

Cata

Kapoor

et al. 2019

International Journal of Hyperthermia

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“…11 More than 40% of all opioid-related overdose deaths were attributed to a prescription opioid alone. 12 Between 2006 and 2016, there were roughly 900 opioid-related deaths in patients with cancer compared with about 200,000 deaths in the general population. 13 There is growing awareness that patients with active cancer may also be at risk of opioid misuse.…”

Section: Introductionmentioning

confidence: 99%

How Patients and Providers Weigh the Risks and Benefits of Long-Term Opioid Therapy for Cancer Pain

Giannitrapani

Fereydooni

Azarfar

et al. 2021

JCO Oncology Practice

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PURPOSE: To understand how patients and providers weigh the risks and benefits of long-term opioid therapy (LTOT) for cancer pain. METHODS: Researchers used VA approved audio-recording devices to record interviews. ATLAS t.i., a qualitative analysis software, was used for analysis of transcribed interview data. Participants included 20 Veteran patients and 20 interdisciplinary providers from primary care– and oncology-based practice settings. We conducted semistructured interviews and analyzed transcripts used thematic qualitative methods. Interviews explored factors that affect decision making about appropriateness of LTOT for cancer related pain. We saturated themes for providers and patients separately. RESULTS: Factors affecting patient decision-making included influence from various information sources, persuasion from trusted providers, and sometimes deferral of the decision to their provider. Relative prioritization of pain management as the focal patient concern varied with some patients describing comparatively more fear of chemotherapy than opioid analgesics, comparatively more knowledge of opioids in relation to other drugs;patients expressed a preference to spend the limited time they have with their oncologist discussing cancer treatment rather than opioid use. Factors affecting provider decision making included prognosis, patient goals, patient characteristics, and provider experience and biases. Providers differed in how they weigh the relative importance of alleviating pain or avoiding opioids in the face of treating patients with cancer and histories of substance abuse. CONCLUSION: Divergent perspectives on factors need to be considered when weighing risks and benefits. Policies and interventions should be designed to reduce variation in practice to promote equal access to adequate pain management. Improved shared decision-making initiatives will take advantage of patient decision-making factors and priorities.

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“…However, opioid tolerance, opioid-induced hyperalgesia, and other side effects have always limited the widespread application of opioids in cancer pain. The adverse effects or the improper use of opioid drugs such as morphine was a matter of concern, which leads to inadequate control of cancer pain ( Xia, 2017 ; Arthur and Reddy, 2019 ). According to incomplete statistics, the control rate of cancer pain in China is 43.8∼46.95%, which is lower than the global average ( Li et al, 2017 ; Xia, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Phosphoproteomic Profiling of Rat’s Dorsal Root Ganglia Reveals mTOR as a Potential Target in Bone Cancer Pain and Electro-Acupuncture’s Analgesia

et al. 2021

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Bone cancer pain (BCP) is a clinical refractory mixed pain involving neuropathic and inflammatory pain, with the underlying mechanisms remaining largely unknown. Electro-acupuncture (EA) can partly alleviate BCP according to previous research. We aim to explore the proteins and major pathways involved in BCP and EA treatment through phosphoproteomic profiling. BCP rat model was built by tibial inoculation of MRMT-1 mammary gland carcinoma cells. Mechanical hyperalgesia determined by paw withdrawal thresholds (PWTs) and bone destruction manifested on the radiographs confirmed the success of modeling, which were attenuated by EA treatment. The differentially expressed phosphorylated proteins (DEPs) co-regulated by BCP modeling and EA treatment in rat dorsal root ganglions (DRGs) were analyzed through PEX100 Protein microarray. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis revealed that DEPs were significantly enriched in mammalian target of rapamycin (mTOR) signaling pathway. The phosphorylations of mTOR at Ser2448 and Thr2446 were increased in BCP and downregulated by EA. In addition, the phosphorylation of S6K and Akt, markers of the mTOR complex, were also increased in BCP and downregulated by EA. Inhibition of mTOR signaling alleviated the PWTs of BCP rats, while the mTOR agonist impaired the analgesic effect of EA. Thus, our study provided a landscape of protein phosphorylation changes in DRGs of EA-treated BCP rats and revealed that mTOR signaling can be potentially targeted to alleviate BCP by EA treatment.

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Opioid Prescribing in an Opioid Crisis: What Basic Skills Should an Oncologist Have Regarding Opioid Therapy?

Cited by 9 publications

References 76 publications

Patterns and predictors of outpatient opioid use after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

Patterns and predictors of outpatient opioid use after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

How Patients and Providers Weigh the Risks and Benefits of Long-Term Opioid Therapy for Cancer Pain

Phosphoproteomic Profiling of Rat’s Dorsal Root Ganglia Reveals mTOR as a Potential Target in Bone Cancer Pain and Electro-Acupuncture’s Analgesia

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