Opioid Prescribing Practices in Chronic Pain Management: Guidelines Do Not Sufficiently Influence Clinical Practice

Victor, Timothy W.; Álvarez, Nancy A.; Gould, Errol

doi:10.1016/j.jpain.2009.03.019

Cited by 33 publications

(31 citation statements)

References 18 publications

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“…This finding was contrary to our hypothesis that specialists would be less likely than GP/FMs to prescribe opioid medications, although it was consistent with findings reported by Victor et al (7). However, we observed no difference in the proportions of prescriptions between GP/ FMs and primary care internal medicine physicians, and only very small differences between GP/FMs and both ENTs and OB/GYNs.…”

Section: Discussionsupporting

confidence: 65%

“…A recent study involving two million enrollees in a national health care plan revealed that specialists were more likely than nonspecialists (19.1% versus 13.7%) to prescribe an extended-release opioid for episodes of pain lasting at least 60 days (7). In contrast, a study involving almost 7000 physicians found that rheumatologists and general practitioners were more likely to prescribe long-term opioids than surgeons, neurologists and psychiatrists (21).…”

Section: La Prescription Différentielle D'analgésiques Opioïdes En Fomentioning

confidence: 98%

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Differential Prescribing of Opioid Analgesics According to Physician Specialty for Medicaid Patients with Chronic Noncancer Pain Diagnoses

Ringwalt

Gugelmann

Garrettson

et al. 2014

Pain Research and Management

138

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P ain constitutes one of the most prevalent diagnoses in primary care settings (1), and is the complaint presented by nearly two-thirds of emergency department patients treated in the United States (US) (2). Estimates of the prevalence of all chronic pain in the US population range considerably, from 8% to 48%, depending on the stringency of the definitions used. One recent review offered a weighted estimate of 22% (3); a somewhat more dated review provided an estimate of 15% (4). Opioid analgesics are the mainstay for pharmacological treatment for moderate to severe pain and have improved the quality of life for many (5-7). However, in the first decade of the 21st century, the amount of prescription analgesics, such as fentanyl, hydrocodone, methadone, oxymorphone and oxycodone, increased by a factor of four (8), and deaths due to the abuse and misuse of such analgesics nearly doubled (9). In 2009, poisoning deaths became the leading cause of injury-related death in the US (10).The BACkgRouND: Despite >20 years of studies investigating the characteristics of patients seeking or receiving opioid analgesics, research characterizing factors associated with physicians' opioid prescribing practices has been inconclusive, and the role of practitioner specialty in opioid prescribing practices remains largely unknown. oBjECTIvE: To examine the relationships between physicians' and other providers' primary specialties and their opioid prescribing practices among patients with chronic noncancer pain (CNCP). METHoDS: Prescriptions for opioids filled by 81,459 Medicaid patients with CNCP in North Carolina (USA), 18 to 64 years of age, enrolled at any point during a one-year study period were examined. χ 2 statistics were used to examine bivariate differences in prescribing practices according to specialty. For multivariable analyses, maximum-likelihood logistic regression models were used to examine the effect of specialty on prescribing practices, controlling for patients' pain diagnoses and demographic characteristics. RESuLTS: Of prescriptions filled by patients with CNCP, who constituted 6.4% of the total sample of 1.28 million individuals, 12.0% were for opioids. General practitioner/family medicine specialists and internists were least likely to prescribe opioids, and orthopedists were most likely. Across specialties, men were more likely to receive opioids than women, as were white individuals relative to other races/ethnicities. In multivariate analyses, all specialties except internal medicine had higher odds of prescribing an opioid than general practitioners: orthopedists, OR 7.1 (95% CI 6.7 to 7.5); dentists, OR 3.5 (95% CI 3.3 to 3.6); and emergency medicine physicians, OR 2.7 (95% CI 2.6 to 2.8). CoNCLuSIoNS: Significant differences in opioid prescribing practices across prescriber specialties may be reflective of differing norms concerning the appropriateness of opioids for the control of chronic pain. If so, sharing these norms across specialties may improve the care of patients with CNCP.

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Section: Discussionsupporting

confidence: 65%

Section: La Prescription Différentielle D'analgésiques Opioïdes En Fomentioning

confidence: 98%

Differential Prescribing of Opioid Analgesics According to Physician Specialty for Medicaid Patients with Chronic Noncancer Pain Diagnoses

Ringwalt

Gugelmann

Garrettson

et al. 2014

Pain Research and Management

138

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“…Several safety issues limit use of weak opioids. These agents are commonly combined with acetaminophen, imposing a dosage ceiling on their use (Victor et al, 2009). Codeine has been associated with a high rate of constipation.…”

Section: Weak Opioidsmentioning

confidence: 99%

Pharmacotherapy for Chronic Low Back Pain

Peniston¹

2012

Low Back Pain Pathogenesis and Treatment

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“…Despite the increased use of classical opioids in the treatment of long-term pain, there remains a need for evidence-based and/or patient need-based prescribing guidelines, to ensure that patients receive optimal analgesia. Evidence suggests that physicians' prescribing practices are more likely to be influenced by habit or tradition, rather than by the needs of the individual patient 22,23 . For example, although the natural opioid morphine and the semi-synthetic opioid oxycodone have equivalent analgesic efficacy 24 , oxycodone is often prescribed, despite being more costly and having no obvious clinical advantage 25 .…”

Section: History Of Classical Opioids Development and Usagementioning

confidence: 99%

Opioids: a two-faced Janus

Ahlbeck

2011

Current Medical Research and Opinion

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Background: Long-term pain is a debilitating condition that is costly to treat and has a significant impact on patient quality of life. Classical opioids have been used for the treatment of pain for centuries and are one of the most effective drug classes available for acute severe pain and long-term pain. However, concerns regarding adverse effects, tolerance to analgesic effects and the potential for addiction have resulted in a reluctance to prescribe and use opioids for the management of long-term non-cancer pain. Adverse events, including gastrointestinal side effects such as constipation, nausea and vomiting, and central nervous system side effects such as sedation are responsible for as many as one in five patients discontinuing opioid treatment, often leading to inadequate pain relief and poor patient quality of life. Therefore, new analgesic therapies are needed that are associated with fewer adverse effects, whilst providing sustainable pain relief for patients with long-term pain.

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Opioid Prescribing Practices in Chronic Pain Management: Guidelines Do Not Sufficiently Influence Clinical Practice

Cited by 33 publications

References 18 publications

Differential Prescribing of Opioid Analgesics According to Physician Specialty for Medicaid Patients with Chronic Noncancer Pain Diagnoses

Differential Prescribing of Opioid Analgesics According to Physician Specialty for Medicaid Patients with Chronic Noncancer Pain Diagnoses

Pharmacotherapy for Chronic Low Back Pain

Opioids: a two-faced Janus

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