Pharmacoepidemiology of chronic noncancer pain patients requiring chronic opioid therapy: A nationwide population-based study

Chang, Shu‐Ching; Ma, Chen-Chung; Lee, Chun-Te; Hsieh, Shao-Wei

doi:10.1016/j.aat.2015.04.002

Cited by 11 publications

(10 citation statements)

References 30 publications

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“…In comparison, a recent study showed that patients with chronic non‐cancer pain (CNCP) consumed a median dose of 75 mg OME per day, and only 8.8% of them used less than 20 mg OME daily . The average opioid use among CNCP patients ranges from 20 to 180 mg OME daily and among cancer patients ranges from 30 to 167 mg OME daily (Table ).…”

Section: Discussionmentioning

confidence: 99%

Patterns of opioid use in sickle cell disease

et al. 2016

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Pain, the hallmark complication of sickle cell disease (SCD), is largely managed with opioid analgesics in the United States, but comprehensive data regarding the long-term use of opioids in this patient population is lacking. The pain medication prescription records from a cohort of 203 SCD patients were analyzed. Twenty-five percent were not prescribed opioid medications while 47% took only short-acting opioids, 1% took only long-acting opioids, and 27% took a combination of short-acting and long-acting opioids. The median (interquartile range) daily opioid dose was 6.1 mg (1.7-26.3 mg) of oral morphine equivalents, which is lower than the published opioid use among patients with other pain syndromes. The dose of opioids correlated with the number of admissions due to vaso-occlusive crisis (VOC) (r=0.53, p<0.001). When the patients were grouped into quartiles based on daily dose opioid use, a logistic regression model showed that history of avascular necrosis (AVN) (OR 2.87, 95% CI: 1.37-6.02, p=0.005), 25-OHD levels (OR 0.59, 95% CI: 0.38-0.93, p=0.024) and total bilirubin concentration (OR 0.64, 95% CI: 0.42-0.99, p=0.043) were independently associated with opioid use quartiles. In conclusion, doses and types of opioid medications used by adult SCD patients vary widely. Our findings implicate AVN and lower vitamin D levels as factors associated with higher opioid use. They also suggest an association of higher bilirubin levels, possibly suggesting higher hemolytic rate, with lower opioid use.

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Section: Discussionmentioning

confidence: 99%

Patterns of opioid use in sickle cell disease

et al. 2016

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“…Total rescue analgesic consumption was determined using approximate oral morphine milligram equivalent (MME). 13,14 Randomization A computer-generated individual randomization unit was employed, with a nonstratified sequence in four blocks. Once consent for study participation was approved, a sequentially numbered opaque envelope was accessed to obtain the next allotment.…”

Section: Patient Selectionmentioning

confidence: 99%

A Randomized Controlled Trial of Cryoanalgesia for Pain Management following Pectus Excavatum Repair: A Single-Center, Single-Blind, Parallel Design Study

Rim¹,

Kim

Koo

et al. 2023

Eur J Pediatr Surg

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Introduction: Conventional postoperative pain management, with an intravenous patient-controlled approach or thoracic epidural analgesia, has proved suboptimal following a minimally invasive repair of pectus excavatum (MIRPE). Considering its postulated mechanism of action, we encouraged cryoanalgesia as an effective method for post-repair pain management and a possibly superior alternative. Methods: A randomized, single-blind clinical trial was tested on patients undergoing PE repair in March and December 2022. Among 101 patients, consenting study participants were randomly assigned to one of two groups: cryoanalgesia (group C, n=24) or non-cryoanalgesia (group N, n=24). Group N received conventional pain management. Comparing the results, pain levels were measured using the Visual Analog Scale (VAS-R for resting and VAS-D for dynamic) and the total rescue analgesic consumption was determined. Intrathoracic cryoablation was performed bilaterally on the fourth and seventh intercostal nerves using a cryoprobe at -80°C for 2 min. Results: The two groups had similar baseline-patient characteristics however; group C had a longer mean operative time (159 min vs. 125 min, p<0.01) and experienced significantly less pain throughout the postoperative course, with VAS at 6 h (5.38 vs 7.04, p<0.01) and 48 h (3.17 vs. 5.67, p<0.01). Conclusion: Cryoanalgesia improved postoperative pain control at rest and during movement following PE repair. However, the outcome was less favorable than expected because, the VAS was greater than 4 (moderate pain), although after a day or two, it decreased to lower levels (VAS<4) in the cyro group. Considering its extra invasiveness and instrumentation, a routine cryoanalgesia procedure for pectus surgery is yet to be determined.

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“…5,6 In contrast to Western countries, COP is low in Taiwan due to the restricted Controlled Drug Regulation. [7][8][9] Since 1996, patients with CNCP who need COP must apply for approval. The continuum needs to be accessed by Controlled Drug Management Committees and reported to the Taiwan Food and Drug Administration every 4 months.…”

Section: Articlementioning

confidence: 99%

Longitudinal Trajectory of Opioid Prescribing and its Associated Serious Adverse Events: A Population‐Wide Cohort Study in Taiwan

Chen,

Lin,

Wang

et al. 2023

Clin Pharma and Therapeutics

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Chronic opioid prescribing (COP) for non‐cancer pain is highly restricted in Taiwan, but tramadol is not listed in the regulation on chronic prescribing. This study investigated the trajectories of COP in non‐cancer pain when considering tramadol in Taiwan and identified the risk of serious adverse events. This population‐wide longitudinal cohort study used the Taiwan National Health Insurance claims records from 2001 to 2016. Adults prescribed opioids (including tramadol) and without cancer were selected. Patients who received COP (opioid supply days for 28 days or continuous opioid supply for 14 days) in the first patient quarter were included, and serious adverse events were identified. Group‐based trajectory models were applied to identify patients with a similar trajectory of quarterly COP. The Cox proportional hazard model was applied to assess the association between adverse events and patients' trajectories. Of the 2,360,358 non‐cancer opioid users, 476,934 (20.2%) received COP in the first quarter. Four groups of COP trajectory were identified, and 59,310 (12.8%) patients received COP quarterly over two years. Patients categorized into the trajectory of long‐term COP had a significantly higher crude incidence rate of cardiovascular death, seizure, and hypoglycaemia. Still, there is no newly developed opioid use disorder. There was a substantial underestimate in COP in Taiwan when tramadol was not considered. Notably, 10% of them could receive COP for over two years. The result raises concern about unmet pain management needs and the limited accessibility of alternative treatments for non‐cancer pain.

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Pharmacoepidemiology of chronic noncancer pain patients requiring chronic opioid therapy: A nationwide population-based study

Cited by 11 publications

References 30 publications

Patterns of opioid use in sickle cell disease

Patterns of opioid use in sickle cell disease

A Randomized Controlled Trial of Cryoanalgesia for Pain Management following Pectus Excavatum Repair: A Single-Center, Single-Blind, Parallel Design Study

Longitudinal Trajectory of Opioid Prescribing and its Associated Serious Adverse Events: A Population‐Wide Cohort Study in Taiwan

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