Physician Attitudes Toward Opioid Prescribing for Patients With Persistent Noncancer Pain

Lin, Jeng-Wen; Alfandre, David; Moore, Carlton

doi:10.1097/ajp.0b013e3181565cf1

Cited by 61 publications

(48 citation statements)

References 17 publications

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“…cal dependence, tolerance and addiction [21][22][23][24][25] ; concern about possible diversion of opioid medication for other purposes 12,15,23,24,[26][27][28][29] ; and concern about possible sanctions by state and federal regulatory agencies. 21,27,28,[30][31][32][33] These concerns may complicate clinical decision making regarding the prescription of opioids 34,35 and may result in extra time demands, failures in the patient-physician relationship, and less time on other activities.…”

Section: O Pioid T Her a P Y A Nd Pr E V En T Iv E Serv Ic Esmentioning

confidence: 99%

Chronic Opioid Therapy and Preventive Services in Rural Primary Care: An Oregon Rural Practice-based Research Network Study

Buckley¹,

Calvert²,

Lapidus³

et al. 2010

The Annals of Family Medicine

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PURPOSE For clinicians, using opioid therapy for chronic noncancer pain (CNCP) often gives rise to a confl ict between treating their patients' pain and fears of addiction, diversion of medication, or legal action. Consequent stresses on clinical encounters might adversely affect some elements of clinical care. We evaluated a possible association between chronic opioid therapy (COT) for CNCP and receipt of various preventive services. METHODSWe conducted a retrospective cohort study in 7 primary care clinics within the Oregon Rural Practice-based Research Network (ORPRN). Using medical records of 704 patients, aged 35 to 85 years, seen during a 3-year period, we compared the receipt of 4 preventive services between patients on COT for CNCP and patients not on chronic opioid therapy (non-COT). We used multivariate log-binomial regression analyses to estimate the relative risk of receipt of each preventive service. RESULTSAfter adjustment for plausible confounders, we found that patients using COT had a statistically signifi cantly lower relative risk (RR) of receipt of cervical cancer screening (RR = 0.60; 95% confi dence interval [CI], 0.47-0.76) and colorectal cancer screening (RR = 0.42; 95% CI, 0.22-0.80) when compared with non-COT patients. The RR was reduced, without statistical signifi cance, for lipid screening (RR = 0.77; 95% CI, 0.54-1.10), and not notably reduced for smoking cessation counseling (RR = 0.95; 95% CI, 0.78-1.15).CONCLUSIONS Patients using COT for CNCP were less likely to receive some preventive services. Research is needed to better understand barriers to and improved methods for providing preventive services for these patients.

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Section: O Pioid T Her a P Y A Nd Pr E V En T Iv E Serv Ic Esmentioning

confidence: 99%

Chronic Opioid Therapy and Preventive Services in Rural Primary Care: An Oregon Rural Practice-based Research Network Study

Buckley¹,

Calvert²,

Lapidus³

et al. 2010

The Annals of Family Medicine

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show abstract

“…The attitude of the physician affects the prescription of opioids for patients with CNCP. In a survey by Lin et al [12], most physicians strongly agreed that they were hesitant to prescribe opioid analgesics because of concerns about side effects (58%), diversion for illegal use (37%), and causing addiction (31%). In fact, a recent meta-analysis [4] revealed that many patients withdrew from clinical trials due to adverse effects (oral, 32.5%; intrathecal, 6.3%; transdermal, 17.5%).…”

Section: Discussionmentioning

confidence: 98%

Chronic opioid therapy in patients with chronic noncancer pain in Taiwan

Lin

Hsu

et al. 2010

J Anesth

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“…A number of potentially serious adverse effects and aberrant behaviors such as opioid abuse, addiction, and diversion make it difficult for physicians to prescribe opioids liberally 56 . Therefore, not only the under-treatment of pain is recognized as a major problem for patients which has societal implications 6 but also the opioids are underutilized drugs for chronic pain especially in elderly 57 due to physician’s concerns about the uncertain efficacy, untoward side effects and addiction 58, 59 .…”

Section: Discussionmentioning

confidence: 99%

Tolerability of Opioid Analgesia for Chronic Pain: A Network Meta-Analysis

Zhang

Acuff

et al. 2017

Sci Rep

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Aim of this study was to study the tolerability of opioid analgesia by performing a network meta-analysis (NMA) of randomized-controlled trials (RCTs) which investigated effectiveness of opioids for the management of chronic pain. Research articles reporting outcomes of RCT/s comparing 2 or more opioid analgesics for the management of chronic pain were obtained by database search. Bayesian NMAs were performed to combine direct comparisons between treatments with that of indirect simulated evidence. Study endpoints were: incidence of adverse events, incidence of constipation, trial withdrawal rate, and patient satisfaction with treatment. Outcomes were also compared with conventional meta-analyses. Thirty-two studies investigating 10 opioid drugs fulfilled the eligibility criteria. Tapentadol treatment was top-ranking owing to lower incidence of overall adverse events, constipation, and least trial withdrawal rate. Tapentadol was followed by oxycodone-naloxone combination in providing better tolerability and less trial withdrawal rate. Patient satisfaction was found to be higher with oxycodone-naloxone followed by fentanyl and tapentadol. These results were in agreement with those achieved with conventional meta-analyses. Tapentadol and oxycodone-naloxone are found to exhibit better tolerability characteristics in comparison with other opioid drugs for the management of chronic pain and are associated with low trial withdrawal rate and better patient satisfaction.

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Physician Attitudes Toward Opioid Prescribing for Patients With Persistent Noncancer Pain

Cited by 61 publications

References 17 publications

Chronic Opioid Therapy and Preventive Services in Rural Primary Care: An Oregon Rural Practice-based Research Network Study

Chronic Opioid Therapy and Preventive Services in Rural Primary Care: An Oregon Rural Practice-based Research Network Study

Chronic opioid therapy in patients with chronic noncancer pain in Taiwan

Tolerability of Opioid Analgesia for Chronic Pain: A Network Meta-Analysis

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