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Zhao Q, Qiu X, Liu W, Nian Z, Chen T, Chen J, Xie R, Yang L. Application of a WeChat Mini Program to provide pharmaceutical care for cancer pain patients: A randomized controlled trial. Digit Health 2024; 10:20552076241255654. [PMID: 38766359 PMCID: PMC11100405 DOI: 10.1177/20552076241255654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
Objective This study aimed to develop an individual WeChat Mini Program to provide pharmaceutical care to better manage cancer pain patients and to evaluate its feasibility and the differences in analgesic efficacy, medication adherence and safety versus conventional pharmacy interventions. Methods In this parallel randomized clinical trial, 42 cancer pain patients were equally allocated into the experimental group and the control group. The experimental group received individualized pharmaceutical care based on the "Yao Nin You Wo" WeChat Mini Program, while the control group received conventional care during the 4-week period. Main outcomes contained pain scores, medication adherence, incidences and relief rates of breakthrough pain, and incidences of adverse events. Relief rates of pain were also calculated according to pain scores. Results At the beginning of intervention, none of the pain scores and medication adherence showed relevant differences between the two groups (all P > .05). After intervention, the experimental group had significantly lower pain scores compared to the control group (P = .003). Breakthrough pain of both groups was alleviate; not only the incidence of breakthrough pain considerably was lower at 4 weeks than at baseline, but the relief rate of breakthrough in the experimental group was higher than that in the control group. Compared with the control group, the medication adherence rate of the experimental group was significantly improved (P = .02). Types of adverse events that happened in experimental and groups were similar, but the total incidence of adverse events in the experimental group was lower than that in the control group. Conclusions WeChat Mini Program is a useful and facilitative tool with the potential to improve cancer pain self-management ability in discharged patients. In addition, pharmacists could play a key role through the Mini Program to connect with patients successfully by providing personalized pharmaceutical services.
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Affiliation(s)
- Qiuling Zhao
- Department of pharmacy, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Xiuliang Qiu
- Department of pharmacy, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Wenbin Liu
- Department of pharmacy, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Zilin Nian
- School of Pharmacy, Fujian Medical University, Fuzhou, Fujian, China
| | - Ting Chen
- Department of pharmacy, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Juan Chen
- Department of pharmacy, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Ruixiang Xie
- Department of pharmacy, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Lin Yang
- Department of pharmacy, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China
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Angarita-Fonseca A, Lacasse A, Choinière M, Kaboré JL, Sylvestre MP, Dinkou GDT, Bruneau J, Martel MO, Hovey R, Motulsky A, Rahme E, Pagé MG. Trajectories of opioid consumption as predictors of patient-reported outcomes among individuals attending multidisciplinary pain treatment clinics. Pharmacoepidemiol Drug Saf 2024; 33:e5706. [PMID: 37800356 DOI: 10.1002/pds.5706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/28/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE This study aimed to identify opioid consumption trajectories among persons living with chronic pain (CP) and put them in relation to patient-reported outcomes 6 months after initiating multidisciplinary pain treatment. METHODS This study used data from the Quebec Pain Registry (2008-2014) linked to longitudinal Quebec health insurance databases. We included adults diagnosed with CP and covered by the Quebec public prescription drug insurance plan. The daily cumulative opioid doses in the first 6 months after initiating multidisciplinary pain treatment were transformed into morphine milligram equivalents. An individual-centered approach involving principal factor and cluster analyses applied to longitudinal statistical indicators of opioid use was conducted to classify trajectories. Multivariate regression models were applied to evaluate the associations between trajectory group membership and outcomes at 6-month follow-up (pain intensity, pain interference, depression, and physical and mental health-related quality of life). RESULTS We identified three trajectories of opioid consumption: "no or very low and stable" opioid consumption (n = 2067, 96.3%), "increasing" opioid consumption (n = 40, 1.9%), and "decreasing" opioid consumption (n = 39, 1.8%). Patients in the "no or very low and stable" trajectory were less likely to be current smokers, experience polypharmacy, use opioids or benzodiazepine preceding their first visit, or experience pain interference at treatment initiation. Patients in the "increasing" opioid consumption group had significantly greater depression scores at 6-month compared to patients in the "no or very low and stable" trajectory group. CONCLUSION Opioid consumption trajectories do not seem to be important determinants of most PROs 6 months after initiating multidisciplinary pain treatment.
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Affiliation(s)
- Adriana Angarita-Fonseca
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn Noranda, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn Noranda, Canada
| | - Manon Choinière
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Canada
| | - Jean-Luc Kaboré
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Biomedical Sciences, Université de Montréal, Montreal, Canada
| | - Marie-Pierre Sylvestre
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada
| | | | - Julie Bruneau
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Marc O Martel
- Department of Anesthesia, McGill University, Montreal, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Richard Hovey
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Aude Motulsky
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- School of Public Health, Université de Montréal, Montreal, Canada
| | - Elham Rahme
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - M Gabrielle Pagé
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
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Carmen SG, José LM, Adriana RS, Eugenia GG. A Pilot Randomized Controlled Trial of Effectiveness of a Psychoeducational Intervention on the Management of Musculoskeletal Chronic Noncancer Pain. Pain Manag Nurs 2023; 24:427-435. [PMID: 36944558 DOI: 10.1016/j.pmn.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 01/15/2023] [Accepted: 01/29/2023] [Indexed: 03/23/2023]
Abstract
AIMS To investigate the effectiveness of a psychoeducational intervention on pain intensity management in musculoskeletal chronic noncancer pain and to identify relevant variables and preliminary data to allow the design of a randomized controlled trial. DESIGN Two arms parallel randomized pilot study. SUBJECTS AND SETTING ADULT PATIENTS WITH MUSCULOSKELETAL CHRONIC NONCANCER PAIN WITH MODERATE-SEVERE INTENSITY TREATED AT PRIMARY HEALTH CENTERS. METHODS Participants were randomly assigned to a psychoeducational intervention or a control group without intervention. Pain intensity, quality of life, and opioid use were assessed at baseline and at a 1-month follow-up. RESULTS The sample consisted of 37 adult patients (intervention group: 19; control group: 18). A significant reduction in pain intensity measured by the Verbal Numerical Rating Scale (p = .02, Cohen's d = 0.57) and improvement in quality of life measured by EuroQol-5D questionnaire (p = .04) were observed in the intervention group compared to the control. This improvement on pain intensity was greater in patients without strong opioid treatment (p = .01, Cohen's d = 1.36). Eighty percent of the strong opioids users in the intervention group reduced their consumption, without changes in the control group. CONCLUSIONS These findings provide promising support for the beneficial effects of psychoeducation on the intensity of noncancer chronic musculoskeletal pain. Based on the results, future randomized controlled trials are needed.
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Affiliation(s)
- Sánchez-Gutiérrez Carmen
- Department of Anesthesiology and Pain Medicine, Virgen del Rocío Universitary Hospital, Seville, Spain; Department of Anesthesiology and Pain Medicine, San Juan de Dios del Aljarafe Hospital, Avda, San Juan de Dios S/N. Seville, Spain.
| | - López-Millán José
- Department of Anesthesiology and Pain Medicine, Virgen Macarena Universitary Hospital, Seville, Spain.
| | | | - Gil-García Eugenia
- Department of Nursing, School of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain.
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Goplen CM, Pedersen ME, Ramadi A, Beaupre LA. Opioid prescribing practices prior to elective foot and ankle surgery: a population-based evaluation using health administrative data from a tertiary hospital in Canada. BMC PRIMARY CARE 2022; 23:116. [PMID: 35549666 PMCID: PMC9097109 DOI: 10.1186/s12875-022-01722-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/22/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Complex elective foot and ankle surgery is known to be painful so most patients are prescribed opioids at the time of surgery; however, the number of patients prescribed opioids while waiting for surgery in Canada is unknown. Our primary objective was to describe the pre and postoperative prescribing practices for patients in Alberta, Canada undergoing complex elective foot and ankle surgery. Secondarily, we evaluated postoperative opioid usage and hospital outcomes.
Methods
In this population-based retrospective analysis, we identified all adult patients who underwent unilateral elective orthopedic foot and ankle surgery at a single tertiary hospital between May 1, 2015 and May 31, 2017. Patient and surgical data were extracted from a retrospective chart review and merged with prospectively collected, individual level drug dispensing administrative data to analyze opioid dispensing patterns, including dose, duration, and prescriber for six months before and after foot and ankle surgery.
Results
Of the 100 patients, 45 had at least one opioid prescription dispensed within six months before surgery, and of these, 19 were long-term opioid users (> 90 days of continuous use). Most opioid users obtained opioid prescriptions from family physicians both before (78%) and after (65%) surgery. No preoperative non-users transitioned to long-term opioid use postoperatively, but 68.4% of the preoperative long-term opioid users remained long-term opioid users postoperatively. During the index hospitalization, preoperative long-term opioid users consumed higher doses of opioids (99.7 ± 120.5 mg/day) compared to opioid naive patients (28.5 ± 36.1 mg/day) (p < 0.001). Long-term opioid users stayed one day longer in hospital than opioid-naive patients (3.9 ± 2.8 days vs 2.7 ± 1.1 days; p = 0.01).
Conclusions
A significant number of patients were dispensed opioids before and after foot and ankle surgery with the majority of prescriptions coming from primary care practitioners. Patients who were prescribed long-term opioids preoperatively were more likely to continue to use opioids at follow-up and required larger in-hospital opioid dosages and stayed longer in hospital. Further research and education for both patients and providers are needed to reduce the community-based prescribing of opioid medication pre-operatively and provide alternative pain management strategies prior to surgery to improve postoperative outcomes and reduce long-term postoperative opioid use.
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Jones W, Kaoser R, Fischer B. Patterns, trends and determinants of medical opioid utilization in Canada 2005-2020: characterizing an era of intensive rise and fall. Subst Abuse Treat Prev Policy 2021; 16:65. [PMID: 34521418 PMCID: PMC8438558 DOI: 10.1186/s13011-021-00396-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Into the 21st century, the conflation of high rates of chronic pain, systemic gaps in treatment availability and access, and the arrival of potent new opioid medications (e.g., slow-release oxycodone) facilitated strong increases in medical opioid dispensing in Canada. These persisted until post-2010 alongside rising opioid-related adverse (e.g., morbidity/mortality) outcomes. We examine patterns, trends and determinants of opioid dispensing in Canada, and specifically its 10 provinces, for the years 2005-2020. METHODS Raw data on prescription opioid dispensing were obtained from a large national community-based pharmacy database (IQVIA/Compuscript), converted into Defined-Daily-Doses/1,000 population/day for 'strong' and 'weak' opioid categories per standard methods. Dispensing by opioid category and formulations by province/year was assessed descriptively; regression analysis was applied to examine possible segmentation of over-time strong opioid dispensing. RESULTS All provinces reported starkly increasing strong opioid dispensing peaking 2011-2016, and subsequent marked declines. About half reported lower strong opioid dispensing in 2020 compared to 2005, with continuous inter-provincial differences of > 100 %; weak opioids also declined post-2011/12. Segmented regression suggests breakpoints for strong opioids in 2011/12 and 2015/16, coinciding with main interventions (e.g., selective opioid delisting, new prescribing guidelines) towards more restrictive opioid utilization control. CONCLUSIONS We characterized an era of marked rise and fall, while featuring stark inter-provincial heterogeneity in opioid dispensing in Canada. While little evidence for improvements in pain care outcomes exists, the starkly inverting opioid utilization have been associated with extensive population-level harms (e.g., misuse, morbidity, mortality) over-time. This national case study raises fundamental questions for opioid-related health policy and practice.
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Affiliation(s)
- Wayne Jones
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400, 515 W. Hastings Street, British Columbia, Vancouver, Canada
| | - Ridhwana Kaoser
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400, 515 W. Hastings Street, British Columbia, Vancouver, Canada
| | - Benedikt Fischer
- Centre for Applied Research in Mental Health and Addiction (CARMHA), Faculty of Health Sciences, Simon Fraser University, Suite 2400, 515 W. Hastings Street, British Columbia, Vancouver, Canada.
- Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland, 1023, Grafton, New Zealand.
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada.
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), R. Sena Madureira, 1500 - Vila Clementino, São Paulo, Brazil.
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Interest of registries in neuropathic pain research. Rev Neurol (Paris) 2021; 177:843-848. [PMID: 34384628 DOI: 10.1016/j.neurol.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/22/2022]
Abstract
Neuropathic pain is frequent in the general population, with 7 to 10% of adults presenting with chronic neuropathic pain. To date, the gold standard to evaluate treatments is based on randomized controlled trials. Nonetheless, such design is run on a limited sample and for a limited period. Moreover, many treatments will never be compared directly in sufficiently large and representative populations. A way to overcome several of these limitations is to use real-world data. Indeed, the International Association for the Study of Pain (IASP) includes a special interest group focusing on pain registries and promoting the use of such approaches. In this short narrative review, several of the main chronic pain registries are presented. The strengths and weaknesses of this approach are presented. Indication bias is frequent in observational studies because the choice of treatment is generally influenced by the patients' characteristics. However, a propensity score can be computed to adjust for these differences. The use of propensity score is briefly explained. Some data specific to neuropathic pain are discussed.
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Kaboré JL, Pagé MG, Martel MO, Dassieu L, Hudspith M, Moor G, Sutton K, Roy JS, Williamson OD, Choinière M. Impact of the Opioid Epidemic and Associated Prescribing Restrictions on People Who Live With Chronic Noncancer Pain in Canada. Clin J Pain 2021; 37:607-615. [PMID: 34054062 DOI: 10.1097/ajp.0000000000000951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/18/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Little is known about the consequences of the opioid epidemic on people living with chronic noncancer pain (CNCP). This study examined this issue in people who lived in the most impacted province by opioid overdoses in Canada (British Columbia [BC]) or one of the least impacted (Quebec [QC]), and examined the factors associated with opioid use. MATERIALS AND METHODS This cross-sectional study was carried out in adults living in BC (N=304) and QC (N=1071) who reported CNCP (≥3 months) and completed an online questionnaire that was tailored to their opioid status. RESULTS Almost twice as many participants in BC as in QC were proposed to cease their opioid medication in the past year (P<0.001). The proportion who reported having hoarded opioids in fear of not being able to get more in the future was also significantly higher in BC (P<0.001) compared with QC. In addition, they were significantly more likely to have had their opioid dose decreased than those in QC (P=0.001). No significant association was found between opioid discontinuation and province of residence. Two-thirds of the BC participants felt that the media coverage of the opioid crisis was very to extremely detrimental to CNCP patients in general, this percentage being significantly higher than in QC (P<0.001). DISCUSSION The opioid epidemic and associated prescribing restrictions have had harmful effects on Canadians with CNCP. The clinical community, the general public, and the media need to be aware of these negative consequences to decrease patients' stigmatization and minimize inadequate treatment of CNCP.
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Affiliation(s)
- Jean-Luc Kaboré
- Departments of Pharmacology and Physiology
- Research Centre of the University of Montreal Hospital Centre (CRCHUM)
| | - M Gabrielle Pagé
- Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal
- Research Centre of the University of Montreal Hospital Centre (CRCHUM)
| | - Marc O Martel
- Department of Anesthesia, Faculty of Medicine, Faculty of Dentistry
- Alan Edwards Center for Research on Pain, McGill University, Montreal
| | - Lise Dassieu
- Research Centre of the University of Montreal Hospital Centre (CRCHUM)
| | | | | | | | - Jean-Sébastien Roy
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, QC
| | - Owen D Williamson
- JPOCSC Pain Management Clinic, Fraser Health Authority, Surrey, BC, Canada
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Vic., Australia
| | - Manon Choinière
- Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal
- Research Centre of the University of Montreal Hospital Centre (CRCHUM)
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Dassieu L, Heino A, Develay É, Kaboré JL, Pagé MG, Moor G, Hudspith M, Choinière M. "They think you're trying to get the drug": Qualitative investigation of chronic pain patients' health care experiences during the opioid overdose epidemic in Canada. Can J Pain 2021; 5:66-80. [PMID: 34189391 PMCID: PMC8210863 DOI: 10.1080/24740527.2021.1881886] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 12/22/2022]
Abstract
Background: The opioid overdose epidemic has led health care providers to increased vigilance for opioid-related risks in the treatment of chronic non-cancer pain (CNCP). Media have conveyed stigmatizing representations of opioid analgesics. Aims: This study aimed to understand how the opioid overdose epidemic has impacted health care experiences among people living with CNCP in two Canadian provinces (British Columbia, Quebec). Methods: This qualitative study proceeded through 22 semi-structured interviews conducted in 2019. Participants were recruited from a cross-sectional survey examining the effects of the opioid overdose epidemic on individuals with CNCP. We collected in-depth narratives that we analyzed using a thematic framework. The sample included 12 women and 10 men aged 20 to 70 years, with 11 from each province. Results: Several participants described increased difficulty in accessing medical services for pain since the onset of the opioid overdose epidemic. They reported that some physicians urged them to taper opioids regardless of their pain severity and functional limitations. Some participants reported facing discrimination and care denials as they were labeled "drug-seeking," especially in hospital. Depending on their educational resources, they were unequally able to counter providers' stigmatizing behaviors. However, participants described empathetic relationships with providers with whom they had a long-term relationship. Some participants drew distinctions between themselves and the stigmatized status of "addict" in ways that reinforced stigma toward people who are dependent on opioids. Conclusions: Health policies and provider education programs aimed at reducing opioid-related stigma are needed to counter detrimental consequences of the opioid overdose epidemic for people living with CNCP.
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Affiliation(s)
- Lise Dassieu
- Carrefour de l'innovation et de l'évaluation en santé, Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
| | - Angela Heino
- Pain BC Society, Vancouver, British Columbia, Canada
| | - Élise Develay
- Carrefour de l'innovation et de l'évaluation en santé, Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Jean-Luc Kaboré
- Carrefour de l'innovation et de l'évaluation en santé, Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - M. Gabrielle Pagé
- Carrefour de l'innovation et de l'évaluation en santé, Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Gregg Moor
- Pain BC Society, Vancouver, British Columbia, Canada
| | | | - Manon Choinière
- Carrefour de l'innovation et de l'évaluation en santé, Research Center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Sani AR, Zin CS. Comparison of the Clinical Outcomes between Short-term and Long-term Opioid Users with Noncancer Pain at Pain Clinics. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2020; 12:S728-S732. [PMID: 33828368 PMCID: PMC8021069 DOI: 10.4103/jpbs.jpbs_284_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/09/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The clinical use of opioids for long-term for noncancer pain indications remains a controversy. More studies are needed for evidence-based guidelines in noncancer pain management involving opioids. The primary objective of this study was to investigate the clinical outcomes of the short-term and long-term opioid use among patients with noncancer pain. MATERIALS AND METHODS This is a retrospective cross-sectional study where patients (aged ≥18 years) with noncancer pain treated with opioids were recruited from three pain clinics in Malaysia. Data on patients' opioid use were collected from prescription records. The individual days covered with opioids per patient were calculated and based on this, patients were classified as short-term (<90 days) or long-term (≥90 days) opioid user. Outcome measures included pain intensity and pain interference with daily activities assessed by Brief Pain Inventory - Short Form (BPI-SF), health-related quality of life (HRQoL) assessed by 36-Item Short Form Health Survey version 2 (SF-36v2). These measures were compared between short-term and long-term opioid users. RESULTS Of the 61 noncancer pain patients recruited, 49.2% (n = 30/61) were short-term and 50.8% (n = 31/61) were long-term opioid users. There were no statistically significant differences in the mean scores of pain intensity, pain interference with daily activities, and HRQoL between short-term and long-term opioid users in this study. CONCLUSION Findings of this study imply that long-term opioid therapy does not provide significant pain relief or improvement in patients' functional capability and HRQoL in noncancer pain patients. Future prospective studies with larger sample sizes are needed to support the findings of this study.
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Affiliation(s)
- Asween R Sani
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia (IIUM), Kuantan, Pahang, Malaysia
| | - Che Suraya Zin
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia (IIUM), Kuantan, Pahang, Malaysia
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10
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Kaboré J, Saïdi H, Dassieu L, Choinière M, Pagé MG. Predictors of Long‐Term Opioid Effectiveness in Patients With Chronic Non‐Cancer Pain Attending Multidisciplinary Pain Treatment Clinics: A Quebec Pain Registry Study. Pain Pract 2020; 20:588-599. [DOI: 10.1111/papr.12883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 02/17/2020] [Accepted: 03/07/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Jean‐Luc Kaboré
- Department of Pharmacology and Physiology Faculty of Medicine Université de Montréal Montreal Quebec Canada
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM) Montreal Quebec Canada
| | - Hichem Saïdi
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM) Montreal Quebec Canada
| | - Lise Dassieu
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM) Montreal Quebec Canada
| | - Manon Choinière
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM) Montreal Quebec Canada
- Department of Anesthesiology and Pain Medicine Faculty of Medicine Université de Montréal Montreal Quebec Canada
| | - M. Gabrielle Pagé
- Research Centre of the Centre Hospitalier de l’Université de Montréal (CRCHUM) Montreal Quebec Canada
- Department of Anesthesiology and Pain Medicine Faculty of Medicine Université de Montréal Montreal Quebec Canada
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What Explains Poor Health-related Quality of Life Associated With Opioid Use Among Adults With Chronic Noncancer Pain Conditions? A Blinder-Oaxaca Decomposition. ADDICTIVE DISORDERS & THEIR TREATMENT 2020. [DOI: 10.1097/adt.0000000000000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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Poirier C, Martel MO, Bérubé M, Boulanger A, Gélinas C, Guénette L, Lacasse A, Lussier D, Tousignant-Laflamme Y, Pagé MG. French-Canadian translation of a self-report questionnaire to monitor opioid therapy for chronic pain: The Opioid Compliance Checklist (OCC-FC). Can J Pain 2020; 4:59-66. [PMID: 33987486 PMCID: PMC7951156 DOI: 10.1080/24740527.2020.1724777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/13/2020] [Accepted: 01/22/2020] [Indexed: 10/27/2022]
Abstract
Context: Chronic noncancer pain (CNCP) is a frequent condition among Canadians. The psychosocial and economic costs of CNCP for individuals, their families, and society are substantial. Though opioid therapy is often used to manage CNCP, it is also associated with risks of misuse. The Opioid Compliance Checklist (OCC) was developed to monitor opioid misuse in patients taking opioids for CNCP. The objective of the present study was to provide a French-Canadian translation of the eight-item OCC, the OCC-FC. Methods: The eight-item OCC was translated for use in Québec using published guidelines for the translation and adaptation of self-report measures, including an expert committee and a double forward-backward translation process. A pretest of the adapted eight-item OCC was also conducted among 30 patients with CNCP. Results: A French-Canadian version of the OCC was generated. When ambiguity in the items was detected during expert committee consultation or pretest administration, modifications made were kept to a strict minimum to facilitate future comparisons across studies using the original English and translated French-Canadian version. Discussion: This study provides a culturally adapted tool that will contribute to identifying French-Canadian patients with CNCP who misuse opioids over the course of opioid therapy. This translation of the OCC has the strong potential to be useful in research and clinical settings.
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Affiliation(s)
- Clarice Poirier
- Centre de recherche, Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Marc O. Martel
- Faculty of Dentistry & Department of Anesthesiology, McGill University, Montreal, Quebec, Canada
| | - Mélanie Bérubé
- Faculty of Nursing, Université Laval, Québec City, Quebec, Canada
- Centre de recherche du Centre hospitalier universitaire de Québec, Population Health and Optimal Health Practices Research Unit, Québec City, Quebec, Canada
| | - Aline Boulanger
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Pain Clinic, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Line Guénette
- Centre de recherche du Centre hospitalier universitaire de Québec, Population Health and Optimal Health Practices Research Unit, Québec City, Quebec, Canada
- Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - David Lussier
- Centre de recherche, l’Institut universitaire de gériatrie de Montréal du CIUSSS du Centre-Sud-de-l’Ile-de Montréal, Montreal, Quebec, Canada
- Département de médecine, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - M. Gabrielle Pagé
- Centre de recherche, Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Goplen CM, Randall JR, Kang SH, Vakilian F, Jones CA, Voaklander DC, Beaupre LA. The Influence of Allowable Refill Gaps on Detecting Long-Term Opioid Therapy: An Analysis of Population-Based Administrative Dispensing Data Among Patients with Knee Arthritis Awaiting Total Knee Arthroplasty. J Manag Care Spec Pharm 2019; 25:1064-1072. [PMID: 31556825 PMCID: PMC10401997 DOI: 10.18553/jmcp.2019.25.10.1064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND It is challenging to detect long-term opioid therapy (LTOT) using administrative data, as refill gaps can disrupt opioid utilization episodes. Previous studies have used various methods to define LTOT and allowable refill gaps with little supporting evidence. OBJECTIVE To describe the effect of allowable refill gaps on detecting LTOT among a cohort of patients with arthritis awaiting total knee arthroplasty (TKA) using 3 different methods. METHODS A retrospective analysis of multicenter population-based data between January 1, 2012, and December 31, 2016, identified patients prescribed opioids before TKA in Alberta, Canada. We described 3 methods to detect LTOT based on a (1) fixed number of days between prescriptions; (2) fraction of the preceding prescription length; and (3) combination method that selected whichever refill gap was greatest. We then compared the number of patients classified as long-term opioid users by varying the number of days between prescriptions from 1-90 days (fixed method) or 0.04-3.2 times the duration (fraction method) for each method and refill gap. RESULTS Of the 14,252 patients included in our cohort, 4,393 patients (31%) had an opioid prescription within 180 days before TKA. Detection of LTOT varied from 4.4% to 14.6% (fixed method), 4.2% to 13.2% (fraction method), and 4.5% to 15.1% (mixed method) as refill gaps varied from minimum to maximum. As refills gaps increased, the dose and duration of opioids in the utilization episode decreased for all 3 methods. CONCLUSIONS The allowable refill gap between opioid prescriptions can influence the estimated rate of LTOT when using administrative pharmaceutical dispensing data. Definitional parameters should be carefully considered when using administrative data to define consistent opioid use. DISCLOSURES This work was supported by the Department of Surgery's Clinical Research Grant at the University of Alberta (RES0039945). The authors have no potential conflicts of interest.
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Affiliation(s)
| | - Jason R. Randall
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Sung Hyun Kang
- Alberta Bone and Joint Institute, Calgary, Alberta, Canada
| | - Fatemeh Vakilian
- School of Public Health, University of Alberta, Edmonton, Canada
| | | | | | - Lauren A. Beaupre
- Department of Surgery and Department of Physical Therapy, University of Alberta, Edmonton, Canada
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