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Zugaj MR, Züger A, Keßler J. [Factors influencing analgesic use patterns in patients with chronic tumor-associated pain. : A qualitative pilot study considering different groups of medications]. Schmerz 2023:10.1007/s00482-023-00765-y. [PMID: 37955709 DOI: 10.1007/s00482-023-00765-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Patients are surviving tumor diseases longer and longer due to the improvement of tumor-specific therapy and pain is a common symptom. The gold standard for tumor-associated chronic pain is multimodal therapy. Non-adherence causes high costs and may put patients at risk. The aim of this study was to investigate the adherence behavior and subjective treatment compliance of patients with tumor-associated chronic pain. The focus was on the patients' perspective. Different groups of medications, such as NOPA, opioids, co-analgesics and cannabinoids, as well as non-drug treatments were included. METHODS Semistructured guided interviews with 10 patients with chronic tumor pain were conducted within a qualitative research approach. The interviews were recorded and transcribed. The evaluation was using a focused content structuring interview analysis according to Kuckartz and Rädiker. RESULTS Five main categories were defined. The central category based on the research question was "Adherence behavior from the patient's perspective." The category "Medication therapy" formed the framework of the study. Other main categories were "History of illness", "Relationship with treatment providers" and "Attitudes and beliefs". A total of 77 additional subcategories were formed and interpreted. Adherence behavior from the patients' perspective differed between the different medication groups. A palliative setting influenced treatment decisions and adherence. The medication regimens used were complex and dynamic, especially when there were multiple practitioners involved. Furthermore, there was ambiguity in the use of cannabinoids. Non-drug therapies were marginalized by patients. From the point of view of the patients interviewed, it was not so much the treatment providers who influenced their adherence behavior, but rather their own experiences, attitudes, and convictions. DISCUSSION The study included all medication groups and non-drug therapies equally, complementing previous literature in a qualitative setting. Adherence factors known from previous research were reflected in the subjective perception of the group of patients with chronic pain after tumor diseases. Marginalization of non-medication methods could be explained by the fact that multimodal therapy approaches were too rarely constantly used and controlled in the phase of chronification. Therefore, drug and non-drug therapies should be applied even more consistently to patients with tumor-associated pain.
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Affiliation(s)
- Marco Richard Zugaj
- Universität Heidelberg, Medizinische Fakultät Heidelberg, Klinik für Anästhesiologie, Sektion Schmerzmedizin, Im Neuenheimer Feld 131, 69120, Heidelberg, Deutschland.
| | - Andrea Züger
- Nationales Centrum für Tumorerkrankungen (NCT), NCT Heidelberg, eine Partnerschaft zwischen DKFZ und dem Universitätsklinikum Heidelberg, Deutschland, Universität Heidelberg, Medizinische Fakultät Heidelberg, Abteilung für Medizinische Onkologie, Sektion für translationale Medizinethik, Im Neuenheimer Feld 460, 69120, Heidelberg, Deutschland
| | - Jens Keßler
- Universität Heidelberg, Medizinische Fakultät Heidelberg, Klinik für Anästhesiologie, Sektion Schmerzmedizin, Im Neuenheimer Feld 131, 69120, Heidelberg, Deutschland
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Hartrick CT. Exploiting Injury-Induced Peripheral Opioid Receptor Changes in Novel Analgesic Development for Chronic Pain. FRONTIERS IN PAIN RESEARCH 2022; 3:883164. [PMID: 35557854 PMCID: PMC9090307 DOI: 10.3389/fpain.2022.883164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
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Singier A, Noize P, Berdaï D, Daveluy A, Arnaud M, Molimard M, Bégaud B, Salvo F. Medicine misuse: A systematic review and proposed hierarchical terminology. Br J Clin Pharmacol 2020; 87:1695-1704. [PMID: 33295072 DOI: 10.1111/bcp.14604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/25/2020] [Accepted: 10/05/2020] [Indexed: 12/31/2022] Open
Abstract
AIMS Although medicine misuse is a public health issue, it has multiple meanings in the medical literature. This study aimed to characterize, classify and identify the most appropriate definitions of medicine misuse. METHODS A systematic review was performed in Medline, ISI Web of Science, SocINDEX, PsycInfo, PsycArticles and Psychological and Behavioral Sciences Collection, using keywords related to "misuse", "appropriateness" and "medicine" between 1 November 2008 and 25 August 2020. Additional searches were conducted in websites of regulatory agencies and public health institutions. Two authors independently selected studies providing both definitions and examples of misuse, while a third resolved disagreements. Definitions were used to propose a hierarchical classification based on initiator, intent, purpose and context of medicine misuse. The study is registered on PROSPERO: CRD42018115789. RESULTS Of 3404 identified records, 51 were included. A total of 71 definitions and 74 examples of misuse were retrieved. When the prescriber is initiator and according to intent, potential medicine misuse referred to "intentional or unintentional prescribing not in line with clinical evidence". Based on context, they could prescribe medicines not clinically justified, i.e. overprescribing, or prescribe indicated medicines incorrectly, i.e. misprescribing. Among other groups of definitions, those overlapping with drug abuse or medication use errors were considered out-of-scope. CONCLUSION This systematic review provides a comprehensive overview of the terms and definitions used to characterize medicine misuse and could serve as a basis for a terminology that makes clear distinctions between misuse, abuse and errors.
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Affiliation(s)
| | - Pernelle Noize
- Univ. Bordeaux, INSERM, BPH, U1219, Bordeaux, France.,CHU de Bordeaux, Service de Pharmacologie Médicale, Bordeaux, France
| | - Driss Berdaï
- CHU de Bordeaux, Service de Pharmacologie Médicale, Bordeaux, France
| | - Amélie Daveluy
- Univ. Bordeaux, INSERM, BPH, U1219, Bordeaux, France.,CHU de Bordeaux, Service de Pharmacologie Médicale, Bordeaux, France
| | | | - Mathieu Molimard
- Univ. Bordeaux, INSERM, BPH, U1219, Bordeaux, France.,CHU de Bordeaux, Service de Pharmacologie Médicale, Bordeaux, France
| | | | - Francesco Salvo
- Univ. Bordeaux, INSERM, BPH, U1219, Bordeaux, France.,CHU de Bordeaux, Service de Pharmacologie Médicale, Bordeaux, France
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Bouri F, El Ansari W, Mahmoud S, Elhessy A, Al-Ansari A, Al-Dosari MAA. Orthopedic Professionals' Recognition and Knowledge of Pain and Perceived Barriers to Optimal Pain Management at Five Hospitals. Healthcare (Basel) 2018; 6:E98. [PMID: 30104518 PMCID: PMC6165346 DOI: 10.3390/healthcare6030098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 12/17/2022] Open
Abstract
Pain is a challenge for orthopedic healthcare professionals (OHCP). However, pain studies examined the competencies of a single OHCP category, did not consider various pain management domains or barriers to optimal pain service, and are deficient across the Arabic Eastern Mediterranean region. We surveyed OHCP's recognition and knowledge of pain and perceived barriers to optimal pain service (361 OHCP, five hospitals). Chi square compared doctors' (n = 63) vs. nurses/physiotherapists' (n = 187) views. In terms of pain recognition, more nurses had pain management training, confidently assessed pediatric/elderly pain, were aware of their departments' pain protocols, and felt that their patients receive proper pain management. More doctors comfortably prescribed opiate medications and agreed that some nationalities were more sensitive to pain. For pain knowledge, more nurses felt patients are accurate in assessing their pain, vital signs are accurate in assessing children's pain, children feel less pain because of nervous system immaturity, narcotics are not preferred due respiratory depression, and knew pre-emptive analgesia. As for barriers to optimal pain service, less nurses agreed about the lack of local policies/guidelines, knowledge, and skills; time to pre-medicate patients; knowledge about medications; complexity of the clinical environment; and physicians being not comfortable prescribing pain medication. We conclude that doctors required confidence in pain, especially pediatric and geriatric pain, using vital signs in assessing pain and narcotics use. Their most perceived barriers were lack of local policies/guidelines and skills. Nurses required more confidence in medications, caring for patients on narcotics, expressed fewer barriers than doctors, and the complexity of the clinical environment was their highest barrier. Educational programs with clinical application could improve OHCPs' pain competencies/clinical practices in pain assessment and administration of analgesics.
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Affiliation(s)
- Fadi Bouri
- Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar.
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar.
- College of Medicine, Qatar University, Doha 2713, Qatar.
| | - Shady Mahmoud
- Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar.
| | - Ahmed Elhessy
- Department of Orthopedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar.
| | - Abdulla Al-Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar.
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Muir H, Seymour F. Screening tools to assess risk of opioid abuse in the Canadian primary healthcare setting. Nurse Pract 2017; 42:45-50. [PMID: 28346282 DOI: 10.1097/01.npr.0000508172.41410.3b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Opioid therapy for patients with chronic pain is increasing in frequency along with rates of opioid abuse. Many screening tools are available to assess for the risk of opioid abuse. NPs should use screening tools that are cross-validated for use in chronic pain patients in the Canadian primary healthcare setting.
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Affiliation(s)
- Hollie Muir
- Hollie Muir is an NP at the Oromocto Health Centre, Oromocto, N.B., Canada. Fran Seymour is a senior teaching associate and NP at the University of New Brunswick, Frederickton, N.B., Canada
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Chaudhary S, Compton P. Use of risk mitigation practices by family nurse practitioners prescribing opioids for the management of chronic nonmalignant pain. Subst Abus 2016; 38:95-104. [DOI: 10.1080/08897077.2016.1265038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Sahil Chaudhary
- Department of Health Systems Administration, Georgetown University, Washington, DC, USA
| | - Peggy Compton
- Department of Advanced Nursing Practice, Georgetown University, Washington, DC, USA
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Zhao Y, Li Y, Zhang X, Lou F. Translation and validation of the Chinese version of the Current Opioid Misuse Measure (COMM) for patients with chronic pain in Mainland China. Health Qual Life Outcomes 2015; 13:147. [PMID: 26374505 PMCID: PMC4572659 DOI: 10.1186/s12955-015-0329-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 08/23/2015] [Indexed: 01/20/2023] Open
Abstract
Background Management of prescription opioids misuse and abuse problems among chronic pain patients has been increasingly important worldwide and little literature concerning prescription opioids can be found in mainland China so far. Methods The Current Opioid Misuse Measure (COMM) was translated into Chinese following Brislin’s model of cross-culture translation and was completed by a convenience sample of 180 patients with chronic pain recruited from two major hospitals in Jinan, Shandong province. Data were analyzed using internal consistency, test-retest reliability, exploratory factor analysis and confirmatory factor analysis. Results The internal consistency coefficient for the total score of the COMM was 0.85 and item-total correlations of all items were above 0.20. Besides, the test-retest reliability was satisfactory with an ICC of 0.91 (95 % CI = 0.65-0.98). Four principal components were extracted, accounting for 65.30 % of the variance, and the factor loadings of all 17 items were above 0.40. Conclusions The Chinese version of COMM showed satisfactory reliability and validity, and could be used as a screening tool to evaluate and monitor current aberrant drug-related behavior among Chinese patients with chronic pain.
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Affiliation(s)
- Yang Zhao
- School of Nursing, Shandong University, No.44, Wenhuaxi Road, Jinan, Shandong Province, 250012, People's Republic of China. .,Nursing Faculty, Tianjin Medical College, No. 14 Liulin Road, Tianjin, 300222, People's Republic of China.
| | - Yuli Li
- School of Nursing, Shandong University, No.44, Wenhuaxi Road, Jinan, Shandong Province, 250012, People's Republic of China.
| | - Xuekun Zhang
- School of Nursing, Shandong University, No.44, Wenhuaxi Road, Jinan, Shandong Province, 250012, People's Republic of China.
| | - Fenglan Lou
- School of Nursing, Shandong University, No.44, Wenhuaxi Road, Jinan, Shandong Province, 250012, People's Republic of China.
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Screening and Assessment for Substance Abuse. Subst Abus 2015. [DOI: 10.1007/978-1-4939-1951-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schatman ME, Darnall BD. A practical and ethical solution to the opioid scheduling conundrum. J Pain Res 2013; 7:1-3. [PMID: 24353439 PMCID: PMC3862644 DOI: 10.2147/jpr.s58148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Beth D Darnall
- Stanford University School of Medicine, Division of Pain Medicine, Palo Alto, CA, USA
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Jongen JLM, Hans G, Benzon HT, Huygen F, Hartrick CT. Neuropathic Pain and Pharmacological Treatment. Pain Pract 2013; 14:283-95. [DOI: 10.1111/papr.12085] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 04/26/2013] [Indexed: 12/27/2022]
Affiliation(s)
- Joost L. M. Jongen
- Department of Neurology; Erasmus MC; Rotterdam The Netherlands
- Department of Anesthesiology; Erasmus MC; Rotterdam The Netherlands
| | - Guy Hans
- Department of Anesthesiology and Multidisciplinary Pain Center; Antwerp University Hospital; Edegem Belgium
| | - Honorio T. Benzon
- Department of Anesthesiology; Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Frank Huygen
- Department of Anesthesiology and Pain Medicine; Erasmus MC; Rotterdam The Netherlands
| | - Craig T. Hartrick
- Departments of Biomedical Sciences and Anesthesiology; Oakland University William Beaumont School of Medicine; Rochester Michigan U.S.A
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The Future of Population-Based Postmarket Drug Risk Assessment: A Regulator’s Perspective. Clin Pharmacol Ther 2013; 94:349-58. [DOI: 10.1038/clpt.2013.118] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 05/29/2013] [Indexed: 01/03/2023]
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Alleviation of chronic pain following rat spinal cord compression injury with multimodal actions of huperzine A. Proc Natl Acad Sci U S A 2013; 110:E746-55. [PMID: 23386718 DOI: 10.1073/pnas.1300083110] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Diverse mechanisms including activation of NMDA receptors, microglial activation, reactive astrogliosis, loss of descending inhibition, and spasticity are responsible for ∼40% of cases of intractable neuropathic pain after spinal cord injury (SCI). Because conventional treatments blocking individual mechanisms elicit only short-term effectiveness, a multimodal approach with simultaneous actions against major pain-related pathways may have value for clinical management of chronic pain. We hypothesize that [-]-huperzine A (HUP-A), an alkaloid isolated from the club moss Huperzia serrata, that is a potent reversible inhibitor of acetylcholinesterase and NMDA receptors, could mitigate pain without invoking drug tolerance or dependence by stimulating cholinergic interneurons to impede pain signaling, inhibiting inflammation via microglial cholinergic activation, and blocking NMDA-mediated central hypersensitization. We tested our hypothesis by administering HUP-A i.p. or intrathecally to female Sprague-Dawley rats (200-235 g body weight) after moderate static compression (35 g for 5 min) of T10 spinal cord. Compared with controls, HUP-A treatment demonstrates significant analgesic effects in both regimens. SCI rats manifested no drug tolerance following repeated bolus i.p. or chronic intrathecal HUP-A dosing. The pain-ameliorating effect of HUP-A is cholinergic dependent. Relative to vehicle treatment, HUP-A administration also reduced neural inflammation, retained higher numbers of calcium-impermeable GluR2-containing AMPA receptors, and prevented Homer1a up-regulation in dorsal horn sensory neurons. Therefore, HUP-A may provide safe and effective management for chronic postneurotrauma pain by reestablishing homeostasis of sensory circuits.
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Abstract
INTRODUCTION Noradrenergic reuptake inhibitors can be effective analgesics, finding application in a wide variety of clinical pain settings. Due to a shift toward noradrenergic-mediated pain pathways following nerve injury, they are particularly well suited to the treatment of neuropathic pain. This phenotypic shift makes neuropathic pain difficult to control with opioids alone; some noradrenergic reuptake inhibitors have demonstrated synergy with opioids. Agents currently in early clinical trials are discussed and include both novel delivery of old drugs and the development of new drugs. AREAS COVERED This review was limited to noradrenergic reuptake inhibitors and analgesia. Literature search included the terms adrenergic, noradrenergic, reuptake, inhibitors, analgesia, NET, norepinephrine transporter, and pain using Medline, Google scholar, Web of Knowledge, www.clinicaltrials.gov, and Pharmaprojects (Informa UK Ltd. 2012). EXPERT OPINION Topical drug delivery and the use of combinations of agents both topically and systemically are under active investigation. The intrathecal delivery of noradrenergic reuptake inhibitors, allowing delivery directly to the central nervous system thus limiting systemic exposure, represents an exciting avenue of investigation. Gaps in current knowledge have complicated the development of prophylactic therapies for susceptible individuals or preemptive intervention. Disease-modifying agents and selective inhibitors would facilitate these treatment strategies.
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Affiliation(s)
- Craig T Hartrick
- Oakland University William Beaumont School of Medicine, 525 O'Dowd Hall, Rochester, MI 48309, USA.
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