Opioids Commonly Prescribed for Pain Relief from Osteoarthritis

PainRelief.com Interview with:

Dr. Jonas Bloch Thorlund  MSc, PhD
Professor of Musculoskeletal Health
Department of Sports Science and Clinical Biomechanics &
Research Unit for General Practice (Dept. of Public Health) 
Dr. Thorlund

PainRelief.com:  What is the background for this study?

Response: Opioids are commonly prescribed to patients with knee and hip osteoarthritis (OA). But for newly diagnosed patients’ clinical guidelines recommend exercise therapy, patient education and weight loss (if needed) as first line treatment. These treatments can be supplemented or replaced with biomechanical interventions (insoles, wedges, cane use, etc.), and paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) if needed. Generally, opioids are should only be used when other treatment options are exhausted, ineffective or contraindicated. Thus, treatment with opioids shortly after OA diagnosis is considered inappropriate according to guidelines.

Knee Osteoarthritis: Orthopedists Prescribing More NSAIDS and Less Lifestyle Management for Pain Relief

PainRelief.com Interview with:

Samannaaz Khoja, PT, PhD
Research Assistant Professor
Department of Physical Therapy
University of Pittsburgh School of Health and Rehabilitation Sciences

Samannaaz Khoja, PT, PhD Research Assistant Professor Department of Physical Therapy University of Pittsburgh School of Health and Rehabilitation Sciences
Dr. Khoja

PainRelief.com: What is the background for this study? 

ResponseThe purpose of this study was to describe and compare rates of physicians’ recommendation for physical therapy (PT), lifestyle-counseling, and pain medication for knee osteoarthritis (KOA) between 2007 and 2015. The study also aimed to identify patient, physician and practice-level factors associated with each treatment recommendation.   We used survey data from the National Ambulatory Medical Care Survey, data from this survey is publicly available and is housed within the CDC. We identified 2297 knee OA related visits, which approximated to 67 (±4) million weighted physician visits between 2007 and 2015 (around 8 million visits/year).

Do Men and Women Have Different Pain Relief Response to Opioids?

PainRelief.com Interview with:
Roberta Agabio, M.D.
Dpt. Biomedical Sciences
University of Cagliari
Cittadella Universitaria Monserrato
Monserrato (CA) – ITALY

PainRelief.com:  What is the background for this study?

Response: Pain is the leading cause for seeking medical care worldwide, and opioids are the most frequently prescribed drugs for pain relief. Differences and similarities between men and women in both effectiveness and side effects to opioids used for pain relief have been described. In addition, individuals may respond differently to these medications for other reasons for example: the intensity of pain experienced, amount and type of administration of opioids (e.g. fixed doses established by physicians or flexible doses decided by patients), mental condition, age, body weight, and use of alcohol, tobacco and/or cannabis.

However, the role of these factors in influencing sex differences and similarities in the response to opioids used for pain control has not been thoroughly investigated.

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Who Teaches Faculty to Educate Medical Residents About Opioids for Chronic Pain?

PainRelief.com Interview with:

Payel Roy, MD
Section of General Internal Medicine
Department of Medicine
Boston University School of Medicine and Boston Medical Center
Boston, Massachusetts.

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Given the current opioid crisis, we know how important it is to educate physicians-in-training in safer opioid prescribing.  But we can’t educate them properly if their faculty mentors don’t feel comfortable prescribing opioids themselves.  Our study evaluated a program designed to improve faculty physicians’ comfort in prescribing opioids safely and teaching these practices to trainee physicians.  

We found that faculty development programs can improve their confidence in prescribing opioids safely and teaching their trainees about prescribing, however translating these attitudes into teaching practice remains a challenge.

Who Prescribes More Opioids for Pain Relief? Physicians or Physician Extenders?

Photo of Dr. Michael Issac Ellenbogen, M.D.

Michael Ellenbogen, MD
Assistant Professor of Internal Medicine
Johns Hopkins School of Medicine 

What is the background for this study? What are the main findings?

Nurse practitioners (NPs) and physician assistants (PAs) are becoming an increasingly important and larger part of the healthcare workforce, especially in general internal medicine. To our knowledge, differences in opioid prescribing among generalist physicians, NPs, and PAs have not been evaluated. We aimed to learn if there are differences in opioid prescribing among generalist physicians, NPs, and PAs to Medicare beneficiaries.     

We performed a serial cross-sectional analysis of prescription claims from 2013 to 2016 using publicly available data from the Centers for Medicare and Medicaid Services. All generalist physicians, NPs, and PAs who provided more than ten total prescription claims between 2013 and 2016 were included. These prescribers were subsetted as practicing in a primary care, urgent care, or hospital-based setting.

We found that the overall volume and proportion of opioid prescribing is heavily right-skewed. The mean opioid prescription proportions (as a proportion of all prescription claims) for physicians in primary care, urgent care/walk-in clinics, and hospital medicine were 4.69, 6.72, and 6.66 relative to 7.10, 11.97, and 11.01 for PAs.  The adjusted total opioid claims across these four years for physicians was 660 (95% confidence interval: 660-661), for NPs was 755 

(95% CI: 753-757), and for PAs was 812 (95% CI: 811-814). 

What should readers take away from your report?

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Nordic Countries Also See Rapid Increase in Opioid Prescriptions for Pain Relief

PainRelief.com Interview with:
Ley (Ashley) Muller, PhD
University of Oslo

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: The North American opioid crisis is clearly linked to the high availability of prescription opioids. In the Nordic countries of Denmark, Sweden, and Norway, the pharmaceutical industry is much more regulated, including bans on marketing to physicians, so the market isn’t flush with opioids. However, these countries have ageing populations with some of the highest rates of chronic non-cancer pain in the world, and over-prescription for this type of pain was one of the triggers of the North American crisis. 

This begs the question: how sure are we that strong pharmaceutical regulations alone can protect countries from prescription opioid problems?  

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National Trends in Prescription Opioid Risk Reduction Practices

PainRelief.com Interview with:
Daniel P. Alford, MD, MPH
Professor of Medicine
Associate Dean, Continuing Medical Education
Director, Clinical Addiction Research and Education (CARE) Unit
Director, Safe and Competent Opioid Prescribing Education (SCOPE of Pain) Program
Boston University School of Medicine
Boston Medical Center, Boston MA 02118

PainRelief.com: What is the background for this study?

Response: Boston University School of Medicine’s Safe and Competent Opioid Prescribing Education (SCOPE of Pain) is the longest-running safer opioid prescribing educational program under the FDA’s opioid Risk Evaluation and Mitigation Strategy (REMS). 

This study analyzed clinicians’, who were registering to attend a SCOPE of Pain training, self-report of performing five opioid prescribing risk-mitigation practices with patients prescribed opioids for chronic pain including:

  1. Use of patient-prescriber agreements,

2) Informing patients about taking opioids exactly as prescribed,

3) Discussing safe opioid storage and disposal,

4) Discussing risks of opioid-associated respiratory depression and overdose, and

5) Monitoring for misuse including urine drug test and/or pill counts, prior to participating in the training.

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Variety of Pain Relief Medications Reduced Opioid Usage in Trauma Patients

PainRelief.com Interview with:
Christine S. Cocanour, M.D., F.A.C.S., F.C.C.M.
Division of Trauma, Acute Care Surgery and Surgical Critical Care 
UC Davis Health

PainRelief.com:  What is the background for this study?

Response: Our critical care pharmacists (Duby, Hamrick and Lee) and surgeons (Cocanour, Beyer) wanted to decrease our use of opioids without compromising pain control in our trauma patients—especially those that were admitted to the ICU.  To help make more appropriate choices we put together an order set that was a multimodal approach to pain management. 

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Opioid-Induced Constipation

Chronic Pain Patients: Opioid Induced Constipation a Serious Concern After Surgery

PainRelief.com Interview with:

Jonathan Jahr, MD, DABA, FASA

Dr. Jonathan Jahr is an anesthesiologist in Los Angeles, California and is affiliated with multiple hospitals in the area, including UCLA Medical Center and UCLA Medical Center-Santa Monica. He received his medical degree from New York Medical College and has been in practice for more than 20 years.

Dr-Jonathan-Jahr

PainRelief.com:  What is the background for this study?  Why is it important?

Response: I have worked in the hospital setting for the past 25 years and have conducted multiple studies on different opioid and non-opioid strategies for managing both chronic and acute pain. I also co-edited a textbook entitled Essence of Analgesia and Analgesics. My background and the research I’ve done sets the stage for newer pain management protocols that can provide patients with significant pain relief, and improved satisfaction and outcomes due to fewer or avoided opioid related side effects (ORADS) such as opioid-induced constipation (OIC).

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EXPAREL TAP Block Provides Pain Relief For Cesarean Delivery With Less Opioids

PainRelief.com Interview with:

B. Wycke Baker, MD
Chief of Service, Anesthesiology at Texas Children’s Pavilion for Women
Clinical Professor of Anesthesiology, Obstetrics and Gynecology
Baylor College of Medicine 

pacira pharmaceuticals

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: For this study, we reviewed the charts of 201 women who underwent cesarean deliveries and received a multimodal pain management protocol with or without a TAP block utilizing EXPAREL, a long-acting, non-opioid option to manage pain following surgery. A TAP block, or a transversus abdominis plane block, is a field block that numbs the nerves that supply the abdominal wall. The study included patients who underwent elective, unscheduled waiting list, or emergency cesarean delivery with combined spinal-epidural anesthesia and post-cesarean pain management at Texas Children’s Hospital Pavilion for Women between 2012 and 2015.

The findings revealed many positive outcomes for patients who received a TAP block utilizing EXPAREL compared to those who received multimodal pain control without a TAP block utilizing EXPAREL. For instance, patients who received EXPAREL TAP block showed a significant decrease in postsurgical pain as well as a significant decrease in opioid consumption. On average, patients who received EXPAREL TAP block had shorter time to discharge from PACU, shorter time to readiness for discharge to home, and shorter length of stay in hospital than those who did not receive EXPAREL TAP block.

Further, a significantly higher number of patients treated with EXPAREL TAP block (12%) compared to those without EXPAREL TAP block (3%) consumed no opioids after surgery. Fewer patients treated with EXPAREL TAP block (34%) compared to those without EXPAREL TAP block (50%) reported any adverse events following the delivery.

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