Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Mar 2014
Exploratory study of emergency physicians' use of a prescription monitoring program using a framework of technology acceptance.
Emergency physicians (EPs) are faced with significant challenges regarding pain management, while preventing abuse of prescription opioids. Prescription monitoring programs (PMPs) are increasingly used to help allay the abuse of controlled substances. The objective of this study was to determine EPs' intention to use the Texas PMP within the framework of the Technology Acceptance Model. ⋯ PMP users reported a positive intention to use the PMP, with perceived usefulness (β = 0.62, p < 0.01) as the only statistically significant predictor of intention for PMP users. This exploratory study provides a basis for understanding EPs' intention to use a PMP. The use of PMPs by EPs may lead to a decrease in prescription opioid abuse and improve patient safety related to opioid prescribing in the emergency department setting.
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J Pain Palliat Care Pharmacother · Mar 2014
The Global Opioid Policy Initiative: a wealth of information, but what is next?
Recently, the outcomes were published of the Global Opioid Policy Initiative, evaluating the availability, cost of opioid medicines and the regulatory barriers that are possibly impeding access for the management of cancer pain in developing countries. Other studies have shown that the vast majority of the world population has no access to opioid analgesics. This study shows by country which opioid medicines are available, what they cost to the patient, and investigates the presence of barriers for access to these medicines. ⋯ The last publication on the project is a "What's next?" that is over focusing on palliative care, forgetting that outside palliative care is also a huge need for opioid analgesics in moderate and severe pain. While promoting access to palliative care and pain management, their recognition as a human right by UN bodies would be of great help. Moreover, WHO's Access to Controlled Medicines Programme, could be an important programme to support the countries in making these improvements.
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J Pain Palliat Care Pharmacother · Mar 2014
A single-center, retrospective analysis evaluating the utilization of the opioid risk tool in opioid-treated cancer patients.
The Opioid Risk Tool (ORT) is a screening tool used to assess risk of opioid misuse by stratifying aberrant drug-seeking behaviors and/or identifying known risk factors for drug abuse. The objectives of this study were to risk stratify opioid misuse in a cancer pain population and determine the most common patient risk factors associated with misuse utilizing the ORT. This was a retrospective analysis conducted at an academic comprehensive cancer center. ⋯ Twenty-five percent (n = 28) of the sample population were deemed high risk based on the ORT. Screening of cancer patients in the palliative care setting suggests that risk factors for opioid misuse exist. Stratifying patients based on a routine screening tool may help identify cancer patients at risk for aberrant drug behaviors.
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J Pain Palliat Care Pharmacother · Mar 2014
Case ReportsIntercostal administration of liposomal bupivacaine as a prognostic nerve block prior to phenol neurolysis for intractable chest wall pain.
Inadequate pain relief from systemic medications is common in patients with advanced malignancy. Chest wall pain secondary to tumor involvement of chest wall structures can be challenging to manage with systemic medications, and occasionally patients benefit from interventional procedures such as intercostal nerve blocks and neurolysis. In this report, the authors describe the case of a 58-year-old woman with advanced non-small cell lung cancer with tumor invasion into the third thoracic rib. ⋯ This formulation of bupivacaine provided an excellent prognostic blockade, which lasted for approximately 96 hours. This extended period of time allowed the patient to fully evaluate the prognostic blockade, prior to proceeding with neurolysis with phenol. This case suggests that liposomal bupivacaine may be a valuable adjunctive agent for prognostic blockade prior to neurolysis for cancer pain.