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Use of Opioids in Management of Chronic Pain in Non-Cancer Patients
Schug, M, D.O., Hamad, K, M.D., Vanumu, V, M.D.
Saint Elizabeth Medical Center, Family Medicine Residency, Utica, NY
Introduction: Past research has shown that the long-term use of opioids within the structure
of strict treatment guidelines, is successful in reducing pain and improving functionality of
patients. Establishing the goals of treatment is essential to successful pain management with
opioids. Periodic review of a patient’s care is essential, using appropriate medication
adjustments with assessment of activity level and pain levels. Goals of treatment center on
improved pain control with improved functionality and quality of life. These goals will ideally be
mutually arrived at, by patient and provider, with periodic visits using opiate treatment
guidelines.
Our research involves the implementation of such guidelines at the Sister Rose Vincent
Family Medicine Center at the St. Elizabeth Medical Center in Utica, NY; these aim to direct
opiate prescription in treatment of chronic pain to both reduce pain and to increase functional
status and quality of life. We aim to demonstrate that adherence to opiate treatment guidelines,
even if and when it calls for reduction in dosages of opiates prescribed over a three month
period, will produce either no change or a possible improvement in patient functionality, without
a corresponding increase in reported pain levels by patients. At the same time, we expect that
at the time of initial implementation of guidelines, patient’s satisfaction may decrease or levels
of reported pain may increase, due to the patient’s initial response to the change in their
treatment.
Methods: Subjects have included pain patients from the Sister Rose Vincent Family Medicine
Center over the age of 18, both male and female. The patient pool included those with chronic,
noncancerous pain (such as chronic neck pain, chronic back pain and fibromyalgia) who had
been prescribed opiate pain medications for six months prior to the study; those from this pool
who volunteered to participate in the study were included. While our initial aim was to have a
sample size of100 patients, we have found significant resistance to participation from many
patients. After a research participation agreement was introduced and accepted, participating
subjects were administered a 4-question questionnaire, asking their assessment of pain since
last visit, current pain level, perception of functional status in relation to pain since last visit and
current functional status; this assessment took place monthly. Additionally, the type and dose
of opioid medication used, date of starting medication, date of exam, age, sex, and any
adverse events were recorded. Three months after initial data was collected, new pain
management guidelines are being implemented for the subjects. These guidelines include
instructions on approaches to stratifying patients in terms of opiate risk potential, and adjusting
the type and dosage of opiate medication accordingly. Subjects then are assessed monthly
with the same questionnaire as they did for their earlier visits to the clinic once these guidelines
are in place.
The level of pain, functional status, and medication dosage will be compared before and
after applying the guidelines. Improvement will be determined to have occurred: 1) if pain and
functional status decrease and increase, respectively, with correlating dosage staying the same
pre and post guideline implantation, or 2) if pain and functional status either remain the same
or improve when opiate dosage decreased after the guideline implementation.
Trend analysis and t-tests will be used for analysis of collected data.
Results: Currently data is being collected as the study will run until April 15, 2013
Conclusions: Not available at this time