Background

Aims

Methods

Results

Conclusions

References

• Opioid prescribing for persistent non-cancer pain is increasing• Negative physiological and psychological associations with

their use are well documented1, 2

• Evidence is lacking that these potential risks are outweighed by their ability at either reducing pain or increasing function and quality 3, 4

• Anecdotally, a significant proportion of our patients are on long-term strong opioids for their chronic pain conditions

• Our outpatient pain service operates within the model of a multi-professional, multi-disciplinary team and its clinicians are committed to responsible opioid prescribing2

• To evaluate a cross-section of our patient population, identifying the number of patients on strong opioids

• To better delineate the features associated with their pain management strategy and strong opioid use

• To make comparisons to those not taking strong opioids to guide the need for further service development

• To institute service changes if necessary and to re-evaluate their effects in the future

• We see a significant proportion of patients on strong opioids for the treatment of their persistent non-cancer pain• Evidence lacks as to the efficacy of opioids in this patient population and there is risk for serious adverse effects• Patients taking strong opioids might be more effectively served with a specific and focused clinic• This will help us better manage the complex issues they present:

• By addressing problematic opioid use such as narcotic bowel and opioid-induced hyperalgesia• By reducing over-medication• By exploring issues around addiction

• Future development will focus on further integration of allied professionals such as clinical psychology and addiction services to create an Integrated Care Pathway

• Prospective audit registered and permissions sought via the Trust’s Clinical Effectiveness Unit

• Consecutive patients attending secondary care pain clinic (Consultant or CNS led clinic, both new and follow-upincluded)

• Data collection tool: 20 point questionnaire• Data collection format: Structured interview at outpatient

consultation with pain management team• Cross-site data collection, two-week window, November 2015

(1) Ballantyne et al.. Opioid Therapy for Chronic Pain. N Engl J Med 2003;349:1943-53, (2) www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware, (3) American Pain Society and American Academy of Pain Medicine. Consensus statement: The use of opioids for the treatment of chronic pain. February 2009, (4) M. Von Korff, R.A. Deyo. Potent opioids for chronic musculoskeletal pain: flying blind? Pain 109 (2004)207–209.

102 - Strong opioid treatment for persistent non-cancer pain:A Prospective evaluation of prevalence from a secondary care multidisciplinary pain clinic

Dr P. Keogh1 MB BCh, Dr K. Ullrich1 MD & Dr J Gallagher MB BCh1 - 1Barts Health NHS Trust, United Kingdom

142 outpatient encounters recorded

36% 37%

27%

0

5

10

15

20

25

30

35

40

Noopioid Weakopioidonly Strongopioid

Percen

tage

38 patients (27%) were on a strong opioid

37% male63% female

Median oral morphine equivalent daily dose 67.5mg

Range 10mg to 500mg

3.5 yearsmedian strong

opioid use

(n=16)58%

(n=22)42%

0 10 20 30 40 50 60 70

Onan

Anti-

neurop

athic

Notonan

Anti-

neurop

athic

Percentage

OpioidRotation12% Increase

OpoiodDose3%

NoChangeinOpioidDose

36%

DecreaseOpioidDose

5%

Injection13%

Physio/Psychology/PMP

15%

Change,Add,TitrateAnti-neuropathic

16%

Concurrent anti-neuropathic therapy

Clinic outcomes for those on strong opioids

31%

21%

8%

18%

11% 11%

0% 0%

38%

32%

6%

12%

1%

7%

2% 2%

0

5

10

15

20

25

30

35

40

Neu

roaxial

Mecha

nical

Neu

roaxial

Radicular

Neu

ropa

thi

cOther

Widesprea

d/

Fibrom

yalgi

a

Abdo

minal

/Pe

lvic

Perip

heral

Joint

Head

ache

Other/

Unk

nown

Percen

tage

StrongOpioidTakers

Non-StrongOpioidTakers

Diagnosis – predominant type of pain

Other demographics comparable