Opioid utilization patterns among patients with cancer and non-cancer pain.

Objective: Opioid pain medication continues to be an important treatment option for patients with moderate to severe cancer and non-cancer pain; however, limited evidence is available regarding differences in opioid use between these two populations. The objective of this analysis was to compare real-world opioid use patterns over time in these two populations.

Design: Retrospective analysis of administrative claims data.

A Systematic Assessment and Monitoring Intervention to Improve Pain Management and Quality Reporting Among Home Hospice Patients.

Background: Validated and reproducible means to systematically improve pain documentation and outcomes in home-based hospice populations are generally lacking. This article describes a novel electronic medical record (EMR)-embedded pain monitoring and management program for home-based hospice patients.

Measures: Pain relief was measured by patients' self-defined pain within 48 hours of initiating care, recorded on a 0-10 pain scale.

Hospice Underutilization in the U.S.: The Misalignment of Regulatory Policy and Clinical Reality.

After three and a half decades of experience with the Medicare hospice benefit in the U.S., despite excellent quality outcomes in symptom management, patient and family satisfaction, and reduction in health care costs, only 12%-15% of beneficiaries' days during the last year of life are spent being cared for within the highly cost-effective interdisciplinary coordinated advanced illness care model known as hospice.

Impact of opioid-induced constipation on healthcare resource utilization and costs for cancer pain patients receiving continuous opioid therapy.

Purpose: Opioid therapy is often associated with adverse effects, including opioid-induced constipation (OIC), in patients receiving opioids for cancer pain. This retrospective observational cohort study evaluated healthcare utilization and costs during the first year after initiating opioid therapy among cancer patients with (cohort 1) and without (cohort 2) constipation.

Methods: This study used administrative claims data from the HealthCore Integrated Research Environment between January 1, 2006, and April 30, 2014.

A Model for Effective and Efficient Hospice Care: Proactive Telephone-Based Enhancement of Life Through Excellent Caring, "TeleCaring" in Advanced Illness.

Background: A community-based non-profit hospice provider implemented "TeleCaring" as a quality improvement intervention to identify and take action on patient or caregiver needs or concerns, such as uncontrolled symptoms or prescription problems.

Measures: We assessed the rate of acceptance of the intervention, intensity of the intervention, escalations of calls from Specialists to Nurses, and the effect of the intervention on utilization of clinical services, clinical miles traveled, and family satisfaction with care.

Intervention: TeleCaring consisted of daily proactive phone calls to patients and caregivers by Specialists and Nurses.

Time to declare victory and unite pain and palliative medicine.

The value and importance of improved communication and collaboration among pain management and palliative care clinicians is presented. The commentator uses the case report in this issue of the journal on the use of indwelling catheters for continuous interscalene blocks in cancer pain management as an example of why these two medical subspecialties need improved collaboration and integration.

Cannabinoids for neuropathic pain.

Treatment options for neuropathic pain have limited efficacy and use is fraught with dose-limiting adverse effects. The endocannabinoid system has been elucidated over the last several years, demonstrating a significant interface with pain homeostasis. Exogenous cannabinoids have been demonstrated to be effective in a range of experimental neuropathic pain models, and there is mounting evidence for therapeutic use in human neuropathic pain conditions.

Alternative routes to oral opioid administration in palliative care: a review and clinical summary.

Objective: A major goal of palliative care is to provide comfort, and pain is one of the most common causes of treatable suffering in patients with advanced disease. Opioids are indispensable for pain management in palliative care and can usually be provided by the oral route, which is safe, effective, and of lowest cost in most cases. As patients near the end of life, however, the need for alternate routes of medication increases with up to 70% of patients requiring a nonoral route for opioid administration.

Nebulized medications for the treatment of dyspnea: a literature review.

Background: Dyspnea significantly impacts quality of life and is one of the most common symptoms in advanced illness. Systemically-administered opioids and benzodiazepines have been the most studied and utilized pharmacologic treatments for refractory dyspnea. Less attention has been given to the use of these medications and others when nebulized.

Clinic-based outpatient palliative care before hospice is associated with longer hospice length of service.

Context: Outpatient nonhospice palliative care has been shown to provide many benefits to patients facing advanced illness, but such services remain uncommon in the U.S. Little is known about the association between clinic-based outpatient palliative care consultation and the timing of hospice enrollment.

Evaluation of the performance improvement CME paradigm for pain management in the long-term care setting.

Objective: A performance improvement continuing medical education (PI CME) activity was designed to assist clinicians with accurately identifying and appropriately managing persistent pain in long-term care facility (LTCF) residents.

Design: Volunteer LTCFs participated in a three-stage PI CME model consisting of: 1) baseline assessment, 2) implementation of practice improvement interventions, and 3) reassessment. Expert faculty chose performance measures and interventions for the activity.

The endocannabinoid system, cannabinoids, and pain.

The endocannabinoid system is involved in a host of homeostatic and physiologic functions, including modulation of pain and inflammation. The specific roles of currently identified endocannabinoids that act as ligands at endogenous cannabinoid receptors within the central nervous system (primarily but not exclusively CB 1 receptors) and in the periphery (primarily but not exclusively CB 2 receptors) are only partially elucidated, but they do exert an influence on nociception. Exogenous plant-based cannabinoids (phytocannabinoids) and chemically related compounds, like the terpenes, commonly found in many foods, have been found to exert significant analgesic effects in various chronic pain conditions.

An examination of adherence to pain medication plans in older cancer patients in hospice care.

Context: Timely and appropriate management of pain is essential to promote comfort at the end of life.

Objectives: To determine if pain-related factors and nonpharmacologic interventions affect medication adherence in older cancer patients in community-based hospices.

Methods: The study involved cancer patients aged 55 years and older, newly admitted to one of the 13 community-based hospices in the midwestern U.

The effect of a translating research into practice (TRIP)--cancer intervention on cancer pain management in older adults in hospice.

Background: Pain is a major concern for individuals with cancer, particularly older adults who make up the largest segment of individuals with cancer and who have some of the most unique pain challenges. One of the priorities of hospice is to provide a pain-free death, and while outcomes are better in hospice, patients still die with poorly controlled pain.

Objective: This article reports on the results of a Translating Research into Practice intervention designed to promote the adoption of evidence-based pain practices for older adults with cancer in community-based hospices.

Ask The Experts: Pain management and end-of-life care.

Perry G Fine, MD, completed medical school in 1981 at the Medical College of Virginia in Richmond (VA, USA). He served an internship in 1982 at the Community Hospital of Sonoma County in Santa Rosa, California, and completed his residency in 1984 at the University of Utah Health Sciences Center in Salt Lake City (UT, USA). In addition, Dr Fine completed a fellowship in 1985 at the Smythe Pain Clinic of the University of Toronto in Ontario, Canada.

Recommendations for urine drug monitoring as a component of opioid therapy in the treatment of chronic pain.

Objective: Several prominent guidelines recommend that patients on long-term opioid therapy have periodic urine drug monitoring (UDM) for appropriate use; however, none address the specific questions of which patients to test, which substances to test for, how often to test, and how to act on the results.

Design: In the absence of adequate scientific evidence in the literature, a panel of experts in the field of pain and addiction medicine was convened to develop consensus UDM recommendations. The panel met three times between March 2010 and April 2011, and reviewed several drafts of the recommendations document between meetings.