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Are Physicians Safely Prescribing Opioids for Chronic Noncancer Pain? A Systematic Review of Current Evidence. | LitMetric

Are Physicians Safely Prescribing Opioids for Chronic Noncancer Pain? A Systematic Review of Current Evidence.

Pain Pract

Centre for Evaluation and Information on Pharmacodependence-Addictovigilance, 'Centre d'Evaluation et d'Information sur la Pharmacodépendance-Addictovigilance' (CEIP-A), Nancy University Medical Center, Nancy, France.

Published: March 2016

AI Article Synopsis

  • The increasing prescription of opioids for chronic noncancer pain has led to a rise in opioid abuse and overdose deaths, highlighting the need for adherence to treatment guidelines to improve outcomes and reduce risks.* ! -
  • A systematic review identified 14 studies on physician adherence to opioid risk reduction strategies and found that while most doctors apply some guidelines, many still neglect essential practices like using pain scales and recognizing risks of prescribing fentanyl to opioid-naïve patients.* ! -
  • Key knowledge gaps among physicians were revealed, indicating a need for more practical guidelines and enhanced education to ensure patient safety and better use of opioids in treatment.* !

Article Abstract

Background: With rising prescription of opioid medications for chronic noncancer pain (CNCP) in the past years, opioid abuse and overdose deaths have increased in parallel. To ensure adequate treatment outcomes and reduce the risks linked with the chronic use of opioids, practitioner's adherence to treatment guidelines is essential. This study summarizes published recommendations about the strategies to reduce the risks associated with the chronic use of opioids and evaluates the adherence of physicians to these recommendations.

Method: A systematic literature search was undertaken in May 2014 using major databases. Studies were included if they examined the adherence of practitioners with at least one form of opioid risk reduction strategy. Benchmark guidelines cited in these studies were also reviewed.

Results: The search yielded 683 records, 14 of which were found to evaluate adherence of physicians to opioid risk reduction strategies. Nine benchmark guidelines were found. Almost all physicians consider opioid therapy only when other safer approaches have failed and do not prescribe opioids at doses greater than 200 mg/day of morphine equivalent. Unfortunately, less than 50% assess pain intensity using a pain scale; they often consider transdermal fentanyl safe for opioid-naïve patients and fail to discontinue opioids if they were ineffective in relieving patients' pain.

Conclusions: Substantial practice and knowledge gaps were identified, including the use of pain scales and prescription of transdermal fentanyl in opioid-naïve patients, which have important implications for patient's safety. Guidelines more practical to physicians' settings and further education of physicians are warranted.

Download full-text PDF

Source
http://dx.doi.org/10.1111/papr.12289DOI Listing

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