TY - JOUR
T1 - Opiates for chronic nonmalignant pain syndromes
T2 - Can appropriate candidates be identified for outpatient clinic management?
AU - White, Kevin T.
AU - Dillingham, Timothy R.
AU - González-Fernández, Marlís
AU - Rothfield, Linda
PY - 2009/12/1
Y1 - 2009/12/1
N2 - Objective: To better define patients appropriate for opiate management for chronic pain syndromes. Design: Retrospective study of 65 patients with noncancerous pain syndromes who were on or being considered for opiates and who were transitioned into a structured outpatient clinic with close monitoring and management. Noncompliance with this outpatient pain management program was the primary outcome. Noncompliance was defined as (1) receipt of prescriptions from providers outside of this clinic, (2) increase in medication dosage without proper approval, (3) refusing toxicology screening on entrance into the program, (4) negative toxicology tests for prescribed medications, (5) positive toxicology tests for psychoactive medications not prescribed, or (6) discovery on toxicology tests of the presence of illicit substances. Results: There were 24 cases of noncompliance (37%), with age <56 yrs old demonstrating significant (P = 0.02) association with persons who were noncompliant with the outpatient program. Forty-three percent of those younger than 56 yrs were noncompliant with program, yet no patient older than 56 yrs was noncompliant. Working status approached significance (P = 0.07) with those patients out of work demonstrating a greater likelihood of noncompliance. There were no correlations found between other patient characteristics and the level of compliance with the program. ConclusionS: When considering opiates as a treatment option, pain clinics should have a heightened suspicion for younger and unemployed patients. Although these findings should be examined in larger studies, they suggest that nonmedical factors play a substantial role regarding success in such a structured opiate pain program.
AB - Objective: To better define patients appropriate for opiate management for chronic pain syndromes. Design: Retrospective study of 65 patients with noncancerous pain syndromes who were on or being considered for opiates and who were transitioned into a structured outpatient clinic with close monitoring and management. Noncompliance with this outpatient pain management program was the primary outcome. Noncompliance was defined as (1) receipt of prescriptions from providers outside of this clinic, (2) increase in medication dosage without proper approval, (3) refusing toxicology screening on entrance into the program, (4) negative toxicology tests for prescribed medications, (5) positive toxicology tests for psychoactive medications not prescribed, or (6) discovery on toxicology tests of the presence of illicit substances. Results: There were 24 cases of noncompliance (37%), with age <56 yrs old demonstrating significant (P = 0.02) association with persons who were noncompliant with the outpatient program. Forty-three percent of those younger than 56 yrs were noncompliant with program, yet no patient older than 56 yrs was noncompliant. Working status approached significance (P = 0.07) with those patients out of work demonstrating a greater likelihood of noncompliance. There were no correlations found between other patient characteristics and the level of compliance with the program. ConclusionS: When considering opiates as a treatment option, pain clinics should have a heightened suspicion for younger and unemployed patients. Although these findings should be examined in larger studies, they suggest that nonmedical factors play a substantial role regarding success in such a structured opiate pain program.
KW - Chronic pain
KW - Opiates
KW - Outpatients
KW - Pain management
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U2 - 10.1097/PHM.0b013e3181bc006e
DO - 10.1097/PHM.0b013e3181bc006e
M3 - Article
C2 - 19789432
AN - SCOPUS:73349132705
VL - 88
SP - 995
EP - 1001
JO - American Journal of Physical Medicine
JF - American Journal of Physical Medicine
SN - 0894-9115
IS - 12
ER -