Background Opioids are safe and effective drugs that improve the quality of life of patients with chronic pain. However, they require close monitoring and appropriate training. Pain specialists consider that pain often has a mixed origin that requires prescription aids for the treatment of neuropathic pain.
Purpose To analyse the adequacy of the recommendations for the treatment of chronic pain with opioid drugs in a tertiary care hospital.
Material and methods This was a prospective study identifying prescriptions of opioid drugs (transdermal fentanyl, delayed release morphine and delayed release oxycodone) in patients hospitalised for 2 months using the electronic health record. We collected requirements for adjuvant drugs for the treatment of neuropathic pain, laxatives and rescue analgesia, and being following or not by the unit pain (UP).
Results 79 patients were prescribed any of the opioids studied, 38 men, with a mean age of 67.7 years, and 41 women, with a mean of 64.4 years. Distribution of patients by services was: oncology and haematology (25), internal medicine (13), general and digestive surgery (15), palliative care unit (6), geriatrics (4), pneumology (4) and other services (12). 47% patients were treated with transdermal fentanyl, 34% with oral morphine and 19% with oxycodone tablets. 23% of patients were monitored by UP. Prescription of transdermal fentanyl in patients followed by UP was only 21.6%. The most frequently prescribed drug for rescue was morphine (56%). 100% of patients followed by the UP had rescue analgesia, compared with 69% in the group without monitoring. 29% had prescribed treatment for neuropathic pain, 52% with pregabalin. In those followed by UP, prescription of an adjuvant for neuropathic pain occurred in 67%. It should be noted that 57% of patients treated with gabapentin needed the an adjuvant, versus 33% with pregabalin. 70% had a laxative prescribed, with little difference whether or not patients were followed-up by UP (72% vs 69%).
Conclusion Pharmaceutical validation should be undertaken with these types of high risk drugs, so that prescription of analgesia rescue as well as prescribing laxatives can be recommended. Likewise, prescription of transdermal fentanyl should follow a protocol when favoured over oral and lower cost opioids.
References and/or acknowledgements Dtsch Arztebl Int2016;113:616–25.
Med J Aust 2016;205:334.
No conflict of interest
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