Exploring the role of chronic pain clinics: Potential for opioid reduction

Amol M Patwardhan, Ryan Matika, Janalee Gordon, Brian Singer, Michelle Salloum, Mohab Ibrahim

Research output: Contribution to journalReview article

Abstract

Background: The management of chronic nonmalignant pain with high-dose opioids has partially contributed to the current opioid epidemic, with some responsibility shared by chronic pain clinics. Traditionally, both primary care providers and patients used chronic pain clinics as a source for continued medical management of patients on high-dose opioids, often resulting in tolerance and escalating doses. Although opioids continue to be an important component of the management of some chronic pain conditions, improvement in function and comfort must be documented. Pain clinics are ideally suited for reducing opioid usage while improving pain and function with the use of a multimodal approach to pain management. We assessed whether the application of multimodal treatment directed by pain specialists in a pain clinic provides for improved function and reduced dosages of opioid analgesics. Objective: We evaluated the role of a pain clinic staffed by fellowship-trained pain physicians in reducing pain and opioid use in chronic nonmalignant pain patients. Study Design: This study used a retrospective design. Setting: The research took place in an outpatient pain clinic in a tertiary referral center/teaching hospital. Methods: Of 1268 charts reviewed, 296 patients were on chronic opioids at the time of first evaluation. After a thorough evaluation, the patients were treated with nonopioid pharmacotherapy and interventional pain procedures as necessary. The data utilized from patients’ latest follow-up visit included current pain level using the Numerical Rating Scale (NRS-11), opioid usage, and various functional parameters. Results: NRS-11 scores decreased by 33.8% from 6.8 (± 0.1)/10 to 4.5 (± 0.2)/10. The pain frequency and number of pain episodes improved by 36.8 ± 2 and 36.2 ± 2.1, respectively. Additionally, the ability to sleep, work, and perform chores significantly improved. Total opioid use decreased by about 55.4% from 53.8 ± 4 to about 24 ± 2.8 MME/patient/day. Limitation: This study is not a randomized prospective controlled study. The patients analyzed are still getting therapy and their pain status may change. Some opioids are underrepresented in the analyzed cohort. Finally, this study lacks in-depth stratification by type of pain, age, gender, and duration of opioid use. Conclusion: Chronic pain clinics can play a pivotal role in reducing opioid usage while improving pain and function in patients on chronic opioids. We wish to emphasize the importance of allocating resources toward nonopioid treatments that may improve the function and well-being of patients.

Original languageEnglish (US)
Pages (from-to)E603-E610
JournalPain Physician
Volume21
Issue number6
StatePublished - Nov 1 2018

Fingerprint

Pain Clinics
Chronic Pain
Opioid Analgesics
Pain
Combined Modality Therapy
Aptitude
Pain Management
Ambulatory Care Facilities
Tertiary Care Centers
Teaching Hospitals

Keywords

  • Chronic pain
  • Improved functional capacity
  • Improved pain
  • Multimodal pain management
  • Opioid reduction
  • Pain clinic
  • Pain management

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Patwardhan, A. M., Matika, R., Gordon, J., Singer, B., Salloum, M., & Ibrahim, M. (2018). Exploring the role of chronic pain clinics: Potential for opioid reduction. Pain Physician, 21(6), E603-E610.

Exploring the role of chronic pain clinics : Potential for opioid reduction. / Patwardhan, Amol M; Matika, Ryan; Gordon, Janalee; Singer, Brian; Salloum, Michelle; Ibrahim, Mohab.

In: Pain Physician, Vol. 21, No. 6, 01.11.2018, p. E603-E610.

Research output: Contribution to journalReview article

Patwardhan, AM, Matika, R, Gordon, J, Singer, B, Salloum, M & Ibrahim, M 2018, 'Exploring the role of chronic pain clinics: Potential for opioid reduction', Pain Physician, vol. 21, no. 6, pp. E603-E610.
Patwardhan AM, Matika R, Gordon J, Singer B, Salloum M, Ibrahim M. Exploring the role of chronic pain clinics: Potential for opioid reduction. Pain Physician. 2018 Nov 1;21(6):E603-E610.
Patwardhan, Amol M ; Matika, Ryan ; Gordon, Janalee ; Singer, Brian ; Salloum, Michelle ; Ibrahim, Mohab. / Exploring the role of chronic pain clinics : Potential for opioid reduction. In: Pain Physician. 2018 ; Vol. 21, No. 6. pp. E603-E610.
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abstract = "Background: The management of chronic nonmalignant pain with high-dose opioids has partially contributed to the current opioid epidemic, with some responsibility shared by chronic pain clinics. Traditionally, both primary care providers and patients used chronic pain clinics as a source for continued medical management of patients on high-dose opioids, often resulting in tolerance and escalating doses. Although opioids continue to be an important component of the management of some chronic pain conditions, improvement in function and comfort must be documented. Pain clinics are ideally suited for reducing opioid usage while improving pain and function with the use of a multimodal approach to pain management. We assessed whether the application of multimodal treatment directed by pain specialists in a pain clinic provides for improved function and reduced dosages of opioid analgesics. Objective: We evaluated the role of a pain clinic staffed by fellowship-trained pain physicians in reducing pain and opioid use in chronic nonmalignant pain patients. Study Design: This study used a retrospective design. Setting: The research took place in an outpatient pain clinic in a tertiary referral center/teaching hospital. Methods: Of 1268 charts reviewed, 296 patients were on chronic opioids at the time of first evaluation. After a thorough evaluation, the patients were treated with nonopioid pharmacotherapy and interventional pain procedures as necessary. The data utilized from patients’ latest follow-up visit included current pain level using the Numerical Rating Scale (NRS-11), opioid usage, and various functional parameters. Results: NRS-11 scores decreased by 33.8{\%} from 6.8 (± 0.1)/10 to 4.5 (± 0.2)/10. The pain frequency and number of pain episodes improved by 36.8 ± 2 and 36.2 ± 2.1, respectively. Additionally, the ability to sleep, work, and perform chores significantly improved. Total opioid use decreased by about 55.4{\%} from 53.8 ± 4 to about 24 ± 2.8 MME/patient/day. Limitation: This study is not a randomized prospective controlled study. The patients analyzed are still getting therapy and their pain status may change. Some opioids are underrepresented in the analyzed cohort. Finally, this study lacks in-depth stratification by type of pain, age, gender, and duration of opioid use. Conclusion: Chronic pain clinics can play a pivotal role in reducing opioid usage while improving pain and function in patients on chronic opioids. We wish to emphasize the importance of allocating resources toward nonopioid treatments that may improve the function and well-being of patients.",
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