Article Figures & Data
Figures
- Figure 1.
Are you prescribing opioids inappropriately? Recommendations for chronic noncancer pain (CNCP) management with opioids at initial and follow up visits.
- Figure 2.
Urine drug screen information sheet. Detailed information on substances tested according to type of urine drug screen ordered.
Tables
- Table 1.
Documented Items Required to Determine the Level of Appropriateness for Opioid Prescribing Preintervention and Postintervention among Patients with Chronic Noncancer Pain
Item Preintervention (N = 177) Postintervention (N = 96) P Value Further Definitions Overall level of appropriateness score, mean (SD) 5.54 (1.23) 6.29 (1.26) <.001 Opioid appropriateness score (out of nine) was calculated based on the number of documented items described below. Documented items required: (1) Use of nonpharmacologic methods, N (%) 129 (72.9) 82 (85.4) .023 Utilized either physical therapy or osteopathic manipulative treatment. (2) Specialist consultation, N (%) 126 (71.2) 66 (68.8) .680 Specialist consultation warranted if on methadone, >120 morphine equivalents, or >2 psychiatric conditions. (3) Imaging/EMG/labs to identify pain generator, N (%) 137 (77.4) 80 (83.3) .275 For the purpose of identifying CNCP being treated with opioids. (4) Use of nonopioid medications, N (%) 172 (97.2) 95 (99.0) .669 For the purpose of identifying CNCP being treated with opioids. (5) Visit to discuss CNCP at least every 6 months, N (%) 160 (90.4) 90 (93.8) 0.494 (6) Pain level/therapeutic/functional goals discussions, N (%) 56 (31.6) 66 (68.8) <.001 Discussed during the last patient's medical encounter for CNCP. (7) UDS within last year, N (%) 29 (16.4) 24 (25.0) .109 (8) Pain contract/agreement within past year, N (%) 9 (5.1) 12 (12.5) .034 (9) Documented details on drug use, substance abuse or detox, N (%) 162 (91.5) 89 (92.7) .819 At any time prior to or at the reviewed medical encounter. EMG, electromyogram; CNCP, chronic noncancer pain; SD, standard deviation; UDS, urine drug screen.
- Table 2.
Characteristics and Demographics of Chronic Noncancer Patients Preintervention and Postintervention
Characteristic Preintervention (N = 177) Postintervention (N = 96) P Value Age (mean) 55.5 56.3 .613 Nonwhite race, N (%) 100 (56.5) 53 (55.2) .899 Female, N (%) 111 (62.7) 62 (64.6) .794 History of severe chronic obstructive pulmonary disease, N (%) 7 (4.0) 6 (6.3) .390 History of sleep apnea, N (%) 51 (28.8) 31 (32.3) .582 History of illegal drugs or alcohol abuse, N (%): 53 (30.0) 28 (29.2) 1.000 Heroin, N (%) 7 (4.0) 1 (1.0) .267 Cocaine, N (%) 16 (9.0) 8 (8.3) 1.000 Alcohol, N (%) 22 (12.4) 10 (10.4) .697 Marijuana, N (%) 29 (16.4) 16 (16.7) 1.000 History of addiction to opioid, N (%) 18 (10.2) 7 (7.3) .514 History of opioid overdose, N (%) 7 (4.0) 5 (5.2) .759 Psychiatric conditions: Posttraumatic stress disorder, N (%) 10 (5.6) 7 (7.3) .607 Schizophrenia, N (%) 11 (6.2) 7 (7.3) .800 Bipolar, N (%) 14 (7.9) 8 (8.3) 1.000 Panic, N (%) 37 (20.9) 24 (25.0) .450 Anxiety, N (%) 113 (63.8) 66 (68.8) .427 Depression, N (%) 126 (71.2) 72 (75.0) .571 Current type of pain: Neuropathy, N (%) 27 (15.3) 28 (29.2) .010 Abdominal, N (%) 7 (4.0) 7 (7.3) .258 Fibromyalgia, N (%) 24 (13.6) 4 (4.2) .020 Shoulder, N (%) 37 (20.9) 13 (13.5) .144 Pelvic/hip, N (%) 25 (14.1) 11 (11.5) .580 Limb, N (%) 91 (51.4) 45 (46.9) .527 Back/neck/thoracic, N (%) 115 (65.0) 66 (68.8) .592 Headache, N (%) 4 (2.3) 4 (4.2) .458 Opioids used: Oxycodone, N (%) 76 (42.7) 39 (40.6) .798 Hydrocodone, N (%) 63 (35.4) 31 (32.3) .689 Tramadol, N (%) 47 (26.6) 28 (29.2) .672 Morphine, N (%) 19 (10.7) 11 (11.5) .842 Fentanyl, N (%) 4 (2.2) 4 (4.2) .457 Methadone, N (%) 3 (1.7) 1 (1.0) 1.000 Codeine, N (%) 1 (0.6) 2 (2.1) .283 Morphine dose equivalent (mean) 37.9 31.3 .363 Nonopioids used: Acetaminophen, N (%) 61 (34.5) 41 (42.7) .192 Nonsteroidal anti-inflammatory drug, N (%) 116 (65.5) 66 (68.8) .687 Topical, N (%) 62 (35.0) 41 (42.7) .240 Muscle relaxant, N (%) 83 (46.9) 57 (59.4) .057 Antidepressant, N (%) 98 (55.4) 59 (61.5) .370 Antiepileptic, N (%) 76 (42.9) 49 (51.0) .206 Concomitant benzodiazepine use, N (%) 37 (20.9) 29 (30.2) .103 Specialist for current pain: Physical therapy, N (%) 126 (71.2) 74 (77.1) .319 Osteopathic manipulative treatment, N (%) 104 (58.8) 49 (51.0) .251 Surgery, N (%) 8 (4.5) 8 (8.3) .279 Gastrointestinal, N (%) 6 (3.4) 7 (7.3) .232 Podiatry, N (%) 14 (7.9) 12 (12.5) .280 Neurologist, N (%) 19 (10.7) 12 (12.5) .692 Behavioral health, N (%) 65 (36.7) 36 (37.9) .896 Rheumatology, N (%) 13 (7.3) 10 (10.4) .373 Pain management, N (%) 59 (33.3) 40 (41.7) .189 Orthopedist, N (%) 79 (44.6) 37 (38.5) .370
