To describe the prevalence of chronic pain and the risk of opioid misuse in a palliative care clinic.
Methods:
We reviewed patient records for 6 months for source of pain, treatment status, opioid misuse risk (Cut down, Annoyed, Guilty, and Eye-opener [CAGE] and Screener and Opioid Assessment for Patients with Pain version 1.0—Short Form [SOAPP-SF] scores), and urine drug screens.
Results:
Of 323 patients, 91% had cancer, 56% undergoing cancer treatment, while 28% had no evidence of disease. Eighty-six (27%) patients had noncancer pain. In all, 46% of new patients had positive scores on the SOAPP-SF and 15% had a positive CAGE. Of the less than 5% of visits that included a urine drug screen, 56% had aberrant results.
Conclusion:
Chronic pain and indicators of opioid misuse risk were prevalent. Outpatient palliative care practices should develop policies to address these issues.
MorrisonRSMaroney-GalinCKralovecPDMeierDE. The growth of palliative care programs in US hospitals. J Palliat Med. 2005;8(6):1127–1134.
2.
FrommeEKBascomPBSmithMD. Survival, mortality, and location of death for patients seen by a hospital-based palliative team. J Palliat Med. 2006;9(4):903–911.
3.
MeierDEBeresfordL. Outpatient clinics are a new frontier for palliative care. J Palliat Med. 2008;11(6):823–828.
4.
RabowMWSmithAKBraunJLWeissmanDE. Outpatient palliative care practices. Arch Intern Med. 2010;170:654–655.
5.
BergerGNO'RiordanDLKerrKPantilatSZ. Prevalence and characteristics of outpatient palliative care services in California. Arch Intern Med. 2011;171(22):2057–2059.
6.
JacobsenJJacksonVDahlinC. Components of early outpatient palliative care consultation in patients with metastatic nonsmall cell lung cancer. J Pall Med. 2011;14(4):459–464.
7.
FollwellMBurmanDLeLW. Phase II study of an outpatient palliative care intervention in patients with metastatic cancer. J Clin Oncol. 2009;27(2):206–213.
8.
MuirJCDalyFDavisMS. Integrating palliative care into the outpatient, private practice oncology setting. J Pain Symptom Manage. 2010;40(1):126–135.
9.
Porta-SalesJCodorniuNGómez-BatisteX. Patient appointment process, symptom control and prediction of follow-up compliance in a palliative care outpatient clinic. J Pain Symptom Manage. 2005;30(2):145–153.
10.
BrueraEMichaudMViganoANeumannCMWatanabeSHansonJ. Multidisciplinary symptom control clinic in a cancer center: a retrospective study. Support Care Cancer. 2001;9(3):162–168.
11.
CasarettDJHirschmanKBCoffeyJFPierreL. Does a palliative care clinic have a role in improving end-of-life care? Results of a pilot program. J Palliat Med. 2002;5(3):387–396.
12.
StrasserFSweeneyCWilleyJBenisch-TolleySPalmerJLBrueraE. Impact of a half-day multidisciplinary symptom control and palliative care outpatient clinic in a comprehensive cancer center on recommendations, symptom intensity, and patient satisfaction: a retrospective descriptive study. J Pain Symptom Manage. 2004;27(6):481–491.
13.
TemelJSGreenJAMuzikanskyA. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733–742.
14.
FlemingMFBalousekSLKlessigCLMundtMPBrownDD. Substance use disorders in a primary care sample receiving daily opioid therapy. J Pain. 2007;8(7):573–582.
15.
ManchikantiLCashKADamronKSManchukondaRPampatiVMcManusCD. Controlled substance abuse and illicit drug use in chronic pain patients: an evaluation of multiple variables. Pain Physician. 2006;9(3):215–226.
16.
MorascoBJGritznerSLewisLOldhamRTurkDCDobschaSK. Systematic review of prevalence, correlates, and treatment outcomes for chronic non-cancer pain in patients with comorbid substance use disorder. Pain. 2011;152(3):488–497.
17.
EwingJA. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984;252(14):1905–1907.
18.
DhallaSKopecJA. The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies. Clin Invest Med. 2007;30(1):33–41.
19.
ButlerSFFernandezKBenoitCBudmanSHJamisonRN. Validation of the revised screener and opioid assessment for patients with pain (SOAPP-R). J Pain. 2008;9(4):360–372.
20.
Inflexxion. Screener and Opioid Assessment for Patients with Pain (SOAPP) version 1.0 SF;2008. https://www.painedu.org/soapp.asp. Accessed April 6, 2014.
21.
AkbikHButlerSFBudmanSHFernandezKKatzNPJamisonRN. Validation and clinical application of the screener and opioid assessment for patients with pain (SOAPP). J Pain Symptom Manage. 2006;32(3):287–293.
22.
MooreTMJonesTBrowderJHDaffronSPassikSD. A comparison of common screening methods for predicting aberrant drug-related behavior among patients receiving opioids for chronic pain management. Pain Med. 2009;10(8):1426–1433.
23.
KoyyalaguntaDBrueraEAignerCNusratHDriverLNovyD. Risk stratification of opioid misuse among patients with cancer pain using the SOAPP-SF. Pain Med. 2013;14(5):667–675.
24.
Opioids in the management of chronic non-cancer pain: an update of the American Society of Interventional Pain Physicians’ (ASIPP) Guidelines. Pain Physician. 2008;11(2 suppl):S5–S62.
25.
Substance Abuse and Mental Health Services Administration. Results From the 2006 National Survey on Drug Use and Health Report. Rockville, MD: Office of Applied Studies; 2007. NSDUH Series H-32; DHHS publication no. SMA 07-4293.
26.
ChabalCErjavecMKJacobsonLMarianoAChaneyE. Prescription opiate abuse in chronic pain patients: clinical criteria, incidence, and predictors. Clin J Pain. 1997;13(2):150–155.
27.
FishbainDAColeBLewisJRosomoffHLRosomoffRS. What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review. Pain Med. 2008;9(4):444–459.
28.
DunnKMSaundersKWRutterCM. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010;152(2):85–92.
29.
PortenoyRK. Treatment of cancer pain. Lancet. 2011;377(9784):2236–2247.
30.
ChouRFanciulloGJFinePG. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113–130.
31.
WasanADButlerSFBudmanSHBenoitCFernandezKJamisonRN. Psychiatric history and psychologic adjustment as risk factors for aberrant drug-related behavior among patients with chronic pain. Clin J Pain. 2007;23(4):307–315.
