Analgesic Prescription Research Articles

Evaluation of common prescription analgesics and adjuvant analgesics as markers of suicide risk: a longitudinal population-based study in England.

Analgesics prescriptions may provide a marker for identifying individuals at higher risk of suicide. In particular, awareness of which analgesics are implicated may help clinicians assess and modify risk. A case-control study in England using the Clinical Practice Research Datalink (for primary care records) linked with hospital and national mortality electronic registries. We included patients aged ≥15 who died by suicide between 2001 and 2019 (N=14,515), to whom we individually matched 580,159 controls by suicide date and general practice (N=594,674). Odds ratios (ORs) for suicide, controlled for age and sex, were assessed using conditional logistic regression. Suicide risks were highest in those prescribed adjuvant analgesics (pregabalin, gabapentin and carbamazepine) (adjusted OR 4.07; 95% confidence intervals CI: 3.62-4.57), followed by those prescribed opioids (adjusted OR 2.01; 95% CI: 1.88-2.15) and those prescribed non-opioid analgesics (adjusted OR 1.48; 95% CI: 1.39-1.58) compared to those not prescribed these medications. By individual analgesic, the highest suicide risks were seen in patients prescribed oxycodone (adjusted OR 6.70; 95% CI: 4.49-9.37); pregabalin (adjusted OR 6.50; 95% CI: 5.41-7.81); morphine (adjusted OR 4.54; 95% CI: 3.73-5.52); and gabapentin (adjusted OR 3.12; 95% CI: 2.59-3.75). Suicide risk increased linearly with the number of analgesic prescriptions in the final year (p<0.01 based on the likelihood ratio test), and the more different analgesics categories were prescribed in the final year (p<0.01 based on the likelihood ratio test). Analgesic prescribing was associated with higher suicide risk. This is a particular issue with regard to adjuvant non-opiate analgesics. There was no funding for this study.

Post hoc analysis of the SONAR trial indicates that the endothelin receptor antagonist atrasentan is associated with less pain in patients with type 2 diabetes and chronic kidney disease

Pain is prevalent among patients with diabetes and chronic kidney disease (CKD). The management of chronic pain in these patients is limited by nephrotoxicity of commonly used drugs including non-steroidal anti-inflammatory drugs (NSAIDs) and opioids. Since previous studies implicated endothelin-1 in pain nociception, our post hoc analysis of the SONAR trial assessed the association between the endothelin receptor antagonist atrasentan and pain and prescription of analgesics. SONAR was a randomized, double-blind, placebo-controlled clinical trial that recruited participants with type 2 diabetes and CKD (estimated glomerular filtration rate 25-75 ml/min/1.73 m2; urinary albumin-to-creatinine ratio 300-5000 mg/g). Participants were randomized to receive atrasentan or placebo (1834 each arm). The main outcome was pain-related adverse events (AEs) reported by investigators. We applied Cox regression to assess the effect of atrasentan compared to placebo on the risk of the first reported pain-related AE and, secondly, first prescription of analgesics. We used the Anderson-Gill method to assess effects on all (first and subsequent) pain-related AEs. During 2.2-year median follow-up, 1183 pain-related AEs occurred. Rates for the first pain-related event were 138.2 and 170.2 per 1000 person-years in the atrasentan and placebo group respectively (hazard ratio 0.82 [95% confidence interval 0.72-0.93]). Atrasentan also reduced the rate of all (first and subsequent) pain-related AEs (rate ratio 0.80 [0.70-0.91]). These findings were similar after accounting for competing risk of death (sub-hazard ratio 0.81 [0.71-0.92]). Patients treated with atrasentan initiated fewer analgesics including NSAIDs and opioids compared to placebo during follow-up (hazard ratio = 0.72 [0.60-0.88]). Thus, atrasentan was associated with reduced pain-related events and pain-related use of analgesics in carefully selected patients with type 2 diabetes and CKD.

Variability in Opioid Prescribing Among Plastic Surgery Residents After Bilateral Breast Reduction.

Prescription opioid misuse in the United States accounts for significant avoidable morbidity and mortality. Over one third of all prescriptions written by surgeons are for opioids. Although opioids continue to provide needed analgesia for surgical patients, there are few guidelines in the plastic surgery literature for their safe and appropriate use after surgery. The consequence is wide variability and excessive opioid prescriptions. Understanding patterns of prescribing among plastic surgery residents is a crucial step toward developing safer practice models for managing postoperative pain. The authors performed a retrospective analysis of discharge opioid prescriptions after bilateral breast reduction at a single academic medical center from 2018 to 2021. Single factor 1-way analysis of variance was used to evaluate prescribing patterns by resident, postgraduate year, attending of record, and patient characteristics for 126 patients. A multivariate analysis was performed to determine the degree to which these factors predicted opioid prescriptions. This analysis revealed significant variability among residents prescribing opioids after bilateral breast reductions (P < 0.001) irrespective of patient comorbidities and demographics. Residents were found to be the main predictor of opioid prescriptions after surgery (P < 0.001) with a greater number of morphine milligram equivalents prescribed by the more junior residents (P < 0.001). Excessive and variable opioid prescriptions among plastic surgery residents highlight the need for opioid prescribing education early in surgical training and improved oversight and communication with attending surgeons. Furthermore, implementation of evidence-based opioid-conscious analgesic protocols after common surgical procedures may improve patient safety by standardizing postoperative analgesic prescriptions.

Survey of medications for myelomeningocele patients over their lifetime in Japan

BackgroundThis study aimed to investigate medication prescriptions for patients with myelomeningocele (MMC) across different age groups, particularly in adulthood and after middle age. MethodsThe Japan Medical Data Center (JMDC) database, based on medical claims data, was utilized for this analysis. Patients were divided into 10-year age groups, and prescriptions for analgesics, anticonvulsants, psychotropic drugs, lifestyle disease-related drugs, drugs for urinary incontinence, and laxatives were examined. To compare the differences in the utilization of medications unrelated to lifestyle-related diseases across different age groups, the data was categorized into three age groups: 19 or under, 20–39, and 40 or older. ResultsAmong the 556 MMC patients, the percentage of those regularly prescribed analgesics increased from 2.8% in patients ≤ 19 to 31.7% in patients 40 or older (p < 0.01). Psychotropic medication use also increased with age, rising significantly from 6.3% in patients ≤ 19 to 34.6% in patients 40 or older (p < 0.01). Patients with MMC showed an increasing trend in prescriptions for lifestyle-related disease medications compared to the normal control group. Notably, the percentage of patients in their 30 s taking hypertension medication was 4.9%, significantly higher than the 0.86% in the control group (p = 0.029). In their 40 s, 22.9% of MMC patients were prescribed hyperlipidemia medication, significantly higher than the 3.9% in the control group (p < 0.01). ConclusionComprehensive multidisciplinary support and follow-up are crucial to enhance the quality of life for MMC patients, with particular attention to pain management, psychological care, and treatment of lifestyle-related diseases.

FTP1.10 Analgesic Management of Traumatic Rib Fractures on the General Surgery Take in a Non-Trauma Unit

Abstract Aims To evaluate the analgesic prescription for inpatients with rib fractures Methods Patients (18 years or over) who were admitted with rib fractures and underwent imaging between August 2021 and September 2022 were identified from a prospectively maintained radiology database. Those discharged or transferred to a tertiary centre were excluded. Analgesic prescription, pain scores and referral to specialist services were retrieved from a prospectively maintained electronic patient record system (Meditech, Version 6, USA). Results Type of analgesia Percentage of patients receiving prescription (%) Paracetamol 100% NSAIDS 29% Weak opioid (codeine/ tramadol) 54% Strong opioid 100% Patient controlled analgesia 17% Thoracic epidural 4% Regional anaesthesia blocks 0% Conclusions The current practice of multimodal analgesic prescription for inpatients with rib fractures needs improvement.

133 A review of analgesia prescription in patients admitted with Neck of Femur Fractures

Abstract Background Analgesics are amongst the most commonly prescribed drugs within a hospital setting. Often prescribed based on clinical judgement and perceived pain, without formal evaluation. They are integral to patients comfort and experience. A study in 2008 showed that when patients had moderate to severe pain, they had only about a 50 percent chance of obtaining adequate pain relief, while another study in 2010 showed that the average cost per patient for readmission due to pain was $1,869 (≈£1,571) per visit. Aim Methods Review of drug charts of all the neck of femur patients admitted from 04/10/2022 to 22/10/2022 (30 in total). Recorded patient pain score extracted from admission clerking. Results Conclusion Pain score tends not to be recorded at the time of admission and analgesia is prescribed based on clinical judgement. Therefore, a poster of new Trust guidelines for patients admitted with Neck of Femur Fractures (NOF) was circulated amongst Orthopaedics department and A&amp;E in Watford General Hospital, United Kingdom.

Conservative treatment for dropped head syndrome.

Previous reports on the outcome of conservative treatment for dropped head syndrome (DHS) are scarce. The purpose of this study was to elucidate the efficacy of conservative treatment for DHS and to identify possible predictive factors relating to the outcome. Among 76 DHS patients, conservative treatment (2-3months collar application, active neck range of motion exercise, and occasional prescription of analgesics) succeeded in 17 patients (22.4%, group S, 4 male, 13 female, mean age 75.9years). The treatment failed in the remaining 59 patients (group F). Clinical and radiological parameters were compared between the groups. Radiological findings of group S were compared between before treatment and at follow-up. Duration of disease was 6.6 ± 9.3months in group S and 20.0 ± 27.6months in group F. C2-7 angle (degree), the incidence of anterior slippage of the vertebra (%), reducibility (%), and upper thoracic kyphosis angle (degree) in group S/F were - 19.2 ± 17.5/- 34.6 ± 26.6, 23.5/62.7, 100/52, and 6.7 ± 8.6/17.9 ± 13.7, respectively. C2-7 angles were - 19.2 ± 17.5 degrees at pre-treatment and 10.2 ± 20.7 degrees at follow-up. These differences were statistically significant. The present study indicated that conservative treatment was successful in 22% of DHS patients, with improvement in their cervical kyphotic alignment. Shorter duration of disease, relatively smaller cervical kyphosis without anterior slippage of the vertebra, reducibility, and abundant compensation at the upper thoracic region were good indications for the success of conservative treatment.

Answering Big Questions in Pain Medicine.

The future of pain medicine is marked by many questions. What can other nations around the world learn from the opioid crisis that is still affecting the United States? The American opioid experience was mischaracterized and wrongly described, and its causes were misdiagnosed from the outset, leading to its mismanagement and the abandonment of many chronic pain patients to their suffering. There are a few new drugs in the analgesic armamentarium. What new targets do we have in pain medicine? There are many breakthroughs, discoveries, and potential new targets that could add to our analgesic prescribing choices. These include sigma receptors, d-amino acid oxidase, endoplasmic reticulum stress receptors, histone deacetylase, and others. Neuromodulation had been used with varying degrees of success for years, but with a simplistic approach based on the gate theory of pain. Despite our familiarity with neuromodulation and spinal cord stimulators, neuromodulation research indicates that the activation of glial cells may activate the immune system and enhance analgesia. Neuromodulation studies have concentrated on how electricity affects neuronal activity rather than how electrical activity could reduce pain. There are still more frontiers in our battle against pain and some promising avenues for treatments. This narrative review will try to summarize what can be done from the perspective of recent technological and pharmacological developments.

Urine drug testing in the context of opioid analgesic prescribing for chronic pain: a content analysis of U.S. state laws in 2022.

In response to the opioid crisis, U.S. states have passed laws requiring urine drug testing (UDT) when opioid analgesics are prescribed for chronic pain. We sought to identify state law UDT requirements. We searched NexisUni legal database using terms related to UDT, chronic pain, and opioids. We included laws effective during spring 2022 that required UDT when opioids were prescribed for chronic pain. We performed deductive content analysis, coding laws for mandated UDT frequency, type of clinician and type of payer to whom the law applied, and circumstances under which UDT was mandated. We found 32 laws across 13 states that met our inclusion criteria. UDT requirements varied substantially by state, including with regard to the type of clinician to whom the law applied, the mandated frequency of UDT (eg, at initiation/assessment, at least annually, more than once per year), and the circumstances in which UDT was mandated (eg, patient had substance use disorder; dosage/day threshold). Relatively few states have UDT mandates associated with prescribing opioids as chronic pain treatment. When developing policy indicators for empirical studies, researchers evaluating how UDT policy affects health outcomes must consider the complexity and lack of uniformity of UDT requirements. In addition, even if states mandate UDT, it is unclear whether clinicians understand the best way to use the test results.

Association Of Neuropathic Pain Improvement And hs-CRP Changes Among Trigeminal Neuralgia Patients Experienced Radiofrequency Ablation 60o and 65o Celcius: 6 months follow up

INTRODUCTION: Trigeminal neuralgia (NT) is a neuropathic pain that involves the trigeminal nerve in the face. The first-line medical management of patients with NT is Carbamazepine (CBZ). Radiofrequency ablation (RFA) procedure is a minimally invasive procedure using a high-frequency current-generating device that produced heat ablate of C-fibers with effectiveness around 76% for 10 yeas follow-up. Inflammed trigeminal nerve (TG) or the branch(es) might be one of the underlying mechanisms unless vascular compression is a common etiology. The heat effects might be according to the temperature set up varies recently from 60°C to 95°C. METHOD: This observational study enrolled 75 severe NT subjects without satisfactory improvement of treatments, divided into 3 groups: analgesics prescription (Control), RFA 60, and RFA 65 Groups. The LANSS scores and hs-CRP levels were followed-up before (baseline), 2 weeks, 3, and 6 months experienced the treatments. Subjects ages in the range of 48.32 + 12.73 to 50.88 + 14.59 years old, and the duration of illness from 4.48 to 10.32 months. RESULT: The LANSS score &gt;12 before treatments showed significance improvements (p&lt;0.001), as in the Control (64% with neuropathic pain), RFA 60 (100% with neuropathic pain), and RFA 65 group (92% with nociceptive pain) at 2 weeks followed-up. At 3 and 6 months observed 100% subjects with nociceptive pain but without significancies. Even though the hs-CRP levels observed reduced for all groups, especially RFA 60 and RFA 65, but have no significances. CONCLUSION: The LANSS scores changes observed significant improvement in all groups, which mentioned if the neuropathic pain syndromes might be better under each treatment. The Hs-CRP levels improvement is better in the neuro ablation groups than analgesic drugs treatment. Even though the Hs-CRP are following of systemic nonspecific inflammation, NT is a focal inflammation.

Racial and Ethnic Disparities in Opioid Prescriptions for Patients with Abdominal Pain: Analysis of the National Ambulatory Medical Care Survey.

Disparities in pain control have been extensively studied in the hospital setting, but less is known regarding the racial/ethnic disparities in opioid prescriptions for patients with abdominal pain in ambulatory clinics. We examined opioid prescriptions during visits by patients presenting with abdominal pain between the years of 2006 and 2015, respectively, in the National Ambulatory Medical Care Survey database. Data weights for national-level estimates were applied. We identified 4006 outpatient visits, equivalent to 114 million weighted visits. Rates of opioid use was highest among non-Hispanic White patients (12%), and then non-Hispanic Black patients (11%), and was the lowest in Hispanic patients (6%). Hispanic patients had lower odds of receiving opioid prescriptions compared to non-Hispanic White patients (OR = 0.49; 95% CI, 0.31-0.77, p = 0.002) and all non-Hispanic patients (OR 0.48; 95% CI 0.30-0.75; p = 0.002). No significant differences were noted in non-opioid analgesia prescriptions (p = 0.507). A higher frequency of anti-depressants/anti-psychotic prescriptions and alcohol use was recorded amongst the non-Hispanic patients (p = 0.027 and p = 0.001, respectively). Rates of opioid prescriptions for abdominal pain patients were substantially lower for the Hispanic patients compared with the non-Hispanic patients, despite having a decreased rate of high-risk features, such as alcohol use and depression. The root cause of this disparity needs further research to ensure equitable access to pain management.

Prediction of New-Onset Diabetes Mellitus within 12 Months after Liver Transplantation-A Machine Learning Approach.

Liver transplantation (LT) is a routine therapeutic approach for patients with acute liver failure, end-stage liver disease and/or early-stage liver cancer. While 5-year survival rates have increased to over 80%, long-term outcomes are critically influenced by extrahepatic sequelae of LT and immunosuppressive therapy, including diabetes mellitus (DM). In this study, we used machine learning (ML) to predict the probability of new-onset DM following LT. A cohort of 216 LT patients was identified from the Disease Analyzer (DA) database (IQVIA) between 2005 and 2020. Three ML models comprising random forest (RF), logistic regression (LR), and eXtreme Gradient Boosting (XGBoost) were tested as predictors of new-onset DM within 12 months after LT. 18 out of 216 LT patients (8.3%) were diagnosed with DM within 12 months after the index date. The performance of the RF model in predicting the development of DM was the highest (accuracy = 79.5%, AUC 77.5%). It correctly identified 75.0% of the DM patients and 80.0% of the non-DM patients in the testing dataset. In terms of predictive variables, patients' age, frequency and time of proton pump inhibitor prescription as well as prescriptions of analgesics, immunosuppressants, vitamin D, and two antibiotic drugs (broad spectrum penicillins, fluocinolone) were identified. Pending external validation, our data suggest that ML models can be used to predict the occurrence of new-onset DM following LT. Such tools could help to identify LT patients at risk of unfavorable outcomes and to implement respective clinical strategies of prevention.

Radiation oncologists' scope of practice and role in cancer management in Australia, New Zealand, and Singapore: Are we clinicians or technicians?

To evaluate the scope of practice and role in cancer management for radiation oncologists in Australia, New Zealand, and Singapore (ANZ). A 27-question survey was emailed to all practicing radiation oncologists listed on the RANZCR database in mid-2021. There was a 54% response rate. Respondents reported managing symptoms associated with radiation therapy (96%), cancer-related symptoms (86%), writing narcotic and analgesic prescriptions (76%), being involved in palliative care (57%), prescribing non-cytotoxic systemic therapy (45%), and admitting patients (41%). Just over 20% wanted to expand their scope of practice, but for those who were unable to, insufficient time (35%), inter-specialty political difficulties (14%), and lack of support from the organisation (12%) were the major reasons. Over half of respondents (56.4%) thought they provided an opinion on the overall role of cancer management. Just under 20% provided a radiation therapy opinion only and <1% provided radiation therapy at the request of the referring clinician. The remainder reported a combination of these. Over 80% of respondents thought their ideal role was to be involved in overall cancer management and 20% believed they should be providing an opinion on radiation therapy only. The ideal role matched the actual role in over 87% of respondents and most respondents thought radiation oncology training enabled an opinion on overall cancer management. Over 90% of respondents were satisfied with their current role in cancer management. Radiation oncologists felt they were perceived as independent clinicians and the large majority (87%) thought radiation oncologists should be part of a multidisciplinary team rather than leaders in cancer management. This study has revealed a broad but expected scope of practice for ANZ radiation oncologists with the large majority providing an opinion on overall cancer management or radiation therapy and their ideal role matching their actual role.

Changes in opioid and other analgesic prescribing following voluntary and mandatory prescription drug monitoring program implementation: A time series analysis of early outcomes.

Australian prescription drug monitoring programs (PDMPs) provide information about a patient's recent medication history for controlled drugs at the point of prescribing and dispensing. Despite their increasing use, the evidence for PDMPs is mixed, and is almost exclusively from the United States. This study examined the impact of PDMP implementation on opioid prescribing among general practitioners in Victoria, Australia. We examined data on analgesic prescribing using electronic records of 464 medical practices in the Australian state of Victoria between 01/04/2017 and 31/12/ 2020. We used interrupted time series analyses, to examine immediate and longer-term trends in medication prescribing following voluntary (from April 2019) and mandatory PDMP implementation (from April 2020). We examined changes in three outcomes (i) 'high' opioid dose (50-100mg oral morphine equivalent daily dose (OMEDD) and over 100mg (OMEDD) prescribing (ii) prescribing of high-risk medication combinations (opioids with either benzodiazepines or pregabalin), and (iii) initiation of non-controlled pain medications (tricyclic antidepressants, pregabalin and tramadol). We found no effect of voluntary or mandatory PDMP implementation on 'high-dose' opioid prescribing with reductions only seen in those prescribed <20mg OMEDD (i.e., the lowest dose category). Co-prescribing of opioids with benzodiazepines (additional 11.87 [95%CI 2.04 to 21.67] patients/10,000 and pregabalin (additional 3.54 [95% CI 0.82 to 6.26] patients/10,000 increased following mandatory PDMP implementation among those prescribed opioids. In contrast to trends of reduced initiation prior to PDMP implementation, we found increased new initiation of non-monitored medications following PDMP implementation (e.g., an immediate increase of 2.32 [95%CI 0.02 to 4.54], patients/10,000 received pregabalin and 3.06 [95%CI 0.54 to 5.5] patients/10,000 received tricyclic antidepressants after mandatory PDMP implementation), and increased tramadol initiation during the voluntary PDMP period (an increase of 11.26 [95%CI: 5.84, 16.67] patients /10,000). PDMP implementation did not appear to reduce prescribing of high opioid doses or high-risk combinations. Increased initiation of tricyclic antidepressants, pregabalin and tramadol may indicate a possible unintended effect.

Poster 125: Cannabis Use Disorder is Not Associated with Opioid Analgesic Use or Patient-Reported Outcomes after Anterior Cruciate Ligament Reconstruction: A Retrospective Matched-Cohort Analysis

Objectives: Cannabis use disorder (CUD), also known as marijuana use disorder, is prevalent yet underdiagnosed psychiatric condition among the U.S. population. Epidemiologic studies have identified a high rate of comorbidity between CUD and chronic pain and other psychiatric disorders. There is a concern among orthopedic surgeons that patients with CUD who undergo elective procedures, such as anterior cruciate ligament reconstruction (ACLR), may be at higher risk for long-term opioid use and poorer outcomes following surgery. The aim of this study was to compare opioid use and patient- reported outcomes (PROs) following ACLR between patients with CUD versus controls. Methods: We conducted a retrospective review of patients with an active diagnosis of CUD who underwent primary ACLR surgery at a single center from 2011-2021 with minimum 3-month follow-up. Patients with CUD were identified using ICD-10 code F12 and its associated sub-codes. CUD patients were matched to controls on age, sex, and follow-up time using greedy nearest-neighbor propensity score matching. Analgesic prescriptions up to one year postoperative were abstracted from medical records and all opioid analgesic doses were converted to morphine milligram equivalents (MMEs). Pre- and post-operative Patient-Reported Outcome Information System (PROMIS) scores, 90-day readmissions, and 90-day revisions were also abstracted from medical records. Outcomes were compared between CUD and control groups using Mann-Whitney U test and Fisher’s exact test. P-values &lt;0.05 were considered significant. Results: 104 CUD patients were matched to 104 controls. Sex demographics were the same in both groups (65.4% male, 34.6% female) and there were no significant differences in mean age (CUD 29.9 vs control 29.2 years; p=0.57), BMI (CUD 25.5 vs control 25.5 years; p=0.95), or follow-up time (CUD 16.1 vs control 15.1 months; p=0.65). Both groups were prescribed postoperative opioids at similar rates (CUD 82.7% vs control 83.7%; p=1.00). Among those prescribed opioids, there were no significant differences in total days supplied (CUD 12.5 vs control 10.8; p=0.67), total MMEs (CUD 558 vs control 445; p=0.71), or MMEs per day (CUD 47.5 vs control 46.3; p=0.65). Likewise, there were no significant differences in pre-to-postoperative improvement in PROMIS Pain Intensity (CUD -5.8 vs control -5.1; p=0.51), Pain Interference (CUD -8.3 vs control -7.6; p=0.81), Mobility (CUD 10.9 vs control 11.1; p=0.90), Mental Health (CUD 0.03 vs control 0.54; p=0.74), or Physical Health (CUD 3.9 vs control 4.2; p=0.94). Conclusions: Patients with CUD do not appear to consume opioid analgesics at a higher frequency or duration than their counterparts without CUD following ACLR surgery. Furthermore, both groups experience similar improvements in patient-reported outcomes following ACLR and these improvements are not diminished among CUD patients. While orthopedic surgeons should continue to screen patients for cannabis use as part of a thorough preoperative assessment, cannabis abuse or dependence in itself is not cause for concern for worse post-ACLR outcomes.

Design and implementation of an electronic opioid management plan to support consistent communication of opioid analgesia prescribing intentions to patients and general practitioners

AbstractOpioid prescribing requires careful planning to minimise the risk of serious adverse outcomes. However, documentation of discharge opioid plans for patients and their general practitioners (GPs) is inconsistent, particularly when opioids are commenced in the emergency department or after surgery. We describe an initiative to promote consistent discharge opioid plan communication by implementing an opioid management plan (OMP) in our hospital's electronic medical record. Completion of an electronic form by the prescriber generates an OMP note in the medical history, which is used by the pharmacist to provide tailored opioid patient education. The OMP also populates the discharge summary that is sent to the GP and the Australian national digital health record platform, My Health Record. Preliminary evaluation shows incorporating OMP documentation into routine workflows has assisted prescribers to consistently document the plan for supplied opioids, supporting continuity of care. Workflow optimisation is ongoing to further improve discharge summary documentation and provision of patient‐friendly written information. This study was conducted as a quality improvement project and audits conducted as part of the project were approved by Austin Health's Office for Research (Project No: LNR/18/Austin/155). Informed patient consent was not required by Austin Health.

Resource use in the last year of life of prostate cancer patients-A register-based analysis.

Given the paucity of data on the end of life (EOL) of prostate-cancer (PC) patients, we investigated medication prescription patterns and hospitalizations during their final year of life. The data base of the Österreichische Gesundheitskasse Vienna (ÖGK-W) was used to identify all men who died with the diagnosis PC between 1.1.2015 and 31.12.2021 and who were under androgen deprivation and/or new hormonal therapies. Patient age, prescription patterns and hospitalizations during the last year of life were recorded, odds ratios for age groups were analyzed. A total of 1.109 patients were included. ADT was given in 86.7% (n = 962) and NHT in 62.8% (n = 696). Overall, prescription of analgesics increased from 41% (n = 455) during the first to 65.1% (n = 722) in the last quarter of the final year of life. Prescription of NSAIDs was almost consistent (18-20%) whereas the number of patients receiving other non-opioids (paracetamol, metamizole) more than doubled (18 to 39%). Older men had lower prescription rates for NSAID (OR: 0.47, 95% CI: 0.35-0.64), non-opioids (OR: 0.43, 95% CI: 0.32-0.57), opioids (OR: 0.45, 95% CI: 0.34-0.6) and adjuvant analgesics (OR: 0.42, 95% CI: 0.28-0.65). Approximately 2/3 of patients (n = 733) died in the hospital with a median of four hospitalizations in the final year of life. The overall cumulative length of admission was less than 50d in 61.9%, 51-100d in 30.6% and >100d in 7.6%. Younger patients (<70 yrs) were more likely to die in the hospital (OR: 1.66, 95% CI: 1.15-2.39), had a higher median rate of hospitalizations (n = 6) and longer cumulative duration of admissions. Resource use increased during the last year life of PC patients with highest rates in younger men. Hospitalization rates were high and 2/3 died in the hospital, both showed clear age dependency with higher rates, duration and death in the hospital for younger men.

#2901 PAIN MANAGEMENT IN PATIENTS WITH CHRONIC KIDNEY DISEASE: BEWARE OF INERTIA!

Abstract Background and Aims Pain and pain management are major concerns when facing patients with chronic kidney disease (CKD), and it can be more challenging for practitioners other than nephrologists. In practice, one of the aspects of this challenge is the reluctance to initiate or adapt a treatment for this particular group of patients. With this in mind, we proposed to study pain management in patients with CKD by primary care givers by identifying the causes of therapeutic inertia. Method A survey, self-administered via internet and elaborated via Google-Forms (including multiple and unique choice questions) was carried out among primary care physicians in November 2022. Results Sixty primary care physicians answered our survey with a male-to-female gender-ratio of 0.36 and a mean age of 30.65 years [18-57]. Most of the practitioners enrolled in our survey worked in urban areas (98%). Half of them worked in university hospitals, 20% in regional hospitals, 23% in local community clinics and 6.7% in private offices. When asked about their immediate feeling when managing a patient with CKD for a reason other than their kidney disease, anxiety was mostly cited (55%), with indifference, fear and confidence reported respectively in 23%, 8% and 3% of practitioners. Forty-three (71%) of the participants admitted to have difficulties initiating treatment in CKD patients. The main reasons were lack of knowledge about dose adjustments (45%), fear of adverse effects (71%), unavailability of recommended treatments for CKD patient (13%) and lack of access to nephrologist's opinion (26%). When asked about pain management in CKD patients, one out of three doctors did not prescribe the maximum dose of paracetamol for CKD patients when it was necessary. This was due to a fear of overdose (61%), fear of adverse effects (42%) and fear of interactions with other treatments (14%). Forty percent of the participants admitted delaying the increase of paracetamol doses if the initial dose is ineffective. Ninety per cent of participants did not prescribe non-steroidal anti-inflammatory drugs to CKD patients even if indicated. In this case, 61% preferred to use another therapeutic alternative, 55% feared the risk of long-term nephrotoxicity, 16% feared interactions with other treatments and 9.3% did not know how to monitor the tolerance of the treatment. Concerning not relieved by level 1 analgesic treatment pain, 55% did not reach the permitted dose of Tramadol when necessary. As for codeine, 60% of practitioners did not reach the maximum doses if indicated. In 94% of the cases, this was due to apprehension about side effects. Fifty-five per cent of the participants did not seek for a nephrologist's opinion when initiating or modifying analgesic treatment in these patients. Practitioners did not feel the need to do so in 39% of the cases. One out of four participants did not ask for a specialist's opinion because of heavy workload, absence of a nephrologist nearby or in order not to delay pain management. Conclusion Managing patients with CKD calls for great caution when prescribing treatments. However, it is necessary to avoid therapeutic inertia. Our survey illustrates an example regarding a common symptom (pain) that might worsen their quality of life. We suggest that regular seminars on the topic of analgesics prescription for CKD patients should be proposed in order to improve their management.

The diagnostic challenges and two-step surgical approach to an infected dentigerous cyst resembling a unicystic ameloblastoma: A case report

Background: A dentigerous cyst is the second-most frequently observed odontogenic cyst, and an ameloblastoma is one of the most frequently observed odontogenic tumors. Both are mostly associated with an impacted mandibular third molar and have similar characteristics. Diagnostic difficulties often result in misdiagnosis and remain a challenge to overcome. Comprehensive clinical, radiographic, and histopathological views are essential to correctly diagnose the problem and formulate the most suitable treatment plan. Purpose: This case report aims to present a thorough approach to the diagnostic and surgical procedures involved in treating a dentigerous cyst that resembles an ameloblastoma by using marsupialization followed by enucleation. Case: This article presents the case report of a 27-year-old male patient with an infected dentigerous cyst resembling a unicystic ameloblastoma associated with a totally impacted lower mandibular left third molar. The patient had a history of swelling, pain, and pus drainage in the retromolar area. Symptoms subsided after antibiotic and analgesic prescriptions, but the lesion remained and was slowly progressing. The diagnostic approach began with a fine-needle aspiration biopsy, and the result confirmed a benign cystic lesion that was suspected to be an odontogenic tumor. Then an incisional biopsy was conducted under local anesthesia, diagnosing an infected dentigerous cyst. Case Management: Marsupialization and decompression using an obturator was preferred, followed by enucleation. Nine months later, a radiographic examination revealed satisfactory bone regeneration without recurrence. Conclusion: An incisional biopsy plays a vital role in establishing a definitive diagnosis. Marsupialization followed by enucleation offers an excellent combination of treatments achieving complete cyst removal, anatomical structure preservation, and bone regeneration with minimal complications.

Efficiency of fascia iliaca block in total hip arthroplasty

Introduction. The present study examined the effect of iliac fascia blockade in patients after primary total hip arthroplasty (TEH). Purpose. Evaluation of the efficacy and safety of using the iliac fascia blockade in the postoperative period after TEH. Materials and methods. The study included 60 patients who underwent primary TEH. Patients were randomly divided into two groups: group 1 (n = 30) – patients who underwent a multimodal scheme of postoperative analgesia in the postoperative period; group 2 (n = 30) – patients who, in addition to multimodal analgesia, underwent blockade of the iliac fascia of the thigh under ultrasound navigation after surgery. In the postoperative period, the level of pain syndrome at rest and during movement was recorded using a visual analog scale of the pain level (VAS 1 and VAS 2) after 6–12–24–48 hours. We also recorded the frequency and quantity of prescription of narcotic analgesics and noted the frequency of side effects from their use. Results. The level of pain syndrome at rest and during movement in the first 24 hours was lower in patients of the 2nd group. After 48 hours, there were no significant differences between the groups in the level of pain. Patients in group 1 were prescribed opioid analgesics more often than patients in group 2. The number of side effects from the use of narcotic analgesics was greater in patients of group 1. Conclusions. The use of the iliac fascia block is an effective method of perioperative analgesia after hip arthroplasty. This method allows achieving a high level of pain relief and reduces the need for prescription of opioid analgesics.