Background Aims Methods Results Conclusions References • Opioid prescribing for persistent non-cancer pain is increasing • Negative physiological and psychological associations with their use are well documented 1, 2 • Evidence is lacking that these potential risks are outweighed by their ability at either reducing pain or increasing function and quality 3, 4 • Anecdotally, a significant proportion of our patients are on long-term strong opioids for their chronic pain conditions • Our outpatient pain service operates within the model of a multi-professional, multi-disciplinary team and its clinicians are committed to responsible opioid prescribing 2 • To evaluate a cross-section of our patient population, identifying the number of patients on strong opioids • To better delineate the features associated with their pain management strategy and strong opioid use • To make comparisons to those not taking strong opioids to guide the need for further service development • To institute service changes if necessary and to re-evaluate their effects in the future • We see a significant proportion of patients on strong opioids for the treatment of their persistent non-cancer pain • Evidence lacks as to the efficacy of opioids in this patient population and there is risk for serious adverse effects • Patients taking strong opioids might be more effectively served with a specific and focused clinic • This will help us better manage the complex issues they present: • By addressing problematic opioid use such as narcotic bowel and opioid-induced hyperalgesia • By reducing over-medication • By exploring issues around addiction • Future development will focus on further integration of allied professionals such as clinical psychology and addiction services to create an Integrated Care Pathway • Prospective audit registered and permissions sought via the Trust’s Clinical Effectiveness Unit • Consecutive patients attending secondary care pain clinic (Consultant or CNS led clinic, both new and follow-up included) • Data collection tool: 20 point questionnaire • Data collection format: Structured interview at outpatient consultation with pain management team • Cross-site data collection, two-week window, November 2015 (1) Ballantyne et al.. Opioid Therapy for Chronic Pain. N Engl J Med 2003;349:1943-53, (2) www.fpm.ac.uk/faculty-of-pain-medicine/opioids-aware, (3) American Pain Society and American Academy of Pain Medicine. Consensus statement: The use of opioids for the treatment of chronic pain. February 2009, (4) M. Von Korff, R.A. Deyo. Potent opioids for chronic musculoskeletal pain: flying blind? Pain 109 (2004)207–209. 102 - Strong opioid treatment for persistent non-cancer pain: A Prospective evaluation of prevalence from a secondary care multidisciplinary pain clinic Dr P. Keogh 1 MB BCh, Dr K. Ullrich 1 MD & Dr J Gallagher MB BCh 1 - 1 Barts Health NHS Trust, United Kingdom 142 outpatient encounters recorded 36% 37% 27% 0 5 10 15 20 25 30 35 40 No opioid Weak opioid only Strong opioid Percentage 38 patients (27%) were on a strong opioid 37% male 63% female Median oral morphine equivalent daily dose 67.5mg Range 10mg to 500mg 3.5 years median strong opioid use (n=16) 58% (n= 22) 42% 0 10 20 30 40 50 60 70 On an Anti- neuropathic Not on an Anti- neuropathic Percentage Opioid Rotation 12% Increase Opoiod Dose 3% No Change in Opioid Dose 36% Decrease Opioid Dose 5% Injection 13% Physio/Psych ology/PMP 15% Change, Add, Titrate Anti- neuropathic 16% Concurrent anti-neuropathic therapy Clinic outcomes for those on strong opioids 31% 21% 8% 18% 11% 11% 0% 0% 38% 32% 6% 12% 1% 7% 2% 2% 0 5 10 15 20 25 30 35 40 Neuroaxial Mechanical Neuroaxial Radicular Neuropathi c Other Widesprea d/ Fibromyalgi a Abdominal / Pelvic Peripheral Joint Headache Other / Unknown Percentage Strong Opioid Takers Non-Strong Opioid Takers Diagnosis – predominant type of pain Other demographics comparable