Viewpoint: Pain Management Often Inadequate Charlotte A. Kenreigh, PharmD, and Linda Timm Wagner, PharmD This viewpoint offers commentary on important clinical research in the area of pharmacy. Opioid Prescribing: An Assessment Using Quality Statements Jenkins BG, Tuffin PH, Choo CL, Schug SA J Clin Pharm Ther. 2005;30(6):597-602 Study Summary The management of pain with opioid analgesics is a common topic of discussion in the medical arena. Much of the evidence regarding pain management suggests that analgesic regimens are often inadequate, causing patients to experience unnecessary pain. Although many studies have suggested that there is room for improvement in this area, little information is available to frame prescribing patterns that lead to suboptimal use of analgesics. The investigators in this study sought to determine the quality of opioid prescribing in a large tertiary hospital in Western Australia. Patients were randomly selected on discharge for participation in the study. A total of 209 patients who were prescribed opioids during their hospital stay and/or at discharge were included in the study group. Details of all opioid medications prescribed were collected and entered into a database. These prescriptions were then assessed using quality statements that were developed on the basis of recommendations from the National Health and Medical Research Council of Australia and the World Health Organization Cancer Pain Relief Guidelines. Several potential problems with opioid prescribing were identified: no breakthrough opioid prescribed (13.4%); breakthrough opioid different from regular opioid (5.3%); inappropriate breakthrough opioid dose (7.2%); no oral opioid prescribed "when required" (prn) despite the patient's ability to take other oral medications (13.3%); intramuscular route of administration (47.8%), which is considered unsafe and unreliable; inappropriate combination of routes of administration (23.4%); polyprescribing of more than 1 'prn' opioid (51.2%), with a majority of those prescribed for the same route of administration; more than 1 slow-release opioid (4.8%); different opioid prescribed at discharge than used in the hospital (6.7%); and 1 or more dosing intervals that were too long (69.8%), leaving the patient vulnerable to breakthrough pain. Viewpoint Although the study takes place in Australia, the prescribing issues identified here could be applicable to all hospitals. It is clear that there remains substantial room for improvement in the prescribing of opioids. Pharmacists can use their relationship with the patient to determine the effectiveness of opiate prescribing and communicate their findings to the patient's prescribing physician. Charlotte A. Kenreigh, PharmD, and Linda Timm Wagner, PharmD, principals, MLC Solutions, Galena, Ohio Disclosure: Charlotte A. Kenreigh, PharmD, has disclosed no relevant financial relationships. Disclosure: Linda Timm Wagner, PharmD, has disclosed no relevant financial relationships. Medscape Pharmacists. 2006;7(1) Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.