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(401) The Pain Improvement Partnership Program: Status of pain care in long-term care
P76 (400) Large iliopsoas cyst causing femoral nerve palsy and lower extremity radicular pain mimicking spinal pathology J Devarajan, L Ningegowda; Cleveland Clinic, Cleveland, OH A 56 year old female presented with left low back and lower extremity radicular pain over the thigh, leg and foot for 18 months. Initially she had been treated conservatively for low back pain but the symptoms started worsening and patient started noticing left LE weakness involving the thigh muscles associated with numbness and hence was referred to us. Pain was burning and tingling in nature. She had symptoms of neurogenic claudication with symptom exacerbation with walking, standing and moderate relief by medications and rest. Examination revealed moderate restriction in extension of lumbar area, moderate tenderness over the left lumbar paraspinal area with positive facet loading test. There was weakness of the left quadriceps with power 3/5 with diminished left knee reflex. X-ray of the lumbar spine showed evidence of degenerative changes involving facet joints and grade I spondylolisthesis at L4-L5. MRI of the lumbar spine showed degenerative changes of L5-S1, spondylolisthesis of L4 on L5 and mild central canal stenosis. There was incidental finding of cystic appearing mass lesion of the right and left para-pelvic cavity under the iliopsoas muscle bilaterally. CAT scan confirmed presence of cystic masses in the right and left iliac muscles which may be related to geodes of the acetabulum due to significant osteoarthritis of both hips. EMG showed left femoral neuropathy. Since she had back pain with radicular symptoms, transforaminal epidural steroid injection was done at L4-L5 level which did not give any benefit. Orthopedic consult advised left hip replacement along with cyst excision because of the possibility of cyst recurrence if removed alone. She underwent successful total left hip arthroplasty and cyst excision on the left side. After extensive post operative rehabilitation, her quadriceps strength improved and she had relief of the radicular pain. (Robinson, Bone Joint Surg Br, 2007.)
Abstracts
Impediments to Opioid Use (402) Conceptual model of societal burden of non-medical use of prescription opioids/analgesics among patients with chronic pain J Ju, C Mullins, M McPherson, A Tommasello; University of Maryland School of Pharmacy, Baltimore, MD There are growing concerns among the medical community, insurers, policy makers, and society regarding the humanistic, clinical, economic, political, and behavioral outcomes associated with prescription opioid abuse among chronic pain patients. The cost of prescription opioid drug abuse was estimated at $8.6 billion in 2001 from a societal perspective. The projected increase in abuse over the last 7 years suggests that the societal costs will be much higher in 2008. The aim of this study was to develop a conceptual model for assessing the economic burden of nonmedical use of prescription opioids among patients with chronic pain. The long-term goal is to provide a conceptual roadmap for conducting economic studies related to prescription opioid abuse. This study used a Delphi panel of experts in the fields of outcomes research, chronic pain, and drug abuse, to develop the conceptual model using a 4-step process: 1) Draft conceptual model addressing the impacts of non-medical use of prescription opioids on key stakeholders; 2) Independent review of the conceptual model; 3) Modification of the model based on expert feedback; 4) Consensus on the final model. An ecological model was developed to show the multi-level impact of non-medical use of prescription opioids/analgesics on individual, social support network, community/ industry/organizations, public policy development and regulation, and society. The relationships among and across stakeholders were delineated and a conceptual model mapped 20 cost components to six study perspectives of patient, healthcare system, insurer, employer, government, and society. Non-medical use of prescription opioids/analgesics has extensive impact on chronic pain patients and their social network, community, healthcare, insurer, legal systems, public policy/regulation, as well as society. The economic consequences including direct, indirect, and intangible costs to various stakeholders, vary significantly based upon the perspectives, with the societal viewpoint being the most comprehensive. Supported by a grant from the Alpharma Inc.
Ethical, Legal, Financial, and Education
(403) Knowledge, experience, and beliefs about pain and analgesia: Results of a general household survey in Texas
Education–Professional and Lay
S Strassels, H Petty, K Torges, L Driver; University of Texas, Austin, TX The purpose of this study was to describe knowledge, experience, and beliefs about pain among Texas residents as part of a statewide effort to improve pain management. These data were obtained from a 2006 statewide telephone survey of adult full-time Texas residents designed to collect information about individuals’ knowledge, experience, and beliefs regarding pain and pain management. Of the 503 adults who participated in this study, half were female, 53% were white, 28% were Latino, 12% were black, and 39% were 31-50 years of age. Fifty-one percent of respondents indicated that they experience pain monthly, and of these people, 43% have pain everyday, 55% have had pain for at least three years, and 63% have moderate to severe pain. Consequences of pain included sometimes feeling anxious, irritable or depressed (66%), loss of sleep (61%), negative effect on relationships with loved ones and friends (35%), inability to dress myself, drive a car, or go shopping (34%), and feeling hopeless and alone (29%). The most common sources of pain among study participants were arthritis (30%), back pain (23%), and muscle pain (10%). While 57% of persons with pain had sought care, common reasons for not seeking pain included a lack of understanding that untreated pain could worsen (75%) or that pain should be treated as a separate condition (71%), fear of the underlying cause (67%), belief that pain is just a normal part of life (59%), did not know where to go for help (58%), and fear of addiction, embarrassment, or did not want to complain (57%). Furthermore, only 60% of study participants were very confident that their pain would be properly assessed and promptly treated. These data provide insight into the epidemiology, economics, and consequences of pain among Texas adults, and indicate opportunities to improve care for persons with pain.
(401) The Pain Improvement Partnership Program: Status of pain care in long-term care KM Stevenson, J Dahl; University of Wisconsin School of Medicine and Public Health, Madison, WI In early 2007, the Alliance of State Pain Initiatives (ASPI) worked with the Indiana and Missouri Pain Initiatives to implement pain quality programs designed to improve pain care in small health care organizations. Long-term care facilities (a total of 17) comprised the majority of participating organizations. The facility administrators committed to support teams that would assess structures in place to support pain assessment and management; improve staff knowledge; develop an action plan; and assess the impact of the program on patients’ pain experiences. At baseline, all facilities had already adopted a pain rating scale and had policies in place to ensure that staff screened for pain. However, less than half had a standard mandating when pain requires intervention, or a formal mechanism to promise patients attentive care for pain. Only a third provided access to pain care references, provided education to patients and families, or had a pain QI team. Data from the 13 facilities that submitted patient questionnaires and medication records were studied to determine if their practices were in accordance with basic pain guidelines. Of the 21% of patients with moderate to severe pain most or all of the time, less than half had orders for ATC opioids, but 89% of patients for whom an opioid was ordered had an order for a laxative. Twenty percent of orders for short-acting opioids had dosing intervals of 6h or greater; 40% of patients had orders that would allow ⬎4 g APAP per day; 13% of patients ⬎75 years of age had an order for an NSAID; only 12% of patients ⬎65 years of age had orders for a bisphosphonate. Although the majority (65%) of patients was at least somewhat satisfied with their pain management, only 32% were very satisfied. Supported by the Lance Armstrong Foundation.
Abstracts
Impediments to Opioid Use (402) Conceptual model of societal burden of non-medical use of prescription opioids/analgesics among patients with chronic pain J Ju, C Mullins, M McPherson, A Tommasello; University of Maryland School of Pharmacy, Baltimore, MD There are growing concerns among the medical community, insurers, policy makers, and society regarding the humanistic, clinical, economic, political, and behavioral outcomes associated with prescription opioid abuse among chronic pain patients. The cost of prescription opioid drug abuse was estimated at $8.6 billion in 2001 from a societal perspective. The projected increase in abuse over the last 7 years suggests that the societal costs will be much higher in 2008. The aim of this study was to develop a conceptual model for assessing the economic burden of nonmedical use of prescription opioids among patients with chronic pain. The long-term goal is to provide a conceptual roadmap for conducting economic studies related to prescription opioid abuse. This study used a Delphi panel of experts in the fields of outcomes research, chronic pain, and drug abuse, to develop the conceptual model using a 4-step process: 1) Draft conceptual model addressing the impacts of non-medical use of prescription opioids on key stakeholders; 2) Independent review of the conceptual model; 3) Modification of the model based on expert feedback; 4) Consensus on the final model. An ecological model was developed to show the multi-level impact of non-medical use of prescription opioids/analgesics on individual, social support network, community/ industry/organizations, public policy development and regulation, and society. The relationships among and across stakeholders were delineated and a conceptual model mapped 20 cost components to six study perspectives of patient, healthcare system, insurer, employer, government, and society. Non-medical use of prescription opioids/analgesics has extensive impact on chronic pain patients and their social network, community, healthcare, insurer, legal systems, public policy/regulation, as well as society. The economic consequences including direct, indirect, and intangible costs to various stakeholders, vary significantly based upon the perspectives, with the societal viewpoint being the most comprehensive. Supported by a grant from the Alpharma Inc.
Ethical, Legal, Financial, and Education
(403) Knowledge, experience, and beliefs about pain and analgesia: Results of a general household survey in Texas
Education–Professional and Lay
S Strassels, H Petty, K Torges, L Driver; University of Texas, Austin, TX The purpose of this study was to describe knowledge, experience, and beliefs about pain among Texas residents as part of a statewide effort to improve pain management. These data were obtained from a 2006 statewide telephone survey of adult full-time Texas residents designed to collect information about individuals’ knowledge, experience, and beliefs regarding pain and pain management. Of the 503 adults who participated in this study, half were female, 53% were white, 28% were Latino, 12% were black, and 39% were 31-50 years of age. Fifty-one percent of respondents indicated that they experience pain monthly, and of these people, 43% have pain everyday, 55% have had pain for at least three years, and 63% have moderate to severe pain. Consequences of pain included sometimes feeling anxious, irritable or depressed (66%), loss of sleep (61%), negative effect on relationships with loved ones and friends (35%), inability to dress myself, drive a car, or go shopping (34%), and feeling hopeless and alone (29%). The most common sources of pain among study participants were arthritis (30%), back pain (23%), and muscle pain (10%). While 57% of persons with pain had sought care, common reasons for not seeking pain included a lack of understanding that untreated pain could worsen (75%) or that pain should be treated as a separate condition (71%), fear of the underlying cause (67%), belief that pain is just a normal part of life (59%), did not know where to go for help (58%), and fear of addiction, embarrassment, or did not want to complain (57%). Furthermore, only 60% of study participants were very confident that their pain would be properly assessed and promptly treated. These data provide insight into the epidemiology, economics, and consequences of pain among Texas adults, and indicate opportunities to improve care for persons with pain.
(401) The Pain Improvement Partnership Program: Status of pain care in long-term care KM Stevenson, J Dahl; University of Wisconsin School of Medicine and Public Health, Madison, WI In early 2007, the Alliance of State Pain Initiatives (ASPI) worked with the Indiana and Missouri Pain Initiatives to implement pain quality programs designed to improve pain care in small health care organizations. Long-term care facilities (a total of 17) comprised the majority of participating organizations. The facility administrators committed to support teams that would assess structures in place to support pain assessment and management; improve staff knowledge; develop an action plan; and assess the impact of the program on patients’ pain experiences. At baseline, all facilities had already adopted a pain rating scale and had policies in place to ensure that staff screened for pain. However, less than half had a standard mandating when pain requires intervention, or a formal mechanism to promise patients attentive care for pain. Only a third provided access to pain care references, provided education to patients and families, or had a pain QI team. Data from the 13 facilities that submitted patient questionnaires and medication records were studied to determine if their practices were in accordance with basic pain guidelines. Of the 21% of patients with moderate to severe pain most or all of the time, less than half had orders for ATC opioids, but 89% of patients for whom an opioid was ordered had an order for a laxative. Twenty percent of orders for short-acting opioids had dosing intervals of 6h or greater; 40% of patients had orders that would allow ⬎4 g APAP per day; 13% of patients ⬎75 years of age had an order for an NSAID; only 12% of patients ⬎65 years of age had orders for a bisphosphonate. Although the majority (65%) of patients was at least somewhat satisfied with their pain management, only 32% were very satisfied. Supported by the Lance Armstrong Foundation.