Steven W Brose1,2, Heather Schneck3, Dennis J Bourbeau2,4,5. 1. Syracuse DVAMC, Syracuse, NY. 2. Cleveland FES Center, Cleveland, OH. 3. Case Western Reserve University, Cleveland, OH. 4. Louis Stokes Cleveland DVAMC, Cleveland, OH. 5. MetroHealth Medical Center, 151 Research, Louis Stokes Cleveland DVAMC, 10701 East Blvd, Cleveland, OH 44106.
Abstract
BACKGROUND: The increasing use of prescription opioids has contributed to the epidemic of opioid abuse in the United States. Efforts to reduce opioid prescriptions and offer alternatives for pain management are needed. OBJECTIVE: To determine the success of a multidisciplinary project to manage chronic pain while reducing reliance on opioids in a population of patients with spinal cord injury (SCI). DESIGN: Retrospective analysis. SETTING: This study was conducted in an SCI system of care in northeast Ohio. PARTICIPANTS: Individuals with SCI receiving outpatient care were included. INTERVENTIONS: Clinicians in SCI and pain management specialties developed a plan to manage individuals with SCI, particularly for individuals using opioids, including physical, occupational, recreational, and vocational therapy. These services worked closely with the SCI physicians when chronic pain was identified to help better medically manage their pathology and support efforts to decrease opioid use in a multipronged approach. MAIN OUTCOMES: The primary outcome measures from opioid prescription data from 2008 to 2016 were the percent of outpatients receiving opioids, opioid prescription rates, and opioid prescription doses over time. RESULTS: The percentage of outpatients receiving opioids and the number of opioid prescriptions through the outpatient service significantly decreased, from 39% to 16% and from 2.5 to 1.5 prescriptions per patient per quarter, respectively, correlating with the introduction of the multidisciplinary interventions. The total morphine equivalent quantities of prescription medications, particularly nonmethadone opioids, also decreased significantly. CONCLUSIONS: The multidisciplinary interventional approach was associated with marked decreases in the percentage of patients receiving opioids and the amounts of opioids being prescribed. This reduction could have a significant impact on the opioid crisis. LEVEL OF EVIDENCE: IV.
BACKGROUND: The increasing use of prescription opioids has contributed to the epidemic of opioid abuse in the United States. Efforts to reduce opioid prescriptions and offer alternatives for pain management are needed. OBJECTIVE: To determine the success of a multidisciplinary project to manage chronic pain while reducing reliance on opioids in a population of patients with spinal cord injury (SCI). DESIGN: Retrospective analysis. SETTING: This study was conducted in an SCI system of care in northeast Ohio. PARTICIPANTS: Individuals with SCI receiving outpatient care were included. INTERVENTIONS: Clinicians in SCI and pain management specialties developed a plan to manage individuals with SCI, particularly for individuals using opioids, including physical, occupational, recreational, and vocational therapy. These services worked closely with the SCI physicians when chronic pain was identified to help better medically manage their pathology and support efforts to decrease opioid use in a multipronged approach. MAIN OUTCOMES: The primary outcome measures from opioid prescription data from 2008 to 2016 were the percent of outpatients receiving opioids, opioid prescription rates, and opioid prescription doses over time. RESULTS: The percentage of outpatients receiving opioids and the number of opioid prescriptions through the outpatient service significantly decreased, from 39% to 16% and from 2.5 to 1.5 prescriptions per patient per quarter, respectively, correlating with the introduction of the multidisciplinary interventions. The total morphine equivalent quantities of prescription medications, particularly nonmethadone opioids, also decreased significantly. CONCLUSIONS: The multidisciplinary interventional approach was associated with marked decreases in the percentage of patients receiving opioids and the amounts of opioids being prescribed. This reduction could have a significant impact on the opioid crisis. LEVEL OF EVIDENCE: IV.