Pulse article: opioid prescription for pain after spinal cord damage (SCD), differences from recommended guidelines, and a proposed algorithm for the use of opioids for pain after SCD

Spinal Cord Series and Cases, 2019 · DOI: https://doi.org/10.1038/s41394-019-0189-5 · Published: April 23, 2019

Simple Explanation

This study investigates how doctors prescribe opioid painkillers to people with spinal cord damage (SCD). It compares these practices to established guidelines. The survey reveals that many doctors prescribe opioids for long-term pain after SCD, and a significant number don't believe in setting upper limits on dosage if the patient tolerates the drug well. This contradicts current guidelines. The authors propose a new algorithm, or step-by-step guide, to help doctors align their opioid prescribing with recommended practices, aiming to reduce risks like overdose and addiction.

Study Duration

August to November 2018

Participants

123 physicians

Evidence Level

Not specified

Key Findings

1
Most physicians prescribe opioids for intractable pain after SCD, but a significant proportion do not believe in a specific upper limit of opioid dose if the drug is tolerated.
2
Tramadol is the most common opioid prescribed first line for chronic neuropathic pain related to SCD.
3
Most physicians are not significantly influenced by regulatory bodies when prescribing opioids, and the primary concern when considering tapering opioids is the fear of the patient developing an opioid-use disorder.

Research Summary

This international survey of physicians reveals that opioid prescribing practices for chronic pain in persons with spinal cord damage (SCD) often differ from established clinical practice guidelines. A key difference lies in the maximum opioid dose prescribed per day, with nearly half of the surveyed clinicians believing there should be no specific limit if the patient tolerates the dose, contrasting with guideline recommendations. To bridge the gap between clinical practice and guidelines, the authors propose an algorithm for opioid prescription after SCD, aiming to reduce the risk of adverse consequences like overdose.

Practical Implications

Guideline Adherence

Highlights the need for increased awareness and adherence to clinical practice guidelines regarding opioid prescription for chronic pain in SCD patients.

Risk Mitigation

Emphasizes the importance of educating prescribers about the risks associated with higher doses of opioids, particularly in the vulnerable population with SCD.

Algorithm Implementation

Suggests the potential benefits of implementing the proposed algorithm to align practice patterns with recommended guidelines and reduce adverse outcomes.

Study Limitations

1
Relatively small sample size
2
Over/under-representation of different regions of the world
3
Guidelines used for comparison were developed using different methods and study questions

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