Balanced Opioid Prescribing via a Clinical Trade-Off: Pain Relief vs. Adverse Effects of Discomfort, Dependence, and Tolerance/Hypersensitivity

IF 2.5 4区 管理学 Q3 MANAGEMENT
Abdullah Gökçınar, M. Çakanyıldırım, Theodore John Price, Meredith C. B. Adams
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引用次数: 2

Abstract

In the backdrop of the opioid epidemic, opioid prescribing has distinct medical and social challenges. Overprescribing contributes to the ongoing opioid epidemic, whereas underprescribing yields inadequate pain relief. Moreover, opioids have serious adverse effects including tolerance and increased sensitivity to pain, paradoxically inducing more pain. Prescribing trade-offs are recognized but not modeled in the literature. We study the prescribing decisions for chronic, acute, and persistent pain types to minimize the cumulative pain that incorporates opioid adverse effects (discomfort and dependence) and the risk of tolerance or hypersensitivity (THS) developed with opioid use. After finding closed-form solutions for each pain type, we analytically investigate the sensitivity of acute pain prescriptions and examine policies on incorporation of THS, patient handover, and adaptive treatments. Our analyses show that the role of adverse effects in prescribing decisions is as critical as that of the pain level. Interestingly, we find that the optimal prescription duration is not necessarily increasing with the recovery time. We show that not incorporating THS or information curtailment at patient handovers leads to overprescribing that can be mitigated by adaptive treatments. Last, using real-life pain and opioid use data from two sources, we estimate THS parameters and discuss the proximity of our model to clinical practice. This paper has a pain management framework that leads to tractable models. These models can potentially support balanced opioid prescribing after their validation in a clinical setting. Then, they can be helpful to policy makers in assessment of prescription policies and of the controversy around over- and underprescribing.
通过临床权衡平衡阿片类药物处方:疼痛缓解与不良反应,不适,依赖,耐受性/过敏
在阿片类药物流行的背景下,阿片类药物处方具有明显的医疗和社会挑战。处方过量导致阿片类药物持续流行,而处方不足导致疼痛缓解不足。此外,阿片类药物具有严重的副作用,包括耐受性和对疼痛的敏感性增加,矛盾的是引起更多的疼痛。处方权衡是公认的,但没有在文献中建模。我们研究了慢性、急性和持续性疼痛类型的处方决定,以尽量减少阿片类药物不良反应(不适和依赖)的累积疼痛,以及阿片类药物使用引起的耐受或超敏反应(THS)的风险。在找到每种疼痛类型的封闭形式解决方案后,我们分析了急性疼痛处方的敏感性,并检查了结合三手疗法、患者移交和适应性治疗的政策。我们的分析表明,不良反应在处方决策中的作用与疼痛程度一样重要。有趣的是,我们发现最佳处方持续时间并不一定随着恢复时间的增加而增加。我们表明,在病人移交时不纳入三手烟或信息限制会导致处方过量,这可以通过适应性治疗来缓解。最后,利用来自两个来源的真实疼痛和阿片类药物使用数据,我们估计了三手烟参数,并讨论了我们的模型与临床实践的接近性。本文提供了一个疼痛管理框架,可以生成可处理的模型。这些模型在临床验证后可以潜在地支持平衡阿片类药物处方。然后,它们可以帮助政策制定者评估处方政策以及围绕处方过量和不足的争议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Decision Analysis
Decision Analysis MANAGEMENT-
CiteScore
3.10
自引率
21.10%
发文量
19
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