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
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Tiffany K Wong1, Marcalee Sipski Alexander2, Peter Wayne New3,4,5
11Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY USA.
Study Design:
Online questionnaire of spinal cord injury (SCI) physicians.
Objectives:
The objective of this study is to characterize the approach to opioid prescription for persons with spinal cord damage (SCD).
Setting:
An international online questionnaire.
Methods:
A survey was posted online and circulated among international societies within the field of SCI medicine from August to November 2018.
Results:
One hundred and twenty-three physicians responded to the survey. Of these, 107 (92%) managed pain for persons with SCD. Most (82%) felt that opioid prescription was appropriate for uncontrolled acute pain, but fewer (67%) felt it was appropriate for chronic pain. Of those who felt opioids had a role in the treatment of neuropathic pain, 46% did not think there should be a specific upper limit of opioid dose. The majority (85%) would continue prescribing high doses (250 morphine milligram equivalent (MME) doses/day) if that dose were effective. Tramadol was the most common opioid prescribed first line.
Conclusion:
Most physicians who responded to this survey prescribe opioids for intractable pain after SCD. A significant proportion of respondents believed that there should not be a specific upper limit of opioid dose prescribed if the drug is tolerated; this does not align with current recommendations. Most physicians do not feel influenced in their prescribing habits by regulatory bodies. If physicians decide to taper an opioid that is being tolerated well, it is most commonly related to a fear of the patient developing an opioid-use disorder. The authors propose an algorithm that may help align practice patterns with current recommended practice guidelines.
