- Title
- 'Possibly the most difficult thing you’ll do’: a nurse supported pathway to enable prescription opioid reduction and entry to treatment for chronic non cancer pain
- Creator
- Nickerson, Kathie
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Masters Research - Master of Philosophy (MPhil)
- Description
- Pain is a multidimensional sensory and emotional experience that, despite its protective mechanism, is aversive to most people. The quest to find a medication to alleviate this sensation led to the widespread use of prescription opioid medications. Although effective for acute and cancer pain opioids have proven to be less beneficial in the treatment of CNCP. Long term treatment is associated with adverse effects and limited benefit. Reduction and cessation of prescription opioids presents a challenge for both prescribers and patients due to the complex effect opioid medication has on the individual and the perceived lack of alternatives. Australia Legislation has sought to limit opioid prescription for CNCP precipitating the need for a dedicated treatment approach to support prescription opioid dose reduction and cessation. The primary aim of this thesis was to evaluate if a nurse supported prescription opioid reduction pathway (NS-PORP) enabled participants with chronic non cancer pain (CNCP), attending a specialist multidisciplinary pain service, to reduce opioid dose and maintain engagement to continue on to group program pain treatment. Secondary aims were to determine if NS-PORP met participant’s expectations in terms of satisfaction and to provide a cost estimation of NS-PORP compared to usual specialist pain medicine physician consultations. The rationale behind the need for an intervention to support opioid dose reduction, that of the complex behavioural issues associated with opioid use and opioid dose reduction, were explored in relation to participant experience and expectation of NS-PORP. A scoping review of the literature described a wide array of intervention types for the purpose of prescription opioid reduction with limited evidence to indicate any specific treatment approach was more effective in promoting opioid dose reduction. This was due to the quality of studies that were conducted and in part to the characteristics of study participants. Barriers and facilitators to participation in interventions for prescription opioid reduction were identified in a small number of studies. Based conceptually on behavioural change theory a nurse supported pathway for prescription opioid reduction (NS-PORP) was developed to meet the needs of patients who had been referred to Hunter Integrated Pain Service (HIPS) and wanted to commence group program pain treatment but were taking a prescription opioid dose greater than the threshold for acceptance into the group program. As a two-step process that included an introduction and education session followed by ongoing telephone support, NS-PORP was delivered through a flexible in person or telehealth approach. To evaluate NS-PORP a prospective cohort study was designed which compared two treatment arms with a comparator arm. The comparator group was made up of patients who participated in the same assessment process, received the same recommendations about medication reduction but chose not to participate in NS-PORP. Univariable logistic regression demonstrated that there were significantly greater odds (OR > 1) of reducing prescription opioid dose to ≤40mg oMEDD when compared to the comparator group, OR 2.67, 95% CI1.12, 6.34, with a p-value of 0.027. Weighting with propensity scoring meant that the odds of achieving opioid reduction were greater again when compared to the comparator group 3.71(1.91, 7.21), p=< .001. Of the treatment group 57% compared with 33% of the comparator group reduced opioid dose to ≤ 40mg oMEDD. Satisfaction was explored with most participants reporting to be highly satisfied (72%) and modest economic savings were estimated from the implementation of NS-PORP. The clinical implications of the study were that NS-PORP provided a beneficial acceptable and cost effective means of supporting prescription opioid reduction which may have utility in primary care as well as specialist multidisciplinary settings. Changes to the intervention recommended by study participants will be considered for inclusion into prospective interventions. This knowledge adds to the evolving body of research compiled on prescription opioid reduction.
- Subject
- chronic pain; persistent pain; prescription opioids; reduction; weaning; tapering; intervention; nurse led; nurse support
- Identifier
- http://hdl.handle.net/1959.13/1483925
- Identifier
- uon:51232
- Rights
- Copyright 2022 Kathie Nickerson
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 2 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 283 KB | Adobe Acrobat PDF | View Details Download |