Michele Kaufman is a freelance medical writer based in New York City, a pharmacist at New York Downtown Hospital, and adjunct faculty at Touro College of Pharmacy.
Practical Optoid Use
At the recent American Pain Society meeting, held May 8–11 in New Orleans, Jennifer Erensen, MPH, and colleagues reviewed opioid conversion recommendations from select clinical practice guidelines and found that they are not all equal when dosing for nonmalignant chronic pain.8 In their abstract (#193), the authors noted conflicting information with substantial variability for opioid conversion. There was no uniformly accepted conversion ratio, with overestimations of equianalgesic doses. Other identified concerns included a failure to consider pain trajectory, use of concomitant medications, patient comorbidities, and interpatient differences. Most of the national guidelines that were evaluated did not address supplemental analgesia for breakthrough pain.
Additionally, the recommendations of the five state and four national guidelines evaluated were based on review articles, case studies, expert opinions, and clinical studies. Most of the studies used to develop the guidelines were not well controlled, were short term, were single-dose studies, and had fewer than 30 enrolled patients.
Prior to this research, a group of pain management experts known as Practical Pain Management (PPM) launched an online patient and professional education portal. They offer current, straightforward, and practical information for patients with chronic pain and medical professionals. All different pain types are discussed, as is current research. Their online opioid calculator is available free at http://opioidcalculator.practicalpainmanagement.com. To make the calculator, PPM asked three leading pain experts to develop their “ideal” opioid conversion calculator using the latest medical evidence. The authors state that this tool can safely and accurately calculate appropriate opioid doses for either opioid-naive patients or for switching patients to different agents.9
References
- Novartis drug Ilaris approved by FDA to treat active systemic juvenile idiopathic arthritis, a serious form of childhood arthritis. Published May 10, 2013. Available at www.pharma.us.novartis.com/newsroom/press releases/Ilaris05102013.shtml. Accessed May 26, 2013.
- Sandoz product website. www.us.sandoz.com/our_products/us_product_launches.shtml. Accessed May 31, 2013.
- FDA approves ACIPHEX Sprinkle (rabeprazole sodium) for use in children Ages 1 to 11. Published March 26, 2013. Available at http://us.eisai.com/view_press_release.asp?ID=147&press=396. Accessed March 29, 2013.
- Dennis M. Japan clears subcutaneous formulation of Roche’s Actemra. Published March 25, 2013. Available at www.firstwordpharma.com/node/1067111. Accessed May 25, 2013.
- Glüer C, Marin F, Ringe JD, et al. Comparative effects of teriparatide and risedronate in glucocorticoid-induced osteoporosis in men: 18-month results of the EuroGIOPs Trial. JBMR. 2013;28:1355-1368.
- Murphy RK, Ketzler L, Rice RDE, Johnson SM, Doss MS, Jaccoma EH. Oral glucosamine supplements as a possible ocular hypertensive agent. JAMA Ophthalmol. May 23, 2013 [Epub ahead of print].
- FDA Drug Safety Communication: FDA approves label changes for zolpidem products, including new dosing and a recommendation to avoid driving the day after Ambien CR use. Published May 14, 2013. Available at www.fda.gov/Drugs/DrugSafety/ucm352085.htm. Accessed May 15, 2013.
- Susman E. Wide variation in guidance for opioid dosing. Published May 12, 2013. Available at www.medpage today.com/MeetingCoverage/APS/39070. Accessed June 5, 2013.
- PPM launches online opioid calculator. Published March 2012. Available at www.practicalpainmanagement.com/treatments/pharmacological/opioids/ppm-launches-online-opioid-calculator. Accessed May 26, 2013.
