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Published online: 2023-11-24

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Between “opioidophobia” and the opioid crisis: a cross-sectional comparison of opinions on opioid analgesic treatment between palliative care patients with cancer and physicians in Poland

Maria Wysocka12, Anna Kieszkowska-Grudny3, Jakub Klimkiewicz45, Jerzy Jarosz6, Martyna Hordowicz7, Andrzej Silczuk8, Tomasz Pasierski1, Anna Klimkiewicz9

Abstract

Introduction. Inadequate pain control may contribute to a desire to die. Early use of opioid analgesics could improve pain treatment. On the other hand, opioids are associated with risk of addiction. We aimed to compare the opinions on opioid analgesic use between palliative care patients and physicians. 

Material and methods. Data on the opinions of hospice and palliative care patients (n = 104) and physicians of different specialties (n = 216) were collected using a survey with closed-ended questions scored on a 5-point Likert scale. 

Results. The majority (87.5%) of cancer patients experienced pain during their illness (mean intensity: 7.01±2.44).More than half (53.3%) of physicians had concerns that patients overuse opioid drugs. Negative connotations associated with the word “morphine” were expressed in both study groups. Survey responses of both patients and physicians were consistent with the phenomenon of “opioidophobia”. 

Conclusions. We found a high degree of consensus between cancer patients’ and physicians’ opinions on opioid analgesic use. However we also found some discrepancies in opinions and they were mostly related to medical knowledge, which may indicate poor patient education about opioid use and poor communication between patients and physicians. It is concerning to note these significant discrepancies concerning opioid use since patients considered opioids useful in ensuring pain relief and improving their quality of life. The majority (almost 90%) of patients surveyed struggled with pain over the course of their illness and treatment. 

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References

  1. Robinson S, Kissane D, Brooker J, et al. A Systematic Review of the Demoralization Syndrome in Individuals With Progressive Disease and Cancer: A Decade of Research. J Pain Symptom Manage. 2015; 49(3): 595–610.
  2. Everdingen Mvv, Hochstenbach L, Joosten E, et al. Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. J Pain Symptom Manage. 2016; 51(6): 1070–1090.e9.
  3. Everdingen Mvv, Rijke JMde, Kessels AG, et al. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007; 18(9): 1437–1449.
  4. Evenepoel M, Haenen V, Baerdemaecker TDe, et al. Pain Prevalence During Cancer Treatment: A Systematic Review and Meta-Analysis. J Pain Symptom Manage. 2022; 63(3): e317–e335.
  5. Bail J, Traeger L, Pirl W, et al. Psychological Symptoms in Advanced Cancer. Semin Oncol Nurs. 2018; 34(3): 241–251.
  6. Makhlouf S, Pini S, Ahmed S, et al. Managing Pain in People with Cancer—a Systematic Review of the Attitudes and Knowledge of Professionals, Patients, Caregivers and Public. J Cancer Educ. 2019; 35(2): 214–240.
  7. Paice J, Bohlke K, Barton D, et al. Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline. J Clin Oncol. 2023; 41(4): 914–930.
  8. Chapman E, Edwards Z, Boland J, et al. Practice review: Evidence-based and effective management of pain in patients with advanced cancer. Palliat Med. 2020; 34(4): 444–453.
  9. Jordan K, Aapro M, Kaasa S, et al. European Society for Medical Oncology (ESMO) position paper on supportive and palliative care. Ann Oncol. 2018; 29(1): 36–43.
  10. Graczyk M, Borkowska A, Krajnik M. Why patients are afraid of opioid analgesics - study on opioid perception in patients treated for chronic pain. Pol Arch Intern Med. 2018; 128(2): 89–97.
  11. https://www.ers.usda.gov/webdocs/publications/100833/err-287.pdf.
  12. Higgins C, Smith BH, Matthews K. Incidence of iatrogenic opioid dependence or abuse in patients with pain who were exposed to opioid analgesic therapy: a systematic review and meta-analysis. Br J Anaesth. 2018; 120(6): 1335–1344.
  13. Gaertner J, Boehlke C, II CS, et al. Early palliative care and the opioid crisis: ten pragmatic steps towards a more rational use of opioids. Ann Palliat Med. 2019; 8(4): 490–497.
  14. Wright E, El-Jawahri A, Temel J, et al. Patient Patterns and Perspectives on Using Opioid Regimens for Chronic Cancer Pain. J Pain Symptom Manage. 2019; 57(6): 1062–1070.
  15. Bosetti C, Santucci C, Radrezza S, et al. Trends in the consumption of opioids for the treatment of severe pain in Europe, 1990–2016. Eur J Pain. 2018; 23(4): 697–707.
  16. Agarwal A, Roberts A, Dusetzina S, et al. Changes in Opioid Prescribing Patterns Among Generalists and Oncologists for Medicare Part D Beneficiaries From 2013 to 2017. JAMA Oncol. 2020; 6(8): 1271–1274.
  17. Arias-Casais, N. (Natalia) et al. (1970) EAPC Atlas of palliative care in Europe 2019, DADUN. https://dadun.unav.edu/handle/10171/56787 (8.07.2023).
  18. Zimmermann A, et al. Patient’s right to pain treatment. Palliat Med Pract. 2018; 12(1): 21–29.
  19. Krajnik M, Currow D, Sobański P. Appropriate pharmacotherapy at the end of life: prescribing safely and only what is needed as part of whole-person care. Pol Arch Intern Med. 2019; 129(10): 654–656.
  20. Wordliczek J, Kotlińska-Lemieszek A, Leppert W, et al. Pharmacotherapy of pain in cancer patients – recommendations of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, and Polish Society of Anaesthesiology and Intensive Therapy. BÓL. 2018; 18(3): 11–53.
  21. Bulls H, Chu E, Goodin B, et al. Framework for opioid stigma in cancer pain. Pain. 2021; 163(2): e182–e189.
  22. Leppert W, Pyszkowska J, Stachowiak A, et al. Access to the treatment with opioid analgesics in Poland – on the basis of a Conference “ATOME: Polish National Symposium on Access to Opioid Medication”. Medycyna Paliatywna/Palliative Medicine. 2015; 7(1): 84–89.
  23. Wright E, El-Jawahri A, Temel J, et al. Patient Patterns and Perspectives on Using Opioid Regimens for Chronic Cancer Pain. J Pain Symptom Manage. 2019; 57(6): 1062–1070.
  24. Jacobsen R, Møldrup C, Christrup L, et al. Patient‐related barriers to cancer pain management: a systematic exploratory review. Scand J Caring Sci. 2009; 23(1): 190–208.
  25. Nijs J, Roose E, Lahousse A, et al. Pain and Opioid Use in Cancer Survivors: A Practical Guide to Account for Perceived Injustice. Pain Physician. 2021; 24(5): 309–317.
  26. Ho JF, Yaakup H, Low GS, et al. Morphine use for cancer pain: A strong analgesic used only at the end of life? A qualitative study on attitudes and perceptions of morphine in patients with advanced cancer and their caregivers. Palliat Med. 2020; 34(5): 619–629.
  27. Gunnarsdottir S, Sigurdardottir V, Kloke M, et al. A multicenter study of attitudinal barriers to cancer pain management. Support Care Cancer. 2017; 25(11): 3595–3602.
  28. Snijders R, Brom L, Theunissen M, et al. Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers (Basel). 2023; 15(3): 591.
  29. Makhlouf S, Pini S, Ahmed S, et al. Managing Pain in People with Cancer—a Systematic Review of the Attitudes and Knowledge of Professionals, Patients, Caregivers and Public. J Cancer Educ. 2019; 35(2): 214–240.
  30. Dzierzanowski T, Kozlowski M. Opioid prescribing attitudes of palliative care physicians versus other specialists: a questionnaire-based survey. Postgrad Med J. 2022; 98(1156): 119–123.
  31. Kim YC, Ahn JS, Calimag MM, et al. ACHEON Working Group. Current practices in cancer pain management in Asia: a survey of patients and physicians across 10 countries. Cancer Med. 2015; 4(8): 1196–1204.
  32. Rash JA, Buckley N, Busse JW, et al. Healthcare provider knowledge, attitudes, beliefs, and practices surrounding the prescription of opioids for chronic non-cancer pain in North America: protocol for a mixed-method systematic review. Syst Rev. 2018; 7(1): 189.
  33. van den Beuken-van Everdingen MHJ, Hochstenbach LMJ, Joosten EAJ, et al. Update on Prevalence of Pain in Patients With Cancer: Systematic Review and Meta-Analysis. J Pain Symptom Manage. 2016; 51(6): 1070–1090.e9.
  34. Reedy F, Pearson M, Greenley S, et al. Professionals', patients' and families' views on the use of opioids for chronic breathlessness: A systematic review using the framework method and pillar process. Palliat Med. 2021; 35(8): 1421–1433.
  35. Opioids and Cancer Pain: Patient Needs and Access Challenges. J Oncol Pract. 2019; 15(5): 225.
  36. Webinar Thursday, November 17, 2022 - new 2022 CDC clinical practice guideline for prescribing opioids for pain (2022) Centers for Disease Control and Prevention. https://emergency.cdc.gov/coca/calls/2022/callinfo_111722.asp (08.07.2023).
  37. Lee YJ, Rosenberg C. Improving Perioperative Pain Education for Patients Prescribed Opioids: An Integrative Review. Pain Manag Nurs. 2023; 24(5): 479–485.
  38. Edwards H, Bennett M. Access to Opioids for Patients with Advanced Disease. Curr Pharm Des. 2019; 25(30): 3203–3208.
  39. Gaertner J, Boehlke C, Simone CB, et al. Early palliative care and the opioid crisis: ten pragmatic steps towards a more rational use of opioids. Ann Palliat Med. 2019; 8(4): 490–497.
  40. Kwekkeboom K, Serlin RC, Ward SE, et al. Revisiting patient-related barriers to cancer pain management in the context of the US opioid crisis. Pain. 2021; 162(6): 1840–1847.
  41. Fredheim OM, Skurtveit S, Sjøgren P, et al. Prescriptions of analgesics during chronic cancer disease trajectories: A complete national cohort study. Pharmacoepidemiol Drug Saf. 2021; 30(11): 1504–1513.
  42. Knaul FM, Farmer PE, Krakauer EL, et al. Lancet Commission on Palliative Care and Pain Relief Study Group. Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage: the Lancet Commission report. Lancet. 2018; 391(10128): 1391–1454.