The Use of Opioids in an Acute Palliative Care Unit to Re-assess Prescriptions
Abstract Introduction This study aimed to re-assess opioid prescriptions in an acute palliative care unit (APCU) 12 years after a previous audit. Methods Consecutive patients with advanced cancer who were admitted to the APCU for a period of 5 months for uncontrolled pain were analyzed. Information...
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Adis, Springer Healthcare
2025-03-01
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| Series: | Pain and Therapy |
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| Online Access: | https://doi.org/10.1007/s40122-025-00728-4 |
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| author | Sebastiano Mercadante Giorgio Sapienza Alessio Lo Cascio Alessandra Casuccio |
| author_facet | Sebastiano Mercadante Giorgio Sapienza Alessio Lo Cascio Alessandra Casuccio |
| author_sort | Sebastiano Mercadante |
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| description | Abstract Introduction This study aimed to re-assess opioid prescriptions in an acute palliative care unit (APCU) 12 years after a previous audit. Methods Consecutive patients with advanced cancer who were admitted to the APCU for a period of 5 months for uncontrolled pain were analyzed. Information regarding opioids, and route of administration, prescribed prior to admission, during admission, and at time of discharge was recorded. Opioids, doses, and routes were changed according to the clinical need to obtain the maximum benefit, individualizing the treatment. The opioid escalation index was calculated in milligrams (OEImg) and as a percentage (OEI%). Results A total of 113 patients were assessed. The mean pain intensity at admission and at time of discharge was 6.4 (SD 1.8) and 2.3 (SD 1.4), respectively (P < 0.0005). The mean opioid dose expressed as oral morphine equivalent (OME) by patients who were receiving opioids before admission was 128 mg/day (SD 120). There was no statistical difference in OME between admission and discharge time. Sixty-one and 20 patients were prescribed a second and a third opioid/route, respectively. Mean OEI% and OEImg were 9.3% (SD = 22.5) and 4.0 mg/day (SD = 24.1), respectively. Only a minority of patients had a breakthrough pain prescription at admission. Intravenous morphine was more frequently prescribed at beginning, then replaced by oral morphine and fentanyl preparations at discharge. Conclusions An intensive and careful use of opioids in the APCU allows for the achievement of adequate analgesia in all examined patients within a short time, without increasing OME. These findings should encourage further studies in APCUs as well as in other palliative care settings. |
| format | Article |
| id | doaj-art-65dbbe6bc01e4b5fa51d0b1db6bbc7ed |
| institution | OA Journals |
| issn | 2193-8237 2193-651X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Pain and Therapy |
| spelling | doaj-art-65dbbe6bc01e4b5fa51d0b1db6bbc7ed2025-08-20T02:32:05ZengAdis, Springer HealthcarePain and Therapy2193-82372193-651X2025-03-01143999100610.1007/s40122-025-00728-4The Use of Opioids in an Acute Palliative Care Unit to Re-assess PrescriptionsSebastiano Mercadante0Giorgio Sapienza1Alessio Lo Cascio2Alessandra Casuccio3Main Regional Center for Pain Relief and Supportive/Palliative Care, La Maddalena Cancer CenterMain Regional Center for Pain Relief and Supportive/Palliative Care, La Maddalena Cancer CenterMain Regional Center for Pain Relief and Supportive/Palliative Care, La Maddalena Cancer CenterDepartment of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of PalermoAbstract Introduction This study aimed to re-assess opioid prescriptions in an acute palliative care unit (APCU) 12 years after a previous audit. Methods Consecutive patients with advanced cancer who were admitted to the APCU for a period of 5 months for uncontrolled pain were analyzed. Information regarding opioids, and route of administration, prescribed prior to admission, during admission, and at time of discharge was recorded. Opioids, doses, and routes were changed according to the clinical need to obtain the maximum benefit, individualizing the treatment. The opioid escalation index was calculated in milligrams (OEImg) and as a percentage (OEI%). Results A total of 113 patients were assessed. The mean pain intensity at admission and at time of discharge was 6.4 (SD 1.8) and 2.3 (SD 1.4), respectively (P < 0.0005). The mean opioid dose expressed as oral morphine equivalent (OME) by patients who were receiving opioids before admission was 128 mg/day (SD 120). There was no statistical difference in OME between admission and discharge time. Sixty-one and 20 patients were prescribed a second and a third opioid/route, respectively. Mean OEI% and OEImg were 9.3% (SD = 22.5) and 4.0 mg/day (SD = 24.1), respectively. Only a minority of patients had a breakthrough pain prescription at admission. Intravenous morphine was more frequently prescribed at beginning, then replaced by oral morphine and fentanyl preparations at discharge. Conclusions An intensive and careful use of opioids in the APCU allows for the achievement of adequate analgesia in all examined patients within a short time, without increasing OME. These findings should encourage further studies in APCUs as well as in other palliative care settings.https://doi.org/10.1007/s40122-025-00728-4Cancer painPalliative careOpioidsAcute palliative care unit |
| spellingShingle | Sebastiano Mercadante Giorgio Sapienza Alessio Lo Cascio Alessandra Casuccio The Use of Opioids in an Acute Palliative Care Unit to Re-assess Prescriptions Pain and Therapy Cancer pain Palliative care Opioids Acute palliative care unit |
| title | The Use of Opioids in an Acute Palliative Care Unit to Re-assess Prescriptions |
| title_full | The Use of Opioids in an Acute Palliative Care Unit to Re-assess Prescriptions |
| title_fullStr | The Use of Opioids in an Acute Palliative Care Unit to Re-assess Prescriptions |
| title_full_unstemmed | The Use of Opioids in an Acute Palliative Care Unit to Re-assess Prescriptions |
| title_short | The Use of Opioids in an Acute Palliative Care Unit to Re-assess Prescriptions |
| title_sort | use of opioids in an acute palliative care unit to re assess prescriptions |
| topic | Cancer pain Palliative care Opioids Acute palliative care unit |
| url | https://doi.org/10.1007/s40122-025-00728-4 |
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