Effects of a non-narcotic pain management program through collaborative practice with pharmacists and physicians

Abstract

Objective: Drug overdose death rates have more than tripled since 1990. Ohio has the eighth highest drug overdose death rate in the United States according to the Centers for Disease Control and Prevention. The objectives of these case reviews were to reduce pain levels and titrate down patient opioid doses through a collaborative practice model between pharmacists and physicians. Method(s): A heterogeneous cohort of 56 patients with opioid dependence was randomly enrolled into an 8-month proof-of-concept case review from October 2013 to May 2014. Pharmacists and physicians collaboratively assessed patients and modified pain treatments. Areas of targeted pain treatment included oxidative stress, inflammation, neuropathy, depression, breakthrough pain, cholesterol-associated inflammation, and muscle pain/spasms. Using a standardized questionnaire, patient responses to treatment were used to adjust therapy and evaluate progress. Result(s): A total of 10 patients were opioid free with variable time frames with a 29.1% overall pain reduction. Twenty-five patients are still receiving treatment with an overall 14.5% pain reduction. There were 4 patients removed and 17 withdrew with a total pain reduction of 6.8%. Overall, there was an 18.2% pain reduction in the total patient population. Forty-five out of 56 patients were evaluated on baseline oral morphine equivalents (OME). The daily OME intake had an average decrease of 23.3 mg or 15.2% overall (including patients who withdrew or were removed) and an average decrease of 17.3% in overall pain for patients with a baseline OME. Conclusion(s): Opioid misuse is an increasing problem in the United States. The joint efforts of pharmacists and physicians make for a particularly effective practice model for reducing opioid use and thus can make a significant impact upon patient care.