Knowledge, attitude, and barriers regarding prescribing long-term opioids among Taiwan physicians treating officially registered patients with chronic noncancer pain

Knowledge, attitudes and practices of pain management among Taiwanese physicians in a reformed 2-year postgraduate training programme: a cross-sectional questionnaire survey

BACKGROUND

Taiwan implemented a reformed 6-year medical education in 2013, with a subsequent 2-year postgraduate training programme starting in August 2019. This study investigated the perceptions of acute and chronic pain management in postgraduate physicians.

METHODS

In late July 2023, a cross-sectional questionnaire survey was conducted of Taiwanese physicians who had almost completed their postgraduate 2-year or 1-year training and those who were starting a postgraduate programme in early August 2023. This survey evaluated their knowledge, attitude and clinical experience related to opioid-based pain management and their perceptions of the opioid crisis in the United States and Taiwan.

RESULTS

Of the 197 postgraduate physicians, 169 (85.8%) responded to the survey. Physicians who had received postgraduate 2-year (n = 48) and 1-year (n = 51) training had a deeper understanding of opioids (p < 0.001) and exhibited greater confidence in acute and chronic pain management (both p < 0.001) compared with those who were just starting a postgraduate programme (n = 70). Of the included physicians, 92 (54.4%) were aware of the ongoing opioid crisis in the United States, but only 28 (16.6%) disagreed with the notion of a current opioid problem in Taiwan. Approximately 27.8% had never heard of multimodal analgesia, and 86.4% expressed a need for further pain management education.

CONCLUSIONS

The postgraduate training programme in Taiwan provides enhanced knowledge of opioids and improves physicians' levels of confidence in acute and chronic pain management. However, only one-sixth of postgraduate physicians are aware that Taiwan does not have an opioid problem.

Opioid-related Transitions for Chronic Pain Management: A Concept Analysis

BACKGROUND

People who are prescribed opioids for pain management may undergo transitions of care. However, little is known about transitions of care that involve a prescribed opioid, which may have significant consequences for people with chronic pain. The purpose of this concept analysis was to define opioid-related transitions (OrTs) and characterize their attributes, antecedents, and consequences.

METHODS

Rodger's evolutionary method for concept analysis was used to identify key attributes, antecedents, and consequences of OrTs. A comprehensive literature search was conducted in September 2024, resulting in the inclusion of 61 articles.

RESULTS

As defined, OrTs occur when opioids are prescribed for chronic pain management and involve an opioid medication transition and/or transition in care settings and/or practitioners. These transitions encompass patient-clinician and clinician-clinician interactions that ideally incorporate opioid-specific information, clear communication, shared decision-making, collective responsibility, weighing the risks and benefits, and knowledge exchange during the processes of opioid prescribing, management, and monitoring. During OrTs, patients and clinicians identified a need for support with care coordination. Notably, team-based involvement in OrTs is present, but guidance for operationalizing patient and clinician support efforts is needed.

CONCLUSIONS

This concept analysis contributes to the conceptual clarity of OrTs by identifying core attributes, antecedents, and consequences. By defining and examining OrTs broadly and including chronic pain, both patient experiences and clinician approaches to managing pain during transitions of care are highlighted. Research is needed on patient and clinician experiences related to managing chronic pain with opioids and the role of nurse-led interventions during OrTs.

Assessment of opioid knowledge and attitudes among senior medical students in Taiwan's pain education curriculum: A cross-sectional questionnaire survey

INTRODUCTION

While the opioid crisis has been a significant concern in North America, Taiwan has not encountered a similar crisis. This study investigated medical students' perceptions of opioid therapy for chronic pain management in Taiwan.

METHODS

A cross-sectional questionnaire survey was conducted among third- and fourth-year medical students who had completed an 18-hour pain medicine curriculum, in comparison with those who did not take the course in Mar 2022 and May 2023. The survey assessed their knowledge, attitude, and perceptions of the opioid crisis in the United States and Taiwan.

RESULTS

In total, 135 (88.2%) of 153 senior medical students who had completed the curriculum responded to the survey. They exhibited a better understanding of opioids (P < 0.001) and held a more negative attitude toward opioid use (P = 0.011) compared with 105 students who did not take the course. Additionally, out of 240 respondents, 177 (73.8%) acknowledged the ongoing opioid crisis in the United States, while only 70 (29.2%) disagreed with the notion of an ongoing opioid crisis in Taiwan. Furthermore, 90% of all students expressed agreement with the need for further education on chronic pain management after graduation.

CONCLUSION

Among senior medical students in Taiwan, those who completed an elective pain medicine curriculum demonstrated enhanced knowledge of opioids, a more cautious attitude toward opioid use, and a willingness to receive further education on chronic pain management. Over 70% of students remained uncertain or incorrectly believed that there was an opioid crisis in Taiwan.

Ethical considerations and decision making in opioid prescribing for chronic pain: A case study in rheumatology practice

ABSTRACT

Dilemmas regarding opioid prescribing for chronic pain frequently occur within health care settings. The ethical principles of autonomy, beneficence, nonmaleficence, and justice, as well as the principles of care ethics, can assist in addressing these opioid-related dilemmas. The purpose of this clinical case study is to provide a case study highlighting an opioid prescribing dilemma and then identify opioid-related transition considerations; address ethical questions that nurse practitioners (NPs) may encounter in clinical practice when providing care for individuals living with chronic pain who may need or use a prescribed opioid medication; and draw on the ethical principles and care ethics to provide guidance for NPs who face these challenging issues.

Gender Differences in Depression and Sex Hormones among Patients Receiving Long-Term Opioid Treatment for Chronic Noncancer Pain in Taiwan-A Multicenter Cross-Sectional Study

Background: Long-term use of opioids for chronic noncancer pain is associated with sex hormone disturbances. The interferences with sex hormones, sexual function, and depression were investigated in patients with chronic noncancer pain. Methods: A cross-sectional multicenter survey was conducted on 170 officially registered outpatients receiving long-term opioid treatment in nine medical centers in Taiwan between October 2018 and July 2019. Serum sex hormone levels were examined after the collection of self-administered questionnaires containing the Taiwanese version of the Brief Pain Inventory, depressive status, and sexual function interference. Results: Among 117 (68.8%) questionnaire responses from 170 enrolled outpatients, 38 women and 62 men completed the sex hormone tests, among whom only 23 (23%) had previously received blood hormone tests. Low serum total testosterone levels were detected in 34 (89.5%) women (<30 ng/dL) and 31 (50%) men (<300 ng/dL). Over 60% of women and men reported reduced sexual desire and function despite a nearly 50% reduction in pain intensity and daily function interference over the previous week after opioid treatment. Women generally had higher risks of a depression diagnosis (p = 0.034) and severe depressive symptoms (p = 0.003) and nonsignificantly lower opioid treatment duration (median 81 vs. 120 months) and morphine milligram equivalent (median 134 vs. 165 mg/day) compared with men. Conclusions: This survey demonstrated the high prevalence of depression diagnosis, low sex hormone levels, and reduced sexual function among Taiwanese patients with chronic noncancer pain receiving prolonged opioid therapy. Regular hypogonadal screenings are recommended for further management.