Login Register Cart 0
Generic placeholder image

Current Drug Research Reviews

Editor-in-Chief

ISSN (Print): 2589-9775
ISSN (Online): 2589-9783

Back
Journal Home About Journal Editorial Board Current Issue Volumes/Issues
Subscribe
Research Article

Pain-Prescription Differences - An Analysis of 500,000 Discharge Summaries

Author(s): Saskia Preissner, Vishal B. Siramshetty, Mathias Dunkel, Paul Steinborn, Friedrich C. Luft and Robert Preissner*

Volume 11, Issue 1, 2019

Page: [58 - 66] Pages: 9

DOI: 10.2174/1874473711666180911091846

Abstract

Background: Pain-relief prescriptions have led to an alarming increase in drug-related abuse.

Objective: In this study, we estimate the pain reliever prescription rates at a major German academic hospital center and compare with the nationwide trends from Germany and prescription reports from the USA.

Methods: We analysed >500,000 discharge summaries from Charité, encompassing the years 2006 to 2015, and extracted the medications and diagnoses from each discharge summary. Prescription reports from the USA and Germany were collected and compared with the trends at Charité to identify the frequently prescribed pain relievers and their world-wide utilization trends. The average costs of pain therapy were also calculated and compared between the three regions.

Results: Metamizole (dipyrone), a non-opioid analgesic, was the most commonly prescribed pain reliever at Charité (59%) and in Germany (23%) while oxycodone (29%), a semi-synthetic opioid, was most commonly ordered in the USA. Surprisingly, metamizole was prescribed to nearly 20% of all patients at Charité, a drug that has been banned for safety reasons (agranulocytosis) in most developed countries including Canada, United Kingdom, and USA. A large number of prospective cases with high risk for agranulocytosis and other side effects were found. The average cost of pain therapy greatly varied between the USA (125.3 EUR) and Charité (17.2 EUR).

Conclusion: The choice of pain relievers varies regionally and is often in disagreement with approved indications and regulatory guidelines. A pronounced East-West gradient was observed with metamizole use and the opposite with prescription opioids.

Keywords: Chronic pain, drug-related abuse, analgesic, metamizole, oxycodone, agranulocytosis.

« Previous Next »
Graphical Abstract

[1]
AAPM Facts and Figures on Pain 2016 Available from: http:// www.painmed.org/patientcenter/facts_on_pain.aspx (Accessed on 3rd Sep, 2018).
[2]
Brennan F. The US Congressional “Decade on Pain Control and Research” 2001-2011: A Review. J Pain Palliat Care Pharmacother 2015; 29(3): 212-27.
[3]
Harned M, Sloan P. Safety concerns with long-term opioid use. Expert Opin Drug Saf 2016; 15(7): 955-62.
[4]
Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recommendations and reports: Morbidity and mortality weekly report Recommendations and reports 2016; 65(1): 1-49.
[5]
Casati A, Sedefov R, Pfeiffer-Gerschel T. Misuse of medicines in the European Union: A systematic review of the literature. Eur Addict Res 2012; 18(5): 228-45.
[6]
Weisberg DF, Becker WC, Fiellin DA, Stannard C. Prescription opioid misuse in the United States and the United Kingdom: Cautionary lessons. Int J Drug Policy 2014; 25(6): 1124-30.
[7]
van Amsterdam J, van den Brink W. The Misuse of Prescription Opioids: A Threat for Europe? Curr Drug Abuse Rev 2015; 8(1): 3-14.
[8]
Addiction TEMCfDaD. 2011 Annual report on the state of the drugs problem in Europe 2011 [Available from: . http://www. emcdda.europa.eu/publications/annual-report/2011 (Accessed on 3rd Sep, 2018).
[9]
Schubert I, Ihle P, Sabatowski R. Increase in opiate prescription in Germany between 2000 and 2010: A study based on insurance data. Dtsch Arztebl Int 2013; 110(4): 45-51.
[10]
Smith SR, Deshpande BR, Collins JE, Katz JN, Losina E. Comparative pain reduction of oral non-steroidal anti-inflammatory drugs and opioids for knee osteoarthritis: systematic analytic review. Osteoarthritis Cartilage 2016; 24(6): 962-72.
[11]
Torres LM, Rodríguez MJ, Montero A, et al. Efficacy and safety of dipyrone versus tramadol in the management of pain after hysterectomy: A randomized, double-blind, multicenter study. Reg Anesth Pain Med 2001; 26(2): 118-24.
[12]
Introduction to Drug Utilisation Research 2016. [Available from: . http://www.whocc.no/filearchive/ publications/ drug_utilization_ research.pdf
[13]
Neubert A, Hsia Y, de Jong-van den Berg LT, et al. Comparison of anti-diabetic drug prescribing in children and adolescents in seven European countries. Br J Clin Pharmacol 2011; 72(6): 969-77.
[14]
Rani F, Murray ML, Byrne PJ, Wong IC. Epidemiologic features of antipsychotic prescribing to children and adolescents in primary care in the United Kingdom. Pediatrics 2008; 121(5): 1002-9.
[15]
Zamora-Legoff JA, Achenbach SJ, Crowson CS, Krause ML, Davis JM III, Matteson EL. Opioid use in patients with rheumatoid arthritis 2005-2014: A population-based comparative study. Clin Rheumatol 2016; 35(5): 1137-44.
[16]
Arzneiverordnungs-Report 2015. Schwabe U, Paffrath D, editors: Springer: Berlin Heidelberg; 2015 .
[17]
Statista. Top pain drugs in the United States based on revenue in 2011-2012 (in million U.S. dollars) 2012 [Available from: https://www.statista.com/statistics/242678/revenues-of-top-pain-drugs-in-the-us-2011-2012/ (Accessed on 3rd Sep, 2018).
[18]
WHO Drug Information 2016. Available from: http://www. who.int/medicines/publications/druginformation/issues/DrugInformation2016_Vol30-2/en/ (Accessed on 3rd Sep, 2018).
[19]
2015. Consolidated List of Products - Whose Consumption and/or Sale Have Been Banned, Withdrawn, Severely Restricted or Not Approved by Governments, Twelfth Issue - Pharmaceuticals. United Nations - New York, 2005.
[20]
2015. Consolidated List of Products - Whose Consumption and/or Sale Have Been Banned, Withdrawn, Severely Restricted or Not Approved by Governments, Twelfth Issue - Pharmaceuticals. United Nations - New York, 2005
[21]
Narcotic Drugs - Technical Reports 2015.
[22]
DiMarco M. DiMarco M. Data Maps 2016. Available from: https://datamaps. github.io (Accessed on 3rd Sep, 2018).
[23]
(National Average Drug Acquisition Cost) 2016. Available from: https://data.medicaid.gov/Drug-Prices/NADAC-National-Average-Drug-Acquisition-Cost-/a4y5-998d (Accessed on 3rd Sep, 2018).
[24]
Age and Sex Composition in the United States: 2013 2013 [Available from: [Available from: . https://www.census.gov/population/ age/ data/ 2013 comp.html (Accessed on 3rd Sep, 2018).
[25]
Substance Abuse and Mental Health Services Administration. Center for Behavioral Health Statistics and Quality National Survey on Drug Use and Health ICPSR36361-v1 Inter-university Consortium for Political and Social Research. ICPSR 2014.
[26]
Siramshetty VB, Nickel J, Omieczynski C, Gohlke BO, Drwal MN, Preissner R. WITHDRAWN--a resource for withdrawn and discontinued drugs. Nucleic Acids Res 2016; 44(D1): D1080-6.
[27]
Johnson M, Collett B, Castro-Lopes JM. The challenges of pain management in primary care: a pan-European survey. J Pain Res 2013; 6: 393-401.
[28]
Johnson SR. New CDC guidelines are unlikely to affect opioid prescribing practices. Mod Healthc 2016; 46(12): 11.
[29]
Berterame S, Erthal J, Thomas J, et al. Use of and barriers to access to opioid analgesics: A worldwide, regional, and national study. Lancet 2016; 387(10028): 1644-56.
[30]
Moßhammer D, Haumann H, Mörike K, Joos S. Polypharmacy-an upward trend with unpredictable effects. Dtsch Arztebl Int 2016; 113(38): 627-33.
[31]
Garcia S, Canoniero M, Lopes G, Soriano AO. Metamizole use among Hispanics in Miami: Report of a survey conducted in a primary care setting. South Med J 2006; 99(9): 924-6.
[32]
Taylor L, Abarca S, Henry B, Friedman L. Use of Neo-melubrina, a banned antipyretic drug, in San Diego, California: A survey of patients and providers. West J Med 2001; 175(3): 159-63.
[33]
Andrade S, Bartels DB, Lange R, Sandford L, Gurwitz J. Safety of metamizole: A systematic review of the literature. J Clin Pharm Ther 2016; 41(5): 459-77.
[34]
Huber M, Andersohn F, Sarganas G, et al. Metamizole-induced agranulocytosis revisited: Results from the prospective Berlin Case-Control Surveillance Study. Eur J Clin Pharmacol 2015; 71(2): 219-27.
[35]
Blaser LS, Tramonti A, Egger P, Haschke M, Krähenbühl S, Rätz Bravo AE. Hematological safety of metamizole: Retrospective analysis of WHO and Swiss spontaneous safety reports. Eur J Clin Pharmacol 2015; 71(2): 209-17.
[36]
Maj S, Centkowski P. A prospective study of the incidence of agranulocytosis and aplastic anemia associated with the oral use of metamizole sodium in Poland. Med Sci Monit 2004; 10(9): PI93-5.
[37]
Maj S, Lis Y. The incidence of metamizole sodium-induced agranulocytosis in Poland. J Int Med Res 2002; 30(5): 488-95.
[38]
Kötter T, da Costa BR, Fässler M, et al. Metamizole-associated adverse events: A systematic review and meta-analysis. PLoS One 2015; 10(4): e0122918.
[39]
Bäckström M, Hägg S, Mjörndal T, Dahlqvist R. Utilization pattern of metamizole in northern Sweden and risk estimates of agranulocytosis. Pharmacoepidemiol Drug Saf 2002; 11(3): 239-45.

Rights & Permissions Print Cite
Article Metrics
85
2
© 2024 Bentham Science Publishers | Privacy Policy