Clinical impact of a personalized pharmaceutical plan on opioid management in non-cancer pain: a pilot study

Non-cancer pain of the locomotor apparatus is the main symptom justifying referral to a rheumatologist with potential introduction of opioids, leading to addiction if misused. The objective was to evaluate the impact of a personalized pharmaceutical plan on patients' knowledge of their opioid treatment and its duration. This prospective non-randomized pilot study was conducted during 7 months with standardized data collected in a French rheumatology department. Patients with rheumatic diseases and non-cancer pain requiring opioid treatment were included. The intervention group had a 30-min opioid-targeted pharmaceutical interview and received a full medication plan and the control group received usual care. A total of 17 patients were included in the intervention group and 18 in the control group. Among patients in the intervention group, only 6 (35%) knew that immediate-release opioids have a rapid and short action, 9 (53%) were worried about taking opioids, and 13 (76%) reported that they would refer to the information document provided if side effects occurred. A trend toward a shorter duration of treatment was observed in the study group (HR = 1.87, 95% CI 0.93 to 3.76, p = 0.08), but this trend was attenuated when adjusting on hospital duration (HR = 1.53, 95% CI 0.74 to 3.15, p = 0.25). This pilot study provides preliminary evidence on the role of the clinical pharmacist in the management of non-cancer pain with strong opioids. Clinical benefits will be assessed in a randomized study. Key Points • Knowledge of opioids is insufficient in rheumatology patients with non-cancer pain. • Pharmaceutical interviews may improve patients' knowledge of opioids.