Korean J Pain.  2022 Oct;35(4):475-487. 10.3344/kjp.2022.35.4.475.

Actual situation and prescribing patterns of opioids by pain physicians in South Korea

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
  • 2Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
  • 3Department of Anesthesiology and Pain Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
  • 4Department of Anesthesiology and Pain Medicine, Jeong-clinic, Seoul, Korea
  • 5Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul, Korea
  • 6Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea
  • 7Department of Anesthesiology and Pain Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea

Abstract

Background
Use of opioids for chronic intractable pain is increasing globally, and their proper use can improve patients’ quality of life. In contrast, opioid use disorders, such as abuse or addiction, caused by prescribing opioids, are a worldwide issue. This study aimed to understand current opioid prescribing patterns and pain physicians’ experiences with opioid use in South Korea.
Methods
Pain physicians in 42 university hospitals in South Korea were asked to complete anonymous questionnaires regarding opioid prescriptions.
Results
A total of 69 surveys were completed. Most pain physicians started prescribing opioids at a pain score of 7/10 and aimed to reduce pain by 50%. Most physicians (73.1%) actively explained the prescribed medications and possible side effects, and 61.2% of physicians preferred the prescription interval of 4 weeks. Immediate-release opioids were the most popular treatment for breakthrough pain (92.6%). The most common side effect encountered by physicians was constipation (43.3%), followed by nausea/vomiting (34.3%). Of the physicians, 56.5% replied that addiction and misuse prevalences were less than 5%. However, the most concerning side effect was addiction (33.0%).
Conclusions
The survey results showed that the prescribing patterns of pain physicians generally followed Korean guidelines. Physicians were most interested in the safety and effectiveness of opioid prescriptions. They were most concerned about respiratory depression and abuse or addiction. A significant number of physicians agreed that the NHIS regulations needed improvement for patient convenience and safe and effective treatment, though there were pros and cons of the NHIS restrictions on prescription conditions.

Keyword

Analgesics; Opioid; Breakthrough Pain; Chronic Pain; Opioid-Related Disorders; Pain; Intractable; Pain Management; Physicians; Prescriptions; Prevalence; Surveys and Questionnaires

Figure

  • Fig. 1 What is the pain score for prescribing opioids for the first time? NRS: numeric rating scale.

  • Fig. 2 What are the pain relief goals when prescribing opioids?

  • Fig. 3 Whether side effects are explained when prescribing opioids?

  • Fig. 4 What is the ratio of two or more opioids prescribed when prescribing opioids?

  • Fig. 5 How long is the normal period of opioid prescription?

  • Fig. 6 Were opioids prescribed for breakthrough pain in patients taking opioids? IR: immediate-release opioids, PRN: pro re nata.

  • Fig. 7 (A) What is your opinion on the prescription period limitations recommended by the National Health Insurance in Korea? (B) If the prescription period needs to be extended, select the reason. (C) If the prescription period needs to be shortened, select the reason.

  • Fig. 8 (A) What is your opinion of the prescription dose limit by National Health Insurance in Korea? (B) If the prescription dose limit needs to be increased, select the reason. (C) If the prescription dose limit needs to be decreased, select the reason.

  • Fig. 9 What are the three major problems you consider when prescribing opioids?

  • Fig. 10 What are the most common side effects of opioids that you have encountered? (Observed) and What are the side effects of opioids that you are most concerned about? (Expected).

  • Fig. 11 What is the patients’ compliance to opioids?

  • Fig. 12 What are the prevalences of opioid abuse and addiction?


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