How does waiting for access to The Metro South Pain Rehabilitation Centre affect patients’ use of high risk monitored medicines?

About the Project

Chief Investigator: Kristen Tynan, Senior Clinical Pharmacist, MSH Pain Rehabilitation Centre (MSHPRC)

Project Title: How does waiting for access to The Metro South Pain Rehabilitation Centre affect patients’ use of high risk monitored medicines?

Project Team: Prof. Tamara Ownsworth, Sam Borg, Prof. Michel Coppieters, Dr Nicholas Aitcheson and Ms Christie Cheung.

Hopkins Program:
This project aligns with The Hopkins Centre Enabling Technologies and Environments Research program and is funded as a Short-term 'Bright Sparks' Clinical Fellowship. Read more about Hopkins Clinical Fellowship Projects.

Project Significances:
Long wait times to access pain medicine clinics pose a significant burden on patients with chronic pain, impacting them mentally, physically, and economically. Amidst the COVID-19 pandemic, the Metro South Pain Rehabilitation Centre (PRC) has implemented changes to reduce patient waitlists, yet the impact and safety of opioid and other high-risk monitored medicines during this waiting period remain unassessed. Currently, there is no established guidance on medication dosage when triaging and categorising patients, leading to potential adjustments in patient categorisation based on perceived medication safety by triaging clinicians. 

The combination of opioids with gabapentinoids and benzodiazepines elevates the risk of harm for patients, particularly in terms of central nervous system depression and mortality. Concerns have escalated over the increased use of this combination, with highlighted risks including respiratory depression and mortality. A 2019 Drug Safety Communication from the US Food and Drug Administration warned of respiratory problems associated with pregabalin and gabapentin, particularly in patients with respiratory risk factors.  Although it is common to prescribe gabapentinoids and opioids together for pain management, numerous safety alerts and case reports in recent years have underscored the dangers of respiratory depression and, in severe cases, death associated with this combination. Patients waiting a long time for specialist pain management input, may leave them vulnerable, increasing their medication doses and placing them at risk of harm.  

Aims and Benefits:
The overall aim of this project is to determine whether patient’s opioid dosages (oral morphine daily dose / oMEDD), and other high risk monitored medications such as gabapentinoids and benzodiazepines increase whilst sitting on the PRC waitlist and whether this needs to be considered when triaging patients for the service. To determine whether opioid oMEDD, gabapentinoid and benzodiazepine doses increase or decrease from GP referral to filling of initial patient questionnaire. To determine whether the current triage criteria is safety netting patients who are at risk of increasing opioids and other drugs of dependence.

Progress to date:

• Ethics application done before project start 2023. Preliminary data collection prior to study – 2023.
• Started Bright Sparks project 12th March 2024.
• Data collection is on track – expected to be finished end of June 2024.
• Consultation with Sam Borg through process to ensure analysis to start July/August 2024.
• This project was informed by a scoping review conducted by the research team (in development), identifying wait-list deterioration as an important but under-researched area.
• A peer-reviewed journal article of the project will be developed (under preparation).
• BIBS24 conference presentation 

Expected outcomes:
This study will generate novel information on changes regarding high-risk Monitored Medications for patients awaiting pain specialist input. Findings will be used to inform stronger triage criteria for new patient referrals, with a view to reducing patient deterioration whilst waiting for care. It is anticipated that this research will be used to inform stronger national triaging criteria standards. It is anticipated that the data may contribute to clearer triage guidance and hence reduce wait times for patients on high risk Monitored Medications. This project has lead to a future audit of gabapentinoids and opioid combination usage in the Princess Alexandra Hospital auditing cases where the combination has lead to harm to the patient. 

Funding:
This research clinical fellowship project was funded by The Hopkins Centre – a joint initiative of Department of Rehabilitation, Metro South Health and Griffith University. The Motor Accident Insurance Commission provided funding to The Hopkins Centre to support and conduct research activities that aim to improve the treatment and rehabilitation of people injured in motor vehicle crashes.