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Article ; Online: How I treat pain in hematologic malignancies safely with opioid therapy.

Geyer, Holly L / Gazelka, Halena / Mesa, Ruben

2020 Volume 135, Issue 26, Page(s) 2354–2364

Abstract: The field of malignant hematology has experienced extraordinary advancements with survival rates doubling for many disorders. As a result, many life-threatening conditions have since evolved into chronic medical ailments. Paralleling these advancements ... ...

Abstract	The field of malignant hematology has experienced extraordinary advancements with survival rates doubling for many disorders. As a result, many life-threatening conditions have since evolved into chronic medical ailments. Paralleling these advancements have been increasing rates of complex hematologic pain syndromes, present in up to 60% of patients with malignancy who are receiving active treatment and up to 33% of patients during survivorship. Opioids remain the practice cornerstone to managing malignancy-associated pain. Prevention and management of opioid-related complications have received significant national attention over the past decade, and emerging data suggest that patients with cancer are at equal if not higher risk of opioid-related complications when compared with patients without malignancy. Numerous tools and procedural practice guides are available to help facilitate safe prescribing. The recent development of cancer-specific resources directing algorithmic use of validated pain screening tools, prescription drug monitoring programs, urine drug screens, opioid use disorder risk screening instruments, and controlled substance agreements have further strengthened the framework for safe prescribing. This article, which integrates federal and organizational guidelines with known risk factors for cancer patients, offers a case-based discussion for reviewing safe opioid prescribing practices in the hematology setting.
MeSH term(s)	Abdominal Pain/drug therapy ; Abdominal Pain/etiology ; Adult ; Analgesics, Opioid/adverse effects ; Analgesics, Opioid/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Back Pain/etiology ; Back Pain/therapy ; Chronic Pain/drug therapy ; Chronic Pain/etiology ; Chronic Pain/physiopathology ; Chronic Pain/therapy ; Combined Modality Therapy ; Disease Susceptibility ; Drug Monitoring ; Hematologic Neoplasms/complications ; Hematologic Neoplasms/physiopathology ; Hostility ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications ; Male ; Middle Aged ; Multiple Myeloma/complications ; Opioid-Related Disorders/prevention & control ; Oxycodone/adverse effects ; Oxycodone/therapeutic use ; Pain Management ; Patient Education as Topic ; Phantom Limb/etiology ; Phantom Limb/psychology ; Phantom Limb/therapy ; Physical Therapy Modalities ; Risk Assessment ; Stress Disorders, Post-Traumatic/complications ; Substance-Related Disorders/complications ; Thrombocythemia, Essential/complications ; Yoga
Chemical Substances	Analgesics, Opioid ; Anti-Inflammatory Agents, Non-Steroidal ; Oxycodone (CD35PMG570)
Language	English
Publishing date	2020-04-24
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	80069-7
ISSN	1528-0020 ; 0006-4971
ISSN (online)	1528-0020
ISSN	0006-4971
DOI	10.1182/blood.2019003116
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Article: Pharmacists' perspectives on opioid stewardship challenges.

Westcott, Kristina L / Swanson, Andrea K / Zavaleta, Kathryn W / Gazelka, Halena M / Philpot, Lindsey M / Cunningham, Julie L

Journal of opioid management

2023 Volume 19, Issue 3, Page(s) 239–245

Abstract: Objective: Pharmacists are in a distinctive position to champion opioid stewardship principles in communications with prescribers and patients. This effort is focused on elucidating perceived barriers to uphold these principles observed in pharmacy ... ...

Abstract	Objective: Pharmacists are in a distinctive position to champion opioid stewardship principles in communications with prescribers and patients. This effort is focused on elucidating perceived barriers to uphold these principles observed in pharmacy practice. Design: Qualitative research study. Setting: A healthcare system, consisting of inpatient and outpatient settings across several United States (US) states in both rural and academic settings. Participants: Twenty-six pharmacists who represented the study setting in the sole healthcare system. Interventions: Five virtual focus groups were conducted with the 26 pharmacists from inpatient and outpatient settings across four states in both rural and academic settings. Trained moderators conducted 1-hour focus group meetings that consisted of a mix of poll and discussion questions. Main outcome measure: Participant questions were related to awareness, knowledge, and system issues affecting opioid stewardship. Results: All pharmacists reported their routine follow-up with prescribers when questions or concerns arise but noted workload as a barrier to meticulous review of opioid prescriptions. Participants highlighted best practices, including transparency on the rationale for guideline exceptions to improve the management of after-hours concerns. Suggestions were integration of guidelines into prescriber and pharmacist order review workflows and a more visible prescriber review of prescription drug monitoring programs. Conclusions: Improvements in communication and transparency of information related to opioid prescribing between pharmacists and prescribers would enhance opioid stewardship. Integration of opioid guidelines into opioid ordering and review would improve efficiency, guideline adherence, and, most importantly, patient care.
MeSH term(s)	Humans ; United States ; Analgesics, Opioid/adverse effects ; Pharmacists ; Practice Patterns, Physicians' ; Focus Groups ; Qualitative Research
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2023-05-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2397614-7
ISSN	1551-7489
ISSN	1551-7489
DOI	10.5055/jom.2023.0779
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Article ; Online: Opioids in Older Adults: Indications, Prescribing, Complications, and Alternative Therapies for Primary Care.

Gazelka, Halena M / Leal, Janette C / Lapid, Maria I / Rummans, Teresa A

Mayo Clinic proceedings

2020 Volume 95, Issue 4, Page(s) 793–800

Abstract: The fact that opioids are valuable tools for the management of pain has been known and used for thousands of years. Currently, millions of Americans are treated annually with opioids, and many of these patients are elderly. Opioids present risks to ... ...

Abstract	The fact that opioids are valuable tools for the management of pain has been known and used for thousands of years. Currently, millions of Americans are treated annually with opioids, and many of these patients are elderly. Opioids present risks to geriatric patients, some of which are unique to the population, and providers should have a good grasp of those risks. An understanding of how to select appropriate medications for the management of pain and of the myriad of alternatives available for pain management is vital to the care of older patients. This article presents a review, for primary care providers, of issues unique to opioid management in older adults.
MeSH term(s)	Age Factors ; Aged ; Analgesics, Opioid/adverse effects ; Analgesics, Opioid/therapeutic use ; Humans ; Pain Management/adverse effects ; Pain Management/methods ; Primary Health Care/methods
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2020-02-11
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	124027-4
ISSN	1942-5546 ; 0025-6196
ISSN (online)	1942-5546
ISSN	0025-6196
DOI	10.1016/j.mayocp.2020.02.002
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Article ; Online: #WomeninPainMedicine: We Are Here.

Moeschler, Susan M / Warner, Nafisseh S / Gazelka, Halena M

Regional anesthesia and pain medicine

2018 Volume 43, Issue 7, Page(s) 809–810

MeSH term(s)	Female ; Humans ; Pain ; Physicians, Women
Language	English
Publishing date	2018-09-19
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	1425299-5
ISSN	1532-8651 ; 1098-7339 ; 0146-521X
ISSN (online)	1532-8651
ISSN	1098-7339 ; 0146-521X
DOI	10.1097/AAP.0000000000000860
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Article ; Online: Finding the Balance Between Reduced Opioid Prescribing and Patient-reported Pain Management Among General Surgery Patients.

Gudmundsdottir, Hallbera / Ubl, Daniel S / Yost, Kathleen J / Gazelka, Halena M / Habermann, Elizabeth B / Thiels, Cornelius A

Annals of surgery

2022 Volume 278, Issue 2, Page(s) 208–215

Abstract: Objective: To compare patient-reported outcomes before and after implementation of evidence-based, procedure-specific opioid prescribing guidelines.: Background: The opioid epidemic remains a significant public health issue. Many institutions have ... ...

Abstract	Objective: To compare patient-reported outcomes before and after implementation of evidence-based, procedure-specific opioid prescribing guidelines. Background: The opioid epidemic remains a significant public health issue. Many institutions have responded by reducing opioid prescribing after surgery. However, the impact of this on patient-reported outcomes remains poorly understood. Methods: Opioid-naïve adults undergoing 12 elective general surgery procedures at a single institution prospectively completed telephone surveys at median 26 days from discharge. Patients were compared before (March 2017-January 2018) and after (May 2019-November 2019) implementation of evidence-based, procedure-specific opioid prescribing guidelines. Results: A total of 603 preguideline and 138 postguideline patients met inclusion criteria and completed surveys. Overall, 60.5% of preguideline and 92.5% of postguideline prescriptions fell within recommendations ( P <0.001), while refill rates were similar (4.5% vs 5.8%, P =0.50). A statistically significant drop in median morphine milligram equivalent prescribed was observed for 9 of 12 procedures (75%). No opioids were prescribed for 16.7% of patients in both cohorts ( P =0.98). While 93.3% of preguideline and 87.7% of postguideline patients were very/somewhat satisfied with their pain control, the proportion of patients who were very/somewhat dissatisfied increased from 4.2% to 9.4% ( P =0.039). Conclusions: Prescribing guidelines successfully reduced opioid prescribing without increased refill rates. Despite decreased prescribing overall, there was a continued reluctance to prescribe no opioids after surgery. Although most patients experienced good pain control, there remains a subset of patients whose pain is not optimally managed in the era of reduced opioid prescribing.
MeSH term(s)	Adult ; Humans ; Analgesics, Opioid/therapeutic use ; Pain, Postoperative/drug therapy ; Pain Management/methods ; Practice Patterns, Physicians' ; Surveys and Questionnaires ; Retrospective Studies
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2022-08-26
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000005680
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Article ; Online: Multidisciplinary Controlled Substance Advisory Group Provides Support to the Primary Care Provider.

Cunningham, Julie L / Bremseth, Kimberly A / Crane, Sarah J / Gazelka, Halena M / Gilliam, Wesley P / Haag, Jordan D / Melin, Gabrielle J / Lai, Benjamin

Mayo Clinic proceedings

2022 Volume 97, Issue 5, Page(s) 830–834

MeSH term(s)	Controlled Substances ; Humans ; Practice Patterns, Physicians' ; Primary Health Care
Chemical Substances	Controlled Substances
Language	English
Publishing date	2022-04-09
Publishing country	England
Document type	Journal Article
ZDB-ID	124027-4
ISSN	1942-5546 ; 0025-6196
ISSN (online)	1942-5546
ISSN	0025-6196
DOI	10.1016/j.mayocp.2022.01.030
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Article: Partnering with Palliative Care: A Case Report of Severe Pain in Critical Limb Ischemia Treated Successfully with a Continuous Popliteal Nerve Catheter.

D'Souza, Ryan S / Shen, Stephanie / Ojukwu, Frederick / Gazelka, Halena M / Pulos, Bridget P

Case reports in anesthesiology

2020 Volume 2020, Page(s) 1054521

Abstract: Background: Critical limb ischemia (CLI) is limb pain occurring at rest or impending limb loss as a result of lack of blood flow to the affected extremity. CLI pain is challenging to control despite multimodal pharmacologic analgesia and surgical ... ...

Abstract	Background: Critical limb ischemia (CLI) is limb pain occurring at rest or impending limb loss as a result of lack of blood flow to the affected extremity. CLI pain is challenging to control despite multimodal pharmacologic analgesia and surgical intervention. We described the successful use of a continuous local anesthetic infusion via a popliteal nerve catheter to control severe refractory ischemic lower limb pain in a patient who failed surgical intervention and performed a brief narrative literature review on regional anesthesia for ischemic pain. Conclusion: This is the first report of successful analgesia for CLI via a continuous popliteal catheter in a patient with rethrombosis and failed surgical revascularization. Based on our collaborative experience, we recommend the development of partnerships between the acute pain service and palliative care service to facilitate the early evaluation and decision to utilize regional anesthesia for treatment of CLI.
Language	English
Publishing date	2020-04-06
Publishing country	United States
Document type	Case Reports
ZDB-ID	2659087-6
ISSN	2090-6390 ; 2090-6382
ISSN (online)	2090-6390
ISSN	2090-6382
DOI	10.1155/2020/1054521
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Article: Why we still prescribe so many opioids: A qualitative study on -barriers and facilitators to prescribing guideline implementation.

Zavaleta, Kathryn W / Philpot, Lindsey M / Cunningham, Julie L / Gazelka, Halena M / Geyer, Holly L / Rismeyer, Denise L / Stitz, Amber M / Clements, Casey M

Journal of opioid management

2021 Volume 17, Issue 2, Page(s) 115–124

Abstract: Introduction: Opioid prescribing occurs within almost every healthcare setting. Implementation of safe, effective opioid stewardship programs represents a critical but daunting challenge for medical leaders. This study sought to understand the barriers ... ...

Abstract	Introduction: Opioid prescribing occurs within almost every healthcare setting. Implementation of safe, effective opioid stewardship programs represents a critical but daunting challenge for medical leaders. This study sought to understand the barriers and aids to the routine use of clinical guidelines for opioid prescribing among healthcare professionals and to identify areas in need of additional education for prescribing providers, pharmacists, and nurses. Methods: Data collection and analysis in 2018-2019 employed a team of two trained facilitators who conducted 20 focus groups using a structured facilitation guide to explore operational, interpersonal, and patient care-related barriers to best practice adherence. Each professional group was interviewed separately, with similar care settings assigned together. Invitation to participate was based on a sampling methodology representing emergency, medical specialty, primary care, and surgical practice settings. Results: Key concerns among all groups reflected the inadequacy of available tools for staff to appropriately assess and treat patients' pain. Tools and technology to support safe opioid prescribing were also cited as a barrier by all three professional groups. All groups noted that prescribers tend to rely upon default settings within the electronic medical record when issuing prescriptions. Both pharmacists and prescribers cited time and scheduling as a barrier to adherence. Conclusions: In spite of significant regulatory and public policy efforts to address the opioid crisis, healthcare organizations face significant challenges to improve adherence to best practice prescribing guidelines. These findings highlight several facilitators for change which could boost opioid stewardship initiatives to focus on critical systems' factors for improvement.
MeSH term(s)	Analgesics, Opioid/adverse effects ; Humans ; Opioid Epidemic ; Practice Patterns, Physicians' ; Primary Health Care ; Qualitative Research
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2021-04-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2397614-7
ISSN	1551-7489
ISSN	1551-7489
DOI	10.5055/jom.2021.0622
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Article ; Online: Spinal Cord Stimulation for Treatment of Neuropathic Pain Associated With Erythromelalgia.

Matzke, Laura L / Lamer, Tim J / Gazelka, Halena M

Regional anesthesia and pain medicine

2016 Volume 41, Issue 5, Page(s) 619–620

Abstract: Objective: Erythromelalgia is a rare disorder associated with neuropathic pain that commonly affects the lower extremities. This pain is often refractory to multimodal treatment. Both pharmacologic management and interventional anesthetic blocks have ... ...

Abstract	Objective: Erythromelalgia is a rare disorder associated with neuropathic pain that commonly affects the lower extremities. This pain is often refractory to multimodal treatment. Both pharmacologic management and interventional anesthetic blocks have been used with varying and often limited success. To date, little experience has been gained with the use of spinal cord stimulation in treating pain associated with erythromelalgia. Case report: We present a case of successful treatment of pain secondary to erythromelalgia with a spinal cord stimulator in an 80-year-old woman. This patient had severe pain and debility secondary to erythromelalgia, having undergone trials of multiple medical therapies before presenting to our clinic. Dual-lead percutaneous spinal cord stimulation was successfully implanted without complication, leading to excellent pain control, now 18 months postimplant. Conclusions: Spinal cord stimulation may be a promising treatment of neuropathic pain associated with erythromelalgia.
MeSH term(s)	Aged, 80 and over ; Erythromelalgia/complications ; Erythromelalgia/diagnosis ; Female ; Humans ; Neuralgia/diagnosis ; Neuralgia/etiology ; Neuralgia/therapy ; Pain Measurement ; Severity of Illness Index ; Spinal Cord Stimulation ; Treatment Outcome
Language	English
Publishing date	2016-08-10
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	1425299-5
ISSN	1532-8651 ; 1098-7339 ; 0146-521X
ISSN (online)	1532-8651
ISSN	1098-7339 ; 0146-521X
DOI	10.1097/AAP.0000000000000457
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Article ; Online: Collaborative improvement on acute opioid prescribing among diverse health systems.

Clements, Casey M / Hanson, Kristine T / Zavaleta, Kathryn W / Stitz, Amber M / Clark, Sean E / Schwarz, Randy R / Homan, Jessica R / Larson, Mark V / Habermann, Elizabeth B / Gazelka, Halena M

PloS one

2022 Volume 17, Issue 6, Page(s) e0270179

Abstract: Background: Despite broad awareness of the opioid epidemic and the understanding that patients require much fewer opioids than traditionally prescribed, improvement efforts to decrease prescribing have only produced modest advances in recent years.: ... ...

Abstract	Background: Despite broad awareness of the opioid epidemic and the understanding that patients require much fewer opioids than traditionally prescribed, improvement efforts to decrease prescribing have only produced modest advances in recent years. Methods and findings: By using a collaborative model for shared expertise and accountability, nine diverse health care systems completed quality improvement projects together over the course of one year to reduce opioid prescriptions for acute pain. The collaborative approach was flexible to each individual system's goals, and seven of the nine participant institutions definitively achieved their desired results. Conclusions: This report demonstrates the utility of a collaborative model of improvement to bring about real change in opioid prescribing practices and may inform quality improvement efforts at other institutions.
MeSH term(s)	Analgesics, Opioid/therapeutic use ; Drug Prescriptions ; Epidemics ; Humans ; Practice Patterns, Physicians' ; Quality Improvement
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2022-06-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0270179
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