Accuracy of Patient Medication Reporting Using the Neuropathic Pain Medication Log
Carrie A Kubiak, MD1, Jennifer B Hamill, MPH1, Hyungjin M Kim, ScD1, Randy S Roth, MD, PhD1, Paul S Cederna, MD2, Stephen WP Kemp, PhD1, Michael E Geisser, MD, PhD1 and Theodore A Kung, MD3, (1)University of Michigan, Ann Arbor, MI, (2)Plastic Surgery, University of Michigan, Ann Arbor, MI, (3)Section of Plastic & Reconstructive Surgery, University of Michigan, Ann Arbor, MI
Introduction
Neuropathic pain patients frequently obtain multimodal pain prescriptions from multiple providers across many specialties, health care systems and pharmacies. We developed the Neuropathic Pain Medication Log (NPML), a comprehensive pain medication tracking tool to help quantify multimodal pain medication use in patients with major limb amputations. This tool utilizes patient-reported data to track over the counter analgesics, opioids, anticonvulsants, antidepressants, and other adjuvant pharmacologic therapies used to treat neuropathic pain. The purpose of the current study is to examine the accuracy of the NPML by comparing its data with that from the electronic medical record (EMR) and the Michigan Automated Prescription System (MAPS), a system that monitors all controlled substances dispensed by pharmacies including opioids, anticonvulsants, and anxiolytics.
Materials & Methods
Patients undergoing primary lower extremity amputation and amputation revision surgery with transection of peripheral nerves were recruited for participation in this study. Subjects were asked to complete a medication log preoperatively as well as 4 and 12 months postoperatively. Patient-reported pain medications were identified and quantified using the NPML tool. For this study, the total number of patient-reported pain medications, number of opioids, number of anticonvulsants, and number of antidepressant medications were collected and compared to both EMR and MAPS data for each individual patient at every time point.
Results
A total of 91 NPMLs representing 44 preoperative and 47 postoperative patient-reported medication logs were included in the analysis. On average, patients reported 2.65 ± 1.92 total pain medications compared to 3.14 ± 1.96 reported in the EMR (p=0.086). The difference in pain medication reporting is presented in Table 1 and Table 2. The average difference between patient-reported medications and EMR medication data was -0.48 for total number of medications, -0.13 for number of opioids, 0.0 for number of anticonvulsants, and -0.02 for antidepressants. Similarly, the average difference between patient-reported medications and MAPS controlled substance medication data was +0.05.
Conclusions
The NPML can be used to efficiently and accurately gather important data about pharmacologic treatment of neuropathic pain. Future studies will seek to further validate its potential as a reliable medication log instrument for research and clinical practice.
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