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 Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 27  |  Issue : 3  |  Page : 142-146

Drug utilization pattern in a pain clinic of a tertiary care teaching hospital in Eastern India


1 Department of Anaesthesiology, College of Medicine & JNM Hospital, Kalyani, Nadia, West Bengal, India
2 Department of Pharmacology, College of Medicine & JNM Hospital, Kalyani, Nadia, West Bengal, India
3 2nd Prof M.B.B.S. Student, College of Medicine & JNM Hospital, Kalyani, Nadia, West Bengal, India
4 Principal, College of Medicine & JNM Hospital, Kalyani, Nadia, West Bengal, India

Date of Web Publication7-Jan-2014

Correspondence Address:
Debjyoti Dutta
Department of Anaesthesiology, College of Medicine and JNM Hospital, Kalyani, Nadia - 741 235, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-5333.124598

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  Abstract 

Background: Patients attend the Pain Clinic with varieties of complains of pain, like low back pain, knee pain, shoulder pain, headache, facial pain, different neuralgias and other neuropathic pain states. They receive a multimodal treatment for their pain, Multimodal pain therapy is an integrated multidisciplinary treatment in small groups with a closely coordinated therapeutic approach. Drugs that are prescribed for treatment are not only NSAIDS or Opioids, but also various groups of adjuvant pain medications like anti-epileptics, antidepressants etc. Aim: To find out the drug utilization pattern in the Pain Clinic of a tertiary care medical college hospital in Eastern India. Materials and Methods: A cross sectional; unicentric study was conducted in the Pain Clinic during April 2013 to June 2013. New patients who were willing to participate in the study were enrolled as per selection criteria. A copy of prescriptions were collected from the patients. The drugs prescription patterns were analyzed. Result: 319 patients were included in this study in three months period and their prescriptions were analyzed. Female patients (222) were more in number than male (97). As single prescription and also as combination therapy, paracetamol was found to be the most frequently prescribed drug. Frequently used adjuvant pain medications were found to be pregabalin (21.63%) and amitriptyline (16.92%.). Antacid was commonly prescribed as gastroprotective agent. Among drug combinations paracetamol (325 mg) + tramadol (37.5 mg) combination was used most frequently. (55.17%). Conclusion: In this uncentric study we found that patacetamol, tramadol, pregabalin and amitriptyline are the commonly used medications in a pain clinic. We need more multi-centric and comparative Indian studies.

Keywords: Analgesic, drug utilization study, pain clinic


How to cite this article:
Dutta D, Dalai CK, Roy S, Naskar C, Bhattacharyya D. Drug utilization pattern in a pain clinic of a tertiary care teaching hospital in Eastern India. Indian J Pain 2013;27:142-6

How to cite this URL:
Dutta D, Dalai CK, Roy S, Naskar C, Bhattacharyya D. Drug utilization pattern in a pain clinic of a tertiary care teaching hospital in Eastern India. Indian J Pain [serial online] 2013 [cited 2019 Dec 6];27:142-6. Available from: http://www.indianjpain.org/text.asp?2013/27/3/142/124598


  Introduction Top


The International Association for the Study of Pain (IASP) defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." 1 So pain is always a subjective experience and that it is a sensation perceived in some part of the body. At the same time it is unpleasant and therefore also has an emotional component. Many people report pain in the absence of tissue damage or any probable pathophysiologic cause. There is usually no way to distinguish their experience from that attributable to tissue damage; it should be accepted as pain. [1]

Pain may be classified as acute and chronic. Acute pain is provoked by a specific disease or injury, serves an useful biologic purpose; it is associated with skeletal muscle spasm and sympathetic nervous system activation, and is often self-limited. [2] Chronic pain is defined as 'pain of a duration or intensity that adversely affects the function or well-being of a patient" by the American Society of Anesthesiologists. [3] The IASP defines it as "pain without apparent biological value that has persisted beyond the normal tissue healing time usually taken to be 3 months. [4]

The prevalence of chronic pain among general population ranges from 10-46% depending upon the study population surveyed, survey method and definition of chronic pain used. In a survey of World Health Organization (WHO) on primary care patients, the prevalence of chronic pain from India was reported as 19%. [5]

Pain clinic have been designed to help patients deal with this widespread issue. These clinics are focused on overriding goal of practicing of pain management by including clinician from different specialties who participate in the treatment of pain. A multidisciplinary pain center is typically started by Anaesthesiologists, Neurologists, Physical medicine and Rehabilitation Doctors, Psychologists, Physical Therapists and Acupuncturists. [6],[7]

In India, the concept of Pain Clinic or pain management centre was initiated at major institutions in the 1970s and it is only in the last few years that we have seen more of such centres being set up. [8]

The World Health Organization (WHO) addressed drug utilization as the marketing, distribution, prescription and use of drugs in a society, considering its consequences, either medical, social, and economic. [9] Studies on the process of drug utilization focus on the factors related to the prescribing, dispensing, administering, and taking of medication, and its associated events, covering the medical and non-medical determinants of drug utilization, the effects of drug utilization, as well as studies of how drug utilization relates to the effects of drug use, beneficial or adverse. [10] The therapeutic practice is expected to be primarily based on evidence provided by pre marketing clinical trials, but complementary data from post marketing period are needed to provide an adequate basis for improving drug therapy.

This drug utilization study was conducted to study the pattern of drug uses in Pain Clinic of a Tertiary care, Teaching Hospital in Eastern India.


  Materials and Methods Top


Written informed consent was taken from each participant willing to participate in the study. Illiterate individuals gave their fingerprint (left thumb impression) instead of signature in the presence of an appropriate witness.

Subject selection criteria

All patients attending Pain Clinic for the first time, between 18-70 years of age, irrespective of sex, were included. However, patients who were pregnant, lactating, unable to comply due to mental retardation, unconsciousness or drug addiction were excluded from the study.

Study area

The study was conducted in the Department of Anaesthesiology. Data compilation and Statistical analysis were done in Department of Pharmacology, College of Medicine & JNM Hospital, Kalyani, Nadia, West Bengal.

Study design: Cross sectional, Unicentric study.

Study period: From April 2013 to June 2013.

Study methodology

A cross sectional, unicentric study was conducted in the Pain Clinic of an urban, tertiary care, Medical College Hospital in West Bengal during April 2013 to June 2013. New prescriptions were collected from patients attending the Pain Clinic. The drug prescription pattern was analyzed. No follow up of prescriptions were included.

Parameters for Evaluation

The parameters included gender distribution, age of the patients, type of illness (provisional diagnosis), type of drugs prescribed, prescribed in generic form, average number of drugs per prescription.

Result and Analysis

319 patients were included in this study and their prescriptions were analyzed, only prescriptions on first visit were included in the study.

The demographic profiles have been described in [Table 1], [Figure 1], [Figure 2], [Figure 3], [Figure 4].
Figure 1: Age Distribution of the patients

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Figure 2: Sex distribution of the patients

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Figure 3: Shows distribution of illness as per provisional diagnosis In 132 patients no definite provisional diagnosis was written on prescriptions on fi rst visit

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Figure 4: Bar diagram showing distribution of illness as per provitional diagnosis on fi rst visit

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Table 1: Demographic characteristics

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Distribution of Prescribed Drugs

Distributions of prescribed drugs of various groups are tabulated in [Table 2] and [Figure 5]. It is seen that all drugs were prescribed in generic form.
Figure 5: Shows the distribution of prescribed drugs in pain clinic

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Table 2: Shows the distribution of prescribed drugs in pain clinic

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Drug Combinations

Drug combinations were also prescribed frequently. Some combinations also prescribed in brand name. [Table 3] and [Figure 6] shows the distribution of drug combination with dose.
Figure 6: Shows the distribution of drug combination

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Table 3: Shows the drug combination with dose

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Monotherapy vs Polytherapy

Prescriptions contain either single drug therapy or contain multiple drug therapy. In [Table 4] and [Figure 7], the pattern of prescription either monotherapy or polytherapy is tabulated.
Figure 7: Shows the distribution of monotherapy and polytherapy prescriptions

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Table 4: Shows the trends of monotherapy and polytherapy prescriptions

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  Discussion Top


The study was conducted to see the drug prescription pattern in Pain Clinic in a Tertiary Teaching Hospital in Eastern India. As per the selection criteria, prescriptions from 319 patients who attended the pain clinic were collected in prescheduled 3 months from April, 2013 to June 2013.

It was seen that maximum number of patients attending pain clinic were of age between 31-40 years (32.6%), interestingly it was seen that female outnumbers males.(male:female-30.4:69.6). The average age of male patients was 47.2, whereas in females it was 38.74 years. The provisional diagnosis was written in the prescription on first visit in 187 prescriptions (58.62%), whereas in 132 prescriptions provisional diagnosis was not written, investigations were advised for the diagnosis (41.37%). In the study patients osteoarthritis was found to be the most common cause (10.03%) for pain. The average number of drugs per prescription was 3.1.

Among the prescriptions, drugs found prescribed frequently were analgesics (both opioid and NSAIDS), adjuvants like amitriptyline, carbamazepine, pregabalin, gabapentin. Amitriptyline, flunarizine, valproate were prescribed for migraine. Carbamazepine was used for trigeminal neuralgia. Deferent gastro-protective agents like antacids, rabeprazole, famotidine were prescribed widely. Levofloxacin was also found to be prescribed in conditions associated with suspected bacterial infection.

Antacids were found in (63.63%) prescriptions, whereas paracetamol (as single preparation) was found in 19.7% prescriptions. Frequently used adjuvant pain medications were found to be pregabalin (21.63%) and amitriptyline (16.92%.). Most commonly prescribed combination was found to be paracetamol (325mg) + Tramadol (37.5 mg) (55.17%), followed by Aceclofenac (100mg) + Paracetamol (500mg) 16.3%. Majority of combination used for chronic pain contain paracetamol (86.34%) as a component.

So from this pattern of drug uses it can be said that paracetamol is a common component in majority of drug combination, may due to its high safety profile.

Majority of prescription contain multiple drug therapy (298 prescription-93.5%), whereas single drug prescriptions are very less in number (21 prescriptions, 6.5%).

Most of the drugs were prescribed in generic form, whereas drug combinations were mostly prescribed in brand name. It may be due to difficulty to write individual drug with dose in a combination, which is also time consuming.


  Conclusion Top


In this unicentric study we found that patacetamol, tramadol, pregabalin and amitriptyline are the commonly used medications in a pain clinic. Among the drug combination paracetamol (325 mg) + tramadol (37.5 mg) is most frequently prescribed followed by aceclofenac (100mg) + paracetamol (500mg) combination. Majority of combinations used contain paracetamol (277 prescription-86.34%) as a component. We need more multi-centric and comparative Indian studies.

 
  References Top

1.Christoph S, Andress K. Anesthesia and treatment of chronic pain. Section V-Adult subspeciality management. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL. Millers′s Anesthesia. Ch. 58, 7 th ed. Philadelphia: Churchill Livingstone Elsevier; 2010. p. 1977.  Back to cited text no. 1
    
2.Grichnik KP, Ferrante FM. The difference between acute and chronic pain. Mt Sinai J Med 1991;58:217-20.  Back to cited text no. 2
[PUBMED]    
3.Practice guidelines for chronic pain management. A report by American society of Anesthesiologists Task Force on Pain Management, Chronic Pain Section. Anesthesiology 1997;86:995-1004.  Back to cited text no. 3
[PUBMED]    
4.Classification of chronic pain. Descriptions of chronic pain syndromes and definition of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl 1986;3:S1-226.  Back to cited text no. 4
[PUBMED]    
5.Gureje O, Von Korff M, Smion GE, Gater R. Persistent pain and well-being. A World Health Organization study in primary care. JAMA 1998;280:147-51.  Back to cited text no. 5
    
6.Arnold B, Brinkschmidt T, Casser HR, Gralow I, Irnich D, Klimczyk K, et al. Multimodal pain therapy: principles and indications. Schmerz 2009;23:112-20.  Back to cited text no. 6
[PUBMED]    
7.The Purpose of Pain Clinics [database on the Internet], all nurses.com, specialties. Available from: http://allnurses.com/pain-management-nursing/purpose-pain-clinics-765001.html. [Last cited on 2013 Aug 09].  Back to cited text no. 7
    
8.Pain Clinic Dr G.P. Dureja [database on the Internet]. Available from http://doctor.ndtv.com/storypage/ndtv/id/3729/type/feature/Pain_Clinics.html. [Last cited on 2013 Oct 17].   Back to cited text no. 8
    
9.WHO Expert Commitee. The Selection of Essential Drugs, technical Report Series no.615, Geneva: World Health Organization, 1977.   Back to cited text no. 9
    
10.Lunde PK, Baksaas I. Epidemiology of drug utilization basic concepts and methodology, Acta Med Scand Suppl 1988;721:7-11.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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