Integrating Analgesic Doses and Pain Trend Analysis: A Novel Clinical Support System

Patients’ perception of pain is subjective. It has always been complicated to prescribe advisable analgesics with optimal dosages according to a patient’s pain severity, especially when the patient has been prescribed a variety of painkillers ¹. Thus, it is vitally important to establish the effective relative doses of individual analgesics using data from doctors’ orders, in order to determine whether or not to change the analgesics or adjust the doses of the individual analgesics in the following days ².

Patients often have difficulty identifying which analgesic provides effective relief of their pain, especially when the medication orders change frequently due to unsatisfactory pain control ³. It is also challenging for patients to differentiate between regular medication administration and “pro re nata” medication when experiencing acute pain. Hence physicians need to cross-reference the patient's description with each dose of medication. It is necessary to compare the administration time with the corresponding pain score changes in order to obtain more empirical evidence. If we solely rely on prescriptions without simultaneously considering the pain scores, it is not possible to determine which medication was effective. Additionally, patients often receive various analgesics concurrently, which makes long-term tracking more challenging ⁴.

Calculating the daily oral morphine equivalent dose is already difficult, and comparing it over multiple days poses an even greater challenge. When combining the patient's pain scores, many existing systems cannot immediately show how temporal trends in pain scores change with different drugs ⁵. Clinicians may need to update orders and prescriptions frequently, but if there are multiple analgesics, they may inadvertently neglect to check whether the prescriptions and doses are correct. Many medication prescriptions have set start and end dates, especially for high-risk drugs or various opioid medications. Therefore, a situation may arise in which the physician is unaware that a patient’s medication has reached its end date, resulting in the patient being without adequate pain relief. Moreover, we also have to consider whether the daily oral morphine equivalent dose is sufficient. Both overdosing or underdosing can directly impact patient safety ⁶. Some systems provide clear information in individual timeframes, but data over an extended period are not easily interpretable and are more difficult to understand. Patients with chronic pain typically use multiple analgesics, and therefore it becomes challenging to comprehensively understand the quantities of medications ⁷.

To date, there is no optimal system that can effectively analyze and integrate analgesic equivalent doses with trends to provide decision-making support for adjustment of analgesics and their doses. Moreover, there is no optimized user interface that can provide integrated information.

In the past, many systems were only able to check medications at single or multiple time points, but they could not provide the equivalent dose at a glance. For example, there are various types of opioid-like medications, and each type has a different strength, typically represented in terms of Morphine Milligram Equivalents (MME) for oral morphine equivalence ⁸. For any given medication, different routes of administration and formulations may have varying oral morphine equivalents ⁹. Moreover, medications can be given in fractions or varying doses, such as half a tablet, half a syringe, or a quarter of a syringe. A patient may receive multiple different medications simultaneously, and each doctor may have a different perspective on the weighting of these medications ¹⁰. As a result, calculating the daily oral morphine equivalent dose can be challenging.

Therefore, we devised a system that not only provides addictive doses for different opioids but also offers information on other analgesics, which can help doctors in the management of different kinds of pain.

There has been no similar or comparable system in the past that effectively integrates the trend analysis of pain medication consumption, and to date there has been no optimal interface design capable of providing integrated information. In addition to its various clinical applications, our system can contribute in other areas.

In terms of clinical education, this system can expand the evaluation of pain treatment effectiveness from a single time point score to the combined presentation of pain scores over time, medication response, and trend analysis. This expansion from text-based teaching to graphical representation can make pain education more engaging and relatable. Medical data digitization is the gateway to intelligent healthcare, and the use of systems that analyze pain trends and their relationship medication dosages paves the way for further development of smart tools in pain management¹¹.

In medical applications, the quantification and graphical representation can be applied to other medical disciplines as well. After customization, this system can systematically present information on the relationships between corticosteroids and inflammation indices in immunology and rheumatology, targeted therapy and tumor indices in oncology, and immunosuppressants and renal function in nephrology.

For medication applications, the system allows analyses of drug efficacy assessments based on actual responses taking into account variations in medication, dosage, and patient indices. It is worth keeping in mind that the response of individual patients to any given medication varies in terms of drug interactions, metabolism, and excretion. The establishment of personalized dose-response curves of drugs would provide actual utility in clinical practice ¹².

In terms of future applications, our system can be expanded to include apps on patients’ smartphones or tablets. Apps can provide patients with access to the hospital's medication prescribing information, with seamless integration of medication use and pain scores. The hospital can provide medication information via a mobile app, which can remind patients when to take a medication and allow them to indicate if they have already taken it. The app can also provide a platform for patients to record their pain scores, which can be sent back to the hospital's system for analysis by healthcare professionals. The doctors can assess the effectiveness of medications and provide recommendations simultaneously. If the patient is hospitalized, the integration of medication use and pain score recording can also be achieved. In addition to enhancing the quality of pain management, the system can also increase patients’ engagement and adherence to the hospital's services.

Our clinical support system addresses the complexities and challenges associated with prescribing and tracking analgesic medications for patients. By integrating real-time calculations of oral morphine equivalents and providing comprehensive analyses of pain duration trends, the system offers physicians valuable decision-making support. It overcomes previous barriers in drug analysis by taking multiple analgesics into account, including opioids and other auxiliary drugs. It has the potential to revolutionize pain management practices and enhance patient outcomes.

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