Most doctors responsible about prescription analgesics for migraines…except when they’re not. In a study on analgesic prescription errors, a startling number of doctors made severe, possibly life-threatening mistakes in filling out prescriptions for migraine treatments like ibuprofen and Sumatriptan to patients of migraine headaches and other chronic pain disorders.
Researchers double-check doctor’s orders
Scientists from the Albany Medical Center wanted to find out how competent most doctors are in filling out painkiller prescriptions for their patients of chronic illness, including migraines. So, for five years, they gathered prescription information provided by a teaching hospital in New York. The results, published by The Journal of Pain, indicated a need for better patient-doctor communication, a foolproof system for chronicling patient therapies, and perhaps a more stringent check system for under-experienced doctors.
Sorry about that…
- Out of 714,290 analgesic prescriptions, 2,044 (.29%) were prescribed incorrectly.
- Out of the medical errors identified by researchers, 22% could have resulted in severe injury.
- Roughly, 14% of potentially serious drug mix-ups involved children.
- The error rate among pediatric prescriptions is twice as high as the error rate for drugs prescribed to adults.
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Top 10 Mistakes Doctors Make
Doctors prescribing analgesics to children and adults made mistakes on many different levels. Below are some of the most common slip-ups:
1. Oops! Wrong drug
Sometimes, doctors made mistakes in prescribing the wrong painkiller for pain symptoms like migraines, confusing oxycodone with morphine or methadone.
2. Oops! Wrong dose
Overdoses of drugs like fentanyl or morphine, or underdoses of gabapentin for neuropathic pain were also recorded.
3. Oops! Wrong patient
Sometimes, pharmacists catch errors resulting from mixing-up of patient files.
4. Oops! Wrong frequency
In certain situations, physicians looking over medical records fail to notice dosage modifications, and prescribe incorrect instructions.
5. Oops! Wrong route
Dosing instructions for triptans for migraine headaches were written inconsistently of its route of delivery.
6. Oops! Wrong dosage form
Dosages for morphine and oxycodone were erroneously prescribed.
7. Oops! Wrong administration directions
Researchers notes instances where doctors gave incorrect instructions for administering analgesics to patients of migraine.
8. Oops! Forgot about contraindications
Patient-specific conditions like gastrointestinal bleeding were overlooked in prescribing pain medication.
9. Oops! Forgot about drug interactions
Interactions between one drug and another contributed to several errors.
10. Oops! Forgot about drug sensitivities
Ibuprofen was ordered for a patient who is allergic to NSAIDs, and morphine was prescribed to a patient with a recorded adverse reaction to morphine.
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Which analgesics are often prescribed incorrectly?
For the investigation, scientists classified prescribed analgesics by drug class and drug delivery method. The following pain medicines were prescribed in error for migraine headache relief and other chronic pain symptoms.
Oral nonsteroidal anti-inflammatory agents (NSAIDs): Nabumetone, Naproxen, Celecoxib, Ibuprofen
Combination products: Aspirin/caffeine/Butalbital, Acetaminophen/Propoxyphene
Immediate release (IR) oral opioids: Buprenorphine, Codeine, Propoxyphene
Long acting/controlled release (LA) oral opioids: Oxycodone SR, Morphine SR
Injectable opioids: Meperidine, Morphine
Patient-controlled analgesics (PCA): Morphine, Fentanyl, and Hydromorphone
Adjunctive agents– Gabapentin, Pregabalin
Triptan for migraines: Sumatriptan
Topical local anesthetics– Capsaicin, Phenazopyridine, Benzocaine
Which analgesics have the highest error rate?
Of all the analgesic drugs included in this study, the ones most often prescribed incorrectly are:
- LA opioids: 19.7%
- Combination drugs: 13.2%
- Injectable opioids: 13.1%
- Oral NSAIDs: 11.2%
Read more about migraine medications:
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Drugs that Prevent or Stop Migraine Attacks, plus Side Effects: Part I, Pain Relief
Drugs that Prevent or Stop Migraine Attacks, plus Side Effects: Part II, Preventative Medications
Analgesic Prescribing Errors and Associated Medication Characteristics
Image credits, from top:
Alex E. Proimos, digitalart, Ambro, griffithchris