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Richards GC, Lluka LJ, Smith MT, Haslam C, Moore B, O'Callaghan J, Strong J. Effects of long-term opioid analgesics on cognitive performance and plasma cytokine concentrations in patients with chronic low back pain: a cross-sectional pilot study. Pain Rep 2018; 3:e669. [PMID: 30123859 PMCID: PMC6085139 DOI: 10.1097/pr9.0000000000000669] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 06/04/2018] [Accepted: 06/08/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Cognitive performance and inflammation are altered in people with chronic low back pain (CLBP). Yet, the magnitude of these changes has been unclear because of the potential influence of opioid analgesics. OBJECTIVES This cross-sectional pilot study aimed to explore whether patients with CLBP receiving long-term opioid analgesics differed from patients not taking opioids on measures of cognitive performance and plasma cytokine concentrations. METHODS Patients with CLBP who were either taking (N = 18) or not taking (N = 22) opioids daily for 3 or more months were recruited from a tertiary care private hospital and compared with healthy adults (N = 20). All groups were administered validated questionnaires to assess depression, anxiety, and stress; a cognitive test of memory, attention, and executive function; and a peripheral blood draw to measure proinflammatory (IL-1β, IL-2, IL-8, IL-12p70, TNF-α, and IFN-γ), anti-inflammatory (IL-4, IL-10, and IL-13), and pleiotropic (IL-6) cytokine concentrations. Patients also completed pain-specific questionnaires. RESULTS Patients receiving opioid analgesics performed significantly (P < 0.05) worse in attention and had significantly (P < 0.05) lower pain self-efficacy beliefs than those patients not taking opioids. Patient groups did not differ in mean pain severity or pain interference scores, tests of memory and executive function, and mean plasma cytokine concentrations, despite long-term opioid analgesics. CONCLUSION Patients receiving long-term opioid analgesics for CLBP have minor differences when compared with patients not taking opioids. This has important clinical implications when considering long-term treatment for patients with CLBP.
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Affiliation(s)
- Georgia C. Richards
- Nuffield Department of Primary Care Health Sciences, Centre for Evidence-Based Medicine, University of Oxford, Oxford, United Kingdom
| | - Lesley J. Lluka
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Maree T. Smith
- Centre for Integrated Preclinical Drug Development, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Catherine Haslam
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Brendan Moore
- Centre for Integrated Preclinical Drug Development, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Greenslopes Private Hospital, Brisbane, Australia
| | | | - Jenny Strong
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Malon J, Shah P, Koh WY, Cattabriga G, Li E, Cao L. Characterizing the demographics of chronic pain patients in the state of Maine using the Maine all payer claims database. BMC Public Health 2018; 18:810. [PMID: 29954350 PMCID: PMC6022454 DOI: 10.1186/s12889-018-5673-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 06/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic pain is currently a significant health problem in the United States. A comprehensive strategy is needed to increase prevention of chronic pain and to improve care for chronic pain patients. However, development of a successful strategy relies, in part, on a better understanding of the demographics and socioeconomics of patients living with chronic pain conditions. The current study was designed to understand the burden of chronic pain in the state of Maine by identifying the prevalence of chronic pain and its relationship with selected demographic and socioeconomic factors in Maine. METHODS The Maine All Payer Claims Database (MEAPCD) (2006-2011) was used in the secondary data analysis to assess the demographic characteristics (such as age, sex, insurance type, and county of residence) of chronic pain patients in Maine. Chronic pain patients were identified based on the presence of pre-identified chronic pain-associated ICD-9 code(s) and opioid prescription information. Potential associations between the prevalence of chronic pain and a number of socioeconomic factors were determined by comparisons to Maine Census data. RESULTS More women in the state were identified as having chronic pain across all counties and all age groups (> 10 years old). Surprisingly, the majority of chronic pain patients were identified based on the diagnostic code criteria and not the opioid prescription criteria. A greater utilization of public health insurance was seen within the chronic pain patients. At the county level, although neither education level nor income were associated with the prevalence of chronic pain, these factors significantly correlated with the usage of public health insurance. CONCLUSIONS Further detailed characterization of the chronic pain patient population in the state of Maine, using multiple data sources, can help design population-targeted strategies to prevent and manage chronic pain.
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Affiliation(s)
- Jennifer Malon
- Center for Excellence in the Neurosciences, University of New England, 11 Hills Beach Rd., Biddeford, ME 04005 USA
| | - Parth Shah
- College of Osteopathic Medicine, University of New England, Biddeford, ME USA
| | - Woon Yuen Koh
- Department of Mathematical Sciences, University of New England, Biddeford, ME USA
| | | | - Edward Li
- College of Pharmacy, University of New England, Portland, ME USA
| | - Ling Cao
- Center for Excellence in the Neurosciences, University of New England, 11 Hills Beach Rd., Biddeford, ME 04005 USA
- College of Osteopathic Medicine, University of New England, Biddeford, ME USA
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Lozier CC, Nugent SM, Smith NX, Yarborough BJ, Dobscha SK, Deyo RA, Morasco BJ. Correlates of Use and Perceived Effectiveness of Non-pharmacologic Strategies for Chronic Pain Among Patients Prescribed Long-term Opioid Therapy. J Gen Intern Med 2018; 33:46-53. [PMID: 29633138 PMCID: PMC5902344 DOI: 10.1007/s11606-018-4325-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Non-pharmacologic treatments (NPTs) are recommended for chronic pain. Information is limited on patient use or perceptions of NPTs. We examined the frequency and correlates of use and self-rated helpfulness of NPTs for chronic pain among patients who are prescribed long-term opioid therapy (LTOT). METHODS Participants (n = 517) with musculoskeletal pain who were prescribed LTOT were recruited from two integrated health systems. They rated the frequency and utility of six clinician-directed and five self-directed NPTs for chronic pain. We categorized NPT use at four levels based on number of interventions used and frequency of use (none, low, moderate, high). Analyses examined clinical and demographic factors that differed among groups for both clinician-directed and self-directed NPTs. RESULTS Seventy-one percent of participants reported use of any NPT for pain within the prior 6 months. NPTs were rated as being helpful by more than 50% of users for all treatments assessed (range 51-79%). High users of clinician-directed NPTs were younger than non-users or low-frequency users and had the most depressive symptoms. In both clinician-directed and self-directed categories, high NPT users had significantly higher pain disability compared to non-NPT users. No significant group differences were detected on other demographic or clinical variables. In multivariable analyses, clinician-directed NPT use was modestly associated with younger age (OR = 0.97, 95% CI = 0.96-0.98) and higher pain disability (OR = 1.01, 95% CI = 1.00-1.02). Variables associated with greater self-directed NPT use were some college education (OR = 1.80, 95% CI = 1.13-2.84), college graduate or more (OR = 2.02, 95% CI = 1.20-3.40), and higher pain disability (OR = 1.01, 95% CI = 1.01-1.02). CONCLUSIONS NPT use was associated with higher pain disability and younger age for both clinician-directed and self-directed NPTs and higher education for self-directed NPTs. These strategies were rated as helpful by those that used them. These results can inform intervention implementation and be used to increase engagement in NPTs for chronic pain.
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Affiliation(s)
- Crystal C Lozier
- VA Portland Health Care System, Portland, OR, USA.
- Oregon Health & Science University, Portland, OR, USA.
| | - Shannon M Nugent
- VA Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Ning X Smith
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | | | - Steven K Dobscha
- VA Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Richard A Deyo
- Oregon Health & Science University, Portland, OR, USA
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | - Benjamin J Morasco
- VA Portland Health Care System, Portland, OR, USA
- Oregon Health & Science University, Portland, OR, USA
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Adams MH, Dobscha SK, Smith NX, Yarborough BJ, Deyo RA, Morasco BJ. Prevalence and Correlates of Low Pain Interference Among Patients With High Pain Intensity Who Are Prescribed Long-Term Opioid Therapy. THE JOURNAL OF PAIN 2018; 19:1074-1081. [PMID: 29705347 DOI: 10.1016/j.jpain.2018.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/09/2018] [Accepted: 04/06/2018] [Indexed: 12/25/2022]
Abstract
The pain experience may vary greatly among individuals reporting equally high levels of pain. We sought to examine the demographic and clinical characteristics associated with pain interference in patients with high pain intensity. Among patients with chronic musculoskeletal pain who were prescribed long-term opioid therapy and who were recruited from 2 health care systems, we identified a subset who reported high pain intensity (n = 189). All individuals completed self-report assessments of clinical and demographic factors. Analyses examined characteristics associated with pain interference. Within this group of patients with high reported pain intensity, 16.4% (n = 31) had low pain interference, 39.2% (n = 74) had moderate pain interference, and 44.4% (n = 84) had high pain interference. In bivariate analyses, patients with lower pain interference had fewer symptoms of depression and anxiety, less pain catastrophizing, a better quality of life, and greater self-efficacy for managing pain. In multivariate analyses, variables most strongly associated with low pain interference, relative to high interference, were depression severity (odds ratio 0.90; 95% confidence interval 0.82-0.99) and pain self-efficacy (odds ratio 1.07; 95% confidence interval 1.02-1.12). Study results suggest that chronic pain treatments that address symptoms of depression and enhance pain self-efficacy may be prioritized, particularly among patients who are prescribed long-term opioid therapy. PERSPECTIVE This article describes the prevalence and correlates of pain interference categories (low, medium, and high) among patients with high pain intensity who are prescribed long-term opioid therapy. Findings reveal that 16.4% of participants with high pain intensity had low impairment. Multivariate analyses indicate that variables significantly associated with low pain interference were lower depression scores and greater pain self-efficacy.
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Affiliation(s)
- Melissa H Adams
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
| | - Steven K Dobscha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon; Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Ning X Smith
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | | | - Richard A Deyo
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon; Departments of Family Medicine, Internal Medicine, and the Oregon Institute for Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon; Department of Psychiatry, Oregon Health & Science University, Portland, Oregon.
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Witkiewitz K, Vowles KE. Alcohol and Opioid Use, Co-Use, and Chronic Pain in the Context of the Opioid Epidemic: A Critical Review. Alcohol Clin Exp Res 2018; 42:478-488. [PMID: 29314075 PMCID: PMC5832605 DOI: 10.1111/acer.13594] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/29/2017] [Indexed: 12/20/2022]
Abstract
The dramatic increase in opioid misuse, opioid use disorder (OUD), and opioid-related overdose deaths in the United States has led to public outcry, policy statements, and funding initiatives. Meanwhile, alcohol misuse and alcohol use disorder (AUD) are a highly prevalent public health problem associated with considerable individual and societal costs. This study provides a critical review of alcohol and opioid misuse, including issues of prevalence, morbidity, and societal costs. We also review research on interactions between alcohol and opioid use, the influence of opioids and alcohol on AUD and OUD treatment outcomes, respectively, the role of pain in the co-use of alcohol and opioids, and treatment of comorbid OUD and AUD. Heavy drinking, opioid misuse, and chronic pain individually represent significant public health problems. Few studies have examined co-use of alcohol and opioids, but available data suggest that co-use is common and likely contributes to opioid overdose-related morbidity and mortality. Co-use of opioids and alcohol is related to worse outcomes in treatment for either substance. Finally, chronic pain frequently co-occurs with use (and co-use) of alcohol and opioids. Opioid use and alcohol use are also likely to complicate the treatment of chronic pain. Research on the interactions between alcohol and opioids, as well as treatment of the comorbid disorders is lacking. Currently, most alcohol research excludes patients with OUD and there is lack of measurement in both AUD and OUD research in relation to pain-related functioning. Research in those with chronic pain often assesses opioid use, but rarely assesses alcohol use or AUD. New research to examine the nexus of alcohol, opioids, and pain, as well as their treatment, is critically needed.
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Affiliation(s)
- Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, NM
| | - Kevin E Vowles
- Department of Psychology, University of New Mexico, Albuquerque, NM
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Nugent SM, Yarborough BJ, Smith NX, Dobscha SK, Deyo RA, Green CA, Morasco BJ. Patterns and correlates of medical cannabis use for pain among patients prescribed long-term opioid therapy. Gen Hosp Psychiatry 2018; 50:104-110. [PMID: 29153783 PMCID: PMC5788035 DOI: 10.1016/j.genhosppsych.2017.11.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/03/2017] [Accepted: 11/04/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Little is known about co-occurring long-term opioid therapy (LTOT) and medical cannabis use. We compared characteristics of patients prescribed LTOT who endorsed using medical cannabis for pain to patients who did not report cannabis use. METHOD Participants (n=371) prescribed LTOT completed self-report measures about pain, substance use, and mental health. RESULTS Eighteen percent of participants endorsed using medical cannabis for pain. No significant differences were detected on pain-related variables, depression, or anxiety between those who endorsed medical cannabis use and those who did not. Medical cannabis users had higher scores of risk for prescription opioid misuse (median=17.0 vs. 11.5, p<0.001), rates of hazardous alcohol use (25% vs. 16%, p<0.05), and rates of nicotine use (42% vs. 26%, p=0.01). Multivariable analyses indicated that medical cannabis use was significantly associated with risk of prescription opioid misuse (β=0.17, p=0.001), but not hazardous alcohol use (aOR=1.96, 95% CI=0.96-4.00, p=0.06) or nicotine use (aOR=1.61, 95% CI=0.90-2.88, p=0.11). CONCLUSION There are potential risks associated with co-occurring LTOT and medical cannabis for pain. Study findings highlight the need for further clinical evaluation in this population. Future research is needed to examine the longitudinal impact of medical cannabis use on pain-related and substance use outcomes.
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Affiliation(s)
- Shannon M. Nugent
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System,Mental Health and Clinical Neurosciences Division, VA Portland Health Care System,Department of Psychiatry, Oregon Health & Science University
| | | | - Ning X. Smith
- Kaiser Permanente Northwest Center for Health Research
| | - Steven K. Dobscha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System,Mental Health and Clinical Neurosciences Division, VA Portland Health Care System,Department of Psychiatry, Oregon Health & Science University
| | - Richard A. Deyo
- Kaiser Permanente Northwest Center for Health Research,Departments of Family Medicine, Internal Medicine, and the Oregon Institute for Occupational Health Sciences, Oregon Health & Science University,Public Health and Preventive Medicine, Oregon Health & Science University
| | - Carla A. Green
- Kaiser Permanente Northwest Center for Health Research,Public Health and Preventive Medicine, Oregon Health & Science University
| | - Benjamin J. Morasco
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System,Mental Health and Clinical Neurosciences Division, VA Portland Health Care System,Department of Psychiatry, Oregon Health & Science University
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