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Moye LS, Tipton AF, Dripps I, Sheets Z, Crombie A, Violin JD, Pradhan AA. Delta opioid receptor agonists are effective for multiple types of headache disorders. Neuropharmacology 2019; 148:77-86. [PMID: 30553828 PMCID: PMC6467218 DOI: 10.1016/j.neuropharm.2018.12.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/19/2018] [Accepted: 12/12/2018] [Indexed: 12/20/2022]
Abstract
Headaches are highly disabling and are among the most common neurological disorders worldwide. Despite the high prevalence of headache, therapeutic options are limited. We recently identified the delta opioid receptor (DOR) as an emerging therapeutic target for migraine. In this study, we examined the effectiveness of a hallmark DOR agonist, SNC80, in disease models reflecting diverse headache disorders including: chronic migraine, post-traumatic headache (PTH), medication overuse headache by triptans (MOH), and opioid-induced hyperalgesia (OIH). To model chronic migraine C57BL/6J mice received chronic intermittent treatment with the known human migraine trigger, nitroglycerin. PTH was modeled by combining the closed head weight drop model with the nitroglycerin model of chronic migraine. For MOH and OIH, mice were chronically treated with sumatriptan or morphine, respectively. The development of periorbital and peripheral allodynia was observed in all four models; and SNC80 significantly inhibited allodynia in all cases. In addition, we also determined if chronic daily treatment with SNC80 would induce MOH/OIH, and we observed limited hyperalgesia relative to sumatriptan or morphine. Together, our results indicate that DOR agonists could be effective in multiple headache disorders, despite their distinct etiology, thus presenting a novel therapeutic target for headache.
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Affiliation(s)
- Laura S Moye
- Department of Psychiatry, University of Illinois at Chicago, USA
| | - Alycia F Tipton
- Department of Psychiatry, University of Illinois at Chicago, USA
| | - Isaac Dripps
- Department of Psychiatry, University of Illinois at Chicago, USA
| | - Zoie Sheets
- Department of Psychiatry, University of Illinois at Chicago, USA
| | | | | | - Amynah A Pradhan
- Department of Psychiatry, University of Illinois at Chicago, USA.
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52
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Bonafede M, Wilson K, Xue F. Long-term treatment patterns of prophylactic and acute migraine medications and incidence of opioid-related adverse events in patients with migraine. Cephalalgia 2019; 39:1086-1098. [DOI: 10.1177/0333102419835465] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To describe long-term treatment patterns in migraine patients initiating prophylactic therapy and to evaluate acute medication use and adverse events associated with opioids. Methods This study used the 2005–2014 IBM MarketScan® databases to evaluate migraine patients initiating prophylactic medication. Outcome measures included persistence with prophylactic migraine medications over 2–5 years. Acute medication use and gastrointestinal-related adverse events and opioid abuse following opioid use were evaluated. Cox proportional hazards models were used to evaluate predictors of non-persistence and predictors of gastrointestinal-related AEs and opioid abuse associated with long-term opioid use. Results In total, 147,832 patients were analyzed. Non-persistence was observed in 90% of patients; 39% switched, 30% restarted, and 31% discontinued treatment. Over the follow-up, 59.9% of patients received triptans, 66.6% non-steroidal anti-inflammatory drugs, 77.4% opioids, and 2.6% ergotamines. Among opioid users, 16.6% experienced nausea/vomiting, 12.2% had constipation, and 10.4% had diarrhea. Opioid abuse was reported in <1% of opioid users. Gastrointestinal-related adverse events increased with increasing number of days’ supply of opioids. Conclusions Non-persistence to prophylactic treatment was frequent among migraine patients. Opioid use was common in migraine patients and the risk of gastrointestinal-related adverse events and opioid abuse increased with long-term use of opioids. These results suggest a need for more effective prophylactic migraine treatments.
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Affiliation(s)
| | | | - Fei Xue
- Center for Observational Research, Amgen, Thousand Oaks, CA, USA
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53
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Seng EK, Gelfand AA, Nicholson RA. Assessing evidence-based medicine and opioid/barbiturate as first-line acute treatment of pediatric migraine and primary headache: A retrospective observational study of health systems data. Cephalalgia 2019; 39:1000-1009. [PMID: 30786733 DOI: 10.1177/0333102419833080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To evaluate providers' use and predictors of evidence-based medicine or opioid/barbiturate as first-line acute treatment for children's initial presentation of acute migraine or primary headache. METHODS This retrospective, observational study utilized patient (children ages 6-17) and provider/encounter characteristics extracted from the patient's Electronic Health Record from 2008-2014 during an initial encounter for migraine or primary headache. The primary outcome was provider evidence-based medicine utilization; overall prescriptions and opioid/barbiturate prescriptions were also evaluated. Hierarchical linear modeling examined whether Level 1 (patient: Demographic, insurance type) and Level 2 (provider/encounter: Treatment setting/location, encounter diagnoses) characteristics influenced outcomes. RESULTS In all, 38,926 patients (56.7% female, mean age = 12.1) and 1617 providers were evaluated. Only 17.7% of patients were diagnosed with migraine; 16.1% received evidence-based medicine. Older children (OR = 1.07, p < 0.001), females (OR = 1.14, p < 0.001), and those diagnosed with migraine (OR = 4.71, p < 0.001) were more likely to receive evidence-based medicine. Among prescriptions, 15.8% were for opioids/barbiturates. Older children (OR = 1.14, p < 0.001) and those cared for in the emergency department/urgent care (OR = 2.02, p < 0.001) were at increased risk. CONCLUSIONS Demographics and migraine diagnosis are associated with evidence-based medicine and opioid/barbiturates. Primary care provides an opportunity to target provider interventions to enhance effective pediatric headache treatment.
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Affiliation(s)
- Elizabeth K Seng
- 1 Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA.,2 Saul R Korey, Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.,3 Montefiore Medical Center, Bronx, NY, USA
| | - Amy A Gelfand
- 4 UCSF Pediatric Headache, Departments of Neurology and Pediatrics, San Francisco, CA, USA
| | - Robert A Nicholson
- 5 Mercy Research, Chesterfield, MO, USA.,6 Mercy Clinic Headache Center, Chesterfield, MO, USA
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Platzbecker K, Zhang MB, Kurth T, Rudolph MI, Eikermann-Haerter K, Burstein R, Eikermann M, Houle T. The association between migraine and hospital readmission due to pain after surgery: A hospital registry study. Cephalalgia 2019; 39:286-295. [PMID: 29984600 PMCID: PMC7192134 DOI: 10.1177/0333102418786457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Migraine has been identified as a risk factor of 30-day hospital readmission after surgery. We aimed to further characterize this association examining pain as a potentially migraine-associated, preventable reason for readmission. HYPOTHESIS Compared to patients with no migraine, surgical patients with migraine are at increased risk of 30-day hospital readmission with an admitting diagnosis specifying pain. METHODS This hospital registry study examined 150,710 patients aged 18 years and above, who underwent surgery with general anesthesia and mechanical ventilation between 2007 and 2015 at a tertiary care center and two affiliated community hospitals in Massachusetts, USA. RESULTS Migraine was associated with an increased risk of 30-day pain-related readmission after surgery (adjusted odds ratio 1.42 [95% confidence interval 1.15-1.75]). The association was stronger for migraine with aura (compared to migraine without aura: Adjusted odds ratio 1.69 [95% confidence interval 1.06-2.70]; compared to no migraine: Adjusted odds ratio 2.20 [95% confidence interval 1.44-3.37]). The predicted adjusted risk of pain-related 30-day readmissions was 9.1 [95% confidence interval 5.3-13.0] in 1000 surgical patients with migraine with aura and 5.4 [95% confidence interval 4.2-6.6] in 1000 patients with migraine without aura, compared to 4.2 [95% confidence interval 3.8-4.5] in 1000 patients with no migraine. Furthermore, migraine was associated with an increased risk of postsurgical 30-day readmission due to a priori defined migraine-related pain (headache or abdominal pain) (adjusted odds ratio 1.55 [95% confidence interval 1.20-2.00]). CONCLUSION Patients with migraine undergoing surgery are at increased risk of 30-day hospital readmission due to pain.
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Affiliation(s)
- Katharina Platzbecker
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Megan Behua Zhang
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tobias Kurth
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Maira Isabella Rudolph
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany
| | - Timothy Houle
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Schroeder RA, Brandes J, Buse DC, Calhoun A, Eikermann-Haerter K, Golden K, Halker R, Kempner J, Maleki N, Moriarty M, Pavlovic J, Shapiro RE, Starling A, Young WB, Nebel RA. Sex and Gender Differences in Migraine—Evaluating Knowledge Gaps. J Womens Health (Larchmt) 2018; 27:965-973. [DOI: 10.1089/jwh.2018.7274] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
| | - Jan Brandes
- Nashville Neuroscience Group, Nashville, Tennessee
- Department of Neurology, Vanderbilt University, Nashville, Tennessee
| | - Dawn C. Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Anne Calhoun
- Carolina Headache Institute, Durham, North Carolina
| | | | | | - Rashmi Halker
- Department of Neurology, Mayo Clinic, Phoenix, Arizona
| | - Joanna Kempner
- Department of Sociology, Rutgers University, New Brunswick, New Jersey
| | - Nasim Maleki
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Maureen Moriarty
- Department of Nursing, Marymount University, Arlington, Virginia
| | - Jelena Pavlovic
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Robert E. Shapiro
- Department of Neurological Sciences, University of Vermont, Burlington, Vermont
| | | | - William B. Young
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rebecca A. Nebel
- Society for Women's Health Research, Washington, District of Columbia
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Higgins C, Smith B, Matthews K. Incidence of iatrogenic opioid dependence or abuse in patients with pain who were exposed to opioid analgesic therapy: a systematic review and meta-analysis. Br J Anaesth 2018; 120:1335-1344. [DOI: 10.1016/j.bja.2018.03.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 02/16/2018] [Accepted: 03/16/2018] [Indexed: 11/24/2022] Open
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Molina KC, Fairman KA, Sclar DA. Concomitant use of opioid medications with triptans or serotonergic antidepressants in US office-based physician visits. DRUG HEALTHCARE AND PATIENT SAFETY 2018; 10:37-43. [PMID: 29760569 PMCID: PMC5937481 DOI: 10.2147/dhps.s151073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Opioids are not recommended for routine treatment of migraine because their benefits are outweighed by risks of medication overuse headache and abuse/dependence. A March 2016 US Food and Drug Administration (FDA) safety communication warned of the risk of serotonin syndrome from using opioids concomitantly with 5-hydroxytryptamine receptor agonists (triptans) or serotonergic antidepressants: selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). Epidemiological information about co-prescribing of these medications is limited. The objective of this study was to estimate the nationwide prevalence of co-prescribing of an opioid with a serotonergic antidepressant and/or triptan in US office-based physician visits made by 1) all patients and 2) patients diagnosed with migraine. Methods National Ambulatory Medical Care Survey (NAMCS) data were obtained for 2013 and 2014. Physician office visits that included the new or continued prescribing of ≥1 opioid medication with a triptan or an SSRI/SNRI were identified. Co-prescribed opioids were stratified by agent to determine the proportion of co-prescriptions with opioids posing a higher risk of serotonergic agonism (meperidine, tapentadol, and tramadol). Results Of an annualized mean 903.6 million office-based physician visits in 2013-2014, 17.7 million (2.0% of all US visits) resulted in the prescribing of ≥1 opioid medication with a triptan or an SSRI/SNRI. Opioid-SSRI/SNRI was co-prescribed in 16,044,721 visits, while opioid-triptan was co-prescribed in 1,622,827 visits. One-fifth of opioid co-prescribing was attributable to higher-risk opioids, predominantly tramadol (18.6% of opioid-SSRI/SNRI, 21.8% of opioid-triptan). Of 7,672,193 visits for patients diagnosed with migraine, 16.3% included opioid prescribing and 2.0% included co-prescribed opioid-triptan. Conclusion During a period approximately 2 years prior to an FDA warning about the risk of serotonin syndrome from opioid-SSRI/SNRI or opioid-triptan co-prescribing, use of these combinations was common in the USA. Studies on prescribing patterns following the March 2016 warning, and on the risk of serotonin syndrome associated with these co-prescriptions, are needed.
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Affiliation(s)
- Kyle C Molina
- Department of Pharmacy Practice, Midwestern University College of Pharmacy-Glendale, Glendale, AZ, USA
| | - Kathleen A Fairman
- Department of Pharmacy Practice, Midwestern University College of Pharmacy-Glendale, Glendale, AZ, USA
| | - David A Sclar
- Department of Pharmacy Practice, Midwestern University College of Pharmacy-Glendale, Glendale, AZ, USA
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59
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Alexoudi A, Politis K, Moukidou A, Tsatovidou R, Ververaki S, Tavernarakis A, Siatouni A, Verentzioti A, Mitsikostas D, Gatzonis S. Variables Affecting Factors Associated with Primary Headache. Clin Pract 2018; 8:1031. [PMID: 29383231 PMCID: PMC5768158 DOI: 10.4081/cp.2018.1031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 11/27/2017] [Accepted: 12/01/2017] [Indexed: 11/23/2022] Open
Abstract
Primary headache syndromes’ development is associated with biological, psychological and social parameters. Factors such as daily habits, behavioral characteristics and sleep disorders also play an important role. We aim to identify the variables which affect the above factors. The study included 111 patients affected by primary headache. The patients were stratified into subgroups according to gender, age, occupation and headache type. Women attained higher scores than men in three of the evaluation rating scales and lower scores in the severity of dependence scale. Occupation was associated with SF36 and Hamilton anxiety scale. Unemployed had higher scores in Hamilton anxiety. Migraineurs and occupied individuals have lower SF36 scores. Women are associated with depression, anxiety and higher disability derived from headache. Men are more prone to dependence on opioids. Unemployment was linked with anxiety and well-being. The migraneurs presented a decreased level of quality of life.
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60
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Teckchandani S, Barad M. Treatment Strategies for the Opioid-Dependent Patient. Curr Pain Headache Rep 2017; 21:45. [DOI: 10.1007/s11916-017-0644-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Charleston Iv L, Burke JF. Do racial/ethnic disparities exist in recommended migraine treatments in US ambulatory care? Cephalalgia 2017. [PMID: 28649860 DOI: 10.1177/0333102417716933] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Racial disparities in migraine have been reported in the US. Migraine in African Americans (AA) is more frequent, more severe, more likely to become chronic and associated with more depression and lower quality of life compared to non-Hispanic Whites (NHW). It is possible that racial differences in prescribing practices contribute to these differences, but little is known about the quality of migraine prescribing patterns in the US or whether racial differences exist. Objective To determine if racial differences in quality of migraine medical prescription care exist. Methods We used data from the National Ambulatory Medical Care Survey to estimate differences in the use of migraine prophylactic and abortive medications by race. Quality of migraine care was defined using the American Academy of Neurology Headache Quality Measure Set (AAN-HQMS). Patients were assigned to one of four categories representing the overall quality of evidence for their abortive and prophylactic medications using the AAN-HQMS. We hypothesized that there would be suboptimal migraine treatment in minority populations. Racial comparisons were made using descriptive statistics after applying NAMCS survey weights. Results Two thousand, eight hundred and sixty visits were included in the study, representing approximately 50 million migraine visits in the US from 2006-2013. In all, 41.3% of AA, 40.8% of NHW, and 41.2% of Hispanic (HI) patients received no prophylactic treatments ( p = 0.99). A total of 18.8% of AA patients, 11.9% of NHW patients, and 6.9% of HI patients received exclusively Level A prophylaxis ( p = 0.30). A total of 47.1% of AA patients, 38.2% of NHW patients, and 36.3% of HI patients received no abortive treatments ( p = 0.23). In total, 15.3% of AA patients, 19.4% of NHW patients, and 17.7% of HI patients received any Level A abortives (i.e. triptans or Dihydroergotamine; DHE, p = 0.64). A total of 15.2% of all patients had a prescription for opiates, but there were no racial differences. Conclusions Migraine may be undertreated with prophylactic medications. Level A acute analgesics may be underused and opiates overused. No major racial/ethnic differences in abortive or prophylactic treatment were identified.
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Najjar M, Hall T, Estupinan B. Metoclopramide for Acute Migraine Treatment in the Emergency Department: An Effective Alternative to Opioids. Cureus 2017; 9:e1181. [PMID: 28533997 PMCID: PMC5438233 DOI: 10.7759/cureus.1181] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
In light of recent warnings by the United States (US) Surgeon General and Centers for Disease Control (CDC) guidelines for recommending more prudent use of opioid narcotics, the search for a non-opioid alternative for aborting acute migraines is particularly relevant. The CDC also estimates the prevalence of opioid dependence may be as high as 26% among patients prescribed opioids for chronic pain, not due to cancer, in the primary care setting. Given such staggering data, it is imperative that we, as caretakers, not foster opioid dependence but rather continue to investigate non-opioid therapies for the management of acute migraines in the emergent care settings. Our literature review demonstrates that metoclopramide should be used more frequently as first-line therapy for an acute migraine over opioids. The use of opioids specifically has been discouraged as migraine treatment by the American Headache Society citing “insufficient evidence” as the main reason. Metoclopramide, specifically using the 10 mg dose, has been cited as “highly likely to be effective” by the same guidelines. Another major issue with opioids is the growing potential for abuse, thus minimizing the use of these drugs for only special circumstances would be beneficial overall.
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Affiliation(s)
- Mejdi Najjar
- College of Medicine, University of Central Florida College of Medicine
| | - Tyler Hall
- College of Medicine, University of Central Florida College of Medicine
| | - Blanca Estupinan
- College of Medicine, University of Central Florida College of Medicine
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63
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Stone MT, Weed V, Kulich RJ. Opioid Treatment of Migraine: Risk Factors and Behavioral Issues. Curr Pain Headache Rep 2017; 20:51. [PMID: 27474093 DOI: 10.1007/s11916-016-0581-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Migraine can impact every aspect of a person's functioning. Psychological comorbidities, cognitive constructs, and behavioral responses to pain greatly impact the perception of migraine pain, treatment efficacy and outcome, and overall quality of life and functioning. Current considerations for migraine treatment emphasize the utility of the biopsychosocial model in understanding and treating migraine, noting both the importance of addressing psychological factors such as cognitive beliefs as well as psychiatric comorbidities. The guidelines for migraine treatment implicate opioid therapy as a second or third tier treatment. Guidelines and recommendations for the safe use of opioid medications among patients with chronic pain emphasize the importance of screening prior to prescribing opioid medications. Chronic opioid therapy has been shown to further levels of disability, decrease quality of life, and correlate to psychiatric comorbidities, concerns that are already present in migraine patients. While opioid treatment provides an alternative for persons with contraindications for alternative migraine treatments, it is critical that opioids be used sparingly and exclusively in conjunction with comprehensive assessment and integration of psychological treatment.
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Affiliation(s)
- Melissa T Stone
- Integrated Behavioral Associates, 169 Libbey Parkway, Weymouth, MA, 02189, USA. .,South Shore Medical Center, 143 Longwater Drive, Norwell, MA, 02061, USA.
| | - Valerie Weed
- Boston PainCare Center, Waltham, MA, USA.,Tufts School of Medicine, Waltham, MA, USA.,Shriners Hospital for Children-Boston, 85 First Avenue, Waltham, MA, 021451, USA
| | - Ronald J Kulich
- Dept. of Diagnostic Sciences, Craniofacial Pain, and Headache Center, Tufts University School of Dental Medicine, Boston, MA, USA.,Lecturer in Anesthesia, Critical Care and Pain Medicine/Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 1 Kneeland Street, Boston, MA, 02111, USA
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64
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Shao E, Hughes J, Eley R. The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study. World J Emerg Med 2017; 8:170-176. [PMID: 28680512 PMCID: PMC5496823 DOI: 10.5847/wjem.j.1920-8642.2017.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/26/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Migraine is a common neurological condition that frequently presents to the emergency department (ED). Many medications are available to treat migraine. This study aims to characterize the demographics of patients who present to a large metropolitan ED with migraine, and to identify the medications used in treating this condition. METHODS This study is a retrospective database interrogation of clinical records, used to collect quantitative data on patient demographics and medication prescriptions in the ED. RESULTS A total of 2 228 patients were identified as being treated for migraine over a 10-year period. The proportion of the ED population presenting with migraine steadily increased in this time. Females (71%) more commonly presented to the ED with migraine than males. The migraine population was significantly younger (M=37.05, SD=13.23) than the whole ED population (M=46.17 SD=20.50) (P<0.001). A variety of medications were used in the treatment of migraine in the ED. Simple analgesics such as paracetamol and ibuprofen, anti-emetics and intravenous (IV) fluids with phenothiazine additives were commonly used. Over 20% of patients were prescribed oral or parenteral opiates (42 of 194 initial medication prescriptions, and 64 of 292 as required medication prescriptions). Triptans were very rarely used. CONCLUSION Migraine is an increasingly common presentation to the ED. People presenting to the ED with migraine are more likely to be younger and female than the general ED population. Peak presentations for migraines occurred in January and February. The medications that are prescribed in the ED for migraine is varied and are not always in line with current evidence for the treatment of migraine. The excessive reliance on opiates and lack of the use of triptans denotes a significant variation from published guidelines.
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Affiliation(s)
- Emily Shao
- Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - James Hughes
- Emergency Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Rob Eley
- Emergency Department, Princess Alexandra Hospital, Brisbane, Australia
- Emergency Medicine Research Program, The University of Queensland Faculty of Medicine, Brisbane, Australia
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65
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Sheridan DC, Meckler GD. Inpatient Pediatric Migraine Treatment: Does Choice of Abortive Therapy Affect Length of Stay? J Pediatr 2016; 179:211-215. [PMID: 27634627 DOI: 10.1016/j.jpeds.2016.08.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 07/21/2016] [Accepted: 08/16/2016] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe the inpatient management of pediatric migraine and the association between specific medications and hospital length of stay (LOS). STUDY DESIGN Historical cohort study review of patients age <19 years of age admitted to a single tertiary care children's hospital between 2010 and 2015 for treatment of migraine headache. RESULTS The cohort consisted of 58 encounters with an average patient age of 14.3 years (SD 3.2 years) with a female predominance (62%). The mean number of inpatient medications received by patients was 3 (range 1-7), with dopamine antagonists and dihydroergotamine used most commonly (67% and 59% of encounters, respectively). The average LOS was 56 hours (95% CI 48.2-63.2) and did not vary by medication received, although patients who received an opioid had a significantly longer LOS (79.2 vs 47.9 hours respectively; P < .001). CONCLUSIONS Children admitted to the hospital for treatment of migraine headache frequently require a large number of medications over an average hospital LOS of more than 2 days without apparent differences based on medication received other than prolonged stays for subjects who received opioids.
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Affiliation(s)
- David C Sheridan
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR.
| | - Garth D Meckler
- Department of Pediatrics, Pediatric Emergency Medicine, University of British Columbia BC Children's Hospital, Vancouver, British Columbia, Canada
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66
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Review of the Typical and Atypical Treatment Options for Acute Migraine Headache in the Emergency Department. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40138-016-0099-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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67
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Aly Z, Rosen N, Evans RW. Migraine and the Risk of Suicide. Headache 2016; 56:753-61. [PMID: 27028299 DOI: 10.1111/head.12815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 02/26/2016] [Indexed: 01/09/2023]
Abstract
Rarely and tragically, migraineurs commit suicide or overdose on medications we prescribe.
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Affiliation(s)
- Zarmeneh Aly
- Department of Neuro Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Noah Rosen
- Cushing Neuroscience Institute, Hofstra Northwell Health, Great Neck, NY, USA
| | - Randolph W Evans
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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69
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Abstract
Concussion and mild traumatic brain injury are common injuries in pediatrics, and posttraumatic headache is the most common complaint following them. Although most children and teens recover from a simple, isolated concussion without incidents within 1-2 weeks, some develop symptoms that can last for months. It is important to manage both acute and persistent posttraumatic headaches appropriately to speed recovery, minimize disability, and maximize function. In this article, we review the definitions, epidemiology, and current recommendations for the evaluation and treatment of acute and persistent posttraumatic headaches. Although this is still a developing field and there is much that we still need to learn about concussion and the best strategies to prevent and treat these injuries and their sequelae, we hope that this review will help providers to understand the current evidence and treatment recommendations to improve care for children with concussion and mild traumatic brain injury.
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Kacperski J, Arthur T. Management of post-traumatic headaches in children and adolescents. Headache 2015; 56:36-48. [DOI: 10.1111/head.12737] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 01/03/2023]
Affiliation(s)
- Joanne Kacperski
- Division of Neurology; Cincinnati Children's Hospital Medical Center; Cincinnati OH USA
| | - Todd Arthur
- Department of Pediatrics, College of Medicine; University of Cincinnati; Cincinnati OH USA
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Minen MT, Lindberg K, Wells RE, Suzuki J, Grudzen C, Balcer L, Loder E. Survey of Opioid and Barbiturate Prescriptions in Patients Attending a Tertiary Care Headache Center. Headache 2015; 55:1183-91. [PMID: 26316376 DOI: 10.1111/head.12645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To educate physicians about appropriate acute migraine treatment guidelines by determining (1) where headache patients were first prescribed opioids and barbiturates, and (2) the characteristics of the patient population who had been prescribed opioids and barbiturates. BACKGROUND Several specialty societies issued recommendations that caution against the indiscriminate use of opioids or barbiturate containing medications for the treatment of migraine. These medications are still being prescribed in various medical settings and could put headache specialists in a difficult position when patients request these agents. METHODS Patients presenting to a headache center comprised of eight physicians were asked to complete a survey that assessed headache types, comorbid conditions, and whether they had ever been prescribed opioids or barbiturates. If they responded affirmatively to the latter question, they were asked about the prescribing doctor, medication effectiveness, and whether they were currently on the medication. Data collection took place over a one month period. RESULTS Two hundred forty-four patients were given the survey and 218 of these patients completed it. The predominant diagnosis was migraine (83.9%). More than half of the patients reported having been prescribed an opioid (54.8%) or a barbiturate (56.7%). About one fifth were on opioids (19.4%) or barbiturates (20.7%) at the time of completing the survey. Most patients reported being on opioids for more than 2 years (24.6%) or less than one week (32.1%). The reasons most frequently cited for stopping opioids were that the medications did not help (30.9%) or that they saw a new doctor who would not prescribe them (29.4%). Among patients who had previously been on barbiturates, 32.2% had been on these for over 2 years. Most patients (61.8%) stopped barbiturates because they did not find the medication helpful, while 17.6% said they saw a new doctor who would not prescribe them. The physician specialty most frequently cited as being the first prescriber for opioids was emergency medicine (20.2%) with family doctors and general neurologists the next groups at 17.7% each. General neurologists were the most frequent (37.8%) first prescribers of barbiturates. CONCLUSIONS Approximately 20% of patients presenting to a headache center reported current use of opioids and/or barbiturates. ED physicians were reported to be the most frequent first prescribers of opioids and general neurologists were the most frequent first prescribers of barbiturates. Taken as a whole, these data provide a useful snapshot of the wide variety of physician specialties that might benefit from additional education on the appropriate use of opioids and barbiturate-containing medications in patients with headaches.
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Affiliation(s)
- Mia T Minen
- Department of Neurology, NYU Langone Medical Center
| | | | - Rebecca E Wells
- Department of Neurology, WakeForest Baptist Hospital, Winston Salem, USA
| | - Joji Suzuki
- Department of Psychiatry, Brigham and Women's/Faulkner Hospitals, Boston, USA
| | - Corita Grudzen
- Department of Emergency Medicine, NYU Langone Medical Center, NY, USA
| | - Laura Balcer
- Department of Neurology, NYU Langone Medical Center, NY, USA
| | - Elizabeth Loder
- Department of Neurology, Brigham and Women's/Faulkner Hospitals, Boston, MA
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Meyer R, Patel AM, Rattana SK, Quock TP, Mody SH. Prescription opioid abuse: a literature review of the clinical and economic burden in the United States. Popul Health Manag 2015; 17:372-87. [PMID: 25075734 DOI: 10.1089/pop.2013.0098] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Between 2002 and 2007, the nonmedical use of prescription pain relievers grew from 11.0 million to 12.5 million people in the United States. Societal costs attributable to prescription opioid abuse were estimated at $55.7 billion in 2007. The purpose of this study was to comprehensively review the recent clinical and economic evaluations of prescription opioid abuse. A comprehensive literature search was conducted for studies published from 2002 to 2012. Articles were included if they were original research studies in English that reported the clinical and economic burden associated with prescription opioid abuse. A total of 23 studies (183 unique citations identified, 54 articles subjected to full text review) were included in this review and analysis. Findings from the review demonstrated that rates of opioid overdose-related deaths ranged from 5528 deaths in 2002 to 14,800 in 2008. Furthermore, overdose reportedly results in 830,652 years of potential life lost before age 65. Opioid abusers were generally more likely to utilize medical services, such as emergency department, physician outpatient visits, and inpatient hospital stays, relative to non-abusers. When compared to a matched control group (non-abusers), mean annual excess health care costs for opioid abusers with private insurance ranged from $14,054 to $20,546. Similarly, the mean annual excess health care costs for opioid abusers with Medicaid ranged from $5874 to $15,183. The issue of opioid abuse has significant clinical and economic consequences for patients, health care providers, commercial and government payers, and society as a whole.
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Serrano D, Buse DC, Manack Adams A, Reed ML, Lipton RB. Acute Treatment Optimization in Episodic and Chronic Migraine: Results of the American Migraine Prevalence and Prevention (AMPP) Study. Headache 2015; 55:502-18. [DOI: 10.1111/head.12553] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2015] [Indexed: 01/03/2023]
Affiliation(s)
- Daniel Serrano
- Endpoint Outcomes; Boston MA USA
- Albert Einstein College of Medicine; Bronx NY USA
| | - Dawn C. Buse
- Albert Einstein College of Medicine; Bronx NY USA
| | | | | | - Richard B. Lipton
- Albert Einstein College of Medicine; Bronx NY USA
- Montefiore Medical Center; Bronx NY USA
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Grace PM, Maier SF, Watkins LR. Opioid-induced central immune signaling: implications for opioid analgesia. Headache 2015; 55:475-89. [PMID: 25833219 DOI: 10.1111/head.12552] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2015] [Indexed: 12/30/2022]
Abstract
Despite being the mainstay of pain management, opioids are limited in their clinical utility by adverse effects, such as tolerance and paradoxical hyperalgesia. Research of the past 15 years has extended beyond neurons, to implicate central nervous system immune signaling in these adverse effects. This article will provide an overview of these central immune mechanisms in opioid tolerance and paradoxical hyperalgesia, including those mediated by Toll-like receptor 4, purinergic, ceramide, and chemokine signaling. Challenges for the future, as well as new lines of investigation will be highlighted.
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Pinchefsky E, Dubrovsky AS, Friedman D, Shevell M. Part II--Management of pediatric post-traumatic headaches. Pediatr Neurol 2015; 52:270-80. [PMID: 25499091 DOI: 10.1016/j.pediatrneurol.2014.10.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 10/09/2014] [Accepted: 10/09/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Post-traumatic headache is one of the most common symptoms occurring after mild traumatic brain injury in children. METHODS This is an expert opinion-based two-part review on pediatric post-traumatic headaches. In part II, we focus on the medical management of post-traumatic headaches. There are no randomized controlled trials evaluating the efficacy of therapies specifically for pediatric post-traumatic headaches. Thus, the algorithm we propose has been extrapolated from the primary headache literature and small noncontrolled trials of post-traumatic headache. RESULTS Most post-traumatic headaches are migraine or tension type, and standard medications for these headache types are used. A multifaceted approach is needed to address all the possible causes of headache and any comorbid conditions that may delay recovery or alter treatment choices. For acute treatment, nonsteroidal anti-inflammatories can be used. If the headaches have migrainous features and nonsteroidal anti-inflammatories are not effective, triptans may be beneficial. Opioids are not indicated. Medication overuse should be avoided. For preventive treatments, some reports indicate that amitriptyline, gabapentin, or topiramate may be beneficial. Amitriptyline is a good choice because it can be used to treat both migraine and tension-type headaches. Nerve blocks, nutraceuticals (e.g. melatonin), and behavioral therapies may also be useful, and lifestyle factors, especially adequate sleep hygiene and strategies to cope with anxiety, should be emphasized. CONCLUSIONS Improved treatment of acute post-traumatic headache may reduce the likelihood of developing chronic headaches, which can be especially problematic to effectively manage and can be functionally debilitating.
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Affiliation(s)
- Elana Pinchefsky
- Division of Pediatric Neurology, Departments of Pediatrics and Neurology/Neurosurgery, Montreal Children's Hospital / McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Alexander Sasha Dubrovsky
- Department of Pediatric Emergency Medicine, Montreal Children's Hospital Trauma Centre, McGill University Health Centre, Montreal, Quebec, Canada
| | - Debbie Friedman
- Trauma Programs, Mild Traumatic Brain Injury Program, Concussion Clinic, Montreal, Quebec, Canada; Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Michael Shevell
- Department of Pediatrics, Departments of Pediatrics and Neurology/Neurosurgery, Montreal Children's Hospital Trauma Centre, McGill University Health Centre, Montreal, Quebec, Canada.
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Runken MC, Goodwin B, Shah M, Eaddy M, D'Souza A, Bowers B, Bell CF. Migraine-related healthcare resource use and costs for subjects prescribed fixed-dose combination sumatriptan/naproxen sodium vs. single-entity oral triptans in a managed care population in the USA. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:109-120. [PMID: 25294555 DOI: 10.1007/s40258-014-0129-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Randomized clinical trials have demonstrated that the efficacy of a fixed-dose single-tablet combination containing sumatriptan and naproxen sodium (S/NS) was greater than either of its individual components. Simplifying drug regimens (e.g., via a fixed-dose combination) has been shown to improve "real-world" outcomes by reducing pill burden and treatment regimen complexity, improving adherence, and reducing healthcare resource use and associated costs; however, no studies assessing such outcomes have been conducted to date for the acute treatment of migraine. OBJECTIVE To assess migraine-related healthcare resource use and associated costs for subjects prescribed S/NS vs. subjects prescribed single-entity oral triptans (SOTs) within a managed care population in the USA. METHODS In this retrospective analysis of administrative claims data from July 1, 2008 to December 31, 2009 (IMS LifeLink), subjects meeting the following criteria were selected: one or more pharmacy claim(s) for either S/NS or SOT (index date), aged 18-64 years; at least one migraine diagnosis, and continuous enrollment in the 6 months prior to and post the index date. The study population was subsequently stratified for two analyses: triptan-naïve (triptan naïve in the 6-month period prior to the index date) and triptan-switch (triptan user in the 6-month period prior to the index date and switching to another triptan). Subjects prescribed S/NS were propensity-score matched with subjects prescribed SOT (triptan-naïve analysis: 1:3; triptan-switch analysis: 1:1) to assess differences in healthcare resource use and associated costs (2009 US$) between the S/NS and SOT groups. RESULTS Results from the triptan-naïve and triptan-switch analyses suggest that subjects prescribed S/NS are likely to have similar healthcare resource use patterns as those either newly initiated on an SOT or switching SOTs, as measured by migraine medication use, migraine-related healthcare resource use, and all-cause healthcare resource use. One exception was the observed increased use of opioids in the SOT group compared with the S/NS group (change in mean number of tablets pre-index vs. post-index, S/NS vs. SOT; triptan-naïve analysis: 8.6 vs.18.3, p = 0.045; triptan-switch analysis: -8.2 vs. 17.7; p = 0.120). Total costs from the triptan-naïve analysis indicated that the S/NS group had lower migraine-related (US$744 vs. US$820; p = 0.067) and all-cause healthcare costs (US$4,391 vs. US$4,870; p = 0.040) when compared with the SOT group, driven by savings in medical costs (migraine-related: US$252 vs. US$380; p = 0.001; all-cause: US$3,023 vs. US$3,599; p = 0.014). However, no significant differences were observed for total costs from the triptan-switch analysis (migraine-related healthcare costs, S/NS vs. SOT: US$1,159 vs. US$1,117; p = 0.929; all-cause healthcare costs: US$5,128 vs. US$4,788; p = 0.381). CONCLUSION Study results suggest similar healthcare resource use patterns and associated costs when comparing S/NS and SOT across a triptan-naïve and triptan-experienced population. While the current study focuses on direct medical costs, future studies should extend beyond such a perspective to explore functional status, productivity, and health-related quality of life and satisfaction, attributes not captured in administrative claims data, but nonetheless important treatment goals.
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Affiliation(s)
- M Chris Runken
- GlaxoSmithKline, Research Triangle Park, Durham, NC, USA
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77
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Chronic migraine with medication overuse: Association between disability and quality of life measures, and impact of disease on patients' lives. J Neurol Sci 2015; 348:60-6. [DOI: 10.1016/j.jns.2014.11.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/31/2014] [Accepted: 11/03/2014] [Indexed: 01/20/2023]
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Reed ML, Fanning KM, Serrano D, Buse DC, Lipton RB. Persistent frequent nausea is associated with progression to chronic migraine: AMPP study results. Headache 2014; 55:76-87. [PMID: 25250833 DOI: 10.1111/head.12450] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Though nausea is a cardinal feature of migraine, its influence on migraine progression has not been evaluated. This article aims to evaluate persistent frequent headache-related nausea (PFN) in persons with episodic migraine (EM) as a predictor of new onset chronic migraine (CM). METHODS This prospective cohort study uses data from the 2007 and 2008 American Migraine Prevalence and Prevention study surveys to identify subgroups with episodic International Classification of Headache Disorders, 2nd edition defined migraine and either PFN or no or low frequency nausea (NLFN). PFN was defined by the presence of nausea ≥ half the time in both 2007 and 2008. NLFN was defined by nausea that was present<half the time, rarely or never in both years. Persons were considered CM in 2009 if they met symptom criteria for migraine with headaches ≥15 days per month over the preceding 3 months. Univariate differences in demographics for PFN and NLFN were evaluated with chi-square. Binary logistic regressions were performed hierarchically to assess progression to CM in 2009 as a function of nausea status in 2007 and 2008. The initial model included sociodemographic variables only. Subsequent models added the following variables in a hierarchical manner: migraine symptom severity composite score (to control for the impact of other headache features), headache-related disability, depression, opioid use, and an interaction term for nausea status and opioid use. Odds ratios (OR) and 95% confidence intervals (CI) contrasted PFN and NLFN on the rate of progression to CM in 2009. RESULTS There were 3182 respondents with headache symptom and frequency data available for all 3 years of the analysis. PFN was found in 43.7% (1389) of respondents, and 3.4% (47) progressed to CM. NLFN was seen in 27.6% (877) of the EM group, and 1.5% progressed to CM. In comparison with the NLFN group, PFN was more common in females (P<.001) and Caucasians (P<.06). PFN was associated with a doubling of the risk of progression to CM after adjusting for sociodemographic variables (OR 2.09, 95% CI 1.11-3.91, P=.022). Adding the symptom composite score and headache-related disability covariates to the model attenuated the association slightly (OR 2.00, 95% CI 1.03-3.87, P=.04). With the addition of depression, the association fell just below statistical significance but progression risk with PFN remained at nearly two-fold that of the NLFN group (OR 1.90, 95% CI 0.98-3.71, P=.059). When opioid use and the nausea by opioid use interaction are added to the final model, the significant effect and the doubling of CM progression risk for those with PFN was retained (OR 2.24, 95% CI 1.07-4.70, P=.033). CONCLUSIONS Persistent frequent nausea is common (43.7%) among persons with episodic migraine. After controlling for sociodemographics, migraine symptom severity, headache-related disability, depression, and opioid medication use, migraineurs with frequent nausea that persisted for 2 years of study were twice as likely to progress to CM compared to those with no or low frequency nausea. The study is limited by self-reports of symptom and headache frequency data and the use of modified diagnostic criteria. Additional prospective research is needed to confirm study findings. Persistent frequent nausea could be a marker for the risk of progression to CM or it could be in the causal pathway.
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80
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Zhang AL, Parker SJ, Smit DV, Taylor DM, Xue CCL. Acupuncture and standard emergency department care for pain and/or nausea and its impact on emergency care delivery: a feasibility study. Acupunct Med 2014; 32:250-6. [PMID: 24610638 DOI: 10.1136/acupmed-2013-010501] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the feasibility of delivering acupuncture in an emergency department (ED) to patients presenting with pain and/or nausea. METHODS A feasibility study (with historical controls) undertaken at the Northern Hospital ED in Melbourne, Australia, involving people presenting to ED triage with pain (VAS 0-10) and/or nausea (Morrow Index 1-6) between January and August 2010 (n=400). The acupuncture group comprised 200 patients who received usual medical care and acupuncture; the usual care group comprised 200 patients with retrospective data closely matched from ED electronic health records. RESULTS Refusal rate was 31%, with 'symptoms under control owing to medical treatment before acupuncture' the most prevalent reason for refusal (n=36); 52.5% of participants responded 'definitely yes' for their willingness to repeat acupuncture, and a further 31.8% responded 'probably yes'. Over half (57%) reported a satisfaction score of 10 for acupuncture treatment. Musculoskeletal conditions were the most common conditions treated n=117 (58.5%), followed by abdominal or flank pain n=49 (24.5%). Adverse events were rare (2%) and mild. Pain and nausea scores reduced from a mean±SD of 7.01±2.02 before acupuncture to 4.72±2.62 after acupuncture and from 2.6±2.19 to 1.42±1.86, respectively. CONCLUSIONS Acupuncture in the ED appears safe and acceptable for patients with pain and/or nausea. Results suggest combined care may provide effective pain and nausea relief in ED patients. Further high-quality, sufficiently powered randomised studies evaluating the cost-effectiveness and efficacy of the add-on effect of acupuncture are recommended.
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Affiliation(s)
- Anthony L Zhang
- School of Health Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Shefton J Parker
- School of Health Sciences, RMIT University, Bundoora, Victoria, Australia
| | - De Villiers Smit
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - David McD Taylor
- Department of Emergency, Austin Health, Heidelberg, Victoria, Australia
| | - Charlie C L Xue
- School of Health Sciences, RMIT University, Bundoora, Victoria, Australia
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81
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Affiliation(s)
- Morris Levin
- Department of Neurology; Dartmouth Hitchcock Medical Center; Lebanon NH USA
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82
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Da Silva AN, Lake AE. Clinical Aspects of Medication Overuse Headaches. Headache 2013; 54:211-7. [DOI: 10.1111/head.12223] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - Alvin E. Lake
- MHNI; 3120 Professional Drive; Ann Arbor MI 48104 USA
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Lipton RB, Serrano D, Nicholson RA, Buse DC, Runken MC, Reed ML. Impact of NSAID and Triptan Use on Developing Chronic Migraine: Results From the American Migraine Prevalence and Prevention (AMPP) Study. Headache 2013; 53:1548-63. [DOI: 10.1111/head.12201] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Richard B. Lipton
- Albert Einstein College of Medicine/Montefiore Medical Center; Bronx NY USA
| | | | | | - Dawn C. Buse
- Albert Einstein College of Medicine/Montefiore Medical Center; Bronx NY USA
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84
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Lipton RB, Buse DC, Serrano D, Holland S, Reed ML. Examination of Unmet Treatment Needs Among Persons With Episodic Migraine: Results of the American Migraine Prevalence and Prevention (AMPP) Study. Headache 2013; 53:1300-11. [DOI: 10.1111/head.12154] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2013] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Starr Holland
- Armstrong Atlantic State University; Savannah; GA; USA
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Casucci G, Cevoli S. Controversies in migraine treatment: opioids should be avoided. Neurol Sci 2013; 34 Suppl 1:S125-8. [DOI: 10.1007/s10072-013-1395-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ho KY, Chua NHL, George JM, Yeo SN, Main NB, Choo CY, Tan JWT, Tan KH, Ng BY. Evidence-Based Guidelines on the Use of Opioids in Chronic Non-Cancer Pain—A Consensus Statement by the Pain Association of Singapore Task Force. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n3p138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: While opioids are effective in carefully selected patients with chronic non-cancer pain (CNCP), they are associated with potential risks. Therefore, treatment recommendations for the safe and effective use of opioids in this patient population are needed. Materials and Methods: A multidisciplinary expert panel was convened by the Pain Association of Singapore to develop practical evidence-based recommendations on the use of opioids in the management of CNCP in the local population. This article discusses specific recommendations for various common CNCP conditions. Results: Available data demonstrate weak evidence for the long-term use of opioids. There is moderate evidence for the short-term benefit of opioids in certain CNCP conditions. Patients should be carefully screened and assessed prior to starting opioids. An opioid treatment agreement must be established, and urine drug testing may form part of this agreement. A trial duration of up to 2 months is necessary to determine efficacy, not only in terms of pain relief, but also to document improvement in function and quality of life. Regular reviews are essential with appropriate dose adjustments, if necessary, and routine assessment of analgesic efficacy, aberrant behaviour and adverse effects. The reasons for discontinuation of opioid therapy include side effects, lack of efficacy and aberrant drug behaviour. Conclusion: Due to insufficient evidence, the task force does not recommend the use of opioids as first-line treatment for various CNCP. They can be used as second- or third-line treatment, preferably as part of a multimodal approach. Additional studies conducted over extended periods are required.
Key words: Chronic pain, Consensus statement, Guidelines, Non-cancer pain, Opioids
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Affiliation(s)
| | | | | | - Sow Nam Yeo
- The Pain Specialist, Mount Elizabeth Medical Centre, Singapore
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Abstract
Migraine constitutes a relatively common reason for pediatric emergency room visits. Given the paucity of randomized trials involving pediatric migraineurs in the emergency department setting compared with adults, recommendations for managing these children are largely extrapolated from adult migraine emergency room studies and trials involving outpatient home pediatric migraine therapy. We review current knowledge about pediatric migraineurs presenting at the emergency room and their management, and summarize the best evidence available to guide clinical decision-making.
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Affiliation(s)
- Amy A Gelfand
- Division of Child Neurology, Department of Neurology, University of California, San Francisco, San Francisco, California, USA.
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Kulich RJ, Stone M. Risk Stratification With Opioid Therapy. Headache 2012; 52 Suppl 2:88-93. [DOI: 10.1111/j.1526-4610.2012.02236.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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A high-dose of fentanyl induced delayed anxiety-like behavior in rats. Prevention by a NMDA receptor antagonist and nitrous oxide (N2O). Pharmacol Biochem Behav 2012; 102:562-8. [DOI: 10.1016/j.pbb.2012.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 06/20/2012] [Accepted: 07/01/2012] [Indexed: 11/20/2022]
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