1
|
Bahardoust M, Mousavi S, Dehkharghani MZ, Arab M, Rashidi H, Gorgani H, Haghmoradi M, Askari A. Association of Tramadol Versus Codeine Prescriptions with all-cause mortality and cardiovascular diseases among patients with osteoarthritis: a systematic review and meta-analysis of propensity score-matched population-based cohort studies. Adv Rheumatol 2024; 64:80. [PMID: 39420382 DOI: 10.1186/s42358-024-00417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/16/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Today, the prescription of tramadol in patients with osteoarthritis (OA) has increased significantly, which can be associated with serious consequences. Contradictory results have been reported regarding the association of tramadol versus codeine with the risk of all-cause mortality (ACM) and cardiovascular diseases (CVD). METHODS This systematic review and meta-analysis aimed to evaluate, for the first time, the association of tramadol versus codeine with the risk of ACM and CVD in OA patients for the first time. We searched PubMed, Scopus, Embase, Web of sciences, and Google Scholar with specific keywords and mesh terms to find relevant studies until January 2024. Two independent researchers did the process of searching and screening articles. Cochran's Q and I2 tests evaluated the heterogeneity of the studies. Egger's test was used to evaluate the existence of publication bias. RESULTS Seven population-based cohort studies, matched by the propensity score method, including 1,939,293 participants, were reviewed. The study pooled results did not show a significant association between the prescriptions of tramadol versus codeine with increasing the risk of ACM in OA patients. (Hazard ratio (HR): 1.084, 95% confidence interval (95%) CI: 0.883, 1.286, P: 0.56) In addition, the prescription of tramadol versus codeine was not associated with an increased risk of CVD in OA. (HR: 1.025, 95% CI: 0.89, 1.16, P: 0.68, I2 = 37.8%) CONCLUSION: Our systematic review showed that tramadol prescription compared to codeine in OA patients was not associated with an increased risk of ACM and CVD.
Collapse
Affiliation(s)
- Mansour Bahardoust
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Mousavi
- Pharmacy Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Zolfaghari Dehkharghani
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada Las Vegas (UNLV), Las Vegas, NV, USA
| | - Mahsa Arab
- Department of Orthopedic Surgery, Faculty of Medicine, Golestan University of Medical Sciences, Golestan, Iran
| | - Heeva Rashidi
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Habib Gorgani
- Department of Orthopedic Surgery, Faculty of Medicine, Golestan University of Medical Sciences, Golestan, Iran.
| | - Meisam Haghmoradi
- Department of Orthopedic Surgery, Urmia University of Medical Sciences, Urmia, Iran
| | - Alireza Askari
- Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Shafa Orthopedic Hospital, Baharestan Square, Tehran, 1157637131, Iran.
| |
Collapse
|
2
|
Flores-Marinelarena RR, Rodríguez-Reyna TS, Cantú-Brito C, Lajous M, Flores-Torres MH, Valaguez-Moreno V, Herrera-Venegas CE, Catzin-Kuhlmann A. Hand Osteoarthritis and Subclinical Cardiovascular Disease in Middle-Aged Women. J Womens Health (Larchmt) 2024. [PMID: 39348360 DOI: 10.1089/jwh.2023.1088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2024] Open
Abstract
Objective: To determine subclinical cardiovascular disease (sCVD) in middle-aged women with clinically manifested hand osteoarthritis (HOA) and to improve the characterization of cardiovascular risk in this population. Design: We cross-sectionally evaluated the relationship between HOA and sCVD in 1,803 volunteers from the Mexican Teachers' Cohort. From 2012 to 2016, a subsample from Mexico City, the Northern state Nuevo León, and the Southern states Chiapas and Yucatán was invited for clinical evaluations, during which neurologists examined carotid arteries using ultrasound, and a standardized HOA questionnaire was also administered. HOA was defined as age ≥45 years, hand joint pain, and morning stiffness that lasted no longer than 30 minutes. sCVD was assessed using the intima-media thickness (IMT) and atherosclerotic plaques. Results: Among participants with a mean age of 51 years (±4), 18.4% met the criteria for HOA, and the prevalence of carotid atherosclerosis was 23.1%. After multivariable adjustment, women diagnosed with HOA had a 1.8% (95% confidence interval [CI] 0.3, 3.3) greater mean IMT than those without this joint disease. Similarly, women with HOA had 36% (95% CI 1.01, 1.84) higher odds of carotid atherosclerosis. Conclusions: HOA is associated with sCVD in middle-aged women. This relationship might be due to low-grade chronic inflammation; however, further research is required to clarify the underlying mechanisms.
Collapse
Affiliation(s)
- Rodrigo Rafael Flores-Marinelarena
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Mexico City, Mexico
- Department of Internal Medicine, Fundación Clínica Médica Sur, Mexico City, Mexico
| | | | - Carlos Cantú-Brito
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Mexico City, Mexico
- Division of Neurology and Psychiatry, National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| | - Martín Lajous
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mario H Flores-Torres
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
| | | | | | - Andres Catzin-Kuhlmann
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Mexico City, Mexico
- Department of Medicine, National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| |
Collapse
|
3
|
Giaretta S, Magni A, Migliore A, Natoli S, Puntillo F, Ronconi G, Santoiemma L, Sconza C, Viapiana O, Zanoli G. A Review of Current Approaches to Pain Management in Knee Osteoarthritis with a Focus on Italian Clinical Landscape. J Clin Med 2024; 13:5176. [PMID: 39274389 PMCID: PMC11396710 DOI: 10.3390/jcm13175176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/24/2024] [Accepted: 08/11/2024] [Indexed: 09/16/2024] Open
Abstract
The global cases of knee osteoarthritis (KOA) are projected to increase by 74.9% by 2050. Currently, over half of patients remain dissatisfied with their pain relief. This review addresses unmet needs for moderate-to-severe KOA pain; it offers evidence and insights for improved management. Italian experts from the fields of rheumatology, physical medicine and rehabilitation, orthopedics, primary care, and pain therapy have identified several key issues. They emphasized the need for standardized care protocols to address inconsistencies in patient management across different specialties. Early diagnosis is crucial, as cartilage responds better to early protective and structural therapies. Faster access to physiatrist evaluation and reimbursement for physical, rehabilitative, and pharmacological treatments, including intra-articular (IA) therapy, could reduce access disparities. Concerns surround the adverse effects of oral pharmacological treatments, highlighting the need for safer alternatives. Patient satisfaction with corticosteroids and hyaluronic acid-based IA therapies reduces over time and there is no consensus on the optimal IA therapy protocol. Surgery should be reserved for severe symptoms and radiographic KOA evidence, as chronic pain post-surgery poses significant societal and economic burdens. The experts advocate for a multidisciplinary approach, promoting interaction and collaboration between specialists and general practitioners, to enhance KOA care and treatment consistency in Italy.
Collapse
Affiliation(s)
- Stefano Giaretta
- UOC Ortopedia e Traumatologia OC San Bortolo di Vicenza (AULSS 8 Berica), 36100 Vicenza, Italy
| | - Alberto Magni
- Local Health Department, Desenzano sul Garda, 25015 Brescia, Italy
| | - Alberto Migliore
- Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, 00189 Rome, Italy
| | - Silvia Natoli
- Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Pain Unit, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Filomena Puntillo
- Anaesthesia, Intensive Care and Pain Unit, Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gianpaolo Ronconi
- Department of Rehabilitation, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | | | | | - Ombretta Viapiana
- Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona, 37126 Verona, Italy
| | - Gustavo Zanoli
- Orthopaedic Ward, Casa di Cura Santa Maria Maddalena, Occhiobello, 45030 Rovigo, Italy
| |
Collapse
|
4
|
Guo R, Ou YN, Ma LY, Tang L, Yang L, Feng JF, Cheng W, Tan L, Yu JT. Osteoarthritis, osteoarthritis treatment and risk of incident dementia: a prospective cohort study based on UK Biobank. Age Ageing 2024; 53:afae167. [PMID: 39108220 PMCID: PMC11303829 DOI: 10.1093/ageing/afae167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/22/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND We aimed to investigate the association between OA and treatment with dementia risk and structural brain abnormalities. METHODS We recruited a total of 466,460 individuals from the UK Biobank to investigate the impact of OA on the incidence of dementia. Among the total population, there were 63,081 participants diagnosed with OA. We subsequently categorised the OA patients into medication and surgery groups based on treatment routes. Cox regression models explored the associations between OA/OA treatment and dementia risk, with the results represented as hazard ratios (HRs) and 95% confidence intervals (95% CI). Linear regression models assessed the associations of OA/OA therapy with alterations in cortical structure. RESULTS During an average of 11.90 (± 1.01) years of follow-up, 5,627 individuals were diagnosed with all-cause dementia (ACD), including 2,438 AD (Alzheimer's disease), and 1,312 VaD (vascular dementia) cases. Results revealed that OA was associated with the elevated risk of ACD (HR: 1.116; 95% CI: 1.039-1.199) and AD (HR: 1.127; 95% CI: 1.013-1.254). OA therapy lowered the risk of dementia in both medication group (HR: 0.746; 95% CI: 0.652-0.854) and surgery group (HR: 0.841; 95% CI: 0.736-0.960). OA was negatively associated with cortical area, especially precentral, postcentral and temporal regions. CONCLUSIONS Osteoarthritis increased the likelihood of developing dementia, and had an association with regional brain atrophy. OA treatment lowered the dementia risk. OA is a promising modifiable risk factor for dementia.
Collapse
Affiliation(s)
- Rong Guo
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Ya-Nan Ou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Li-Yun Ma
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Lian Tang
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Liu Yang
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Jian-Feng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- Fudan ISTBI—ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- Zhangjiang Fudan International Innovation Center, Shanghai, China
| | - Wei Cheng
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, Shanghai, China
- Fudan ISTBI—ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, Shanghai, China
| |
Collapse
|
5
|
Neogi T, Dell'Isola A, Englund M, Turkiewicz A. Frequent use of prescription NSAIDs among people with knee or hip osteoarthritis despite contraindications to or precautions with NSAIDs. Osteoarthritis Cartilage 2024:S1063-4584(24)01315-3. [PMID: 39068982 DOI: 10.1016/j.joca.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/21/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To describe the use of non-steroidal anti-inflammatory drugs (NSAID), opioids, and physiotherapy (PT) among persons with newly diagnosed knee or hip osteoarthritis (OA) with and without NSAID contraindications or precautions. DESIGN We used population-based register data to identify adults aged ≥35 as of January 1, 2014, residing in Skåne region (Sweden) between 2004 and 2013, without a previous knee or hip OA diagnosis. Among this cohort, we identified people with incident knee or hip OA diagnosis between 2014 and 2018 and the presence of contraindications to or precautions for oral NSAIDs at the time of OA diagnosis. We estimated the risk of 1) regular oral NSAID use, 2) regular opioid use, and 3) PT during the first year after diagnosis among those with vs. without contraindications or precautions using confounder-adjusted logistic regression with standardization. RESULTS We identified 35,173 persons with newly diagnosed OA, of whom 3257 and 8351 had ≥1 contraindication to oral NSAIDs and ≥1 precaution, respectively. Overall, 27% of individuals used oral NSAIDs (with or without opioids or PT), 10% used opioids, and 57% attended PT. Among patients with contraindications, 21% used oral NSAIDs compared to 31% without (absolute adjusted difference -0.06 (95% CIs: -0.08, -0.05)), 53% vs 59% used PT (adjusted difference -0.03 (-0.05, -0.01)), while 14% vs. 8% had prescribed dispensed opioids (adjusted difference 0.02 (0.01, 0.03)). Similar results were observed for those with precautions. CONCLUSIONS We highlight the need for safer treatment options. People with OA and contraindications/precautions to NSAIDs have a higher risk of opioid use, slightly lower risk of PT use, and continue to be prescribed NSAIDs.
Collapse
Affiliation(s)
- Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA.
| | - Andrea Dell'Isola
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden.
| | - Martin Englund
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Aleksandra Turkiewicz
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| |
Collapse
|
6
|
Hurtado I, Robles C, García-Sempere A, Llopis-Cardona F, Sánchez-Sáez F, Rodríguez-Bernal C, Peiró S, Sanfélix-Gimeno G. Long-term use of prescription opioids for non-cancer pain and mortality: a population-based, propensity-weighted cohort study. Public Health 2024; 232:4-13. [PMID: 38718737 DOI: 10.1016/j.puhe.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE The objective of this study was to identify factors associated with long-term opioid use and to assess the association between long-term use and death. STUDY DESIGN Retrospective cohort study combining several population-wide databases and covering a population of five million inhabitants, including all adults who were initiated on opioid treatment from 2014 to 2018 for non-cancer pain. METHODS We used logistic regression models to identify factors associated with chronic opioid use and carried out survival analyses using multivariable Cox regression modelling for all-cause mortality during follow-up using inverse probability of treatment weighting (IPTW) and propensity scores based on the probability of using opioids chronically. RESULTS Among 760,006 patients, 82,423 (10.85%) used opioids for 90 days or more after initiation. Initial therapy characteristics associated with higher risk for long-term use were initiating with long- and short-acting opioids (when compared to tramadol, odds ratio [OR]: 2.63, 95% confidence interval [CI]: 2.57, 2.69 and OR: 1.60, 95%CI: 1.46, 1.76, respectively), using higher daily doses (when compared to 50 morphine milligramme equivalent [MME] or less, prescribing 50 to 89 daily MME, OR: 1.76, 95%CI: 1.65, 1.87; 90 to 119 daily MME, OR: 2.44, 95%CI: 1.99, 3.01; and more than 120 daily MME, OR: 1.77, 95%CI: 1.64, 1.91), and overlapping with gabapentinoids (OR: 2.26, 95%CI: 2.20, 2.32), benzodiazepines (OR: 1.32, 95%CI: 1.30, 1.35), and antipsychotics (OR: 1.21, 95%CI: 1.16, 1.26). After IPTW, chronic opioid use was associated with higher risk of all-cause mortality when compared to short-term use (Hazard Ratio (HR): 1.37, 95%CI: 1.32, 1.42). Sensitivity analyses provided similar results. CONCLUSION These findings may help healthcare managers to identify and address patients at higher risk of long-term use and riskier prescription patterns.
Collapse
Affiliation(s)
- I Hurtado
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Fisabio, Spain; Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - C Robles
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Fisabio, Spain; Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - A García-Sempere
- Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain.
| | - F Llopis-Cardona
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Fisabio, Spain; Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - F Sánchez-Sáez
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Fisabio, Spain; Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - C Rodríguez-Bernal
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Fisabio, Spain; Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - S Peiró
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Fisabio, Spain; Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - G Sanfélix-Gimeno
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Fisabio, Spain; Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| |
Collapse
|
7
|
Peng F, Chung CH, Koh WY, Chien WC, Lin CE. Risks of mental disorders among inpatients with burn injury: A nationwide cohort study. Burns 2024; 50:1315-1329. [PMID: 38519375 DOI: 10.1016/j.burns.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE This investigation identified the association between burn injuries and the risk of mental disorders in patients with no documented pre-existing psychiatric comorbidities. We also examined the relationship of injury severity and the types of injury with the likelihood of receiving new diagnoses of mental disorders. METHODS This population-based retrospective cohort study used administrative data extracted from the Taiwanese National Health Insurance Research Database (NHIRD) between 2000 and 2013. In total, 10,045 burn survivors were matched with a reference cohort of 40,180 patients without burn injuries and were followed to determine if any mental disorder was diagnosed. Patients diagnosed with mental disorders in the five years before study initiation were excluded to ensure incident diagnoses throughout the research duration. Generalized estimating equations in Cox proportional hazard regression models were used for data analysis. RESULTS In general, burn injury survivors have a 1.21-fold risk of being diagnosed with new mental disorders relative to patients without burn injuries. Total body surface area (TBSA) of ≧ 30% (aHR: 1.49, 95% CI: 1.36-1.63) and third- or fourth-degree burns (aHR: 1.49, 95% CI: 1.37-1.63) had a significantly greater risk of being diagnosed with mental disorders in comparison to the reference cohort. Patients TBSA 10-29% (aHR: 0.85, 95% CI: 0.77-0.93) and first- or second-degree burn victims (aHR: 0.89, 95% CI: 0.81-0.97) had relatively lower risk of mental disorders than the reference cohort. CONCLUSION Burn injuries were associated with an increased risk of mental disorders. Additional research in this field could elucidate this observation, especially if the inherent limitations of the NHIRD can be overcome.
Collapse
Affiliation(s)
- Fan Peng
- Department of Psychiatry, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC; School of Post-baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wan-Ying Koh
- School of Post-baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Department of General Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC; Graduate Institute of Life Science, National Defense Medical Center, Taiwan, ROC.
| | - Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC; School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC.
| |
Collapse
|
8
|
Karst M. Overview: Chronic Pain and Cannabis-Based Medicines. PHARMACOPSYCHIATRY 2024; 57:152-159. [PMID: 38198809 PMCID: PMC11076105 DOI: 10.1055/a-2231-6630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024]
Abstract
Chronic pain is primarily conceptualized as a disease in its own right when it is associated with emotional distress and functional impairment. Pathophysiologically, dysfunction of the cortico-mesolimbic connectome is of major importance, with overlapping signals in the nociceptive and stress systems. The endocannabinoid system plays an important role in the central processing of nociceptive signals and regulates the central stress response. Clinically, there is moderate evidence that cannabis-based medicines (CBM) can contribute to a significant reduction in pain, especially the associated pain affect, and improvement in physical function and sleep quality in a proportion of patients with chronic pain. The analgesic effect appears to be largely independent of the cause of pain. In this context, CBM preferentially regulates stress-associated pain processing.
Collapse
Affiliation(s)
- Matthias Karst
- Anesthesiology, Pain Clinic, Hannover Medical School, Hannover,
Germany
| |
Collapse
|
9
|
Li F, Li J, Yuan Y, Zhang H, Zhang S, Bian L, Wang T, Jiang Z. A real-world comparison of circulating tumor cells in breast cancer from China: Novel device, CTC counts and its overall survival. Heliyon 2024; 10:e29217. [PMID: 38623216 PMCID: PMC11016733 DOI: 10.1016/j.heliyon.2024.e29217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
Background Both CellSearch and CellCollector have been accepted as the proper devices to capture CTC by domestic approval department. However, there is little article about the comparison between these two devices around the world. Herein, we conducted the real-world study to compare with these two devices and to re-verify the efficacy of CTC counts. Methods Patients who meet the following points should be included in the analysis. 1. Female, aged 18 years or older; 2. Eastern Cooperative Oncology Group (ECOG) score 0-2; 3. With at least one measurable tumor lesion; 4. Clear immunohistochemistry result; 5. Accept at least one CTC test. Patients were excluded in the analysis if they had a history of malignant tumors, incomplete follow-up information. Results 536 metastatic breast cancer patients who had been detected for CTC at least once by CellSearch or CellCollector were included in the analysis. CellCollector in vivo CTC detection technology has a higher detection rate than the CellSearch system (69.2% vs 57.4%, P = 0.009). However, the proportion of CTC≥5 detected by CellSearch was higher than CellCollector (37.4% vs 16.3%, P < 0.001). There was a statistically significant difference in overall survival of patients with CTC negative and CTC positive (mOS:49.8 months vs 26.9 months). After 4 weeks of treatment, when CTC decreased by more than 50%, there was a significant difference in survival between the two groups (40.1 months vs 25.8 months, HR = 0.588, 95% CI: 0.350-0.933). In addition, for HER2-positive patients, Patients with CTC HER2 positive had longer overall survival than patients with CTC HER2 negative (median OS: 26.7 months vs 17.3 month, HR = 0.528, 95% CI: 0.269-0.887). Conclusions Real-world data indicate that CTC is an independent prognostic factor, and CellCollector and CellSearch have their own advantages in CTC detection.
Collapse
Affiliation(s)
- Feng Li
- Department of Breast Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, People's Republic of China
| | - Jianbin Li
- Department of Breast Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, People's Republic of China
- Department of Medical Molecular Biology, Beijing Institute of Biotechnology, Academy of Military Medical Sciences, Beijing, 100850, People's Republic of China
| | - Yang Yuan
- Department of Breast Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, People's Republic of China
| | - Huiqiang Zhang
- Department of Breast Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, People's Republic of China
| | - Shaohua Zhang
- Department of Breast Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, People's Republic of China
| | - Li Bian
- Department of Breast Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, People's Republic of China
| | - Tao Wang
- Department of Breast Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, People's Republic of China
| | - Zefei Jiang
- Department of Breast Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100071, People's Republic of China
| |
Collapse
|
10
|
Bosco E, Riester MR, Beaudoin FL, Schoenfeld AJ, Gravenstein S, Mor V, Zullo AR. Comparative safety of tramadol and other opioids following total hip and knee arthroplasty. BMC Geriatr 2024; 24:319. [PMID: 38580920 PMCID: PMC10996118 DOI: 10.1186/s12877-024-04933-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/29/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Tramadol is increasingly used to treat acute postoperative pain among older adults following total hip and knee arthroplasty (THA/TKA). However, tramadol has a complex pharmacology and may be no safer than full opioid agonists. We compared the safety of tramadol, oxycodone, and hydrocodone among opioid-naïve older adults following elective THA/TKA. METHODS This retrospective cohort included Medicare Fee-for-Service beneficiaries ≥ 65 years with elective THA/TKA between January 1, 2010 and September 30, 2015, 12 months of continuous Parts A and B enrollment, 6 months of continuous Part D enrollment, and no opioid use in the 6 months prior to THA/TKA. Participants initiated single-opioid therapy with tramadol, oxycodone, or hydrocodone within 7 days of discharge from THA/TKA hospitalization, regardless of concurrently administered nonopioid analgesics. Outcomes of interest included all-cause hospitalizations or emergency department visits (serious adverse events (SAEs)) and a composite of 10 surgical- and opioid-related SAEs within 90-days of THA/TKA. The intention-to-treat (ITT) and per-protocol (PP) hazard ratios (HRs) for tramadol versus other opioids were estimated using inverse-probability-of-treatment-weighted pooled logistic regression models. RESULTS The study population included 2,697 tramadol, 11,407 oxycodone, and 14,665 hydrocodone initiators. Compared to oxycodone, tramadol increased the rate of all-cause SAEs in ITT analyses only (ITT HR 1.19, 95%CLs, 1.02, 1.41; PP HR 1.05, 95%CLs, 0.86, 1.29). Rates of composite SAEs were not significant across comparisons. Compared to hydrocodone, tramadol increased the rate of all-cause SAEs in the ITT and PP analyses (ITT HR 1.40, 95%CLs, 1.10, 1.76; PP HR 1.34, 95%CLs, 1.03, 1.75), but rates of composite SAEs were not significant across comparisons. CONCLUSIONS Postoperative tramadol was associated with increased rates of all-cause SAEs, but not composite SAEs, compared to oxycodone and hydrocodone. Tramadol does not appear to have a superior safety profile and should not be preferentially prescribed to opioid-naïve older adults following THA/TKA.
Collapse
Affiliation(s)
- Elliott Bosco
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, 02912, USA.
| | - Francesca L Beaudoin
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, 02912, USA
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefan Gravenstein
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
- Department of Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Vincent Mor
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, 02912, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| |
Collapse
|
11
|
Chang HC, Tsai RY, Li CP, Gau SY. Long-term opioid therapy dose patterns in United States patients. Pain 2024; 165:959. [PMID: 38501997 DOI: 10.1097/j.pain.0000000000003178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Affiliation(s)
- Hui-Chin Chang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Library, Chung Shan Medical University Hospital, Taichung, Taiwan
- Evidence-based Medicine Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ru-Yin Tsai
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chen-Pi Li
- Department of Nursing & Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Institute of Medical Education, Chi Mei Medical Center, Tainan, Taiwan
| |
Collapse
|
12
|
Wei J, Hunter D, Lane NE, Wu J, Zeng C, Lei G, Zhang Y. Weight Loss Induced by Antiobesity Medications and All-Cause Mortality Among Patients With Knee or Hip Osteoarthritis. Arthritis Rheumatol 2024; 76:577-586. [PMID: 38053480 DOI: 10.1002/art.42754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/21/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE The current guidelines recommend weight loss for patients with overweight or obesity and knee or hip osteoarthritis (OA); however, there is a paucity of data on the relation of weight loss to death among patients with OA. We aimed to examine the relation of the rate of weight loss induced by antiobesity medications over one year to all-cause mortality among patients with overweight or obesity and knee or hip OA. METHODS Using the IQVIA Medical Research Database, we identified people with overweight or obesity and knee or hip OA. We emulated analyses of a hypothetical target trial to assess the effect of slow-to-moderate (2%-10%) or fast (≥10%) weight loss induced by the initiation of antiobesity medications within one year on all-cause mortality and secondary outcomes over five years' follow-up. RESULTS Among 6,524 participants, the five-year all-cause mortality rates were 5.3%, 4.0%, and 5.4% for weight gain or stable, slow-to-moderate weight loss, and fast weight loss arms, respectively. Compared with the weight gain or stable arm, hazard ratios of all-cause mortality were 0.72 (95% confidence interval [CI] 0.56-0.92) for the slow-to-moderate weight loss arm and 0.99 (95% CI 0.67-1.44) for the fast weight loss arm. We found dose-response protective effects of weight loss on incident hypertension, type 2 diabetes, and venous thromboembolism but a slightly higher risk of cardiovascular disease, albeit not statistically significant, in the fast rate of weight loss arm than in the weight gain or stable arm and no significant relations of weight loss to the risk of cancer. CONCLUSION In this population-based study, a slow-to-moderate, but not fast, rate of weight loss induced by antiobesity medications is associated with a lower risk of all-cause mortality in people with overweight or obesity and knee or hip OA.
Collapse
Affiliation(s)
- Jie Wei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Hunan Key Laboratory of Joint Degeneration and Injury, and Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - David Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Nancy E Lane
- Center for Musculoskeletal Health and Department of Medicine, University of California School of Medicine, Sacramento, California
| | - Jing Wu
- Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University and Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Hunan Key Laboratory of Joint Degeneration and Injury, and National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Hunan Key Laboratory of Joint Degeneration and Injury, and National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School and The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
13
|
Kopriva JM, Schwartz AM, Wilson JM, Shah JA, Farley KX, Wagner ER, Gottschalk MB. Tramadol use before total shoulder arthroplasty: patients have lower risk of complications and resource utilization than those using traditional opioids. J Shoulder Elbow Surg 2024; 33:863-871. [PMID: 37659701 DOI: 10.1016/j.jse.2023.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Evidence continues to mount for the deleterious effects of preoperative opioid use in the setting of total shoulder arthroplasty (TSA). Tramadol, a synthetic opioid with concomitant neurotransmitter effects, has become a popular alternative to traditional opioids, but it has not been well studied in the preoperative setting of TSA. The purpose of this study is to evaluate postsurgical outcomes in TSA for patients with preoperative tramadol use compared with patients using traditional opioids and those who were opioid naïve. METHODS Using the IBM Watson Health MarketScan databases, a retrospective cohort study was performed for patients who underwent TSA from 2009 to 2018. Filled pain prescriptions were collected, and prescribing trends were analyzed. Outcomes were compared between 4 patient cohorts defined by preoperative analgesia use-opioid naïve, tramadol, traditional opioids, and combination (opioids and tramadol). Multivariate analysis was used to account for small variations in cohort demographics and comorbidities. Analysis focused on resource utilization and complications. Revision rates at 1 and 3 years postoperatively were also compared. RESULTS A total of 29,454 TSA patients were studied, with 8959 available for 3-year postoperative follow-up. Of these, 10,462 (35.5%) were prescribed traditional opioids and 2214 (7.5%) tramadol only. From 2009 to 2018, prescribing trends in the United States demonstrated a significant decrease in the number of patients prescribed preoperative narcotics, whereas the number of patients prescribed preoperative tramadol and those who were opioid naïve significantly increased. Compared with opioid-naïve patients, the traditional opioid cohort had significantly increased odds of resource utilization and complications, whereas the tramadol cohort did not. Specifically, the traditional opioid cohort had an increased risk of prosthetic joint infection compared with both opioid-naïve and tramadol cohorts. The traditional opioid cohort had higher revision rates than opioid-naïve patients at 1 and 3 years, whereas the tramadol cohort did not. CONCLUSION Despite a decrease in opioid prescriptions over the study period, many patients in the United States remain on opioids. Although tramadol is not without its own risks, our results suggest that patients taking preoperative tramadol as an alternative to traditional opioids for glenohumeral arthritic pain had a lesser postoperative risk profile, comparable with opioid-naïve patients.
Collapse
Affiliation(s)
- John M Kopriva
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA.
| | - Andrew M Schwartz
- Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA
| | - Jacob M Wilson
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN, USA
| | - Jason A Shah
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Kevin X Farley
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
| | - Eric R Wagner
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | | |
Collapse
|
14
|
Misra D, Felson DT. Evidence-Based Review of Nonsurgical Treatments for Knee and Hip Osteoarthritis. Eur J Rheumatol 2024; 11. [PMID: 38705970 PMCID: PMC11184962 DOI: 10.5152/eurjrheum.2024.22096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/09/2024] [Indexed: 05/07/2024] Open
Abstract
Knee and hip osteoarthritis (OA) are highly prevalent joint diseases that lead to chronic pain, disability, and increased mortality. In this review, we provide a summary of nonsurgical treatments available for knee and hip OA that have evidence to support their use. We also provide a summary of the treatments available for knee and hip OA that do not have sufficient evidence to support their use. Treatments covered in this review include pharmacologic and nonpharmacologic modalities. Cite this article as: Misra D, Felson DT. Evidence-based review of nonsurgical treatments for knee and hip osteoarthritis. Eur J Rheumatol. Published online March 25, 2024. doi: 10.5152/ eurjrheum.2024.22096.
Collapse
Affiliation(s)
- Devyani Misra
- Division of Gerontology and Rheumatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David T. Felson
- Boston University School of Medicine, Boston University, Boston, MA, USA
| |
Collapse
|
15
|
Cai C, Knudsen S, Weant K. Opioid Prescribing by Emergency Physicians: Trends Study of Medicare Part D Prescriber Data 2013-2019. J Emerg Med 2024; 66:e313-e322. [PMID: 38290881 DOI: 10.1016/j.jemermed.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/01/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Emergency physicians play a critical role in mitigating the opioid epidemic in public health. OBJECTIVES To analyze the prescribing of emergency physicians for opioids among Medicare beneficiaries enrolled in the Part D program from 2013 to 2019. METHODS We conducted a retrospective, cross-sectional, descriptive analysis of Medicare Part D prescriber data, focusing on opioid claims between 2013 and 2019. The primary outcome variables evaluated included proportion of opioid claims, trends of the most prescribed opioids, cost of opioid claims, and days' supply per claim. RESULTS A total of 63,586 emergency physicians were identified over the study period. Opioid prescription by emergency physicians decreased from 14.45% to 11.55%, and the cost spent on opioid drugs declined by 50%. The use of drugs such as hydrocodone-acetaminophen and oxycodone-acetaminophen declined substantially, whereas tramadol and acetaminophen-codeine prescription increased. The opioid prescribing rate and days' supply also decreased. CONCLUSIONS The decline in traditional opioid agents such as hydrocodone-acetaminophen was partly offset by an increase in opioids like tramadol, which carry additional potential adverse events. Opioid prescribing rate, average days' supply, and cost of opioid drugs significantly decreased from 2015 to 2019, after a spike in 2015. All regions observed a decrease in emergency physicians, but opioid prescribing rates varied across regions. These trends highlight successful opioid stewardship practices in some areas and the need for further development in others. This information can aid in designing tailored guidelines and policies for emergency physicians to promote effective opioid stewardship practices.
Collapse
Affiliation(s)
- Chao Cai
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Sophia Knudsen
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Kyle Weant
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina
| |
Collapse
|
16
|
Johansson MS, Pottegård A, Søndergaard J, Englund M, Grønne DT, Skou ST, Roos EM, Thorlund JB. Use of prescribed analgesics before and after exercise therapy and patient education in patients with knee or hip osteoarthritis. Rheumatol Int 2024; 44:319-328. [PMID: 37775621 PMCID: PMC10796603 DOI: 10.1007/s00296-023-05432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Abstract
The aim of this study was to investigate utilisation patterns of prescribed analgesics before, during, and after an exercise therapy and patient education program among patients with knee or hip osteoarthritis. This cohort study is based on data from the nationwide Good Life with osteoarthritis in Denmark (GLA:D®) patient-register linked with national health registries including data on prescribed analgesics. GLA:D® consists of 8-12 weeks of exercise and patient education. We included 35,549 knee/hip osteoarthritis patients starting the intervention between January 2013 and November 2018. Utilisation patterns the year before, 3 months during, and the year after the intervention were investigated using total dispensed defined daily doses (DDDs) per month per 1000 population as outcome. During the year before the intervention, use of prescribed paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids increased with 85%, 79% and 22%, respectively. During the intervention, use of paracetamol decreased with 16% with a stable use the following year. Use of NSAIDs and opioids decreased with 38% and 8%, respectively, throughout the intervention and the year after. Sensitivity analyses indicated that the prescription of most analgesics changed over time. For paracetamol, NSAIDs, and opioids, 10% of analgesic users accounted for 45%, 50%, and 70%, respectively, of the total DDDs dispensed during the study period. In general, analgesic use increased the year before the intervention followed by a decrease during the intervention and the year after. A small proportion of analgesic users accounted for half or more of all paracetamol, NSAIDs, and opioids dispensed during the study period.
Collapse
Affiliation(s)
- Melker S Johansson
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Anton Pottegård
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Dorte T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Ewa M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jonas B Thorlund
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
17
|
Yang Z, Mathieson S, Kobayashi S, Abdel Shaheed C, Nogueira LAC, Simic M, Machado G, McLachlan AJ. Prevalence of Nonsteroidal Antiinflammatory Drugs Prescribed for Osteoarthritis: A Systematic Review and Meta-Analysis of Observational Studies. Arthritis Care Res (Hoboken) 2023; 75:2345-2358. [PMID: 37221152 DOI: 10.1002/acr.25157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/04/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Our systematic review aimed to investigate the proportion of participants with osteoarthritis who were prescribed nonsteroidal antiinflammatory drugs (NSAIDs) by their health care provider. METHODS Electronic databases were searched for observational studies reporting NSAID prescribing to participants with diagnosed osteoarthritis of any region. Risk of bias was assessed using a tool designed for observational studies measuring prevalence. Random and fixed-effects meta-analysis was used. Meta-regression investigated study-level factors associated with prescribing. The overall evidence quality was assessed using Grading of Recommendations Assessment, Development, and Evaluation criteria. RESULTS Fifty-one studies were included, published between 1989 and 2022, with 6,494,509 participants. The mean age of participants was 64.7 years (95% confidence interval [95% CI] 62.4, 67.0; n = 34 studies). Most studies were from Europe and Central Asia (n = 23 studies), and North America (n = 12 studies). Most studies were judged to be at low risk of bias (75%). Heterogeneity was eliminated when removing studies with a high risk of bias, to give a pooled estimate of NSAIDs prescribing to participants with osteoarthritis of 43.8% (95% CI 36.8, 51.1; moderate quality of evidence). Meta-regression determined that prescribing was associated with year (decreased prescribing over time; P = 0.05) and geographic region (P = 0.03; higher in Europe and Central Asia and in South Asia than in North America) but not with clinical setting. CONCLUSION Data from over 6.4 million participants with osteoarthritis between 1989 and 2022 indicate that NSAID prescribing has decreased over time and that prescribing differs between geographic locations.
Collapse
Affiliation(s)
| | | | - Sarah Kobayashi
- University of Sydney and Australian Catholic University, Sydney, New South Wales, Australia
| | | | | | - Milena Simic
- University of Sydney, Sydney, New South Wales, Australia
| | | | | |
Collapse
|
18
|
Han S, Lu H, Yu Y, Liu X, Jing F, Wang L, Zhao Y, Hou M. Hyperlipidemia in immune thrombocytopenia: a retrospective study. Thromb J 2023; 21:102. [PMID: 37784127 PMCID: PMC10544441 DOI: 10.1186/s12959-023-00545-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/13/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Immune thrombocytopenia (ITP) is an autoimmune hemorrhagic disease characterized by low platelet count and bleeding manifestations. However, some patients also suffered from atherosclerosis or even infarction. Apart from activated platelets, lipid metabolism takes a large part in the formation of atherosclerosis and metabolic syndrome. The lipid metabolic state in ITP patients is still unknown. METHODS We retrospectively reviewed 302 hospitalized ITP patients in our cohort, comparing their blood lipids, bleeding symptoms, metabolic diseases and treatment responses. RESULTS We found a high proportion of ITP patients suffered from hyperlipidemia, and other metabolic diseases including cardiovascular or cerebral atherosclerosis or infarction, hypertension, and type 2 diabetes. Hyperlipidemia was associated with severe bleeding and treatment refractoriness in ITP. Statins could alleviate thrombocytopenia and bleeding severity, and facilitate ITP treatment, while improving hyperlipidemia in ITP patients. CONCLUSIONS Our present study demonstrated that lipid metabolism might play an indispensable role in ITP pathogenesis and development.
Collapse
Affiliation(s)
- Shouqing Han
- Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China
- Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital of Shandong University, Jinan, China
| | - Hui Lu
- Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Yafei Yu
- Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China
- Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital of Shandong University, Jinan, China
| | - Xinguang Liu
- Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China
- Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital of Shandong University, Jinan, China
| | - Fangmiao Jing
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Liang Wang
- Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China.
- Department of Hematology, Shengli Oilfield Central Hospital, Dongying, China.
| | - Yajing Zhao
- Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China.
- Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital of Shandong University, Jinan, China.
| | - Ming Hou
- Department of Hematology, Qilu Hospital of Shandong University, 107 West Wenhua Road, Jinan, 250012, Shandong, China.
- Leading Research Group of Scientific Innovation, Department of Science and Technology of Shandong Province, Qilu Hospital of Shandong University, Jinan, China.
| |
Collapse
|
19
|
Wei J, Zeng C, Lane NE, Li X, Lei G, Zhang Y. Interactions of Nonsteroidal Antiinflammatory Drugs and Aspirin and Risk of Cardiovascular Disease in Patients With Osteoarthritis. Am J Epidemiol 2023; 192:1432-1448. [PMID: 37073405 DOI: 10.1093/aje/kwad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 03/28/2023] [Accepted: 04/13/2023] [Indexed: 04/20/2023] Open
Abstract
Nonsteroidal antiinf lammatory drugs (NSAIDs) remain the mainstay of the pharmacologic management for relieving osteoarthritis pain, and low-dose aspirin is often prescribed to osteoarthritis patients who are at high risk of cardiovascular disease (CVD). We conducted cohort studies using data from The Health Improvement Network (THIN) database (2000-2019) to assess whether the relationship of initiation of naproxen or ibuprofen vs. initiation of other NSAIDs (excluding both naproxen and ibuprofen), respectively, to the risk of CVD was modified by coprescription of low-dose aspirin among the participants with osteoarthritis. Among participants without coprescription of aspirin, the risk of CVD was lower in naproxen initiators (10.3/1000 person-years) than in other NSAIDs initiators (13.2/1000 person-years; hazard ratio = 0.71, 95% confidence interval: 0.60, 0.85). Among participants with coprescription of aspirin, however, the risk of CVD was higher among naproxen initiators (36.9/1000 person-years) than that among other NSAIDs initiators (34.8/1000 person-years; hazard ratio = 1.48, 95% confidence interval: 1.12, 1.84). The association was significantly modified by coprescription of aspirin (P < 0.001). Similar findings were observed in the association of initiation of ibuprofen vs. other NSAIDs with the risk of CVD, which was significantly modified by coprescription of aspirin (P < 0.001). These findings suggest that osteoarthritis patients and clinicians should be aware of the potential CVD risk of concurrently taking naproxen or ibuprofen and low-dose aspirin.
Collapse
|
20
|
McCormick N, Yokose C, Wei J, Lu N, Wexler DJ, Aviña-Zubieta JA, De Vera MA, Zhang Y, Choi HK. Comparative Effectiveness of Sodium-Glucose Cotransporter-2 Inhibitors for Recurrent Gout Flares and Gout-Primary Emergency Department Visits and Hospitalizations : A General Population Cohort Study. Ann Intern Med 2023; 176:1067-1080. [PMID: 37487215 DOI: 10.7326/m23-0724] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Sodium-glucose cotransporter-2 inhibitors (SGLT2is) decrease serum urate levels, but whether this translates into prevention of recurrent flares among patients with gout and gout-primary emergency department (ED) visits or hospitalizations is unknown. OBJECTIVE To compare gout flares and cardiovascular events among patients with gout initiating SGLT2is versus dipeptidyl peptidase 4 inhibitors (DPP-4is), another second-line glucose-lowering agent not associated with serum urate levels or cardiovascular risk. DESIGN Propensity score-matched, new-user cohort study. SETTING General population database from 1 January 2014 to 30 June 2022. PARTICIPANTS Patients with gout and type 2 diabetes. MEASUREMENTS The primary outcome was recurrent gout flare counts ascertained by ED, hospitalization, outpatient, and medication dispensing records. Secondary outcomes included myocardial infarction and stroke; genital infection (positive control) and osteoarthritis encounter (negative control) were also assessed. Poisson and Cox proportional hazards regressions were used with 1:1 propensity score matching (primary analysis) and overlap weighting (sensitivity analysis). RESULTS After propensity score matching, the flare rate was lower among SGLT2i initiators than DPP-4i initiators (52.4 and 79.7 events per 1000 person-years, respectively), with a rate ratio (RR) of 0.66 (95% CI, 0.57 to 0.75) and a rate difference (RD) of -27.4 (CI, -36.0 to -18.7) per 1000 person-years. The corresponding RR and RD for gout-primary ED visits and hospitalizations were 0.52 (CI, 0.32 to 0.84) and -3.4 (CI, -5.8 to -0.9) per 1000 person-years, respectively. The corresponding hazard ratio (HR) and RD for myocardial infarction were 0.69 (CI, 0.54 to 0.88) and -7.6 (CI, -12.4 to -2.8) per 1000 person-years; the HR for stroke was 0.81 (CI, 0.62 to 1.05). Those who initiated SGLT2is showed higher risk for genital infection (HR, 2.15 [CI, 1.39 to 3.30]) and no altered risk for osteoarthritis encounter (HR, 1.07 [CI, 0.95 to 1.20]). Results were similar when propensity score overlap weighting was applied. LIMITATION Participants had concurrent type 2 diabetes. CONCLUSION Among patients with gout, SGLT2is may reduce recurrent flares and gout-primary ED visits and hospitalizations and may provide cardiovascular benefits. PRIMARY FUNDING SOURCE National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Collapse
Affiliation(s)
- Natalie McCormick
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts; The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; and Arthritis Research Canada, Vancouver, British Columbia, Canada (N.M., H.K.C.)
| | - Chio Yokose
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital; The Mongan Institute, Department of Medicine, Massachusetts General Hospital; and Department of Medicine, Harvard Medical School, Boston, Massachusetts (C.Y., Y.Z.)
| | - Jie Wei
- Health Management Center, Department of Orthopaedics, National Clinical Research Center of Geriatric Disorders, and Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, and Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China (J.W.)
| | - Na Lu
- Arthritis Research Canada, Vancouver, British Columbia, Canada (N.L.)
| | - Deborah J Wexler
- Department of Medicine, Harvard Medical School, and Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts (D.J.W.)
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, and Division of Rheumatology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada (J.A.A.)
| | - Mary A De Vera
- Arthritis Research Canada, and Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada (M.A.D.V.)
| | - Yuqing Zhang
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital; The Mongan Institute, Department of Medicine, Massachusetts General Hospital; and Department of Medicine, Harvard Medical School, Boston, Massachusetts (C.Y., Y.Z.)
| | - Hyon K Choi
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts; The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; and Arthritis Research Canada, Vancouver, British Columbia, Canada (N.M., H.K.C.)
| |
Collapse
|
21
|
Yin P, Jiang Y, Fang X, Wang D, Li Y, Chen M, Deng H, Tang P, Zhang L. Cell-Based Therapies for Degenerative Musculoskeletal Diseases. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2207050. [PMID: 37199688 PMCID: PMC10375105 DOI: 10.1002/advs.202207050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/29/2023] [Indexed: 05/19/2023]
Abstract
Degenerative musculoskeletal diseases (DMDs), including osteoporosis, osteoarthritis, degenerative disc disease, and sarcopenia, present major challenges in the aging population. Patients with DMDs present with pain, functional decline, and reduced exercise tolerance, which result in long-term or permanent deficits in their ability to perform daily activities. Current strategies for dealing with this cluster of diseases focus on relieving pain, but they have a limited capacity to repair function or regenerate tissue. Cell-based therapies have attracted considerable attention in recent years owing to their unique mechanisms of action and remarkable effects on regeneration. In this review, current experimental attempts to use cell-based therapies for DMDs are highlighted, and the modes of action of different cell types and their derivatives, such as exosomes, are generalized. In addition, the latest findings from state-of-the-art clinical trials are reviewed, approaches to improve the efficiency of cell-based therapies are summarized, and unresolved questions and potential future research directions for the translation of cell-based therapies are identified.
Collapse
Affiliation(s)
- Pengbin Yin
- Department of Orthopedicsthe Fourth Medical CenterChinese PLA General HospitalBeijing100853China
- National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijing100853China
| | - Yuheng Jiang
- Department of Orthopedicsthe Fourth Medical CenterChinese PLA General HospitalBeijing100853China
- National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijing100853China
- Department of OrthopedicsGeneral Hospital of Southern Theater Command of PLANo. 111, Liuhua AvenueGuangzhou510010China
| | - Xuan Fang
- Department of Anatomy, Histology and EmbryologySchool of Basic Medical SciencesPeking University Health Science CenterBeijing100191China
| | - Daofeng Wang
- Department of Orthopedicsthe Fourth Medical CenterChinese PLA General HospitalBeijing100853China
- National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijing100853China
| | - Yi Li
- Department of Orthopedicsthe Fourth Medical CenterChinese PLA General HospitalBeijing100853China
- National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijing100853China
| | - Ming Chen
- Department of Orthopedicsthe Fourth Medical CenterChinese PLA General HospitalBeijing100853China
- National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijing100853China
| | - Hao Deng
- Department of OrthopedicsThird Affiliated Hospital of Jinzhou Medical UniversityJinzhouLiaoning Province121000China
| | - Peifu Tang
- Department of Orthopedicsthe Fourth Medical CenterChinese PLA General HospitalBeijing100853China
- National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijing100853China
| | - Licheng Zhang
- Department of Orthopedicsthe Fourth Medical CenterChinese PLA General HospitalBeijing100853China
- National Clinical Research Center for OrthopedicsSports Medicine & RehabilitationBeijing100853China
| |
Collapse
|
22
|
Zheng S, Zhou B, Yang L, Hou A, Zhang J, Yu H, Kuang H, Jiang H, Yang L. System pharmacology analysis to decipher the effect and mechanism of active ingredients combination from Duhuo Jisheng decoction on osteoarthritis in rats. JOURNAL OF ETHNOPHARMACOLOGY 2023:116679. [PMID: 37257711 DOI: 10.1016/j.jep.2023.116679] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
ETHNOPHARMACOLOGY RELEVANCE Duhuo Jisheng decoction is a traditional Chinese formula that has been widely used in clinical practice to treat osteoarthritis, which has the effects of removing invaded cold and dampness, relieving joint pain. However, it is difficult to determine the effective substances and mechanisms due to assorted herbs and components, and further research is needed. AIM OF THE STUDY This study was designed to explore and verify the mechanism and targets of DHJSD in the treatment of OA via network analysis and experiments. METHOD In this study, the active ingredients of DHJSD were qualitatively analyzed by UPLC-QDA. Network analysis was used to identify common targets and pathways. Next, we explored the therapeutic mechanism of DHJSD through a rat model of knee osteoarthritis. HE staining was used to judge the establishment of the animal model. ELISA and Western blotting were used to verify the expression of key pathway proteins. CONCLUSION In this study, seventeen chemical constituents in DHJSD were identified. According to the network analysis, we obtained the potential associated pathways of action. Then, molecular docking and SPR experiments showed that the sixteen identified components had high binding energies to IL-6. HE staining showed that the high-dose group of DHJSD had an obvious therapeutic effect on model rats. Compared with the model group, the levels of IL-1β, TNF-α, IL-6, MMP3, MMP13, ADAMTS4 and ADAMTS5 in serum and the expression of STAT3 and p-STAT3 protein in administration groups were significantly decreased. This result indicated that the IL-6/STAT3 signaling pathway was one of the important pathways regulated by DHJSD to improve OA.
Collapse
Affiliation(s)
- Senwang Zheng
- Key Laboratory of Chinese Materia Medica, Heilongjiang University of Chinese Medicine, Ministry of Education, Harbin, 150040, PR China
| | - Bo Zhou
- Key Laboratory of Chinese Materia Medica, Heilongjiang University of Chinese Medicine, Ministry of Education, Harbin, 150040, PR China
| | - Lin Yang
- Key Laboratory of Chinese Materia Medica, Heilongjiang University of Chinese Medicine, Ministry of Education, Harbin, 150040, PR China; Higher College, Jiangxi University of Traditional Chinese Medicine, NanChang, 330000, PR China
| | - Ajiao Hou
- Key Laboratory of Chinese Materia Medica, Heilongjiang University of Chinese Medicine, Ministry of Education, Harbin, 150040, PR China
| | - Jiaxu Zhang
- Key Laboratory of Chinese Materia Medica, Heilongjiang University of Chinese Medicine, Ministry of Education, Harbin, 150040, PR China
| | - Huan Yu
- Key Laboratory of Chinese Materia Medica, Heilongjiang University of Chinese Medicine, Ministry of Education, Harbin, 150040, PR China
| | - Haixue Kuang
- Key Laboratory of Chinese Materia Medica, Heilongjiang University of Chinese Medicine, Ministry of Education, Harbin, 150040, PR China
| | - Hai Jiang
- Key Laboratory of Chinese Materia Medica, Heilongjiang University of Chinese Medicine, Ministry of Education, Harbin, 150040, PR China.
| | - Liu Yang
- Key Laboratory of Chinese Materia Medica, Heilongjiang University of Chinese Medicine, Ministry of Education, Harbin, 150040, PR China.
| |
Collapse
|
23
|
Oya R, Ogawa S, Oya K, Hirakawa Y, Maeda C, Amaya F. Prevalence of preoperative opioid usage and its impact on postoperative outcomes: a retrospective cohort study. J Anesth 2023:10.1007/s00540-023-03198-0. [PMID: 37160444 DOI: 10.1007/s00540-023-03198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Preoperative opioid treatment increases postoperative adverse events. This study was aimed to analyze preoperative opioid prevalence in countries with low opioid consumption. Additionally, the effect of low opioid usage on postoperative outcomes was also investigated. METHODS We conducted this single center retrospective cohort analysis in a Japanese university-affiliated hospital to investigate opioid usage and its impact on the duration of postoperative hospitalization and in-hospital mortality. Adult patients who underwent general anesthesia between 2015 and 2020 were included. We extracted the patients' characteristics, surgical information and postoperative outcomes. Subgroup analysis to address opioid dose effect was performed in high and low dose opioid subgroups. RESULTS Among 20,306 inpatients, 535 (2.63%) patients used opioids preoperatively. Tramadol was the most frequently used opioid. The median morphine equivalent (MME) dose was 15 mg/day. Median duration of hospitalization was 18 and 9 days in the opioid and non-opioid groups, and in-hospital mortality was 2.06% and 0.42%. Multivariable regression analysis demonstrated that preoperative opioid use was associated with a longer duration of hospitalization and in-hospital mortality. Subgroup analysis demonstrated longer durations of hospitalization in both high (> 30 mg/day MME) and low (≤ 30 mg/day MME) dose opioid groups, while higher in-hospital mortality was seen only in the high dose opioid group. CONCLUSIONS Preoperative opioid usage was one-tenth of the United States average. Despite its low prevalence and small dosage, preoperative opioid usage was associated with poor postoperative outcomes. Dedicated perioperative interventions to prevent opioid-associated adverse events should be developed even in countries with low opioid consumption.
Collapse
Affiliation(s)
- Rina Oya
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-ku, Kyoto, 602-0841, Japan
| | - Satoru Ogawa
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-ku, Kyoto, 602-0841, Japan
| | - Kiyofumi Oya
- Peace Home Care Clinic, 16-21 Oiwake-cho, Otsu, Shiga, 520-0064, Japan
| | - Yuka Hirakawa
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-ku, Kyoto, 602-0841, Japan
| | - Chika Maeda
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-ku, Kyoto, 602-0841, Japan
| | - Fumimasa Amaya
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-ku, Kyoto, 602-0841, Japan.
| |
Collapse
|
24
|
Adalbert JR, Syal A, Varshney K, George B, Hom J, Ilyas AM. The prescription drug monitoring program in a multifactorial approach to the opioid crisis: PDMP data, Pennsylvania, 2016-2020. BMC Health Serv Res 2023; 23:364. [PMID: 37046254 PMCID: PMC10100464 DOI: 10.1186/s12913-023-09272-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 03/09/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Prescription opioids remain an important contributor to the United States opioid crisis and to the development of opioid use disorder for opioid-naïve individuals. Recent legislative actions, such as the implementation of state prescription drug monitoring programs (PDMPs), aim to reduce opioid morbidity and mortality through enhanced tracking and reporting of prescription data. The primary objective of our study was to describe the opioid prescribing trends in the state of Pennsylvania (PA) as recorded by the PA PDMP following legislative changes in reporting guidelines, and discuss the PDMP's role in a multifactorial approach to opioid harm reduction. METHODS State-level opioid prescription data summaries recorded by the PA PDMP for each calendar quarter from August 2016 through March 2020 were collected from the PA Department of Health. Data for oxycodone, hydrocodone, and morphine were analyzed by quarter for total prescription numbers and refills. Prescription lengths, pill quantities, and average morphine milliequivalents (MMEs) were analyzed by quarter for all 14 opioid prescription variants recorded by the PA PDMP. Linear regression was conducted for each group of variables to identify significant differences in prescribing trends. RESULTS For total prescriptions dispensed, the number of oxycodone, hydrocodone, and morphine prescriptions decreased by 34.4, 44.6, and 22.3% respectively (p < 0.0001). Refills fluctuated less consistently with general peaks in Q3 of 2017 and Q3 of 2018 (p = 0.2878). The rate of prescribing for all opioid prescription lengths decreased, ranging in frequency from 22 to 30 days (47.5% of prescriptions) to 31+ days of opioids (0.8% of prescriptions) (p < 0.0001). Similarly, decreased prescribing was observed for all prescription amounts, ranging in frequency from 22 to 60 pills (36.6% of prescriptions) to 60-90 pills (14.2% of prescriptions) (p < 0.0001). Overall, the average MME per opioid prescription decreased by 18.9%. CONCLUSIONS Per the PA PDMP database, opioid prescribing has decreased significantly in PA from 2016 to 2020. The PDMP database is an important tool for tracking opioid prescribing trends in PA, and PDMPs structured similarly in other states may enhance our ability to understand and influence the trajectory of the U.S. opioid crisis. Further research is needed to determine optimal PDMP policies and practices nationwide.
Collapse
Affiliation(s)
- Jenna R Adalbert
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
- Jefferson College of Population Health, Philadelphia, PA, USA.
| | - Amit Syal
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Karan Varshney
- Jefferson College of Population Health, Philadelphia, PA, USA
- Deakin University School of Medicine, Geelong, VIC, USA
| | - Brandon George
- Jefferson College of Population Health, Philadelphia, PA, USA
| | - Jeffrey Hom
- Jefferson College of Population Health, Philadelphia, PA, USA
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Asif M Ilyas
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
- Rothman Orthopaedic Institute Foundation for Opioid Research & Education, Philadelphia, PA, USA
| |
Collapse
|
25
|
Lee SW, Werner B, Nguyen D, Wang C, Kang M, Ayutyanont N, Lee S. Opioid Utility and Hospital Outcomes Among Inpatients Admitted With Osteoarthritis and Spine Disorders. Am J Phys Med Rehabil 2023; 102:353-359. [PMID: 36095159 DOI: 10.1097/phm.0000000000002101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study is to evaluate opioid analgesic utilization and predictors for adverse events during hospitalization and discharge disposition among patients admitted with osteoarthritis or spine disorders. DESIGN This is a retrospective study of 12,747 adult patients admitted to six private community hospitals from 2017 to 2020. Opioid use during hospitalization and risk factors for hospital-acquired adverse events and nonhome discharge were investigated. RESULTS The total number of patients using opioids decreased; however, the daily morphine milligram equivalent use for patients on opioids increased from 2017 to 2020. Increased odds of nonhome discharge were associated with older age, Medicaid, Medicare insurance, and increased lengths of stay, increased body mass index, daily morphine milligram equivalent, and electrolyte replacement in the osteoarthritis group. In the spine group, older age, Black race, Medicaid, Medicare, no insurance, increased Charlson Comorbidity Index, lengths of stay, polypharmacy, and heparin use were associated with nonhome discharge. Adverse events were associated with increased age, lengths of stay, Medicare, polypharmacy, antiemetic, and benzodiazepine use in the osteoarthritis group and increased Charlson Comorbidity Index, lengths of stay, and electrolyte replacement in the spine group. CONCLUSIONS Despite the decreasing number of patients using opioids over the years, patients on opioids had an increased daily morphine milligram equivalent over the same period.
Collapse
Affiliation(s)
- Se Won Lee
- From the Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada (SWL, BW, DN, CW, NA); Department of Computer Science, University of Nevada, Las Vegas, Nevada (MK); and Yeshiva University, New York, New York (SL)
| | | | | | | | | | | | | |
Collapse
|
26
|
Richard MJ, Driban JB, McAlindon TE. Pharmaceutical treatment of osteoarthritis. Osteoarthritis Cartilage 2023; 31:458-466. [PMID: 36414224 DOI: 10.1016/j.joca.2022.11.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/28/2022] [Accepted: 11/13/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To review the current state of pharmaceutical treatment recommendations for the management of osteoarthritis. METHOD A narrative review was drafted to describe treatment guidelines, mechanism of action, pharmacokinetics, and toxicity for nine classes of pharmaceuticals: 1) oral nonsteroidal anti-inflammatory drugs (NSAIDs), 2) topical NSAIDs, 3) COX-2 inhibitors, 4) duloxetine, 5) intra-articular corticosteroids, 6) intra-articular hyaluronic acid, 7) acetaminophen (paracetamol), 8) tramadol, and 9) capsaicin. RESULTS In general, oral and topical NSAIDs, including COX-2 inhibitors, are strongly recommended first-line treatments for osteoarthritis due to their ability to improve pain and function but are associated with increased risks in patients with certain comorbidities (e.g., heightened cardiovascular risks). Intra-articular corticosteroid injections are generally recommended for osteoarthritis management and have relatively minor adverse effects. Other treatments, such as capsaicin, tramadol, and acetaminophen, are more controversial, and many updated guidelines offer differing recommendations. CONCLUSION The pharmaceutical management of osteoarthritis is a constantly evolving field. Promising treatments are emerging, and medicines that were once considered conventional (e.g., acetaminophen) are gradually becoming less acceptable based on concerns with efficacy and safety. Clinicians need to consider the latest evidence and recommendations to make an informed decision with their patients about how to optimize treatment plans for patients with knee, hip, polyarticular, or hand osteoarthritis.
Collapse
Affiliation(s)
- M J Richard
- Division of Rheumatology, Immunology, and Allergy, Tufts Medical Center, Boston, MA, USA.
| | - J B Driban
- Division of Rheumatology, Immunology, and Allergy, Tufts Medical Center, Boston, MA, USA.
| | - T E McAlindon
- Division of Rheumatology, Immunology, and Allergy, Tufts Medical Center, Boston, MA, USA.
| |
Collapse
|
27
|
Wu TY, Wu WT, Lee RP, Chen IH, Yu TC, Wang JH, Yeh KT. Tramadol May Increase Risk of Hip Fracture in Older Adults with Post-Traumatic Osteoarthritis. J Pers Med 2023; 13:jpm13040580. [PMID: 37108965 PMCID: PMC10141182 DOI: 10.3390/jpm13040580] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/25/2023] [Accepted: 03/25/2023] [Indexed: 03/29/2023] Open
Abstract
Tramadol, an analgesic widely used for arthritic pain, is known to have adverse effects. This study investigated the association between the long-term use of tramadol for pain control and subsequent hip fractures in patients aged 60 years or older with posttraumatic osteoarthritis. This population-based retrospective cohort study included patients with posttraumatic osteoarthritis who received tramadol for pain control for more than 90 days within a 1-year period. A control cohort was enrolled using propensity score matching. The primary outcome was a new diagnosis of hip fracture requiring surgery. In total, 3093 patients were classified into each cohort. Tramadol use was identified as a risk factor for hip fracture (adjusted hazard ratio (aHR): 1.41; 95% confidence interval (CI): 1.09–1.82; p = 0.008), especially among patients aged 60–70 years (aHR: 2.11; 95% CI: 1.29–3.47; p = 0.003) and among male patients (aHR: 1.83; 95% CI: 1.24–2.70; p = 0.002). This is the first cohort study focusing on the association between long-term tramadol use and hip fracture among older adults with posttraumatic osteoarthritis. Tramadol, as a long-term pain control analgesic for older adults with posttraumatic osteoarthritis, may increase the risk of hip fracture, especially among male patients and those aged 60–70 years.
Collapse
Affiliation(s)
- Ting-Yu Wu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
| | - Wen-Tien Wu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 970374, Taiwan
| | - Ru-Ping Lee
- Institute of Medical Sciences, Tzu Chi University, Hualien 970374, Taiwan
| | - Ing-Ho Chen
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Tzai-Chiu Yu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
| | - Kuang-Ting Yeh
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
- Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien 970374, Taiwan
- Correspondence:
| |
Collapse
|
28
|
Lin J, Jia S, Zhang W, Nian M, Liu P, Yang L, Zuo J, Li W, Zeng H, Zhang X. Recent Advances in Small Molecule Inhibitors for the Treatment of Osteoarthritis. J Clin Med 2023; 12:jcm12051986. [PMID: 36902773 PMCID: PMC10004353 DOI: 10.3390/jcm12051986] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
Osteoarthritis refers to a degenerative disease with joint pain as the main symptom, and it is caused by various factors, including fibrosis, chapping, ulcers, and loss of articular cartilage. Traditional treatments can only delay the progression of osteoarthritis, and patients may need joint replacement eventually. As a class of organic compound molecules weighing less than 1000 daltons, small molecule inhibitors can target proteins as the main components of most drugs clinically. Small molecule inhibitors for osteoarthritis are under constant research. In this regard, by reviewing relevant manuscripts, small molecule inhibitors targeting MMPs, ADAMTS, IL-1, TNF, WNT, NF-κB, and other proteins were reviewed. We summarized these small molecule inhibitors with different targets and discussed disease-modifying osteoarthritis drugs based on them. These small molecule inhibitors have good inhibitory effects on osteoarthritis, and this review will provide a reference for the treatment of osteoarthritis.
Collapse
Affiliation(s)
- Jianjing Lin
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Shicheng Jia
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen 518036, China
- Shantou University Medical College, Shantou 515041, China
| | - Weifei Zhang
- Department of Bone and Joint, Peking University Shenzhen Hospital, Shenzhen 518036, China
- National & Local Joint Engineering Research Center of Orthopedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Mengyuan Nian
- Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Peng Liu
- Department of Bone and Joint, Peking University Shenzhen Hospital, Shenzhen 518036, China
- National & Local Joint Engineering Research Center of Orthopedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Li Yang
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Jianwei Zuo
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Wei Li
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen 518036, China
- Correspondence: (W.L.); (H.Z.); (X.Z.)
| | - Hui Zeng
- Department of Bone and Joint, Peking University Shenzhen Hospital, Shenzhen 518036, China
- National & Local Joint Engineering Research Center of Orthopedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen 518036, China
- Correspondence: (W.L.); (H.Z.); (X.Z.)
| | - Xintao Zhang
- Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen 518036, China
- Correspondence: (W.L.); (H.Z.); (X.Z.)
| |
Collapse
|
29
|
Wei J, Zhang Y, Hunter D, Zeng C, Lei G. The gut microbiome-joint axis in osteoarthritis. Sci Bull (Beijing) 2023; 68:759-762. [PMID: 36990871 DOI: 10.1016/j.scib.2023.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
|
30
|
Moses-Hampton MK, Povieng B, Ghorayeb JH, Zhang Y, Wu H. Chronic low back pain comorbidity count and its impact on exacerbating opioid and non-opioid prescribing behavior. Pain Pract 2023; 23:252-263. [PMID: 36447402 DOI: 10.1111/papr.13185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/28/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022]
Abstract
RESEARCH OBJECTIVES The objective of the study was to determine the characteristics of chronic low back pain (CLBP) comorbidity and its impact on opioid and non-opioid treatments among Chicagoland patients with CLBP. DESIGN A retrospective cross-sectional study comparing differences in comorbidity and treatment patterns among Chicagoland patients with CLBP against a matched control arm without chronic low back pain (NCLBP). SETTING Academic hospital system outpatient services. PARTICIPANTS Using the International Classification of Diseases, 10th Revision codes (ICD 10) 9589 patients were identified with CLBP with a median age of 57 years old and 62.32% female distribution. The NCLBP group comprised 9589 age-, sex-, race-, and region-matched patients. RESULTS An increased prevalence across all 17 studied comorbidities was found in CLBP patients as compared to NCLBP patients. CLBP patients carried an average of 3.5 comorbidities compared with 2.4 comorbidities in NCLBP patients. Rheumatoid arthritis (RA), joint arthritis, and obesity had the strongest relationship with CLBP. Additionally, we found that the most prescribed treatment for CLBP were opioids, which ranked above NSAIDs and physical therapy. 56% of CLBP patients were prescribed opioids as compared to 36% of NCLBP patients (Odds Ratio = 2.28, 95% CI: 2.16-2.42). Tramadol was the agent with the strongest relationship to CLBP. CLBP patients were more likely to use two or more opioids concomitantly. The number of total treatments was positively associated with the number of comorbidities in both CLBP and NCLBP patients (Cochran-Armitage trend test p < 0.0001). CONCLUSIONS Chronic low back pain patients showed a higher number of comorbidities than their NCLBP counterparts. Comorbidity count trended positively with higher treatment burden with opioids being the most prescribed treatment, often with poly-opioid use, over conservative modalities such as NSAIDs and physical therapy.
Collapse
Affiliation(s)
- Malcolm K Moses-Hampton
- Department of Physical Medicine and Rehabilitation, Rush University Medical Center, Chicago, Illinois, USA
| | - Boss Povieng
- Department of Physical Medicine and Rehabilitation, Rush University Medical Center, Chicago, Illinois, USA
| | - Joe H Ghorayeb
- University of Medicine and Health Sciences, New York, New York, USA
| | - Yanyu Zhang
- Rush University Medical Center Bioinformatics and Biostatistics Core, Chicago, Illinois, USA
| | - Hong Wu
- Department of Physical Medicine and Rehabilitation, Rush University Medical Center, Rush University Medical College, Chicago, Illinois, USA
| |
Collapse
|
31
|
Prognostic Factors Related to Clinical Response in 210 Knees Treated by Platelet-Rich Plasma for Osteoarthritis. Diagnostics (Basel) 2023; 13:diagnostics13040760. [PMID: 36832248 PMCID: PMC9956000 DOI: 10.3390/diagnostics13040760] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/27/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
Many studies have shown the effectiveness of platelet-rich plasma (PRP) in the treatment of knee osteoarthritis. We aimed to determine the factors associated with good or poor response to PRP injections in knee osteoarthritis. This was a prospective observational study. Patients with knee osteoarthritis were recruited from a university hospital. PRP was injected twice at a one-month interval. Pain was assessed on a visual analog scale (VAS) and function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic stage was collected and defined according to the Kellgren-Lawrence classification. Patients were classified as responders if they met the OMERACT-OARSI criteria at 7 months. We included 210 knees. At 7 months, 43.8% were classified as responders. Total WOMAC and VAS were significantly improved between M0 and M7. Physical therapy and a heel-buttock distance >35 cm were the two criteria associated with poor response at M7 by multivariate analysis. Pain VAS at M7 appeared to be lower in patients with osteoarthritis for less than 24 months. No adverse effects were reported. PRP treatment in knee osteoarthritis appears to be well-tolerated and effective, even in patients who reacted poorly to hyaluronic acid. Response was not associated with radiographic stage.
Collapse
|
32
|
Zhang X, Li X, Xiong Y, Wang Y, Wei J, Zeng C, Sha T, Lei G. Efficacy and Safety of Tramadol for Knee or Hip Osteoarthritis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Arthritis Care Res (Hoboken) 2023; 75:158-165. [PMID: 34251756 DOI: 10.1002/acr.24750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/09/2021] [Accepted: 07/08/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine efficacy and safety of tramadol for knee or hip osteoarthritis (OA). METHODS PubMed, Embase, Cochrane Library, and Web of Science were searched up to May 2020 for randomized controlled trials (RCTs) comparing any of the following interventions: tramadol 100 mg/day, 200 mg/day, and 300 mg/day, and placebo for knee or hip OA. Pain and function were measured at or near 12 weeks for efficacy. Gastrointestinal, cardiovascular, and central nervous system (CNS) adverse events (AEs), and withdrawals were measured for safety. Bayesian network meta-analysis was conducted. RESULTS Six RCTs (3,611 participants) were included. Tramadol 100 mg/day (standardized mean difference [SMD] -0.16 [95% confidence interval (95% CI) -0.34, 0.00]), 200 mg/day (SMD -0.21 [95% CI -0.37, -0.06]), and 300 mg/day (SMD -0.30 [95% CI -0.48, -0.14]) were statistically more effective than placebo in pain relief, but only tramadol 300 mg/day was better than placebo in functional improvement (SMD -0.24 [95% CI -0.47, -0.03]). Tramadol 100 mg/day (relative risk [RR] 2.29 [95% credible interval (CrI) 1.22, 4.25]), 200 mg/day (RR 4.35 [95% CrI 2.31, 8.01]), and 300 mg/day (RR 6.02 [95% CrI 3.22, 11.1]) involved a higher risk of gastrointestinal AEs. Similarly, tramadol 100-300 mg/day showed a higher risk of CNS AEs and withdrawals. However, the risk of cardiovascular AEs remained unclear. CONCLUSION Only tramadol 300 mg/day showed minimal improvement in pain and function but with increasing AEs compared with placebo. Tramadol may not be sufficiently recommended for knee or hip OA based on the presented evidence, especially in patients with the risk of gastrointestinal and CNS AEs.
Collapse
Affiliation(s)
- Xiurui Zhang
- Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
| | - Yilin Xiong
- Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yilun Wang
- Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Wei
- Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chao Zeng
- Hunan Key Laboratory of Joint Degeneration and Injury and Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tingting Sha
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
| | - Guanghua Lei
- Hunan Key Laboratory of Joint Degeneration and Injury and Xiangya Hospital, Central South University, Changsha, Hunan, China
| |
Collapse
|
33
|
Xie D, Choi HK, Dalbeth N, Wallace ZS, Sparks JA, Lu N, Zeng C, Li X, Wei J, Lei G, Zhang Y. Gout and Excess Risk of Severe SARS-CoV-2 Infection Among Vaccinated Individuals: A General Population Study. Arthritis Rheumatol 2023; 75:122-132. [PMID: 36082457 PMCID: PMC9537980 DOI: 10.1002/art.42339] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/19/2022] [Accepted: 08/30/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Gout patients often have multiple comorbidities, making them susceptible to SARS-CoV-2 infection and poor outcomes. This study was undertaken to examine the association between gout and the risk of SARS-CoV-2 infection and severe outcomes, especially in patients who have received a SARS-CoV-2 vaccine. METHODS We conducted 2 cohort studies using The Health Improvement Network in the UK. Individuals with gout and those without gout from the general population were followed up from December 8, 2020 to October 31, 2021. We estimated the rate difference (RD) and hazard ratio (HR) of SARS-CoV-2 infection and severe outcomes (i.e., hospitalization and death within 30 days after SARS-CoV-2 infection) for individuals with gout versus those without gout using a Cox proportional hazards model according to SARS-CoV-2 vaccination status. We adjusted for potential confounders by using overlap weighting of exposure scores. RESULTS Among the vaccinated cohort, 1,955 cases of breakthrough COVID-19 infection occurred in 54,576 individuals with gout (4.68 cases per 1,000 person-months), and 52,468 cases occurred in 1,336,377 individuals without gout (3.76 cases per 1,000 person-months). The partially adjusted RD of breakthrough infection was 0.91 cases per 1,000 person-months (95% confidence interval [95% CI] 0.62-1.20 cases per 1,000 person-months), and the partially adjusted HR was 1.24 (95% CI 1.19-1.30). Gout was also associated with an increased risk of hospitalization (adjusted HR 1.30 [95% CI 1.10-1.53]) and death (adjusted HR 1.36 [95% CI 0.87-2.13]). Women with gout had an increased risk of hospitalization (adjusted HR 1.55 [95% CI 1.15-2.10]) and death (adjusted HR 2.46 [95% CI 1.12-5.41]). Similar associations with gout were observed in the unvaccinated cohort. CONCLUSION These general population data suggest that individuals with gout, especially women, have higher risks of SARS-CoV-2 infection and severe outcomes, even when vaccinated.
Collapse
Affiliation(s)
- Dongxing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hyon K. Choi
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Harvard Medical School, Boston, USA
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Zachary S. Wallace
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Harvard Medical School, Boston, USA
| | - Jeffrey A. Sparks
- Harvard Medical School, Boston, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, USA
| | - Na Lu
- Arthritis Research Canada, Richmond, Canada
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Wei
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Harvard Medical School, Boston, USA
| |
Collapse
|
34
|
Potentially inappropriate medication use and mortality in patients with cognitive impairment. Eur J Clin Pharmacol 2022; 78:2013-2020. [DOI: 10.1007/s00228-022-03410-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
|
35
|
Johansson MS, Pottegård A, Søndergaard J, Englund M, Grønne DT, Skou ST, Roos EM, Thorlund JB. Chronic opioid use before and after exercise therapy and patient education among patients with knee or hip osteoarthritis. Osteoarthritis Cartilage 2022; 30:1536-1544. [PMID: 35988705 DOI: 10.1016/j.joca.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/10/2022] [Accepted: 08/01/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate changes in opioid use after supervised exercise therapy and patient education among knee or hip osteoarthritis patients with chronic opioid use. METHOD In this cohort study, we linked data from the Good Life with osteoArthritis in Denmark register (GLA:D®; standardised treatment program for osteoarthritis; January 2013 to November 2018) with national health registries. Among 35,549 patients, 1,262 were classified as chronic opioid users based on amount and temporal distribution of dispensed opioids the year before the intervention. We investigated changes in opioid use, measured as mg oral morphine equivalents (OMEQs), from the year before the intervention to the year after using generalized estimating equations. RESULTS We found a 10% decrease in mg OMEQs from the year before to the year after the intervention (incidence rate ratio [IRR]: 0.90, 95% confidence interval [CI]: 0.86, 0.94). Additional analyses suggested this decrease to be mainly attributable to regulatory actions targeting opioid prescribing during the study period (IRR among patients participating in the intervention before: 0.98 [95% CI: 0.89, 1.07] vs after: 0.83 [0.74, 0.93] regulatory actions). In a random general population sample of matched chronic opioid users, a similar opioid use pattern was observed over time, further supporting the impact of regulatory actions on the opioid use in the study population. CONCLUSION Among patients with knee or hip osteoarthritis and chronic opioid use, a standardised treatment program did not change opioid use when regulatory changes in opioid prescribing were taken into account.
Collapse
Affiliation(s)
- M S Johansson
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - A Pottegård
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - J Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - M Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.
| | - D T Grønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - S T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.
| | - E M Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - J B Thorlund
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| |
Collapse
|
36
|
Tuan RS, Zhang Y, Chen L, Guo Q, Yung PSH, Jiang Q, Lai Y, Yu J, Luo J, Xia J, Xu C, Lei G, Su J, Luo X, Zou W, Qu J, Song B, Zhao X, Ouyang H, Li G, Ding C, Wan C, Chan BP, Yang L, Xiao G, Shi D, Xu J, Cheung LWH, Bai X, Xie H, Xu R, Li ZA, Chen D, Qin L. Current progress and trends in musculoskeletal research: Highlights of NSFC-CUHK academic symposium on bone and joint degeneration and regeneration. J Orthop Translat 2022; 37:175-184. [PMID: 36605329 PMCID: PMC9791426 DOI: 10.1016/j.jot.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Rocky S. Tuan
- The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Lin Chen
- Daping Hospital, The Third Military (Army) Medical University, China
| | - Quanyi Guo
- Chinese PLA General Hospital, Chinese PLA Medical School, China
| | - Patrick SH. Yung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Qing Jiang
- Nanjing Drum Tower Hospital, Nanjing University, China
| | - Yuxiao Lai
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, China
| | - Jiakuo Yu
- Peking University Third Hospital, China
| | - Jian Luo
- School of Medicine, Tongji University, China
| | - Jiang Xia
- Department of Chemistry, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chenjie Xu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong SAR, China
| | - Guanghua Lei
- Xiangya Hospital Central South University, China
| | - Jiacan Su
- Changhai Hospital, People's Liberation Army Naval Medical University, China
| | | | - Weiguo Zou
- Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, China
| | - Jing Qu
- Institute of Zoology, Chinese Academy of Sciences, China
| | - Bing Song
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, China
| | - Xin Zhao
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | - Gang Li
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Changhai Ding
- Zhujiang Hospital of Southern Medical University, Menzies Institute of Medical Research, University of Tasmania, Australia
| | - Chao Wan
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Barbara P. Chan
- Faculty of Engineering, The University of Hong Kong, Hong Kong SAR, China
| | - Liu Yang
- Institute of Orthopaedics, Xijing Hospital, Air Force Medical University, China
| | - Guozhi Xiao
- Department of Biology, Southern University of Science and Technology, China
| | - Dongquan Shi
- Nanjing Drum Tower Hospital, Nanjing University, China
| | - Jiankun Xu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Louis WH. Cheung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaochun Bai
- School of Basic Medical Sciences, Southern Medical University, China
| | - Hui Xie
- Xiangya Hospital Central South University, China
| | - Ren Xu
- State Key Laboratory of Cellular Stress Biology, Xiamen University, China
| | - Zhong Alan Li
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Di Chen
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, China
| | - Ling Qin
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
37
|
Comorbidity phenotypes and risk of mortality in patients with osteoarthritis in the UK: a latent class analysis. Arthritis Res Ther 2022; 24:231. [PMID: 36229868 PMCID: PMC9559033 DOI: 10.1186/s13075-022-02909-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA) is a common chronic condition but its association with other chronic conditions and mortality is largely unknown. This study aimed to use latent class analysis (LCA) of 30 comorbidities in patients with OA and matched controls without OA to identify clusters of comorbidities and examine the associations between the clusters, opioid use, and mortality. METHODS A matched cohort analysis of patients derived from the IQVIA Medical Research Data (IMRD-UK) database between 2000 and 2019. 418,329 patients with newly diagnosed OA were matched to 243,170 patients without OA to identify comorbidity phenotypes. Further analysis investigated the effect of opioid use on mortality in individuals with OA and their matched controls. RESULTS The median (interquartile range (IQR)) number of comorbidities was 2 (1-4) and 1 (0-3) in the OA and control groups respectively. LCA identified six comorbidity phenotypes in individuals with and without OA. Clusters with a high prevalence of comorbidities were characterised by hypertension, circulatory, and metabolic diseases. We identified a comorbidity cluster with the aforementioned comorbidities plus a high prevalence of chronic kidney disease, which was associated with twice the hazard of mortality in hand OA with a hazard ratio (HR) (95% CI) of 2.53 (2.05-3.13) compared to the hazard observed in hip/knee OA subtype 1.33 (1.24-1.42). The impact of opioid use in the first 12 months on hazards of mortality was significantly greater for weak opioids and strong opioids across all groups HR (95% CI) ranging from 1.11 (1.07-11.6) to 1.80 (1.69-1.92)). There was however no evidence of association between NSAID use and altered risk of mortality. CONCLUSION This study identified six comorbidity clusters in individuals with OA and matched controls within this cohort. Opioid use and comorbidity clusters were differentially associated with the risk of mortality. The analyses may help shape the development of future interventions or health services that take into account the impact of these comorbidity clusters.
Collapse
|
38
|
Li H, Dalbeth N, Wallace ZS, Sparks JA, Li X, Zeng C, Wang Y, Xie D, Lei G, Wei J, Zhang Y. Risk of gout flares after COVID-19 vaccination: A case-crossover study. Semin Arthritis Rheum 2022; 56:152059. [PMID: 35797765 PMCID: PMC9239705 DOI: 10.1016/j.semarthrit.2022.152059] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Routine vaccinations are associated with an increased risk of gout flares. We examined the association between COVID-19 vaccination, an immunization program implemented to a large proportion of population, and the risk of gout flares. METHODS We conducted a time-stratified case-crossover study among patients with gout who experienced gout flares between December 2020 and September 2021, using data from The Health Improvement Network. We compared the risk of gout flares on each of the seven days on and after the day of COVID-19 vaccination vs. no vaccination during that period using conditional logistic regression. In addition, we performed subgroup analyses stratified by different COVID-19 vaccines (i.e., BNT162b2, hereafter referred to as BNT, and ChAdOx1 nCov-19, hereafter referred to as ChAd). RESULTS Among 5,904 patients with gout (mean age: 63·1 years; 85·5% male) who experienced gout flares within one month, the risk of gout flares slightly increased on the second day after COVID-19 vaccination (odds ratio: 1·44; 95% CI: 1·02 to 2·07). The risk of gout flares also slightly increased after receiving COVID-19 vaccine on other remaining days (ORs ranged from 1·03 to 1·22); however, none of them was statistically significant. An increased risk of gout flares on the second day after vaccination was mainly observed for the ChAd vaccine (odds ratio: 1·44; 95% CI: 1·00 to 2·05), but not for BNT vaccine (odds ratio: 1·18; 95% CI: 0·67 to 2·02). CONCLUSION COVID-19 vaccination, mainly ChAd vaccination, slightly increases the risk of gout flares on the second day after vaccination. This finding reassures the safety of COVID-19 vaccination for patients with gout.
Collapse
Affiliation(s)
- Hui Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Dongxing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China,Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China,Department of Epidemiology and Health statistics, Xiangya School of Public Health, Central South University, Changsha, China,Corresponding authors
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Corresponding authors
| |
Collapse
|
39
|
Huizinga JL, Stanley EE, Sullivan JK, Song S, Hunter DJ, Paltiel AD, Neogi T, Edwards RR, Katz JN, Losina E. Societal Cost of Opioid Use in Symptomatic Knee Osteoarthritis Patients in the United States. Arthritis Care Res (Hoboken) 2022; 74:1349-1358. [PMID: 33629485 PMCID: PMC8382774 DOI: 10.1002/acr.24581] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/18/2020] [Accepted: 02/12/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Symptomatic knee osteoarthritis (SKOA) is a chronic, disabling condition, requiring long-term pain management; over 800,000 SKOA patients in the US use opioids on a prolonged basis. We aimed to characterize the societal economic burden of opioid use in this population. METHODS We used the Osteoarthritis Policy Model, a validated computer simulation of SKOA, to estimate the opioid-related lifetime and annual cost generated by the US SKOA population. We included direct medical, lost productivity, criminal justice, and diversion costs. We modeled the SKOA cohort with a mean ± SD age of 54 ± 14 years and Western Ontario and McMaster Universities Osteoarthritis Index pain score of 29 ± 17 (0-100, 100 = worst). We estimated annual costs of strong ($1,381) and weak ($671) opioid regimens using Medicare fee schedules, Red Book, the Federal Supply Schedule, and published literature. The annual lost productivity and criminal justice costs of opioid use disorder (OUD), obtained from published literature, were $11,387 and $4,264, per-person, respectively. The 2015-2016 Medicare Current Beneficiary Survey provided OUD prevalence. We conducted sensitivity analyses to examine the robustness of our estimates to uncertainty in input parameters. RESULTS Assuming 5.1% prevalence of prolonged strong opioid use, the total lifetime opioid-related cost generated by the US SKOA population was estimated at $14.0 billion, of which only $7.45 billion (53%) were direct medical costs. CONCLUSION Lost productivity, diversion, and criminal justice costs comprise approximately half of opioid-related costs generated by the US SKOA population. Reducing prolonged opioid use may lead to a meaningful reduction in societal costs that can be used for other public health causes.
Collapse
Affiliation(s)
- Jamie L. Huizinga
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Elizabeth E. Stanley
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - James K. Sullivan
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Shuang Song
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - David J. Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - A. David Paltiel
- Public Health Modeling Unit, Yale School of Public Health, New Haven, CT, United States of America
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Robert R. Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Jeffrey N. Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| |
Collapse
|
40
|
Chalmers BP, LeBrun DG, Lebowitz J, Chiu YF, Joseph AD, Gonzalez Della Valle A. The Effect of Preoperative Tramadol Use on Postoperative Opioid Prescriptions After Primary Total Hip and Knee Arthroplasty: An Institutional Experience of 11,000 Patients. J Arthroplasty 2022; 37:S465-S470. [PMID: 35240282 DOI: 10.1016/j.arth.2022.02.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/13/2022] [Accepted: 02/21/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Preoperative opioid use increases opioid consumption postoperatively, but the effect of tramadol is poorly understood. METHODS We retrospectively reviewed 11,667 patients undergoing primary unilateral THA and TKA at a single institution. Preoperatively, there were 8,201 opioid-naïve patients (70.3%), 1,315 on tramadol (11.3%), 1,408 on narcotics (12.1%) and 743 on narcotics and tramadol (6.3%). We compared morphine milligram equivalents (MMEs) used during hospitalization, prescribed at discharge, and refilled during the first 90 days. We used multivariate analysis to assess whether preoperative tramadol use was associated with increased number of refills and total refilled MMEs. RESULTS Total in-hospital MMEs and daily MMEs was lowest for the opioid naïve patients and significantly increased for the remaining three groups (total in-hospital use: 119, 152, 211, and 196 MMEs, respectively-P < .001) (daily in-hospital use: 66, 74, 100, and 86 MMEs, respectively-P < .001). Opioid refill rate was significantly higher for all patients who were not opioid naïve (32%, 42%, 41%, and 52%, respectively-P < .001). Total MMEs prescribed after discharge was lowest for opioid naïve patients (477, 528, 590 and 658, respectively-P < .001). Logistic and linear regression controlling for age, sex, history of anxiety/depression revealed that THA patients taking tramadol preoperatively were 2.5 times more likely to require post-discharge refills and refilled 80 additional MMEs than opioid naïve patients (P < .001). CONCLUSION Tramadol is not recommended for pain beforeTKA or THA, and surgeons and patients should be aware that it is associated with a substantial increase in postoperative opioid use.
Collapse
Affiliation(s)
- Brian P Chalmers
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Drake G LeBrun
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Juliana Lebowitz
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Yu-Fen Chiu
- Biostatistics Core, Research Administration, Hospital for Special Surgery, New York, NY
| | - Amethia D Joseph
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Alejandro Gonzalez Della Valle
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| |
Collapse
|
41
|
Peng F, Koh WY, Chung CH, Chien WC, Lin CE. Risks of mental disorders among intensive care unit survivors: A nationwide cohort study in Taiwan. Gen Hosp Psychiatry 2022; 77:147-154. [PMID: 35660739 DOI: 10.1016/j.genhosppsych.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aimed to investigate the risk of mental disorders among the intensive care unit (ICU) survivors compared with the hospitalized non-ICU and non-hospitalized patients. METHOD We extracted data from the Taiwanese National Health Insurance Research Database (NHIRD) to conduct a retrospective cohort study. Multivariate Cox proportional hazard regression models were used to analyze the data. Identified from the NHIRD, we matched 15,918 patients with ICU admissions, 63,672 patients without any inpatient admission (non-inpatient department [non-IPD] cohort), and 63,672 patients admitted to a general ward but not the ICU (non-ICU cohort). The patient records were extracted between the periods of 2000-2015 to identify any occurrence of mental disorders. RESULTS During the study period, the overall risk of mental disorder diagnosis was 1.68-fold higher in the ICU cohort than the non-IPD cohort (95% confidence interval (CI): 1.23-1.89, P < 0.001). Alternatively, there were no differences in risks for any mental disorders between the ICU and non-ICU cohorts. CONCLUSION Both admissions to the ICU and the general ward cohorts were associated with a higher risk of any mental disorders compared to the general population. Further clinical studies are warranted to confirm this association due to residual or unmeasured risk factors.
Collapse
Affiliation(s)
- Fan Peng
- Department of General Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC; School of Post-baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Wan-Ying Koh
- School of Post-baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Centre, Taipei, Taiwan, ROC.
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan, ROC; School of Public Health, National Defense Medical Centre, Taipei, Taiwan, ROC; Graduate Institute of Life Science, National Defense Medical center, Taiwan, ROC.
| | - Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, ROC; School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC.
| |
Collapse
|
42
|
Pergolizzi J, Magnusson P, Coluzzi F, Breve F, LeQuang JAK, Varrassi G. Multimechanistic Single-Entity Combinations for Chronic Pain Control: A Narrative Review. Cureus 2022; 14:e26000. [PMID: 35855248 PMCID: PMC9286298 DOI: 10.7759/cureus.26000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/15/2022] [Indexed: 11/05/2022] Open
|
43
|
Li Y, Xie W, Xiao W, Dou D. Progress in osteoarthritis research by the National Natural Science Foundation of China. Bone Res 2022; 10:41. [PMID: 35610209 PMCID: PMC9130253 DOI: 10.1038/s41413-022-00207-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/24/2021] [Accepted: 02/17/2022] [Indexed: 01/10/2023] Open
Abstract
Osteoarthritis (OA) in China is gradually becoming an important scientific research area that has had a significant impact on research and development (R&D) activities in the OA field worldwide. This article summarizes the R&D progress related to OA in China in recent years. The National Natural Science Foundation of China (NSFC) is a national funding institution for basic research and plays a critical role in promoting and supporting Chinese scholars' R&D activities. We collected and analyzed information on NSFC funding in the field of OA from 2010 to 2019, including the amount, the level and the program categories of the funded projects. The data fully demonstrate the important and positive role of the NSFC in supporting free exploration, cultivating research teams and young talent, and boosting OA R&D. In this article, we outline and discuss hot topics in focused areas, key advances in this field and the prospects for progress in OA research in China.
Collapse
Affiliation(s)
- Yusheng Li
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Wenqing Xie
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Wenfeng Xiao
- Deparment of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Dou Dou
- Department of Health Sciences, National Natural Science Foundation of China, Beijing, 100085, China.
| |
Collapse
|
44
|
Ogdie A, Shin DB, Love TJ, Gelfand JM. Body surface area affected by psoriasis and the risk for psoriatic arthritis: a prospective population-based cohort study. Rheumatology (Oxford) 2022; 61:1877-1884. [PMID: 34508558 PMCID: PMC9071556 DOI: 10.1093/rheumatology/keab622] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 07/01/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Increasing psoriasis severity has been associated with comorbidities including cardiovascular disease. The objective of this study was to examine the association of psoriasis severity with the development of PsA. METHODS A prospective population-based cohort study was performed within The Health Improvement Network, a UK medical record database. Patients aged 25-60 years with a code for psoriasis were randomly selected between 2008 and 2011. Questionnaires were sent to their general practitioners to confirm the diagnosis of psoriasis and provide the patient's approximate body surface area (BSA). Incidence of PsA was calculated by BSA, and Cox proportional hazard ratios were used to examine the risk of developing PsA by BSA category after adjusting for other covariates. RESULTS Among 10 474 questionnaires sent, 9987 (95%) were returned, 9069 (91%) had confirmed psoriasis, and BSA was provided for 8881 patients: 52% had mild psoriasis, 36% moderate psoriasis and 12% severe psoriasis. The mean age was 46, and 49% were female. Mean follow-up time was 4.2 years (s.d. 2.1); the incidence of PsA was 5.4 cases per 1000 person-years. After adjusting for age and sex, BSA >10% [hazard ratio (HR) 2.01, 95% CI: 1.29, 3.13], BSA 3-10% (HR 1.44, 95% CI: 1.02, 2.03), obesity (HR 1.64, 95% CI: 1.19, 2.26) and depression (HR 1.68, 95% CI: 1.21, 2.33) were associated with incident PsA. CONCLUSIONS In this large prospective cohort study, BSA assessed by general practitioners was a strong predictor of developing PsA, and obesity and depression were additive risk factors.
Collapse
Affiliation(s)
- Alexis Ogdie
- Departments of Medicine/Rheumatology
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine
| | - Daniel B Shin
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Thorvardur Jon Love
- Department of Medicine, University of Iceland and Landspitali, Reykjavik, Iceland
| | - Joel M Gelfand
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
45
|
Mullins PM, Mazer-Amirshahi M, Pourmand A, Perrone J, Nelson LS, Pines JM. Tramadol Use in United States Emergency Departments 2007-2018. J Emerg Med 2022; 62:668-674. [PMID: 35370038 DOI: 10.1016/j.jemermed.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 01/04/2022] [Accepted: 01/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Amidst the opioid epidemic, there has been an increasing focus on opioid utilization in U.S. emergency departments (EDs). Compared with other opioids, little is known about the use of tramadol over the past decade. Tramadol has uncertain efficacy and a concerning adverse effect profile compared with traditional opioids. OBJECTIVE Our aim was to describe trends in tramadol use in U.S. EDs between 2007 and 2018. METHODS We analyzed the National Hospital Ambulatory Medical Care Survey from 2007 to 2018 to examine ED visits by patients 18 years or older in which tramadol was administered or prescribed. We examined trends in demographics and resource utilization and compared these trends with those of traditional opioids. Survey-weighted analyses were conducted to provide national-level estimates. RESULTS Between 2007 and 2018, ED visits in which tramadol was used increased 70.6%, from 1.7% of all ED visits in 2007 to 2.9% in 2018. The largest increases were noted among patients aged 55 through 64 years and 65 years and older. Diagnostic resource utilization increased across the study period. Overall opioid utilization during the study period decreased from 28.4% in 2007 to 17.9% in 2018 (p < 0.001). The use of other specific opioids declined or remained stable between 2007 and 2018. CONCLUSIONS Although the use of traditional opioids decreased from 2007 to 2018, the use of tramadol increased. Increases were largest among older patients, who may be more susceptible to the adverse effects associated with this medication. Further research in the appropriate use of tramadol in the ED setting is warranted.
Collapse
Affiliation(s)
- Peter M Mullins
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, District of Columbia
| | - Ali Pourmand
- Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jeanmarie Perrone
- Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Lewis S Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jesse M Pines
- US Acute Care Solutions, Canton, Ohio; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania
| |
Collapse
|
46
|
Li L, Marozoff S, Lu N, Xie H, Kopec JA, Cibere J, Esdaile JM, Aviña-Zubieta JA. Association of tramadol with all-cause mortality, cardiovascular diseases, venous thromboembolism, and hip fractures among patients with osteoarthritis: a population-based study. Arthritis Res Ther 2022; 24:85. [PMID: 35410440 PMCID: PMC8996663 DOI: 10.1186/s13075-022-02764-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background The use of tramadol among osteoarthritis (OA) patients has been increasing rapidly around the world, but population-based studies on its safety profile among OA patients are scarce. We sought to determine if tramadol use in OA patients is associated with increased risks of all-cause mortality, cardiovascular diseases (CVD), venous thromboembolism (VTE), and hip fractures compared with commonly prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) or codeine. Methods Using administrative health datasets from British Columbia, Canada, we conducted a sequential propensity score-matched cohort study among all OA patients between 2005 and 2013. The tramadol cohort (i.e., tramadol initiation) was matched with four comparator cohorts (i.e., initiation of naproxen, diclofenac, cyclooxygenase-2 [Cox-2] inhibitors, or codeine). Outcomes are all-cause mortality, first-ever CVD, VTE, and hip fractures within the year after the treatment initiation. Patients were followed until they either experienced an event, left the province, or the 1-year follow-up period ended, whichever occurred first. Cox proportional hazard models were used to estimate hazard ratios after adjusting for competing risk of death. Results Overall, 100,358 OA patients were included (mean age: 68 years, 63% females). All-cause mortality was higher for tramadol compared to NSAIDs with rate differences (RDs/1000 person-years, 95% CI) ranging from 3.3 (0.0–6.7) to 8.1 (4.9–11.4) and hazard ratios (HRs, 95% CI) ranging from 1.2 (1.0–1.4) to 1.5 (1.3–1.8). For CVD, no differences were observed between tramadol and NSAIDs. Tramadol had a higher risk of VTE compared to diclofenac, with RD/1000 person-years (95% CI) of 2.2 (0.7–3.7) and HR (95% CI) of 1.7 (1.3–2.2). Tramadol also had a higher risk of hip fractures compared to diclofenac and Cox-2 inhibitors with RDs/1000 person-years (95% CI) of 1.9 (0.4–3.4) and 1.7 (0.2–3.3), respectively, and HRs (95% CI) of 1.6 (1.2–2.0) and 1.4 (1.1–1.9), respectively. No differences were observed between tramadol and NSAIDs for all events. Conclusions OA patients initiating tramadol have an increased risk of mortality, VTE, and hip fractures within 1 year compared with commonly prescribed NSAIDs, but not with codeine. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02764-3.
Collapse
Affiliation(s)
- Lingyi Li
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Shelby Marozoff
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada
| | - Na Lu
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada
| | - Hui Xie
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Jacek A Kopec
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jolanda Cibere
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - John M Esdaile
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada. .,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada.
| |
Collapse
|
47
|
Glisch C, Ray JB. Things We Do for No Reason™: Prescribing tramadol for inpatients in pain. J Hosp Med 2022; 17:306-309. [PMID: 34730503 DOI: 10.12788/jhm.3643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Chad Glisch
- Medical College of Wisconsin, Department of Medicine, Milwaukee, Wisconsin
| | - James B Ray
- University of Iowa Colleges of Pharmacy & Medicine, Iowa City, Iowa
| |
Collapse
|
48
|
Kotlińska-Lemieszek A, Żylicz Z. Less Well-Known Consequences of the Long-Term Use of Opioid Analgesics: A Comprehensive Literature Review. Drug Des Devel Ther 2022; 16:251-264. [PMID: 35082488 PMCID: PMC8784970 DOI: 10.2147/dddt.s342409] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The adverse effects of short-term opioid analgesics are well known and acknowledged; however, the spectrum of the sequelae of long-term use seems less clear. Some effects may remain undetected but still have the potential to cause harm and reduce patients' quality of life. OBJECTIVE To review the literature on the adverse effects of long-term opioid therapy. METHODS We performed a quasi-systematic search, analyzing articles published in the MEDLINE database between January 2000 and March 2021 that identified adverse effects of opioids used for chronic pain treatment. RESULTS Growing evidence indicates that there are multiple serious adverse effects of opioid treatment. Long-term opioid use may have significant effects on the endocrine, immune, cardiovascular, respiratory, gastrointestinal, and neural systems. Studies show that long-term opioid treatment increases the risk of fractures, infections, cardiovascular complications, sleep-disordered breathing, bowel dysfunction, overdose, and mortality. Opioids may potentially affect cancer development. Most consequences of the long-term use of opioids have been identified in studies of patients with non-malignant pain. CONCLUSION Studies indicate that long-term use of opioids increases the risk of drug-related events in a significant number of patients. Clinicians should be aware of these complications associated with prescribing opioids, discuss them with patients, prevent complications, if possible, and diagnose them early and manage adequately. More human studies are needed to assess the risk, including trials with individual opioids, because they have different adverse effect profiles.
Collapse
Affiliation(s)
- Aleksandra Kotlińska-Lemieszek
- Chair and Department of Palliative Medicine, Pharmacotherapy in Palliative Care Laboratory, Poznan University of Medical Sciences, Poznan, Poland.,Heliodor Święcicki University Hospital, Poznan, Poland
| | - Zbigniew Żylicz
- Institute of Medical Sciences, Medical College, University of Rzeszów, Rzeszów, Poland
| |
Collapse
|
49
|
Sha T, Zhang Y, Li C, Lei G, Wu J, Li X, Yang Z, Zeng C, Wei J. Association of Metformin Use With Risk of Venous Thromboembolism in Adults With Type 2 Diabetes: A General-Population-Based Cohort Study. Am J Epidemiol 2022; 191:856-866. [PMID: 34999759 DOI: 10.1093/aje/kwab291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 12/06/2021] [Accepted: 12/21/2021] [Indexed: 11/14/2022] Open
Abstract
Metformin is hypothesized to protect against the risk of venous thromboembolism (VTE); however, there is a paucity of data supporting this hypothesis. Among individuals aged 40-90 years with a diagnosis of type 2 diabetes in the Health Improvement Network database (2000-2019), we compared the risks of incident VTE, pulmonary embolism, and deep vein thrombosis among metformin initiators with those among sulfonylurea initiators. Individuals were followed from their first prescription refill to an incident VTE, drug discontinuation, switching or augmenting, plan disenrollment, or the end of the study, whichever occurred first. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox model, adjusting for confounders using inverse probability of treatment weighting. Among 117,472 initiators of metformin and 13,835 initiators of sulfonylureas, 555 (1.3/1,000 person-years) and 75 (2.1/1,000 person-years) VTE cases occurred in each group, respectively. The multivariable-adjusted HR was 0.65 (95% CI: 0.51, 0.84). The corresponding risks for pulmonary embolism (adjusted HR = 0.71, 95% CI: 0.50, 1.01) and deep vein thrombosis (adjusted HR = 0.64, 95% CI: 0.48, 0.87) were also lower in metformin initiators than in sulfonylurea initiators. Our study provided empirical evidence to support a lower risk of VTE after initiation of metformin as compared with sulfonylureas among patients with type 2 diabetes.
Collapse
|
50
|
Vartiainen P, Roine RP, Kalso E, Heiskanen T. Worse health‐related quality of life, impaired functioning and psychiatric comorbidities are associated with excess mortality in patients with severe chronic pain. Eur J Pain 2022; 26:1135-1146. [PMID: 35278251 PMCID: PMC9310830 DOI: 10.1002/ejp.1938] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/08/2022]
Abstract
Background Severe chronic pain that interferes with daily activities is associated with an increased risk of mortality. We assessed the overall mortality of tertiary chronic pain patients in comparison with the general population, with a special aim to analyse the association of health‐related quality of life (HRQoL) and its dimensions with the risk of death. Methods In this prospective observational follow‐up study, patients with non‐cancer chronic pain attended an outpatient multidisciplinary pain management (MPM) episode in a tertiary pain clinic in 2004–2012 and were followed until May 2019. Mortality between the patients and the general population was compared with standardized mortality ratios (SMR) in different age groups. Causes of death and comorbidities were compared among the deceased. Association of mortality and HRQoL and its dimensions, measured with the 15D instrument, was studied with Cox proportional hazards model. Results During a mean of 10.4‐year follow‐up of 1498 patients, 296 died. The SMR in the youngest age group (18–49 years) was significantly higher than that of the general population: 2.6 for males and 2.9 for females. Even elderly females (60–69 years) had elevated mortality (SMR 2.3). Low baseline HRQoL at the time of MPM, as well as poor ratings in the psychosocial dimensions of HRQoL, was associated with an increased risk of death. Conclusions Our results support the role of HRQoL measurement by a validated instrument such as the 15D in capturing both the physical and the psychological symptom burden, and consequently, an elevated risk of death, in patients with chronic pain. Significance Severe chronic pain is associated with elevated mortality. In patients in chronic pain under 50 years old, the mortality was 2.5–3 times higher than in the general population. Psychological distress appears to contribute to the increased mortality. Regular follow‐up by health‐related quality of life (HRQoL) measurement could be useful in identifying patients in chronic pain who are in need of intensive symptom management and to prevent early death.
Collapse
Affiliation(s)
- P Vartiainen
- Division of Pain Medicine Department of Anaesthesiology, Intensive Care, and Pain Medicine Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - R P Roine
- Division of Pain Medicine Department of Anaesthesiology, Intensive Care, and Pain Medicine Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - E Kalso
- Division of Pain Medicine Department of Anaesthesiology, Intensive Care, and Pain Medicine Helsinki University Hospital and Department of Pharmacology and SleepWell Research Programme, Faculty of Medicine, University of Helsinki Helsinki Finland
| | - T Heiskanen
- Division of Pain Medicine Department of Anaesthesiology, Intensive Care, and Pain Medicine Helsinki University Hospital and University of Helsinki Helsinki Finland
| |
Collapse
|