1
|
Barbosa BVDDR, Alves JVDO, Costa WK, Aguiar IFDS, Galvão LRL, Silva PMD, Silva LAD, Silva BVSD, Lima JSD, Oliveira AMD, Napoleão TH, Silva MVD, Correia MTDS. Almond fixed oil from Syagrus coronata (Mart.) Becc. has antinociceptive and anti-inflammatory potential, without showing oral toxicity in mice. JOURNAL OF ETHNOPHARMACOLOGY 2024; 331:118283. [PMID: 38734393 DOI: 10.1016/j.jep.2024.118283] [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: 01/30/2024] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Syagrus coronata, a palm tree found in northeastern Brazil, popularly known as licuri, has socioeconomic importance for the production of vegetable oil rich in fatty acids with nutritional and pharmacological effects. Licuri oil is used in traditional medicine to treat inflammation, wound healing, mycosis, back discomfort, eye irritation, and other conditions. AIM OF THE STUDY The study aimed to evaluate the antinociceptive, anti-inflammatory, and antipyretic effects of treatment with Syagrus coronata fixed oil (ScFO), as well as to determine the safety of use in mice. MATERIALS AND METHODS Initially, the chemical characterization was performed by gas chromatography-mass spectrometry. Acute single-dose oral toxicity was evaluated in mice at a dose of 2000 mg/kg. Antinociceptive activity was evaluated through abdominal writhing, formalin, and tail dipping tests, and the anti-inflammatory potential was evaluated through the model of acute inflammation of ear edema, peritonitis, and fever at concentrations of 25, 50, and 100 mg/kg from ScFO. RESULTS In the chemical analysis of ScFO, lauric (43.64%), caprylic (11.7%), and capric (7.2%) acids were detected as major. No mortality or behavioral abnormalities in the mice were evidenced over the 14 days of observation in the acute toxicity test. ScFO treatment decreased abdominal writhing by 27.07, 28.23, and 51.78% at 25, 50, and 100 mg/kg. ScFO demonstrated central and peripheral action in the formalin test, possibly via opioidergic and muscarinic systems. In the tail dipping test, ScFO showed action from the first hour after treatment at all concentrations. ScFO (100 mg/kg) reduced ear edema by 63.76% and leukocyte and neutrophil migration and IL-1β and TNF-α production in the peritonitis test. CONCLUSION Mice treated with ScFO had a reduction in fever after 60 min at all concentrations regardless of dose. Therefore, the fixed oil of S. coronata has the potential for the development of new pharmaceutical formulations for the treatment of pain, inflammation, and fever.
Collapse
Affiliation(s)
| | | | - Wêndeo Kennedy Costa
- Departamento de Bioquímica, Universidade Federal de Pernambuco, Recife, PE, 50670-901, Brazil.
| | | | | | - Paloma Maria da Silva
- Departamento de Bioquímica, Universidade Federal de Pernambuco, Recife, PE, 50670-901, Brazil
| | - Luzia Abílio da Silva
- Departamento de Bioquímica, Universidade Federal de Pernambuco, Recife, PE, 50670-901, Brazil
| | | | - Jucielma Silva de Lima
- Departamento de Bioquímica, Universidade Federal de Pernambuco, Recife, PE, 50670-901, Brazil
| | - Alisson Macário de Oliveira
- Departamento de Bioquímica, Universidade Federal de Pernambuco, Recife, PE, 50670-901, Brazil; Programa de Pós-graduação Em Ciências Farmacêuticas, Universidade Estadual da Paraíba, Campina Grande, PB, 58429-500, Brazil
| | | | - Márcia Vanusa da Silva
- Departamento de Bioquímica, Universidade Federal de Pernambuco, Recife, PE, 50670-901, Brazil
| | | |
Collapse
|
2
|
Coulson HC, Brown M, Burke K, Griffith E, Shadiack V, Garner HR, Foushee JA. Common outpatient diagnoses and associated treatments logged by osteopathic medical students within a geriatric population. J Osteopath Med 2024; 124:337-344. [PMID: 38641919 DOI: 10.1515/jom-2022-0251] [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: 12/23/2022] [Accepted: 02/02/2024] [Indexed: 04/21/2024]
Abstract
CONTEXT Clinical clerkships provide osteopathic medical students the opportunity to participate in the diagnosis and treatment of commonly encountered medical conditions. Appropriate management of these conditions may include pharmacotherapy and/or nonpharmacologic interventions, such as osteopathic manipulative treatment (OMT). Opportunities may exist to expand the utilization of OMT in the management of common conditions, particularly for geriatric patients, who are at increased risk for adverse outcomes from pharmacologic treatments. OBJECTIVES This study aimed to assess the most common diagnoses and corresponding treatments logged by osteopathic medical students within an ambulatory geriatric population. METHODS Patient encounters logged electronically by osteopathic medical students were retrospectively reviewed to determine the most commonly reported diagnostic codes and their treatments. Logged interventions were filtered to include patients over the age of 65 years who were seen on family medicine rotations within an ambulatory setting. The top 10 diagnoses were sorted and assessed to determine the associated treatments, including medications, procedures, and OMT. RESULTS Between January 2018 and June 2020, a total of 11,185 primary diagnoses were logged pertaining to the defined patient population. The most frequently documented diagnoses were essential hypertension (n=1,420; 12.7 %), encounter for well examination (n=1,144; 10.2 %), type 2 diabetes mellitus (n=837; 7.5 %), hyperlipidemia (n=346; 3.1 %), chronic obstructive pulmonary disease (COPD; n=278; 2.5 %), osteoarthritis (OA; n=221; 2.0 %), low back pain (LBP; n=202; 1.8 %), pain in joint (n=187; 1.7 %), hypothyroidism (n=164; 1.5 %), and urinary tract infections (n=160; 1.4 %). Three of the top 10 logged diagnoses were musculoskeletal in nature (OA, LBP, and pain in joint). Pharmacotherapy was reported as the predominant treatment for musculoskeletal conditions, with OMT being logged as a treatment for 10.9 % (n=50) of those cases. The most commonly logged medication class in the management of patients with those musculoskeletal conditions was nonsteroidal anti-inflammatory drugs (NSAIDs; n=128; 27.9 %), while opioids were the second most frequently documented class of medications (n=65; 14.2 %). CONCLUSIONS Musculoskeletal complaints were commonly logged by osteopathic medical students within the studied population. Opioids were documented as a treatment for musculoskeletal conditions more frequently than OMT. As such, opportunities exist to expand the utilization of OMT during clinical clerkships and to decrease the frequency of prescribed medications for pain management.
Collapse
Affiliation(s)
- Hannah C Coulson
- Pathologist at HCT Pathology Services, University of Maryland Shore Medical Center, Easton, MD, USA
| | - Miriam Brown
- Pathology, Microbiology, and Immunology Resident, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kyle Burke
- Family and Community Medicine Resident, Penn State Health, Hershey, PN, USA
| | - Emma Griffith
- Internal Medicine Resident, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Victoria Shadiack
- Assistant Chair Principles of Primary Care and OMM, Edward Via College of Osteopathic Medicine, Carolinas Campus, Spartanburg, SC, USA
| | - Harold R Garner
- Consultant, Illinois College of Osteopathic Medicine (proposed) at the Chicago School, Chicago, IL, USA
| | - Jaime A Foushee
- Department Chair for Biomedical Sciences; Discipline Chair for Pharmacology and Associate Professor, Edward Via College of Osteopathic Medicine, Carolinas Campus, Spartanburg, SC, USA
| |
Collapse
|
3
|
Peiró AM, Grimby-Ekman A, Barrachina J, Escorial M, Margarit C, Selva-Sevilla C, Gerónimo-Pardo M. Health-Related Quality of Life in Chronic Pain Treated With Tapentadol Versus Oxycodone/Naloxone and Its Determinants: A Real-World, Single-Center Retrospective Cohort Study in Spain. Value Health Reg Issues 2024; 44:101013. [PMID: 38981175 DOI: 10.1016/j.vhri.2024.101013] [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: 09/20/2023] [Revised: 04/16/2024] [Accepted: 05/08/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES A substantial proportion of patients with chronic noncancer pain (CNCP) are treated with tapentadol (TAP) or oxycodone/naloxone (OXN) to improve their perceived physical and mental health over time. METHODS A cross-sectional study was conducted in 135 CNCP outpatients with usual prescribing (TAP: n = 58, OXN: n = 77) at a tertiary-care Spanish Hospital to compare health-related quality-of-life (HRQoL) records. Health utility was derived from the EQ-5D-3L. Regression models were performed to search for other HRQoL determinants. Pain intensity, relief, analgesic prescription, adverse events, inpatient stays, emergency department visits, and change to painkiller prescriptions were registered from electronic records. RESULTS Health utility (0.43 ± 0.24 scores, from -0.654 to 1) was similar for both opioids, although TAP showed a significantly low daily opioid dose requirement, neuromodulators use, and constipation side effect compared with OXN. After multivariable adjustment, the significant predictors of impaired HRQoL were pain intensity (β = -0.227, 95% CI -0-035 to -0.005), number of adverse events (β = -0.201, 95% CI -0.024 to -0.004), and opioid daily dose (β = -0.175, 95% CI -0.097 to -0.012). Male sex (β = -0.044) and pain relief (β = 0.158) should be taken into account for future studies. CONCLUSIONS HRQoL was similar for TAP and OXN in real-world patients with CNCP, albeit with a TAP opioid-sparing effect. More work is needed to explore HRQoL determinants in relation to long-term opioid use in CNCP.
Collapse
Affiliation(s)
- Ana M Peiró
- Neuropharmacology Applied to Pain (NED), Clinical Pharmacology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain; Institute of Bioengineering, University Miguel Hernández, Avda. Elche, Spain.
| | - Anna Grimby-Ekman
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jordi Barrachina
- Neuropharmacology Applied to Pain (NED), Clinical Pharmacology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Mónica Escorial
- Neuropharmacology Applied to Pain (NED), Clinical Pharmacology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - César Margarit
- Neuropharmacology Applied to Pain (NED), Clinical Pharmacology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain; Pain Unit, Alicante Department of Health, General Hospital, Alicante, Spain
| | - Carmen Selva-Sevilla
- Department of Applied Economy, Faculty of Economic and Business Sciences, University of Castilla-La Mancha, Albacete, Spain
| | - Manuel Gerónimo-Pardo
- Department of Anesthesiology, Integrated Care Management of Albacete, Albacete, Spain
| |
Collapse
|
4
|
Schaffer AL, Andrews CD, Brown AD, Croker R, Hulme WJ, Nab L, Quinlan J, Speed V, Wood C, Wiedemann M, Massey J, Inglesby P, Bacon SCJ, Mehrkar A, Bates C, Goldacre B, Walker AJ, MacKenna B. Changes in opioid prescribing during the COVID-19 pandemic in England: an interrupted time-series analysis in the OpenSAFELY-TTP cohort. Lancet Public Health 2024; 9:e432-e442. [PMID: 38942555 DOI: 10.1016/s2468-2667(24)00100-2] [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: 02/23/2024] [Revised: 04/26/2024] [Accepted: 05/08/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND The COVID-19 pandemic disrupted health-care delivery, including difficulty accessing in-person care, which could have increased the need for strong pharmacological pain relief. Due to the risks associated with overprescribing of opioids, especially to vulnerable populations, we aimed to quantify changes to measures during the COVID-19 pandemic, overall, and by key subgroups. METHODS For this interrupted time-series analysis study conducted in England, with National Health Service England approval, we used routine clinical data from more than 20 million general practice adult patients in OpenSAFELY-TPP, which is a a secure software platform for analysis of electronic health records. We included all adults registered with a primary care practice using TPP-SystmOne software. Using interrupted time-series analysis, we quantified prevalent and new opioid prescribing before the COVID-19 pandemic (January, 2018-February, 2020), during the lockdown (March, 2020-March, 2021), and recovery periods (April, 2021-June, 2022), overall and stratified by demographics (age, sex, deprivation, ethnicity, and geographical region) and in people in care homes identified via an address-matching algorithm. FINDINGS There was little change in prevalent prescribing during the pandemic, except for a temporary increase in March, 2020. We observed a 9·8% (95% CI -14·5 to -6·5) reduction in new opioid prescribing from March, 2020, with a levelling of the downward trend, and rebounding slightly after April, 2021 (4·1%, 95% CI -0·9 to 9·4). Opioid prescribing rates varied by demographics, but we found a reduction in new prescribing for all subgroups except people aged 80 years or older. Among care home residents, in April, 2020, parenteral opioid prescribing increased by 186·3% (153·1 to 223·9). INTERPRETATION Opioid prescribing increased temporarily among older people and care home residents, likely reflecting use to treat end-of-life COVID-19 symptoms. Despite vulnerable populations being more affected by health-care disruptions, disparities in opioid prescribing by most demographic subgroups did not widen during the pandemic. Further research is needed to understand what is driving the changes in new opioid prescribing and its relation to changes to health-care provision during the pandemic. FUNDING The Wellcome Trust, Medical Research Council, The National Institute for Health and Care Research, UK Research and Innovation, and Health Data Research UK.
Collapse
Affiliation(s)
- Andrea L Schaffer
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Colm D Andrews
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andrew D Brown
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Croker
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - William J Hulme
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Linda Nab
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Victoria Speed
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; King's Thrombosis Centre, King's College Hospital, London, UK
| | - Christopher Wood
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Milan Wiedemann
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jon Massey
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Inglesby
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seb C J Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alex J Walker
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Brockway K, Ahmed S. Beyond breathing: Systematic review of global chronic obstructive pulmonary disease guidelines for pain management. Respir Med 2024; 224:107553. [PMID: 38350512 DOI: 10.1016/j.rmed.2024.107553] [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: 11/20/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Abstract
CONTEXT Patients with chronic obstructive pulmonary disease (COPD) experience pain as both symptom and comorbidity. There has been no evaluation of the recommendations for pain management in updated clinical practice guidelines (CPGs). OBJECTIVES Update the evidence on pain management, determine alignment of pain management recommendations with best-practice, and advocate for optimal pain management in patients with COPD. METHODS PubMed, Guideline International Network, Guideline Portal, Agency for Healthcare Research and Quality, National Institute for Healthcare Excellence, Scottish International Guidelines Network, Institute of Medicine, grey literature, national websites, and bibliographies were searched. CPGs available online for stable COPD produced by organizations representing reputable knowledge of COPD management were included. CPGs unavailable online, not translatable into English, or not including techniques within the defined scope were excluded. Researchers performed frequency counts for the verbatim terms "pain," "physical activity," "exercise," "rehabilitation," "physical therap(ist)/(y), "physiotherap(ist)/(y)," recorded context, and collected recommendations for pain management/treatment when present. RESULTS Of 32 CPGs, 24 included "pain" verbatim. Of these, 13 included recommendations for pain treatment/management. Common recommendations included opioids, pharmacological management, further medical assessment, and surgical intervention. Two CPGs referred to palliative care, one CPG discussed treating cough, and one discussed massage, relaxation, and breathing. CONCLUSIONS Pain management recommendations vary and are not aligned with evidence. Pain should be addressed in patients with COPD, whether directly or indirectly related to the disease. Reduction of variability in pain management and the disease burden is necessary. Pain management should include referrals to providers who can maximize benefit of their services.
Collapse
Affiliation(s)
- Kaelee Brockway
- University of St. Augustine for Health Sciences, 901 W. Walnut Hill Ln, Ste 210, Irving, TX, USA.
| | - Shakeel Ahmed
- University of Florida, College of Public Health & Health Professions, Department of Physical Therapy, Box 100154, UFHSC, Gainesville, FL, 32610-0154, USA.
| |
Collapse
|
6
|
Almeida T, Monaco BA, Vasconcelos F, Piedade GS, Morell A, Ogobuiro I, Lepski GA, Furlanetti LL, Cordeiro KK, Benjamin C, Jagid JR, Cordeiro JG. Everything old is new again. revisiting hypophysectomy for the treatment of refractory cancer-related pain: a systematic review. Neurosurg Rev 2024; 47:111. [PMID: 38467866 DOI: 10.1007/s10143-024-02347-7] [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: 01/12/2024] [Revised: 02/19/2024] [Accepted: 03/05/2024] [Indexed: 03/13/2024]
Abstract
Cancer-related pain is a common and debilitating condition that can significantly affect the quality of life of patients. Opioids, NSAIDs, and antidepressants are among the first-line therapies, but their efficacy is limited or their use can be restricted due to serious side effects. Neuromodulation and lesioning techniques have also proven to be a valuable instrument for managing refractory pain. For patients who have exhausted all standard treatment options, hypophysectomy may be an effective alternative treatment. We conducted a comprehensive systematic review of the available literature on PubMed and Scielo databases on using hypophysectomy to treat refractory cancer-related pain. Data extraction from included studies included study design, treatment model, number of treated patients, sex, age, Karnofsky Performance Status (KPS) score, primary cancer site, lead time from diagnosis to treatment, alcohol injection volume, treatment data, and clinical outcomes. Statistical analysis was reported using counts (N, %) and means (range). The study included data from 735 patients from 24 papers treated with hypophysectomy for refractory cancer-related pain. 329 cancer-related pain patients were treated with NALP, 216 with TSS, 66 with RF, 55 with Y90 brachytherapy, 51 with Gamma Knife radiosurgery (GK), and 18 with cryoablation. The median age was 58.5 years. The average follow-up time was 8.97 months. Good pain relief was observed in 557 out of 735 patients, with complete pain relief in 108 out of 268 patients. Pain improvement onset was observed 24 h after TSS, a few days after NALP or cryoablation, and a few days to 4 weeks after GK. Complications varied among treatment modalities, with diabetes insipidus (DI) being the most common complication. Although mostly forgotten in modern neurosurgical practice, hypophysectomy is an attractive option for treating refractory cancer-related pain after failure of traditional therapies. Radiosurgery is a promising treatment modality due to its high success rate and reduced risk of complications.
Collapse
Affiliation(s)
- Timoteo Almeida
- Department of Radiation Oncology, University of Miami, Miami, USA.
- Department of Neurosurgery, University of Miami, Miami, USA.
- Graduate Program in Principles of Surgery, Mackenzie Evangelical University, Paraná, Brazil.
| | - Bernardo A Monaco
- Graduate Program in Principles of Surgery, Mackenzie Evangelical University, Paraná, Brazil
| | - Fernando Vasconcelos
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, USA
| | - Guilherme S Piedade
- Graduate Program in Principles of Surgery, Mackenzie Evangelical University, Paraná, Brazil
| | - Alexis Morell
- Graduate Program in Principles of Surgery, Mackenzie Evangelical University, Paraná, Brazil
| | | | | | | | | | - Carolina Benjamin
- Graduate Program in Principles of Surgery, Mackenzie Evangelical University, Paraná, Brazil
| | - Jonathan R Jagid
- Graduate Program in Principles of Surgery, Mackenzie Evangelical University, Paraná, Brazil
| | - Joacir G Cordeiro
- Graduate Program in Principles of Surgery, Mackenzie Evangelical University, Paraná, Brazil
| |
Collapse
|
7
|
Chalabianloo F, Fadnes LT, Johansson KA, Høiseth G, Vold JH, Kringen MK, Spigset O, Bramness JG. Methadone pharmacokinetics in opioid agonist treatment: Influencing factors and clinical implications. Basic Clin Pharmacol Toxicol 2024; 134:333-344. [PMID: 38124280 DOI: 10.1111/bcpt.13975] [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: 07/05/2023] [Revised: 11/27/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND A considerable inter-individual variability has been reported in the relationship between methadone doses applied and serum concentrations achieved in methadone maintenance treatment. However, the underlying causes for this variability are not fully understood. OBJECTIVES We investigated the influence of genetic, pathophysiological and pharmacological factors on serum methadone concentration-to-dose ratio (CDR) and discussed the clinical implications of the findings. METHODS We used data from two retrospective laboratory databases and a prospective cohort study to investigate the impact on methadone CDR of hepatic cytochrome P450 enzyme system (CYP) genetic polymorphisms, age, sex, concomitant medication, liver fibrosis and body mass index through linear mixed model analyses. FINDINGS A positive association was found between CDR and the homozygous CYP2B6*6 genotype, concurrent treatment with CYP3A4 inhibitors and body mass index. CDR was lower among women and during concomitant use of CYP inducers. CDR was not associated with age or the degree of liver fibrosis in our investigations. CONCLUSIONS This research work supports the need for individually tailored dosage considering the various factors that influence methadone CDR. The gained knowledge can contribute to reducing the risks associated with the treatment and optimizing the desired outcomes.
Collapse
Affiliation(s)
- Fatemeh Chalabianloo
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kjell Arne Johansson
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Gudrun Høiseth
- Department of Forensic Medicine, Oslo University Hospital, Oslo, Norway
- Center for psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway
| | - Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | - Olav Spigset
- Department of Clinical Pharmacology, St. Olav University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jørgen G Bramness
- Institute of Clinical Medicine, UiT - Norway's Arctic University, Tromsø, Norway
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian National Competency Centre for Dual Disorder, Innland Hospital Trust, Hamar, Norway
| |
Collapse
|
8
|
Konzelmann M, Vuistiner P, Burrus C, Luthi F, Léger B. Analgesic consumption in a large sample of people in musculoskeletal rehabilitation: A descriptive study. Ann Phys Rehabil Med 2024; 67:101776. [PMID: 38118341 DOI: 10.1016/j.rehab.2023.101776] [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: 10/26/2022] [Revised: 04/15/2023] [Accepted: 06/03/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Consumption of opioids is increasing worldwide in people with chronic non-cancer pain, although their effectiveness is debated. OBJECTIVES The aim of the current study was to evaluate analgesic consumption and its association with different variables (demographic variables, pain, anxiety/depression, catastrophism, and kinesiophobia), in the field of musculoskeletal rehabilitation, where no data are available. METHODS This was a retrospective study over a period of 8 years on people hospitalised for rehabilitation after injury. Participants were classified into 3 categories: no analgesics (NA), non-opioid analgesics (NOA), and opioid analgesics (OPA). ANOVA or chi-squared tests were used to compare the 3 groups. RESULTS A total of 4,350 people (84% men; mean [SD] age, 44 [11] years) were included. In total, 20% were taking OPA, 40% NOA and 40% NA. In the OPA group, tramadol was mainly used, and the morphine equivalent median dose was 8.3 mg/day. In the NOA group, paracetamol and ibuprofen were mostly used. Symptoms increased progressively across the 3 groups (NA/NOA/OPA), with increased levels of pain severity/interference, anxiety/depression and catastrophizing, and a higher prevalence of neuropathic pain in the OPA group versus the others. CONCLUSIONS These results are consistent with those found in groups of people with chronic pain taking larger doses of opioids and following opioid reduction or cessation programs. Opioid prescription did not increase over the 8 years, which was reassuring. These factors are important to emphasise because they can be modified in the rehabilitation setting with interdisciplinary management. REGISTRATION Our database was registered on Mendeley Data.
Collapse
Affiliation(s)
- Michel Konzelmann
- Research service. Clinique Romande de réadaptation, Sion, Switzerland; Assessment and consultation service. Clinique Romande de réadaptation, Sion, Switzerland.
| | | | - Cyrille Burrus
- Research service. Clinique Romande de réadaptation, Sion, Switzerland; Rehabilitation of locomotor apparatus service. Clinique Romande de réadaptation, Sion, Switzerland
| | - François Luthi
- Rehabilitation of locomotor apparatus service. Clinique Romande de réadaptation, Sion, Switzerland; Department of locomotor apparatus. Hôpital Orthopédique, Lausanne. Switzerland
| | - Bertrand Léger
- Research service. Clinique Romande de réadaptation, Sion, Switzerland
| |
Collapse
|
9
|
Hammal F, Chiu C, Kung JY, Bradley N, Dillane D. Pain management for hospitalized patients with rib fractures: A systematic review of randomized clinical trials. J Clin Anesth 2024; 92:111276. [PMID: 37883901 DOI: 10.1016/j.jclinane.2023.111276] [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: 06/01/2023] [Revised: 07/24/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023]
Abstract
STUDY OBJECTIVE Rib fractures (RF) are common injuries. Multiple analgesia strategies are available for treatment of pain associated with RF. However, the optimal multimodal technique for pain management is not known. The primary aim of this review was to evaluate the status of evidence derived from randomized clinical trials (RCTs) on the effectiveness of pain management modalities for rib fracture pain. Other patient-centered outcomes were secondary objectives. METHODS Searches were conducted in MEDLINE, Embase, Scopus, and Cochrane Library. The screening process involved two phases, two researchers independently screened the title and abstract and subsequently screened full text. RCT data were extracted independently by two research team members. Consensus was achieved by comparison and discussion when needed. Risk of bias assessment was performed using the Cochrane Risk of Bias 2 tool. RESULTS A total of 1344 citations were identified. Title and abstract screening excluded 1128 citations, and full text review excluded 177 articles. A total of 32 RCTs were included in the full review. Multiple analgesia techniques and medications were identified and their effect on pain score and need for rescue opioid analgesia. None of the included studies were judged to have a high risk of bias, while only 10 studies were assessed as having a low risk of bias. CONCLUSIONS This systematic review found that studies are of low quality with diverse methodologies and outcomes. A reduction in pain scores was found for epidural analgesia when compared with other modalities. However, the low quality of the evidence necessitates cautious interpretation of this finding. PROSPERO registration: CRD42022376298 (Nov, 16, 2022).
Collapse
Affiliation(s)
- Fadi Hammal
- Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Christine Chiu
- Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Janice Y Kung
- John W. Scott Health Sciences Library, University of Alberta Hospital, Edmonton, AB, Canada
| | - Nori Bradley
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Derek Dillane
- Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada.
| |
Collapse
|
10
|
El-Mourad J, Lunghi C, Herrera NP, Zongo A. Dosing of Cannabinoids Associated with an Opioid-Sparing Effect: A Systematic Review of Longitudinal Studies. Pain Manag Nurs 2024; 25:e8-e20. [PMID: 37689509 DOI: 10.1016/j.pmn.2023.08.005] [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: 04/26/2023] [Revised: 07/31/2023] [Accepted: 08/12/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE To assess cannabinoid dosing that could be associated with a reduction in opioid use. DESIGN Systematic review conducted according to the PRISMA statement. DATA SOURCES PubMed, Embase, Web of Science, and PsycINFO were searched up to December 10, 2022. REVIEW/ANALYSIS METHODS We included randomized controlled trials (RCT) and longitudinal observational studies assessing cannabinoids effect on opioid use in patients with acute or chronic pain. Two reviewers independently assessed the studies for inclusion and extracted the data. Tetrahydrocannabinol (THC), Cannabidiol (CBD), and other cannabinoids with dosing were the exposures. Change in opioid doses and opioid discontinuation were the outcomes. RESULTS Fifteen studies (including seven RCTs) were included. Eight studies (six observational and two RCTs) were conducted among patients with chronic pain including three with cancer-related pain. Seven studies involved patients with acute pain (five RCTs).In chronic non-cancer pain patients, two observational studies that assessed THC and CBD in combination (average daily dose 17mg/15mg), and one that assessed a CBD-rich extract (31.4 mg/day), showed a significant reduction in opioid use. Of the three studies conducted on patients with cancer, only the observational study that assessed nabilone (average 1.7 mg/day) showed a significant reduction in opioid use. In patients with acute pain, only two observational studies that assessed dronabinol (5mg and 5-10 mg/day for four days) showed a significant reduction in opioid use. CONCLUSION The opioid-sparing effect of cannabinoids remains uncertain based on current evidence. However, attention could be paid to cannabinoid doses associated with opioid reduction in included observational studies.
Collapse
Affiliation(s)
- Jihane El-Mourad
- Faculty of Pharmacy, Université Laval, Québec, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Québec, Canada
| | - Carlotta Lunghi
- Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Québec, Canada; Department of Health Sciences, Université du Québec à Rimouski, Québec, Canada; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Norma Perez Herrera
- Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Québec, Canada
| | - Arsène Zongo
- Faculty of Pharmacy, Université Laval, Québec, Canada; Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval Research Centre, Québec, Canada.
| |
Collapse
|
11
|
Davies LEM, Koster ES, Damen KF, Beurmanjer H, van Dam VW, Bouvy ML, Schellekens AF. Patients' perspectives on tapering programmes for prescription opioid use disorder: a qualitative study. BMJ Open 2023; 13:e075246. [PMID: 38070938 PMCID: PMC10729188 DOI: 10.1136/bmjopen-2023-075246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Approximately 10% of chronic pain patients who receive opioids develop an opioid use disorder (OUD). Tapering programmes for these patients show high drop-out rates. Insight into chronic pain patients' experiences with tapering programmes for prescription OUD could help improve such programmes. Therefore, we investigated the perspectives of chronic pain patients with prescription OUD to identify facilitators and barriers to initiate and complete a specialised OUD tapering programme. DESIGN A qualitative study using semi-structured interviews on experiences with initiation and completion of opioid tapering was audio recorded, transcribed and subject to directed content analysis. SETTING This study was conducted in two facilities with specialised opioid tapering programmes in the Netherlands. PARTICIPANTS Twenty-five adults with chronic pain undergoing treatment for prescription OUD participated. RESULTS Participants indicated that tapering is a personal process, where willingness and motivation to taper, perceived (medical) support and pain coping strategies have an impact on the tapering outcome. The opportunity to join a medical-assisted tapering programme, shared decision-making regarding tapering pace, tapering location, and receiving medical and psychological support facilitated completion of an opioid tapering programme. CONCLUSIONS According to patients, a successful treatment of prescription OUD requires a patient-centred approach that combines personal treatment goals with shared decision-making on opioid tapering. Referral to a specialised tapering programme that incorporates opioid rotation, non-judgmental attitudes, and psychological support can create a safe and supportive environment, fostering successful tapering and recovery.
Collapse
Affiliation(s)
- Lisa Eveline Maria Davies
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Ellen S Koster
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
- Netherlands Association of Internal Medicine, Utrecht, The Netherlands
| | | | - Harmen Beurmanjer
- Novadic-Kentron, Vught, The Netherlands
- Radboud University Behavioural Science Institute, Nijmegen, The Netherlands
| | - Vivienne Wt van Dam
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Marcel L Bouvy
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Arnt Fa Schellekens
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
| |
Collapse
|
12
|
de la Vega R, Heinisuo IA, López-Martínez AE, Serrano-Ibáñez ER, Ruíz-Párraga GT, Ramírez-Maestre C, Esteve R. ANF therapy ® for pain management, feasibility, satisfaction, perceived symptom reduction and side effects: a real-world multisite observational study. J Phys Ther Sci 2023; 35:768-776. [PMID: 38075509 PMCID: PMC10698316 DOI: 10.1589/jpts.35.768] [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: 07/11/2023] [Accepted: 09/14/2023] [Indexed: 06/17/2024] Open
Abstract
[Purpose] Non-invasive and drug-free interventions for pain are being developed. One of them is ANF (which stands for "Amino Neuro Frequency") Therapy®, which consists in the application of carbonized metal devices on a patient's skin. We aimed to: 1) test perceived changes in pain intensity after ANF application, 2) record frequency and severity of side effects, 3) assess clinician and patient satisfaction, 4) explore effects on swelling and range of motion (ROM). [Participants and Methods] In this real-world multisite observational study, N=113 physical therapists in 45 countries, applied ANF to N=1,054 patients (Mage=45.2, 56.2% female) with pain complaints. Demographic data, pain intensity (NRS-11), effects of ANF on swelling and ROM, clinician and patient satisfaction and side effects were collected. [Results] Main pain locations were: low back (14.9%), knee (12.4%), neck (10%), and shoulder (9.6%). Pre-treatment pain intensity was high (Mean=7.6, SD=1.9). It significantly decreased post-treatment (Mean=3.1, SD=2.0), t(1053)=7.25, with a large effect size (Cohen's d=2.2). Swelling decreased and ROM increased. Average satisfaction with ANF was 92/100. Patients often experienced mild side effects (42.3%): dry mouth, headache and fatigue. [Conclusion] Results show large effect sizes, high satisfaction, and mild and short-term side effects. This is very promising but should be interpreted with caution considering the study limitations.
Collapse
Affiliation(s)
- Rocío de la Vega
- Departament of Personality, Assessment and Psychological
Treatment, Psychology Faculty, University of Málaga: Málaga 29071, Spain
| | | | - Alicia E. López-Martínez
- Departament of Personality, Assessment and Psychological
Treatment, Psychology Faculty, University of Málaga: Málaga 29071, Spain
| | - Elena R. Serrano-Ibáñez
- Departament of Personality, Assessment and Psychological
Treatment, Psychology Faculty, University of Málaga: Málaga 29071, Spain
| | - Gema T. Ruíz-Párraga
- Departament of Personality, Assessment and Psychological
Treatment, Psychology Faculty, University of Málaga: Málaga 29071, Spain
| | - Carmen Ramírez-Maestre
- Departament of Personality, Assessment and Psychological
Treatment, Psychology Faculty, University of Málaga: Málaga 29071, Spain
| | - Rosa Esteve
- Departament of Personality, Assessment and Psychological
Treatment, Psychology Faculty, University of Málaga: Málaga 29071, Spain
| |
Collapse
|
13
|
Nabulsi NA, Sharp LK, Sweiss KI, Patel PR, Calip GS, Lee TA. Patterns of prescription opioid use and opioid-related harms among adult patients with hematologic malignancies. J Oncol Pharm Pract 2023:10781552231210788. [PMID: 37942515 DOI: 10.1177/10781552231210788] [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: 11/10/2023]
Abstract
INTRODUCTION Treatment advances for hematologic malignancies (HM) have dramatically improved life expectancy, necessitating greater focus on long-term cancer pain management. This study explored real-world patterns of opioid use among patients with HM. METHODS This retrospective cohort study identified adults diagnosed with HM from January 1, 2013 through December 31, 2019 using the Truven MarketScan Commercial Claims and Encounters database. Across several HM types, we described rates of high-risk opioid use (based on Pharmacy Quality Alliance measures) and opioid-related harms, including incident opioid use disorder (OUD) diagnoses and opioid-related hospitalizations or emergency department (ED) visits. We used multivariable Cox regression to generate adjusted hazard ratios and 95% confidence intervals comparing the risk of opioid-related harms between patients with versus without high-risk opioid use. RESULTS Our sample included 43,190 patients with HM. Median age at HM diagnosis was 54 years (interquartile range = 44-60). Most patients (61.9%) were diagnosed with lymphoma. Approximately half (49.2%) had an opioid dispensed in the follow-up period. Among all patients, 20.0% met criteria for high-risk opioid use, 0.9% had an OUD diagnosis, and 0.3% experienced an opioid-related hospitalization/ED visit in follow-up. High-risk opioid use increased the risk of an OUD diagnosis by 3.3 times (p < 0.0001) and an opioid-related hospitalization/ED visit 4.2 times (p < 0.0001). CONCLUSION High-risk opioid use was prevalent among patients with HM and significantly increased the risk of opioid-related harms. However, rates of opioid-related harms were low. These findings highlight the importance of continually monitoring pain and opioid use throughout HM survivorship to provide safe, effective HM pain management.
Collapse
Affiliation(s)
- Nadia A Nabulsi
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
| | - Karen I Sweiss
- Department of Pharmacy Practice, University of Illinois Chicago, Chicago, IL, USA
| | - Pritesh R Patel
- Division of Hematology and Oncology, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Gregory S Calip
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
| |
Collapse
|
14
|
Gray E, Erickson M, Bindler R, Eti DU, Wilson M. Experiencing COMFORT: Perceptions of Virtually-delivered Nonpharmacologic Therapies in Adults Prescribed Opioids for Chronic Pain. Pain Manag Nurs 2023; 24:469-476. [PMID: 37179236 PMCID: PMC10524526 DOI: 10.1016/j.pmn.2023.04.002] [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: 09/14/2022] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND An opioid task force within an urban public health district sought to increase access to, and utilization of, non-opioid, nonpharmacologic alternatives for pain management. AIMS The COMFORT (Community-engaged Options to Maximize and Facilitate Opioid ReducTion) study was designed to provide virtual multidimensional integrated nonpharmacologic therapies via a cloud-based videoconferencing platform over six weeks to adults with chronic pain who were prescribed an opioid to investigate measurable health improvements. METHODS A qualitative descriptive analysis explored participants' experiences of a novel pain management intervention. A total of 19 participants consented to participate in the study and 15 completed six virtual consultations with either yoga, massage, chiropractic, or physical therapists. Semi-structured exit interviews were conducted, and data analyzed using content analysis. RESULTS Five main themes were identified, including unmet pain needs, self-care practices, incentive for participation, perception of a virtual environment, and benefits of the intervention. All participants reported at least minor benefits, with about half reporting improvement in pain levels, and some were able to reduce their opioid use. A virtual environment posed challenges for a few participants who found it more difficult to engage with than in-person therapy; others found the platform easy to navigate. CONCLUSIONS Participants with chronic pain were open and willing to try a novel way to access nonpharmacologic consultations to address unmet pain needs. Virtual consultations with pain management experts may increase access to, and utilization of, complementary and integrative treatment modalities.
Collapse
Affiliation(s)
- Emily Gray
- College of Nursing, Washington State University, Spokane, Washington.
| | - Morgan Erickson
- College of Nursing, Washington State University, Spokane, Washington
| | - Ross Bindler
- College of Nursing, Washington State University, Spokane, Washington
| | - Deborah U Eti
- College of Nursing, Washington State University, Spokane, Washington
| | - Marian Wilson
- College of Nursing, Washington State University, Spokane, Washington
| |
Collapse
|
15
|
Edwards KA, Reed DE, Anderson D, Harding K, Turner AP, Soares B, Suri P, Williams RM. Opening the black box of psychological treatments for chronic pain: A clinical perspective for medical providers. PM R 2023; 15:999-1011. [PMID: 36633497 DOI: 10.1002/pmrj.12912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Karlyn A Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Division of Pain Medicine, Stanford University, Stanford, California, USA
| | - David E Reed
- Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Administration Puget Sound Health Care, Seattle, Washington, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Derek Anderson
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
| | - Kaitlin Harding
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
| | - Aaron P Turner
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Bosco Soares
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Pradeep Suri
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, Washington, USA
| | - Rhonda M Williams
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
16
|
Muriel J, Escorial M, Margarit C, Barrachina J, Carvajal C, Morales D, Peiró AM. Long-term deprescription in chronic pain and opioid use disorder patients: Pharmacogenetic and sex differences. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2023; 73:227-241. [PMID: 37307374 DOI: 10.2478/acph-2023-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 06/14/2023]
Abstract
More than half of patients with opioid use disorder for chronic non-cancer pain (CNCP) reduced their dose through a progressive opioid withdrawal supported by a rotation to buprenorphine and/or tramadol. The aim of this research is to analyse the long-term effectiveness of opioid deprescription taking into account the impact of sex and pharmacogenetics on the inter-individual variability. A cross-sectional study was carried out from October 2019 to June 2020 on CNCP patients who had previously undergone an opioid deprescription (n = 119 patients). Demographic, clinical (pain, relief and adverse events) and therapeutic (analgesic use) outcomes were collected. Effectiveness (< 50 mg per day of morphine equivalent daily dose without any aberrant opioid use behaviour) and safety (number of side-effects) were analysed in relation to sex differences and pharmacogenetic markers impact [OPRM1 genotype (rs1799971) and CYP2D6 phenotypes]. Long-term opioid deprescription was achieved in 49 % of the patients with an increase in pain relief and a reduction of adverse events. CYP2D6 poor metabolizers showed the lowest long-term opioid doses. Here, women showed a higher degree of opioid deprescription, but increased use of tramadol and neuromodulators, as well as an increased number of adverse events. Long-term deprescription was successful in half of the cases. Understanding sex and gender interaction plus a genetic impact could help to design more individualized strategies for opioid deprescription.
Collapse
Affiliation(s)
- Javier Muriel
- 1Neuropharmacology applied to Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL), c/Pintor Baeza, 12 03010, Alicante, Spain
| | - Mónica Escorial
- 1Neuropharmacology applied to Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL), c/Pintor Baeza, 12 03010, Alicante, Spain
- 2Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain
| | - César Margarit
- 1Neuropharmacology applied to Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL), c/Pintor Baeza, 12 03010, Alicante, Spain
- 3Pain Unit, Dr. Balmis General University Hospital, ISABIAL, c/Pintor Baeza, 12 03010, Alicante, Spain
| | - Jordi Barrachina
- 1Neuropharmacology applied to Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL), c/Pintor Baeza, 12 03010, Alicante, Spain
- 2Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain
| | - Cristian Carvajal
- 2Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain
| | - Domingo Morales
- 4Operations Research Centre, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain
| | - Ana M Peiró
- 1Neuropharmacology applied to Pain (NED) Alicante Institute for Health and Biomedical Research (ISABIAL), c/Pintor Baeza, 12 03010, Alicante, Spain
- 2Institute of Bioengineering, Miguel Hernández University, Avda. de la Universidad s/n, 03202, Elche, Spain
- 3Pain Unit, Dr. Balmis General University Hospital, ISABIAL, c/Pintor Baeza, 12 03010, Alicante, Spain
- 5Clinical Pharmacology Department, Dr. Balmis General University Hospital ISABIAL, c/Pintor Baeza, 12, 03010 Alicante, Spain
| |
Collapse
|
17
|
Els C, Jackson TD, Hagtvedt R, Kunyk D, Sonnenberg B, Lappi VG, Straube S. High-dose opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2023; 3:CD012299. [PMID: 36961252 PMCID: PMC10037930 DOI: 10.1002/14651858.cd012299.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND This overview was originally published in 2017, and is being updated in 2022. Chronic pain is typically described as pain on most days for at least three months. Chronic non-cancer pain (CNCP) is any chronic pain that is not due to a malignancy. Chronic non-cancer pain in adults is a common and complex clinical issue, for which opioids are prescribed by some physicians for pain management. There are concerns that the use of high doses of opioids for CNCP lacks evidence of effectiveness, and may increase the risk of adverse events. OBJECTIVES To describe the evidence from Cochrane Reviews and overviews regarding the efficacy and safety of high-dose opioids (defined as 200 mg morphine equivalent or more per day) for CNCP. METHODS We identified Cochrane Reviews and overviews by searching the Cochrane Database of Systematic Reviews in The Cochrane Library. The date of the last search was 21 July 2022. Two overview authors independently assessed the search results. We planned to analyse data on any opioid agent used at a high dose for two weeks or more for the treatment of CNCP in adults. MAIN RESULTS We did not identify any reviews or overviews that met the inclusion criteria. The excluded reviews largely reflected low doses or titrated doses, where all doses were analysed as a single group; we were unable to extract any data for high-dose use only. AUTHORS' CONCLUSIONS There is a critical lack of high-quality evidence, in the form of Cochrane Reviews, about how well high-dose opioids work for the management of CNCP in adults, and regarding the presence and severity of adverse events. No evidence-based argument can be made on the use of high-dose opioids, i.e. 200 mg morphine equivalent or more daily, in clinical practice. Considering that high-dose opioids have been, and are still being used in clinical practice to treat CNCP, knowing about the efficacy and safety of these higher doses is imperative.
Collapse
Affiliation(s)
- Charl Els
- Department of Psychiatry, University of Alberta, Edmonton, Canada
- College of Physicians and Surgeons of Alberta, Edmonton, Canada
| | - Tanya D Jackson
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Canada
| | - Reidar Hagtvedt
- Accounting and Business Analytics, Alberta School of Business, University of Alberta, Edmonton, Canada
| | - Diane Kunyk
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Barend Sonnenberg
- Medical Services, Workers' Compensation Board - Alberta, Edmonton, Canada
| | - Vernon G Lappi
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Canada
| | - Sebastian Straube
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Canada
| |
Collapse
|
18
|
Recent trends in acupuncture for chronic pain: A bibliometric analysis and review of the literature. Complement Ther Med 2023; 72:102915. [PMID: 36610367 DOI: 10.1016/j.ctim.2023.102915] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/01/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Acupuncture has been increasingly used in patients with chronic pain, yet no bibliometric analysis of acupuncture studies for chronic pain exists. OBJECTIVES To investigate the characteristics, hotspots and frontiers of global scientific output in acupuncture research for chronic pain over the past decade. METHODS We retrieved publications on acupuncture for chronic pain published from 2011 to 2022 from the Science Citation Index Expanded (SCI-expanded) of the Web of Science Core Collection (WoSCC). The co-occurrence relationships of journals/countries/institutions/authors/keywords were performed using VOSviewer V6.1.2, and CiteSpace V1.6.18 analyzed the clustering and burst analysis of keywords and co-cited references. RESULTS A total of 1616 articles were retrieved. The results showed that the number of annual publications on acupuncture for chronic pain has increased over time, with the main types of literature being original articles (1091 articles, 67.5 %) and review articles (351 articles, 21.7 %). China had the most publications (598 articles, 37 %), with Beijing University of Traditional Chinese Medicine (93 articles, 5.8 %) and Evidence-based Complementary and Alternative Medicine ranked first (169 articles, 10.45 %) as the most prolific affiliate and journal, respectively. Liang FR was the most productive author (43 articles), and the article published by Vickers Andrew J in 2012 had the highest number of citations (625 citations). Recently, "acupuncture" and "pain" appeared most frequently. The hot topics in acupuncture for chronic pain based on keywords clustering analysis were experimental design, hot diseases, interventions, and mechanism studies. According to burst analysis, the main research frontiers were functional connectivity (FC), depression, and risk. CONCLUSION This study provides an in-depth perspective on acupuncture for chronic pain studies, revealing pivotal points, research hotspots, and research trends. Valuable ideas are provided for future research activities.
Collapse
|
19
|
Poole HM, Frank B, Begley E, Woods A, Ramos-Silva A, Merriman M, McCulough R, Montgomery C. Feasibility study of a Behavioural Intervention for Opioid Reduction (BIOR) for patients with chronic non-cancer pain in primary care: a protocol. BMJ Open 2023; 13:e065646. [PMID: 36657771 PMCID: PMC9853248 DOI: 10.1136/bmjopen-2022-065646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Around 30%-50% of adults suffer moderate to severe chronic pain not caused by cancer. Significant numbers are treated with opioids which over time may cease to be effective and produce side effects (eg, nausea, drowsiness and constipation). Stopping taking opioids abruptly can cause unpleasant withdrawal effects. Tapering in small steps is recommended, though some patients might struggle and need support, particularly if they have limited access to pain management alternatives. Awareness of the potential risks as well as benefits of tapering should be explored with patients. METHODS AND ANALYSIS A randomised controlled pilot feasibility study to investigate the effectiveness and feasibility of reducing high doses of opioids through a tapering protocol, education and support in primary care. Working with NHS Knowsley Place, we will identify patients taking 50 mg or above morphine equivalent dose of opioids per day to be randomly allocated to either the tapering group or tapering with support group. At an initial joint appointment with a pain consultant and General Practitioner (GP) GP tapering will be discussed and negotiated. Both groups will have their opioid reduced by 10% per week. The taper with support group will have access to additional support, including motivational counselling, realistic goal setting and a toolkit of resources to promote self-management. Some patients will successfully reduce their dose each week. For others, this may be more difficult, and the tapering reduction will be adjusted to 10% per fortnight. We assess opioid use, pain and quality of life in both groups at the start and end of the study to determine which intervention works best to support people with chronic pain who wish to stop taking opioids. ETHICS AND DISSEMINATION The Behavioural Intervention for Opioid Reduction feasibility study has been granted full approval by Liverpool Central Research Ethics Committee on 7 April 2022 (22/NW/0047). The current protocol version is V.1.1, date 6 July 2022. Results will be published in peer-reviewed journals and disseminated to patient stakeholders in a lay summary report available on the project website and in participating GP surgeries. TRIAL REGISTRATION NUMBER ISRCTN 30201337.
Collapse
Affiliation(s)
- Helen M Poole
- School of Psychology, Liverpool John Moores University, Liverpool, UK
- Pain Research Institute, Liverpool, UK
| | - Bernhard Frank
- Pain Research Institute, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Aimee Woods
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | | | | | | | | |
Collapse
|
20
|
Hu JL, Zhang WJ. The role and pharmacological properties of P2Y12 receptor in cancer and cancer pain. Biomed Pharmacother 2023; 157:113927. [PMID: 36462316 DOI: 10.1016/j.biopha.2022.113927] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 12/05/2022] Open
Abstract
The G protein-coupled P2Y12 receptor (P2Y12R) was cloned in platelets and found to play a key role in maintaining platelet function in hemostasis and thrombosis, and these effects could be mediated by the P2Y12R. However, it has recently been found that P2Y12R-mediated the progression of tumor through interactions between platelets and tumor and stromal cells, as well as through products secreted by platelets. During tumor progression, tumor cells or other cells in the tumor microenvironment (such as immune cells) can secrete large amounts of ATP into the extracellular matrix, and extracellular ATP can be hydrolyzed into ADP. ADP is a P2Y12R activator and plays an important regulatory role in the proliferation and metastasis of tumor cells. P2Y12R is involved in platelet-cancer cell crosstalk and become a potential target for anticancer therapy. Moreover, tumor progression can induce pain, which seriously affects the quality of life of patients. P2Y12R is expressed in microglia and mediates the activities of microglial and participates in the occurrence of cancer pain. Conversely, inhibiting P2Y12R activation and down-regulating its expression has the effect of inhibiting tumor progression and pain. Therefore, P2Y12R can be a common therapeutic target for both. In this article, we explored the potential link between P2Y12R and cancer, discussed the intrinsic link of P2Y12R in cancer pain and the pharmacological properties of P2Y12R antagonists in the treatment of both.
Collapse
Affiliation(s)
- Jia-Ling Hu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province 343000, China
| | - Wen-Jun Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital, Nanchang University, Nanchang City, Jiangxi Province 343000, China.
| |
Collapse
|
21
|
Begley EK, Poole HM, Sumnall HR, Frank BF, Montgomery C. Opioid prescribing and social deprivation: A retrospective analysis of prescribing for CNCP in Liverpool CCG. PLoS One 2023; 18:e0280958. [PMID: 36888607 PMCID: PMC9994720 DOI: 10.1371/journal.pone.0280958] [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: 03/10/2022] [Accepted: 01/12/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Treating Chronic Non-Cancer Pain (CNCP) with long-term, high dose and more potent opioids puts patients at increased risk of harm, whilst providing limited pain relief. Socially deprived areas mapped from Index of Multiple Deprivation (IMD) scores show higher rates of high dose, strong opioid prescribing compared to more affluent areas. OBJECTIVE To explore if opioid prescribing is higher in more deprived areas of Liverpool (UK) and assess the incidence of high dose prescribing to improve clinical pathways for opioid weaning. DESIGN AND SETTING This retrospective observational study used primary care practice and patient level opioid prescribing data for N = 30,474 CNCP patients across Liverpool Clinical Commissioning Group (LCCG) between August 2016 and August 2018. METHOD A Defined Daily Dose (DDD) was calculated for each patient prescribed opioids. DDD was converted into a Morphine Equivalent Dose (MED) and patients stratified according to high (≥120mg) MED cut off. The association between prescribing and deprivation was analysed by linking GP practice codes and IMD scores across LCCG. RESULTS 3.5% of patients were prescribed an average dose above 120mg MED/day. Patients prescribed long-term, high dose, strong opioids were more likely to be female, aged 60+, prescribed three opioids and reside in the North of Liverpool where there is a higher density of areas in the IMD most deprived deciles. CONCLUSION A small but significant proportion of CNCP patients across Liverpool are currently prescribed opioids above the recommended dose threshold of 120mg MED. Identification of fentanyl as a contributor to high dose prescribing resulted in changes to prescribing practice, and reports from NHS pain clinics that fewer patients require tapering from fentanyl. In conclusion, higher rates of high dose opioid prescribing continue to be evident in more socially deprived areas further increasing health inequalities.
Collapse
Affiliation(s)
- Emma K. Begley
- School of Psychology, Liverpool John Moores University, Liverpool, Merseyside, United Kingdom
| | - Helen M. Poole
- School of Psychology, Liverpool John Moores University, Liverpool, Merseyside, United Kingdom
| | - Harry R. Sumnall
- Public Health Institute, Liverpool John Moores University, Liverpool, Merseyside, United Kingdom
| | - Bernhard F. Frank
- Walton Centre NHS Foundation Trust, Liverpool, Merseyside, United Kingdom
- Pain Research Institute, University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - Catharine Montgomery
- School of Psychology, Liverpool John Moores University, Liverpool, Merseyside, United Kingdom
- * E-mail:
| |
Collapse
|
22
|
Liu C, Chen X, Wu S. The effect of massage therapy on pain after surgery: A comprehensive meta-analysis. Complement Ther Med 2022; 71:102892. [PMID: 36309174 DOI: 10.1016/j.ctim.2022.102892] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/30/2022] [Accepted: 10/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Findings on the usefulness of massage therapy (MT) in postoperative pain management are often inconsistent among studies. OBJECTIVES This study's aim is to conduct a meta-analysis of randomized controlled trials (RCT) to clarify the effects of massage therapy in the treatment of postoperative pain. METHODS Three databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) were searched for RCTs published from database inception through January 26, 2021. The primary outcome was pain relief. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. The random-effect model was used to calculate the effect sizes and standardized mean difference (SMD) with 95 % confidential intervals (CIs) as a summary effect. The heterogeneity test was conducted through I2. Subgroup and sensitivity analyses were used to explore the source of heterogeneity. Possible publication bias was assessed using visual inspection of funnel plot asymmetry. RESULTS The analysis included 33 RCTs and showed that MT is effective in reducing postoperative pain (SMD, -1.32; 95 % CI, -2.01 to -0.63; p = 0.0002; I2 = 98.67 %). A similar significant effect was found for both short (immediate assessment) and long terms (assessment performed 4-6 weeks after the MT). Remarkably, we found neither the duration per session nor the dose had an impact on the effect of MT and there seemed to be no difference in the effects of different MT types. In addition, MT seemed to be more effective for adults. Furthermore, MT had better analgesic effects on cesarean section and heart surgery than orthopedic surgery. LIMITATIONS Publication bias is possible due to the inclusion of studies in English only. Additionally, the included studies were extremely heterogeneous. Double-blind research on MT is difficult to implement, and none of the included studies is double-blind. There was some heterogeneity and publication bias in the included studies. In addition, there is no uniform evaluation standard for the operation level of massage practitioners, which may lead to research implementation bias. CONCLUSIONS MT is effective in reducing postoperative pain in both short and long terms.
Collapse
Affiliation(s)
- Chunhua Liu
- Department of Cancer Rehabilitation, Lishui Hospital of Traditional Chinese Medicine, Affiliated to Zhejiang University of Traditional Chinese Medicine, Lishui, Zhejiang, China.
| | - Xiang Chen
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Simin Wu
- Department of Cancer Rehabilitation, Lishui Hospital of Traditional Chinese Medicine, Affiliated to Zhejiang University of Traditional Chinese Medicine, Lishui, Zhejiang, China.
| |
Collapse
|
23
|
Yost JG, Browne CA, Lucki I. (2R,6R)-hydroxynorketamine (HNK) reverses mechanical hypersensitivity in a model of localized inflammatory pain. Neuropharmacology 2022; 221:109276. [PMID: 36198332 DOI: 10.1016/j.neuropharm.2022.109276] [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: 06/07/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 10/07/2022]
Abstract
The ketamine metabolite (2R,6R)-hydroxynorketamine, or (2R,6R)-HNK, was recently reported to evoke antinociception in response to a noxious thermal stimulus in healthy mice and reverse mechanical hypersensitivity in a murine model of neuropathic pain. This study reports the behavioral effects of (2R,6R)-HNK in male and female C57BL/6J mice exposed to a localized inflammatory pain condition and the broad pharmacological mechanism underlying this effect. Hind paw intraplantar injection of λ-carrageenan (CARR) caused inflammation and mechanical hypersensitivity in mice within 2 hours, lasting at least 48 hours. Intraperitoneal administration of (2R,6R)-HNK (10-30 mg/kg i.p.) 2 hours following CARR injection significantly reversed mechanical hypersensitivity within 1 hour in male and female mice, and the effect persisted for 24 hours following a single dose. The magnitude and timing of the analgesic effect of (2R,6R)-HNK were comparable to the non-steroidal anti-inflammatory drug carprofen. The reversal of hypersensitivity by (2R,6R)-HNK was blocked at 4 and 24 hours after administration by pretreatment with the AMPA receptor antagonist NBQX and was not accompanied by changes in locomotor activity. These findings reinforce the growing evidence supporting (2R,6R)-HNK as a novel analgesic in multiple preclinical pain models and further support an AMPAR-dependent mechanism of action. SIGNIFICANCE: The ketamine metabolite (2R,6R)-HNK reversed mechanical hypersensitivity associated with localized inflammation with onset less than one hour and duration greater than 24 hours in an effect comparable to the NSAID carprofen. Reversal of mechanical hypersensitivity by (2R,6R)-HNK is AMPAR-dependent.
Collapse
Affiliation(s)
- Jonathan G Yost
- Neuroscience Graduate Program, Uniformed Services University, Bethesda, MD, 20814, USA
| | - Caroline A Browne
- Neuroscience Graduate Program, Uniformed Services University, Bethesda, MD, 20814, USA; Department of Pharmacology and Molecular Therapeutics, Uniformed Services University, Bethesda, MD, 20814, USA
| | - Irwin Lucki
- Neuroscience Graduate Program, Uniformed Services University, Bethesda, MD, 20814, USA; Department of Pharmacology and Molecular Therapeutics, Uniformed Services University, Bethesda, MD, 20814, USA; Department of Psychiatry, Uniformed Services University, Bethesda, MD, 20814, USA.
| |
Collapse
|
24
|
Noblet T, Jadhakhan F, Bennett A, McCrum C, O'Shea S, Hensman-Crook A, Barratt P, Regan P, Ronan L, Baker D, Rushton A. A multi-site prospective, observational study of physiotherapist independent prescribing activity across musculoskeletal clinics in the United Kingdom. Musculoskelet Sci Pract 2022; 61:102616. [PMID: 35785573 DOI: 10.1016/j.msksp.2022.102616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 06/10/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To establish how advanced practice physiotherapists in the UK working in the musculoskeletal specialty are utilising their independent non-medical prescribing skills. DESIGN Multi-site, prospective, descriptive observational study. Ethics reference No: ERN_19-0994). METHOD The study was conducted by seven advanced practitioners, across seven clinical sites representative of advanced musculoskeletal practice in the UK, between 1st October 2019-March 31, 2020. Advanced physiotherapy practitioner independent prescribers working in a variety of musculoskeletal specialty areas collected data across 5 contexts of musculoskeletal clinical service: first contact practice, primary care, community triage, secondary care orthopaedics, secondary care rheumatology and private practice. Quantitative data were analysed descriptively with qualitative data analysed/synthesised via thematic analysis. RESULTS Prescribing activity data for n = 2470 patients were collected. Prescribing activity was highest for the treatment of nociceptive pain (51.3%) and inflammation (39.6%). Most prescribing activity occurred in the first 2-6 weeks (34.1%) following onset of condition. Medicines optimisation accounted for most of prescribing activity (18.1%), followed by over-the-counter medication recommendation (15.5%). De-prescribing accounted for 10.8% of all prescribing activity recorded. Qualitative data were synthesised into 4 themes: multimodal physiotherapeutic approach, joint decision making and patient choice, working with complexity, and legal and regulatory restriction. CONCLUSIONS Physiotherapist independent prescribing was used within all health sectors in conjunction with advanced skills in musculoskeletal physiotherapy as part of a multimodal physiotherapeutic approach. Prescribing activity was dictated by the clinicians' clinical reasoning and use of joint decision-making. Prescribing activity for acute back and neuropathic radicular pain was limited secondary to recent reclassification of gabapentin and pregabalin.
Collapse
Affiliation(s)
- Tim Noblet
- St George's University Hospitals NHS Foundation Trust, Blackshaw Rd, London, SW17 0QT, UK.
| | - Feroz Jadhakhan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Andrew Bennett
- Sutton Health and Care Alliance, Epsom and St Helier NHS Trust, Outpatient Physiotherapy Department, Fergerson House, St Helier Hospital, Wrythe Lane, SM5 1AA, UK; NHS England and NHS Improvement, 22 London Road, Elephant and Castle, London, SE1 6JW, UK
| | - Carol McCrum
- East Sussex Healthcare NHS Trust, Kings Drive, Eastbourne, BN21 2UD, UK; University of Brighton, Darley Road, Eastbourne, BN20 7UR, UK
| | - Simon O'Shea
- Sheffield Teaching Hospitals NHS Foundation Trust, Graves Move Moore Health and Sports Centre, Bochum Parkway, Sheffield, S8 8JR, UK
| | | | - Paul Barratt
- Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Paul Regan
- Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Lynne Ronan
- Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Dave Baker
- Complete Physio, The Bankside Fitness Hub, Blue Fin Building, 110 Southwark St, London, SE1 0SU, UK
| | - Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; School of Physical Therapy Western University London, Ontario, N6G 1H1, Canada
| |
Collapse
|
25
|
The short-term effects of opioid and non-opioid pharmacotherapies on sleep in people with chronic low back pain: A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev 2022; 65:101672. [DOI: 10.1016/j.smrv.2022.101672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/20/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022]
|
26
|
Ellis K, Munro D, Clarke J. Endometriosis Is Undervalued: A Call to Action. Front Glob Womens Health 2022; 3:902371. [PMID: 35620300 PMCID: PMC9127440 DOI: 10.3389/fgwh.2022.902371] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/19/2022] [Indexed: 01/19/2023] Open
Abstract
Endometriosis is an inflammatory chronic pain condition caused by uterine tissue growing outside of the uterus that afflicts at least 11% of women (and people assigned female at birth) worldwide. This condition results in a substantial burden to these women, and society at large. Although endometriosis was first identified over 160 years ago, substantial knowledge gaps remain, including confirmation of the disease's etiology. Research funding for endometriosis is limited, with funding from bodies like the National Institutes of Health (NIH) constituting only 0.038% of the 2022 health budget—for a condition that affects 6.5 million women in the US alone and over 190 million worldwide. A major issue is that diagnosis of endometriosis is frequently delayed because surgery is required to histologically confirm the diagnosis. This delay increases symptom intensity, the risk of central and peripheral sensitization and the costs of the disease for the patient and their nation. Current conservative treatments of presumed endometriosis are pain management and birth control. Both of these methods are flawed and can be entirely ineffective for the reduction of patient suffering or improving ability to work, and neither addresses the severe infertility issues or higher risk of certain cancers. Endometriosis research deserves the funding and attention that befits a disease with its substantial prevalence, effects, and economic costs. This funding could improve patient outcomes by introducing less invasive and more timely methods for diagnosis and treatment, including options such as novel biomarkers, nanomedicine, and microbiome alterations.
Collapse
Affiliation(s)
- Katherine Ellis
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Deborah Munro
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
- *Correspondence: Deborah Munro
| | - Jennifer Clarke
- Faculty of Health, University of Canterbury, Christchurch, New Zealand
| |
Collapse
|
27
|
BouSaba J, Sannaa W, Camilleri M. Update on the role of naldemedine in opioid-induced constipation in patients with chronic noncancer pain. Therap Adv Gastroenterol 2022; 15:17562848221078638. [PMID: 35509419 PMCID: PMC9058332 DOI: 10.1177/17562848221078638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/17/2022] [Indexed: 02/04/2023] Open
Abstract
Chronic noncancer pain (CNCP) affects up to 20% of adults and can interfere with activities of daily living. Up to 4% of adults in the United States receive chronic opioid therapy and up to 57% of patients on long-term opioids for CNCP report opioid-induced constipation (OIC). OIC is essentially constipation occurring after starting opioid treatment. While laxatives are traditionally the first-line therapy for OIC, 81% of patients taking daily laxatives and opioids still reported OIC and considered that it negatively affected their quality of life. Naldemedine is a peripherally acting µ-opioid receptor antagonists (PAMORA) approved for the treatment of OIC in patients with CNCP. This article reviews the mechanism of action, efficacy, and safety of naldemedine in CNCP patients. Naldemedine improves OIC in patients with CNCP by acting as an opioid receptor antagonist in the gastrointestinal tract. It does not interfere with the analgesic properties of opioids or cause withdrawal symptoms since these effects are centrally mediated, and naldemedine does not cross the blood brain barrier. Naldemedine showed significant and sustained improvement in frequency of bowel movements, quality of life, and constipation-related symptoms. It is generally well tolerated with a higher incidence of gastrointestinal adverse events of mild or moderate severity such as diarrhea, abdominal pain, or vomiting compared to placebo. While there are no randomized, controlled trials that compare head-to-head pharmacological therapies used for treatment of OIC, network meta-analysis shows that naldemedine has an overall good benefit-risk profile compared to the other approved medications.
Collapse
|
28
|
Tack J, Camilleri M, Hale M, Morlion B, Nalamachu S, Webster L, Wild J. Establishing Minimal Clinically Important Differences in Quality of Life Measures in Opioid-Induced Constipation. Clin Gastroenterol Hepatol 2022; 20:855-863. [PMID: 33965574 DOI: 10.1016/j.cgh.2021.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Opioids have a role in chronic pain management. However, opioid-induced constipation may cause patients to skip or reduce opioid doses, leading to inadequate pain relief and negatively impacting quality of life. We sought to establish a minimal clinically important difference to understand whether changes in quality of life scores are of value to patients. METHODS Integrated data from the double-blind, controlled, phase 3 COMPOSE-1 and COMPOSE-2 trials of naldemedine in chronic noncancer pain and opioid-induced constipation were used to determine minimal clinically important differences using Patient Assessment of Constipation Symptoms (PAC-SYM) and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaires. Patients completed the questionnaires (5-point Likert scale; predose, Weeks 2, 4, and 12), kept a daily log of Bowel Movement and Constipation Assessment, and rated satisfaction at end of study. Minimal clinically important differences were computed using an anchor-based method with 6 anchors: 5 from the Bowel Movement and Constipation Assessment and 1 from patient satisfaction. Threshold values for each anchor were set to define responders versus nonresponders based on score definitions. Clinically meaningful cutoff values for changes in PAC-SYM and PAC-QOL scores were determined using receiver operating characteristic curves. RESULTS Data from 1095 patients (549, naldemedine; 546, placebo) were analyzed. The area under the curve for the receiver operating characteristic curves (ranges, 0.719 to 0.798 for PAC-SYM and 0.734 to 0.833 for PAC-QOL) indicated that both instruments can discriminate responders and nonresponders for each anchor. PAC-SYM cutoff values ranged from -1.04 to -0.83; PAC-QOL cutoff values ranged from -0.93 to -0.82. CONCLUSIONS Based on data derived from the anchor method, reductions in PAC-SYM and PAC-QOL scores of >1.0 in patients with chronic noncancer pain and opioid-induced constipation are clinically meaningful. CLINICALTRIALS gov Registration: NCT01965158; NCT01993940.
Collapse
Affiliation(s)
- Jan Tack
- Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium.
| | - Michael Camilleri
- Clinical Enteric Neuroscience Translational and Epidemiological Research, Mayo Clinic, Rochester, Minnesota
| | - Martin Hale
- Gold Coast Research, LLC, Plantation, Florida
| | - Bart Morlion
- Leuven Center for Algology and Pain Management, University Hospital Leuven, University of Leuven, Leuven, Belgium
| | | | | | - James Wild
- Upstate Clinical Research Associates, Williamsville, New York
| |
Collapse
|
29
|
Richards GC, Anwar S, Quinlan J. Averting a UK opioid crisis: getting the public health messages 'right'. J R Soc Med 2022; 115:161-164. [PMID: 35352589 DOI: 10.1177/01410768221089015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Georgia C Richards
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK.,Global Centre on Healthcare and Urbanisation, Kellogg College, University of Oxford, Oxford, OX2 6PN, UK
| | - Sibtain Anwar
- Pain Medicine, Barts Heart Centre and St. Bartholomew's Hospital, EC1A 7BE, London, UK
| | - Jane Quinlan
- Nuffield Department of Anaesthetics, Oxford University Hospitals, NHS Foundation Trust, OX3 9DU, Oxford, UK
| |
Collapse
|
30
|
Suarez-Durall P, Osborne MS, Chan C, Enciso R, Mulligan R. Opioids and older adults: Increasing trends in opioid usage in a dental population compared to a National Database (NHANES). SPECIAL CARE IN DENTISTRY 2022; 42:445-455. [PMID: 35279860 PMCID: PMC9543923 DOI: 10.1111/scd.12709] [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: 11/10/2021] [Revised: 12/17/2021] [Accepted: 02/19/2022] [Indexed: 11/26/2022]
Abstract
Aim To examine self‐reported opioid prevalence at a dental school clinic for patients ≥65 years old as compared to national data, comparing gender, ethnicity/race and older adult age groupings. Methods and results Self‐reported prescription opioid medication use was extracted from the medical record for dental patients ≥65 years old who visited the school's general dental clinic (GDC) in 2012 or 2017. This data was compared to the National Health and Nutrition Examination Survey (NHANES) data for 2011–2012 and 2017–18. There was a significant increase in prevalence of opioid use in adults ≥65 between 2012 (4.5%) and 2017 (6.5%) and for ages 65–79 (from 4.7% to 6.3%) and ≥80 (3.4% to 7.9%), women (4.8% to 7.0%), and African Americans (4.7% to 8.4%) in the GDC. Older adults at the GDC reported less opioid use than the NHANES national average for both periods no matter the gender or the age with variable results for race/ethnicity. Conclusion The prevalence of older adults taking opioids in our general dental school clinic population increased significantly in 2017 as compared to 2012 but was lower than the national average for the respective periods. Awareness of existing opioid usage in older adult patients and its higher adverse risk potential is critical when prescribing analgesics for dental pain for this age group.
Collapse
Affiliation(s)
- Piedad Suarez-Durall
- Department of Geriatrics, Special Needs and Behavioral Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.,Leonard Davis School of Gerontology of University of Southern California, Los Angeles, CA, USA
| | - Maile S Osborne
- Department of Geriatrics, Special Needs and Behavioral Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Chan Chan
- Dental Public Health & Community Outreach, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
| | - Reyes Enciso
- Department of Geriatrics, Special Needs and Behavioral Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Roseann Mulligan
- Leonard Davis School of Gerontology of University of Southern California, Los Angeles, CA, USA.,Dental Public Health & Community Outreach, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
31
|
Yiu CH, Gnjidic D, Patanwala A, Fong I, Begley D, Khor KE, Rimington J, Bugeja B, Penm J. Opioid-related adverse drug events in surgical patients: risk factors and association with clinical outcomes. Expert Opin Drug Saf 2022; 21:1211-1223. [PMID: 35234566 DOI: 10.1080/14740338.2022.2049230] [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: 11/04/2022]
Abstract
BACKGROUND Opioid analgesics are commonly used to treat acute post-operative pain. The primary objective of this study was to identify the risk factors for opioid related adverse drug events (ORADEs) in surgical patients and the association between ORADEs and clinical outcomes. RESEARCH DESIGN AND METHODS : A retrospective cohort study was conducted using data from July 2016 to April 2020. ORADEs were defined using International Classification of Diseases 10th Revision Australian Modification codes. Multivariate logistic regression was performed to identify risk factors for ORADEs. To investigate the association between ORADEs and clinical outcomes, propensity score matching was performed. RESULTS Among 17,886 surgical patients who received opioid analgesics during hospital stay, 1,814 patients (10.2%) experienced ORADEs. Risk factors for general ORADEs included advanced age, comorbidities, concurrent use of benzodiazepines or gabapentionoids and a higher opioid daily dose. Patients who experienced ORADEs were associated with longer length of stay (LOS, Rate Ratio 3.00, 95% CI 2.97-3.04) but similar 28-day readmission rate (Odds Ratio 0.89, 95% CI 0.71-1.11). CONCLUSIONS Risk factors for general ORADEs were advanced age, specific comorbidities, use of benzodiazepines or gabapentionoids and higher opioid dose. Routine use of opioids with gabapentionoids should be avoided and only used after careful consideration.
Collapse
Affiliation(s)
- Chin Hang Yiu
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Science Rd, Camperdown, New South Wales, Australia
| | - Danijela Gnjidic
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Science Rd, Camperdown, New South Wales, Australia
| | - Asad Patanwala
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Science Rd, Camperdown, New South Wales, Australia.,Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, New South Wales, Australia
| | - Ian Fong
- Prince of Wales Hospital, 320-346 Barker St, Randwick, New South Wales, Australia
| | - David Begley
- Prince of Wales Hospital, 320-346 Barker St, Randwick, New South Wales, Australia
| | - Kok Eng Khor
- Prince of Wales Hospital, 320-346 Barker St, Randwick, New South Wales, Australia
| | - Joanne Rimington
- South East Sydney Local Health District, Randwick, New South Wales, Australia
| | - Bernadette Bugeja
- South East Sydney Local Health District, Randwick, New South Wales, Australia
| | - Jonathan Penm
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Science Rd, Camperdown, New South Wales, Australia.,Prince of Wales Hospital, 320-346 Barker St, Randwick, New South Wales, Australia
| |
Collapse
|
32
|
Yiu CH, Vitharana N, Gnjidic D, Patanwala AE, Fong I, Rimington J, Begley D, Bugeja B, Penm J. Patient risk factors for opioid‐related adverse drug events in hospitalized patients: A systematic review. Pharmacotherapy 2022; 42:194-215. [DOI: 10.1002/phar.2666] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Chin Hang Yiu
- Faculty of Medicine and Health Sydney Pharmacy School The University of Sydney Camperdown New South Wales Australia
| | - Nilru Vitharana
- Department of Anaesthesia The Children’s Hospital at Westmead Westmead New South Wales Australia
| | - Danijela Gnjidic
- Faculty of Medicine and Health Sydney Pharmacy School The University of Sydney Camperdown New South Wales Australia
| | - Asad E. Patanwala
- Faculty of Medicine and Health Sydney Pharmacy School The University of Sydney Camperdown New South Wales Australia
- Department of Pharmacy Royal Prince Alfred Hospital Camperdown New South Wales Australia
| | - Ian Fong
- Department of Pharmacy Prince of Wales Hospital Randwick New South Wales Australia
| | - Joanne Rimington
- District Pharmacy Services South Eastern Sydney Local Health District Randwick New South Wales Australia
| | - David Begley
- Department of Pain Management Prince of Wales Hospital Randwick New South Wales Australia
| | - Bernadette Bugeja
- Department of Pain Management Prince of Wales Hospital Randwick New South Wales Australia
| | - Jonathan Penm
- Faculty of Medicine and Health Sydney Pharmacy School The University of Sydney Camperdown New South Wales Australia
- Department of Pharmacy Prince of Wales Hospital Randwick New South Wales Australia
| |
Collapse
|
33
|
Line B, Bess S, Gum JL, Hostin R, Kebaish K, Ames C, Burton D, Mundis G, Eastlack R, Gupta M, Klineberg E, Lafage V, Lafage R, Schwab F, Shaffrey C, Smith JS. Opioid use prior to surgery is associated with worse preoperative and postoperative patient reported quality of life and decreased surgical cost effectiveness for symptomatic adult spine deformity; A matched cohort analysis. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 9:100096. [PMID: 35141660 PMCID: PMC8819939 DOI: 10.1016/j.xnsj.2021.100096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 11/06/2022]
Abstract
Multi-center, matched analysis of surgically treated SASD patients demonstrated preoperative opioid users reported greater pain, worse physical function, worse self-image preoperatively and at minimum 2-years postoperative and reported lower treatment satisfaction compared to opioid nonusers (p<0.05). Preoperative opioid users had longer ICU (40.8 vs 21.4 hours) and hospital stay (10.5 vs 8.0 days) than nonusers following SASD surgery, respectively (p<0.05). Preoperative opioid users demonstrated worse one and two-year postoperative cost/QALY following SASD surgery than nonusers (p<0.05). Preoperative opioid users reported greater opioid use at two-years following SASD surgery than preoperative nonusers (41.2% vs. 12.9%; odds ratio=4.5; 95% confidence interval=2.7-8.3; p<0.05).
Background Preoperative opioid is associated with poor postoperative outcomes for several surgical specialties, including neurosurgical, orthopedic, and general surgery. Patients with symptomatic adult spinal deformity (SASD) are among the highest patient populations reporting opioid use prior to surgery. Surgery for SASD has been demonstrated to improve patient reported quality of life, however, little medical economic data exists evaluating impact of preoperative opioid use upon surgical cost-effectiveness for SASD. The purpose of this study was to evaluate the impact that preoperative opioid use has upon SASD surgery including duration of intensive care unit (ICU) and hospital stay, postoperative complications, patient reported outcome measures (PROMs), and surgical cost-effectiveness using a propensity score matched analysis model. Methods Surgically treated SASD patients enrolled into a prospective multi-center SASD study were assessed for preoperative opioid use, and divided into two cohorts; preoperative opioid users (OPIOID) and preoperative opioid non-users (NON). Propensity score matching (PSM) was used to control for patient age, medical comorbidities, spine deformity type and magnitude, and surgical procedures for OPIOID vs NON. Preoperative and minimum 2-year postoperative PROMs, duration of ICU and hospital stay, postoperative complications, and opioid use at one and two years postoperative were compared for OPIOID vs NON. Preoperative, one year, and minimum two-year postoperative SF6D values were calculated, and one- and two-year postoperative QALYs were calculated using SF6D change from baseline. Hospital costs at the time of index surgery were calculated and cost/QALY compared at one and two years postop for OPIOID vs NON. Results 261/357 patients (mean follow-up 3.3 years) eligible for study were evaluated. Following the PSM control, OPIOID (n=97) had similar preoperative demographics, smoking and depression history, spine deformity magnitude, and surgery performed as NON (n=164; p>0.05). Preoperatively, OPIOID reported greater NRS back pain (7.7 vs 6.7) and leg pain (5.2 vs 3.9), worse ODI (50.8 vs 36.9), worse SF-36 PCS (28.8 vs 35.6), and worse SRS-22r self-image (2.3 vs 2.5) than NON, respectively (p<0.05). OPIOID had longer ICU (41.2 vs 21.4 hours) and hospital stay (10.6 vs 8.0 days) than NON, respectively (p<0.05). At last postoperative follow up, OPIOID reported greater NRS back pain (4.1 vs 2.3) and leg pain (2.9 vs 1.7), worse ODI (32.4 vs 19.4), worse SF-36 PCS (37.4 vs 47.0), worse SRS-22r self-image (3.5 vs 4.0), and lower SRS-22r treatment satisfaction score (2.5 vs 4.5) than NON, respectively (p<0.05). At last follow-up postoperative Cost/QALY was higher for OPIOID ($44,558.31) vs NON ($34,304.36; p<0.05). At last follow up OPIOID reported greater postoperative opioid usage than NON [41.2% vs. 12.9%, respectively; odds ratio =4.7 (95% CI=2.6-8.7; p<0.05)]. Conclusions Prospective, multi-center, matched analysis demonstrated SASD patients using opioids prior to SASD surgery reported worse preoperative and postoperative quality of life, had longer ICU and hospital stay, had less cost effectiveness of SASD surgery. Preoperative opioid users also reported lower treatment satisfaction, and reported greater postoperative opioid use than non-users. These data should be used to council patients on the negative impact preoperative opioid use can have on SASD surgery.
Collapse
|
34
|
Lunny C, Reid EK, Neelakant T, Chen A, Zhang JH, Shinger G, Stevens A, Tasnim S, Sadeghipouya S, Adams S, Zheng YW, Lin L, Yang PH, Dosanjh M, Ngsee P, Ellis U, Shea BJ, Wright JM. A new taxonomy was developed for overlap across 'Overviews of systematic reviews': a meta-research study of research waste. Res Synth Methods 2021; 13:315-329. [PMID: 34927388 PMCID: PMC9303867 DOI: 10.1002/jrsm.1542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/09/2022]
Abstract
Multiple ‘overviews of reviews’ conducted on the same topic (“overlapping overviews”) represent a waste of research resources and can confuse clinicians making decisions amongst competing treatments. We aimed to assess the frequency and characteristics of overlapping overviews. MEDLINE, Epistemonikos and Cochrane Database of Systematic Reviews were searched for overviews that: synthesized reviews of health interventions and conducted systematic searches. Overlap was defined as: duplication of PICO eligibility criteria, and not reported as an update nor a replication. We categorized overview topics according to 22 WHO ICD‐10 medical classifications, overviews as broad or narrow in scope, and overlap as identical, nearly identical, partial, or subsumed. Subsummation was defined as when broad overviews subsumed the populations, interventions and at least one outcome of another overview. Of 541 overviews included, 169 (31%) overlapped across similar PICO, fell within 13 WHO ICD‐10 medical classifications, and 62 topics. 148/169 (88%) overlapping overviews were broad in scope. Fifteen overviews were classified as having nearly identical overlap (9%); 123 partial overlap (73%), and 31 subsumed (18%) others. One third of overviews overlapped in content and a majority covered broad topic areas. A multiplicity of overviews on the same topic adds to the ongoing waste of research resources, time, and effort across medical disciplines. Authors of overviews can use this study and the sample of overviews to identify gaps in the evidence for future analysis, and topics that are already studied, which do not need to be duplicated.
Collapse
Affiliation(s)
- Carole Lunny
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada
| | - Emma K Reid
- Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Trish Neelakant
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada.,Royal College of Surgeons in Ireland
| | - Alyssa Chen
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada
| | - Jia He Zhang
- Faculty of Pharmaceutical Science, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada
| | - Gavindeep Shinger
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada
| | - Adrienne Stevens
- Michael G. DeGroote Cochrane Canada Centre, Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada
| | - Sara Tasnim
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada
| | - Shadi Sadeghipouya
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada
| | - Stephen Adams
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada
| | - Yi Wen Zheng
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada
| | - Lester Lin
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada
| | - Pei Hsuan Yang
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada
| | - Manpreet Dosanjh
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada
| | - Peter Ngsee
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada
| | - Ursula Ellis
- Woodward Library, University of British Columbia, Vancouver, BC, Canada
| | - Beverley J Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - James M Wright
- Cochrane Hypertension Review Group, Therapeutics Initiative, Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, 2176 Health Science Mall, Vancouver, BC, Canada
| |
Collapse
|
35
|
Jenkin DE, Naylor JM, Descallar J, Harris IA. Effectiveness of Oxycodone Hydrochloride (Strong Opioid) vs Combination Acetaminophen and Codeine (Mild Opioid) for Subacute Pain After Fractures Managed Surgically: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2134988. [PMID: 34787656 PMCID: PMC8600392 DOI: 10.1001/jamanetworkopen.2021.34988] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Patients with a surgically managed fracture are commonly discharged from the hospital with a strong opioid prescription, but limited evidence exists to support this practice. OBJECTIVE To test the hypothesis that strong opioids provide greater analgesia than mild opioids over the first week postdischarge from hospital after fracture surgical treatment. DESIGN, SETTING, AND PARTICIPANTS This double-blind, superiority, randomized clinical trial was conducted at a single-center, major trauma hospital in Sydney, Australia. Participants were inpatients who had sustained an acute nonpathological facture of a long bone or the pelvis, patella, calcaneus, or talus who were treated with surgical fixation and enrolled from July 27, 2016, to August 22, 2017. Data were analyzed from June through October 2018. INTERVENTIONS Initiation at discharge of oxycodone hydrochloride 5 mg of 10 mg (ie, 1 or 2 tablets) or combination acetaminophen and codeine 500 mg and 8 mg or 1000 mg and 16 mg (ie, 1 or 2 tablets) 4 times daily for a maximum duration of 3 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was the mean of daily pain scores collected during week 1 of treatment measured using the Numerical Pain Rating Scale (NRS). Participants were asked to rate their mean pain over the previous 24 hours daily using an NRS score from 0 to 10, with 0 representing no pain and 10 representing the worst pain imaginable. The key secondary outcomes were EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L) responses, worst pain, medication adverse events, global perceived effect, and return to work. RESULTS A total of 120 patients with 1 or more acute orthopedic fractures requiring surgical fixation were randomized, including 59 patients in the strong-opioid group (43 [72.9%] men; mean [SD] age, 36.0 [14.1] years; mean oral morphine equivalent for days 1-7 of 32.9 mg) and 61 patients in the mild opioid group (47 [77.1%] men; mean [SD] age, 38.2 [13.5] years; mean oral morphine equivalent for days 1-7 of 5.5 mg). From days 1 to 7 postdischarge, the mean daily NRS mean pain score was 4.04 (95% Cl, 3.67 to 4.41) in the strong opioid group and 4.54 (95% Cl, 4.17 to 4.90) in the mild opioid group. The between-group difference of the primary outcome was not statistically significant (-0.50 [95% Cl, -1.11 to 0.12]; P = .11) despite a 6-fold increased dose of opioids being delivered in the strong opioid group. CONCLUSIONS AND RELEVANCE This study found that treatment with strong opioid medication subacutely was not superior to treatment with milder medication for treatment of pain among patients with surgically managed orthopedic fractures. These findings suggest that ongoing first-line strong opioid use after discharge from the hospital should not be supported. TRIAL REGISTRATION Australia New Zealand Clinical Trial Registry No.: ACTRN12616000941460.
Collapse
Affiliation(s)
- Deanne E. Jenkin
- University of New South Wales, South Western Sydney Clinical School, Sydney, Australia
- Whitlam Orthopaedic Research Centre, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Presently with Daffodil Centre, University of Sydney, a joint venture with Cancer Council New South Wales, Kings Cross, New South Wales, Australia
| | - Justine M. Naylor
- University of New South Wales, South Western Sydney Clinical School, Sydney, Australia
- Whitlam Orthopaedic Research Centre, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Joseph Descallar
- University of New South Wales, South Western Sydney Clinical School, Sydney, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Ian A. Harris
- University of New South Wales, South Western Sydney Clinical School, Sydney, Australia
- Whitlam Orthopaedic Research Centre, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| |
Collapse
|
36
|
Xie J, Strauss VY, Martinez-Laguna D, Carbonell-Abella C, Diez-Perez A, Nogues X, Collins GS, Khalid S, Delmestri A, Turkiewicz A, Englund M, Tadrous M, Reyes C, Prieto-Alhambra D. Association of Tramadol vs Codeine Prescription Dispensation With Mortality and Other Adverse Clinical Outcomes. JAMA 2021; 326:1504-1515. [PMID: 34665205 PMCID: PMC8527363 DOI: 10.1001/jama.2021.15255] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Although tramadol is increasingly used to manage chronic noncancer pain, few safety studies have compared it with other opioids. OBJECTIVE To assess the associations of tramadol, compared with codeine, with mortality and other adverse clinical outcomes as used in outpatient settings. DESIGN, SETTING, AND PARTICIPANTS Retrospective, population-based, propensity score-matched cohort study using a primary care database with routinely collected medical records and pharmacy dispensations covering more than 80% of the population of Catalonia, Spain (≈6 million people). Patients 18 years or older with 1 or more year of available data and dispensation of tramadol or codeine (2007-2017) were included and followed up to December 31, 2017. EXPOSURES New prescription dispensation of tramadol or codeine (no dispensation in the previous year). MAIN OUTCOMES AND MEASURES Outcomes studied were all-cause mortality, cardiovascular events, fractures, constipation, delirium, falls, opioid abuse/dependence, and sleep disorders within 1 year after the first dispensation. Absolute rate differences (ARDs) and hazard ratios (HRs) with 95% confidence intervals were calculated using cause-specific Cox models. RESULTS Of the 1 093 064 patients with a tramadol or codeine dispensation during the study period (326 921 for tramadol, 762 492 for codeine, 3651 for both drugs concomitantly), a total of 368 960 patients (184 480 propensity score-matched pairs) were included after study exclusions and propensity score matching (mean age, 53.1 [SD, 16.1] years; 57.3% women). Compared with codeine, tramadol dispensation was significantly associated with a higher risk of all-cause mortality (incidence, 13.00 vs 5.61 per 1000 person-years; HR, 2.31 [95% CI, 2.08-2.56]; ARD, 7.37 [95% CI, 6.09-8.78] per 1000 person-years), cardiovascular events (incidence, 10.03 vs 8.67 per 1000 person-years; HR, 1.15 [95% CI, 1.05-1.27]; ARD, 1.36 [95% CI, 0.45-2.36] per 1000 person-years), and fractures (incidence, 12.26 vs 8.13 per 1000 person-years; HR, 1.50 [95% CI, 1.37-1.65]; ARD, 4.10 [95% CI, 3.02-5.29] per 1000 person-years). No significant difference was observed for the risk of falls, delirium, constipation, opioid abuse/dependence, or sleep disorders. CONCLUSIONS AND RELEVANCE In this population-based cohort study, a new prescription dispensation of tramadol, compared with codeine, was significantly associated with a higher risk of subsequent all-cause mortality, cardiovascular events, and fractures, but there was no significant difference in the risk of constipation, delirium, falls, opioid abuse/dependence, or sleep disorders. The findings should be interpreted cautiously, given the potential for residual confounding.
Collapse
Affiliation(s)
- Junqing Xie
- Centre for Statistics in Medicine and NIHR Biomedical Research Centre Oxford, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Victoria Y. Strauss
- Centre for Statistics in Medicine and NIHR Biomedical Research Centre Oxford, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Daniel Martinez-Laguna
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFes), Instituto Carlos III, Madrid, Spain
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Cristina Carbonell-Abella
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFes), Instituto Carlos III, Madrid, Spain
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Adolfo Diez-Perez
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFes), Instituto Carlos III, Madrid, Spain
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Musculoskeletal Research Unit, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Xavier Nogues
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFes), Instituto Carlos III, Madrid, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Musculoskeletal Research Unit, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
- Internal Medicine Department, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Gary S. Collins
- Centre for Statistics in Medicine and NIHR Biomedical Research Centre Oxford, NDORMS, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Sara Khalid
- Centre for Statistics in Medicine and NIHR Biomedical Research Centre Oxford, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Antonella Delmestri
- Centre for Statistics in Medicine and NIHR Biomedical Research Centre Oxford, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Aleksandra Turkiewicz
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Faculty of Medicine, Lund University, Lund, Sweden
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Faculty of Medicine, Lund University, Lund, Sweden
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Women’s College Hospital Research Institute, Toronto, Toronto, Ontario, Canada
| | - Carlen Reyes
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFes), Instituto Carlos III, Madrid, Spain
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine and NIHR Biomedical Research Centre Oxford, NDORMS, University of Oxford, Oxford, United Kingdom
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
37
|
Powell VD, Rosenberg JM, Yaganti A, Garpestad C, Lagisetty P, Shannon C, Silveira MJ. Evaluation of Buprenorphine Rotation in Patients Receiving Long-term Opioids for Chronic Pain: A Systematic Review. JAMA Netw Open 2021; 4:e2124152. [PMID: 34495339 PMCID: PMC8427372 DOI: 10.1001/jamanetworkopen.2021.24152] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Individuals with chronic pain who use long-term opioid therapy (LTOT) are at risk of opioid use disorder and other harmful outcomes. Rotation to buprenorphine may be considered, but the outcomes of such rotation in this population have not been systematically reviewed. OBJECTIVE To synthesize the evidence on rotation to buprenorphine from full μ-opioid receptor agonists among individuals with chronic pain who were receiving LTOT, including the outcomes of precipitated opioid withdrawal, pain intensity, pain interference, treatment success, adverse events or adverse effects, mental health condition, and health care use. EVIDENCE REVIEW PubMed, CINAHL, Embase, and PsycInfo were searched from inception through November 3, 2020, for peer-reviewed original English-language research that reported the prespecified outcomes of rotation from prescribed long-term opioids to buprenorphine among individuals with chronic pain. Two independent reviewers extracted data as well as assessed risk of bias and study quality according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Quality of evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. FINDINGS A total of 22 studies were analyzed, of which 5 (22.7%) were randomized clinical trials, 7 (31.8%) were case-control or cohort studies, and 10 (45.5%) were uncontrolled pre-post studies, which involved 1616 unique participants (675 female [41.8%] and 941 male [58.2%] individuals). Six of the 22 studies (27.3%) were primary or secondary analyses of a large randomized clinical trial. Participants had diverse pain and opioid use histories. Rationale for buprenorphine rotation included inadequate analgesia, intolerable adverse effects, risky opioid regimens (eg, high dose and/or sedative coprescriptions), and aberrant opioid use. Most protocols were adapted from protocols for initiating treatment in patients with opioid use disorder and used buccal or sublingual buprenorphine. Very low-quality evidence suggested that buprenorphine rotation was associated with maintained or improved analgesia, with a low risk of precipitating opioid withdrawal. Steady-dose buprenorphine was better tolerated than tapered-dose buprenorphine. Adverse effects were manageable, and severe adverse events were rare. Only 2 studies evaluated mental health outcomes, but none evaluated health care use. Limitations included a high risk of bias in most studies. CONCLUSIONS AND RELEVANCE In this systematic review, buprenorphine was associated with reduced chronic pain intensity without precipitating opioid withdrawal in individuals with chronic pain who were receiving LTOT. Future studies are necessary to ascertain the ideal starting dose, formulation, and administration frequency of buprenorphine as well as the best approach to buprenorphine rotation.
Collapse
Affiliation(s)
- Victoria D. Powell
- Palliative Care Program, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor
- Geriatrics Research, Education, and Clinical Center, LTC Charles S. Kettles Veterans Affairs (VA) Medical Center, Ann Arbor, Michigan
| | - Jack M. Rosenberg
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
- Department of Anesthesiology, University of Michigan, Ann Arbor
- Department of Physical Medicine and Rehabilitation, LTC Charles S. Kettles VA Medical Center, Ann Arbor, Michigan
- Department of Anesthesiology, LTC Charles S. Kettles VA Medical Center, Ann Arbor, Michigan
| | - Avani Yaganti
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | | | - Pooja Lagisetty
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Clinical Management and Research, Ann Arbor VA, Ann Arbor, Michigan
| | - Carol Shannon
- Taubman Health Sciences Library, University of Michigan, Ann Arbor
| | - Maria J. Silveira
- Palliative Care Program, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor
- Geriatrics Research, Education, and Clinical Center, LTC Charles S. Kettles Veterans Affairs (VA) Medical Center, Ann Arbor, Michigan
| |
Collapse
|
38
|
Bérubé M, Dupuis S, Leduc S, Roy I, Côté C, Grzelak S, Clairoux S, Panic S, Lauzier F. Tapering Opioid Prescription Program for High-Risk Trauma Patients: A Pilot Randomized Controlled Trial. Pain Manag Nurs 2021; 23:142-150. [PMID: 34479822 DOI: 10.1016/j.pmn.2021.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/02/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Chronic opioid use has been documented in up to 20% of patients with traumatic injuries. Hence, we developed the Tapering Opioids Prescription Program for high-risk Trauma (TOPP-Trauma) patients. AIMS To assess the feasibility and acceptability of TOPP-Trauma, examine the feasibility of the research methods, and describe its potential efficacy in reducing long-term opioid use. DESIGN A two-arm pilot randomized controlled trial. METHODS Fifty participants discharged home were assigned to TOPP-Trauma or an educational pamphlet. Feasibility was assessed based on ability to provide the program components. The acceptability was assessed with the Treatment Acceptability and Preference Questionnaire. The feasibility of the research methods was evaluated according to standard parameters. Self-reported morphine equivalent dose (MED) and MEDs supplied by pharmacies were measured at 6 and 12 weeks. RESULTS Eighty percent or more of TOPP-Trauma components were delivered as planned, and the program was deemed highly acceptable. Approximately 10% of screened patients were eligible. Eighty-five percent of eligible patients agreed to participate with 20% attrition rates. TOPP-Trauma participants used less MED/day compared to the control group at 6 and 12 weeks (1.2. vs. 12.2 mg; 0.4. vs 4.0 mg), and pharmacies supplied less than half of cumulative MEDs to those who received the program at 12 weeks, but the differences were not statistically significant. CONCLUSIONS Some challenges need to be addressed before testing TOPP-Trauma. These include creating strategies to decrease attrition, offering the program throughout the care continuum to higher risk patients, and evaluating the impacts of reduced opioid use.
Collapse
Affiliation(s)
- Mélanie Bérubé
- Research Center of the CHU de Québec-Université Laval, Population Health and Optimal Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada; Faculty of Nursing, Université Laval, Quebec City, Canada.
| | - Sébastien Dupuis
- Pharmacy Department, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, Canada
| | - Stéphane Leduc
- Orthopaedic Department, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, Canada
| | - Isabel Roy
- Trauma Program, Hôpital du Sacré-Cœur de Montréal, 5400 Boulevard Gouin, Monteal, Canada
| | - Caroline Côté
- Research Center of the CHU de Québec-Université Laval, Population Health and Optimal Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada; Faculty of Nursing, Université Laval, Quebec City, Canada
| | - Sonia Grzelak
- Research Center of the CHU de Québec-Université Laval, Population Health and Optimal Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada; Faculty of Nursing, Université Laval, Quebec City, Canada
| | - Sarah Clairoux
- Pharmacy Department, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'Île-de-Montréal, Montreal, Canada
| | - Stéphane Panic
- Trauma Program, Hôpital du Sacré-Cœur de Montréal, 5400 Boulevard Gouin, Monteal, Canada
| | - François Lauzier
- Research Center of the CHU de Québec-Université Laval, Population Health and Optimal Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Quebec City, Canada
| |
Collapse
|
39
|
Kurteva S, Abrahamowicz M, Gomes T, Tamblyn R. Association of Opioid Consumption Profiles After Hospitalization With Risk of Adverse Health Care Events. JAMA Netw Open 2021; 4:e218782. [PMID: 34003273 PMCID: PMC8132136 DOI: 10.1001/jamanetworkopen.2021.8782] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Although better pain management has guided policies for opioid use over the past few decades, evidence is limited regarding how patterns of use are associated with the risk of potentially avoidable opioid-related adverse events. OBJECTIVE To estimate the risk of harms associated with opioid dose and duration of use, and to ascertain whether the risk is modified by treatment indication and age. DESIGN, SETTING, AND PARTICIPANTS This ad hoc cohort study followed up patients who were enrolled in a cluster randomized trial of medication reconciliation between October 1, 2014, and November 30, 2016, 12 months after they were discharged from the McGill University Health Centre in Montreal, Quebec, Canada. To be eligible for this study, patients needed to have filled at least 1 opioid prescription 3 months after discharge. Patients with a history of using methadone or buprenorphine were excluded. Data analyses were performed between February 1, 2019, and February 28, 2020. EXPOSURES Time-varying measures of opioid use included current use, daily morphine milligram equivalent (MME) dose, cumulative and continuous use duration, and type of ingredients in prescription opioids used. Hospitalization records, dispensed prescriptions records, and postdischarge interviews were used to evaluate adherence to the opioid prescriptions after discharge. MAIN OUTCOMES AND MEASURES Opioid-related emergency department visits, hospital readmissions, or all-cause death. Outcomes were ascertained using provincial medical services claims and hospitalization databases. RESULTS Of 3486 participants in the cluster randomized trial (mean [SD] age of 69.6 [14.9] years; 2010 men [57.7%]), 1511 patients were included in this ad hoc cohort study. Among those with at least 1 opioid dispensation, 241 patients (15.9%) experienced an opioid-related emergency department visit, hospital readmission, or death. Results from marginal structural Cox proportional hazards regression models showed more than a 2-fold increase in the risk of opioid-related adverse events associated with a cumulative use duration of more than 90 days (adjusted hazard ratio, 2.56; 95% CI, 1.25-5.27) compared with 1 to 30 days. A 3-fold risk increase was found with a mean daily dose higher than 90 MME (adjusted hazard ratio, 3.51; 95% CI, 1.58-7.82) compared with 90 MME or lower. CONCLUSIONS AND RELEVANCE This study found an association between risk of adverse health care events and higher opioid doses and longer treatment duration. This finding can inform policies for limiting opioid duration and dose to attenuate the risk of avoidable morbidity.
Collapse
Affiliation(s)
- Siyana Kurteva
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Michal Abrahamowicz
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Tara Gomes
- Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Robyn Tamblyn
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Quebec, Canada
- ICES, Toronto, Ontario, Canada
- McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
40
|
Miyachi T, Ozaki A, Saito H, Sawano T, Tanimoto T, Crump A. Opioids: A 'crisis' of too much or not enough - or simply how rich you are and where you live? Eur J Pain 2021; 25:1181-1194. [PMID: 33822443 DOI: 10.1002/ejp.1767] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The 'Opioid Crisis', which originated in Western countries, has been misrepresented and is misinforming the global public. For 20 years, since the advent of the synthetic opioids, 25,000 Americans, on average, have died annually from opioid-related overdoses. The United States produces and consumes by far the greatest amounts of opioids. National regulations introduced to curb overdoses and restrict opioid availability have condemned many Americans, such as cancer patients or those in need of palliative care, to a life of extreme pain due to lack of access to adequate pain management. As is often the case, US-driven laws have informed and guided international regulations. Worldwide, 83% of countries have low or non-existent access to opioids for pain relief. Over 25 million people are at the end-of-life stage, with eight million people dying annually in unnecessary pain and distress. Ineffectively controlled pain is a global public health issue blighting the lives of billions of people worldwide with immeasurable human and socioeconomic costs. International conventions regulate the trade and use of controlled medications, including many opioids. The goal is to balance widespread access to optimal forms of pain management with restrictions to govern the use and prevent the misuse of controlled substances. Those conventions are failing to meet their goals. International guidelines to inform national legislation have been compromised and withdrawn, thanks to undue interference from US-based opioid manufacturers. The new goal must be to ensure equitable access, for all, to opioids and ensure that optimal pain management becomes a central component of Universal Health Coverage. SIGNIFICANCE: The opioid crisis is, more accurately, a multicomponent global crisis and one that is not fully apparent or well understood. Regulations of the wealthy and powerful to control a surfeit of opioids, which encourages misuse, cannot be allowed to govern legislation in the majority of countries worldwide where citizens have little or no access to opioids to reduce pain and suffering. International conventions must be revised to ensure an optimal balance that allows access to opioids for all those who need them.
Collapse
Affiliation(s)
| | - Akihiko Ozaki
- Medical Governance Research Institute, Tokyo, Japan.,Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan
| | - Toyoaki Sawano
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | | | - Andy Crump
- Medical Governance Research Institute, Tokyo, Japan.,Kitasato University, Tokyo, Japan
| |
Collapse
|
41
|
Phillips FM, Coric D, Sasso R, Lanman T, Lavelle W, Blumenthal S, Lauryssen C, Guyer R, Albert T, Zigler J, Cammisa F, Milam RA. Prospective, multicenter clinical trial comparing M6-C compressible six degrees of freedom cervical disc with anterior cervical discectomy and fusion for the treatment of single-level degenerative cervical radiculopathy: 2-year results of an FDA investigational device exemption study. Spine J 2021; 21:239-252. [PMID: 33096243 DOI: 10.1016/j.spinee.2020.10.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/28/2020] [Accepted: 10/13/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Various designs of total disc replacement (TDR) devices have been compared to anterior cervical discectomy and fusion (ACDF) with favorable outcomes in FDA-approved investigational device exemption trials. The design of M6-C with a compressible viscoelastic nuclear core and an annular structure is substantially different than prior designs and has previously demonstrated favorable kinematics and clinical outcomes in small case series. PURPOSE To evaluate the safety and effectiveness of the novel M6-C compressible artificial cervical disc compared with ACDF for subjects with single-level degenerative cervical radiculopathy. STUDY DESIGN/SETTING Prospective, multicenter, concurrently and historically controlled, FDA-approved investigational device exemption clinical trial. PATIENT SAMPLE Subjects with one-level symptomatic degenerative cervical radiculopathy were enrolled and assigned to receive M6-C or ACDF. OUTCOME MEASURES Pain and function (Neck Disability Index, VAS), quality of life (SF-36), safety, neurologic, and radiographic assessments of motion (both flexion extension and lateral bending) were performed. The primary clinical endpoint was composite clinical success (CCS) at 24 months. METHODS Using propensity score subclassification to control for selection bias, 160 M6-C subjects were compared to a matched subset of 189 ACDF controls (46 concurrent and 143 historical controls). RESULTS Both ACDF and M6-C subjects reported significant improvements in patient-reported outcomes at all time points over baseline. Overall SF-36 Physical Component Score and neck and arm pain scores were significantly improved for M6-C as compared to ACDF treatment. CCS and mean Neck Disability Index improvements were similar between M6-C and ACDF. Correspondingly, there were significantly fewer subjects that utilized pain medication or opioids following M6-C treatment at 24 months relative to baseline. Range of motion was maintained in subjects treated with M6-C. Subsequent surgical interventions, dysphagia rates, and serious adverse events were comparable between groups. CONCLUSIONS M6-C treatment demonstrated both safety and effectiveness for the treatment of degenerative cervical radiculopathy. Treatment with M6-C demonstrated noninferiority for the primary endpoint, indicating a similar ability to achieve CCS at 24 months. However, for the secondary endpoints, M6-C subjects demonstrated significantly improved pain and function compared to ACDF subjects, while maintaining range of motion, improving quality of life, and decreasing analgesic and opioid usage at 2 years postoperatively relative to baseline.
Collapse
Affiliation(s)
- Frank M Phillips
- Midwest Orthopaedics at Rush University Medical Center, 1611 W Harrison St # 300, Chicago, IL 60612, USA.
| | - Domagoj Coric
- Carolina Neurosurgery & Spine Associates, Atruim Health Musculoskeletal Institute, 225 Baldwin Ave, Charlotte, NC 28204, USA
| | - Rick Sasso
- Indiana Spine Group, 13225 N Meridian St, Carmel, IN 46032, USA
| | - Todd Lanman
- Lanman Spinal Neurosurgery, 450 N Roxbury Dr, Beverly Hills, CA 90210, USA
| | - William Lavelle
- Upstate Bone and Joint Center, 6620 Fly Rd, East Syracuse, NY 13057, USA
| | - Scott Blumenthal
- Center for Disc Replacement at TBI, 6020 West Parker Rd #200, Plano, TX 75093, USA
| | - Carl Lauryssen
- Central Texas Brain and Spine, PLLC, 2217 Park Bend Dr, Unit 400, Austin TX 78758, USA
| | - Richard Guyer
- Center for Disc Replacement at TBI, 6020 West Parker Rd #200, Plano, TX 75093, USA
| | - Todd Albert
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | - Jack Zigler
- Center for Disc Replacement at TBI, 6020 West Parker Rd #200, Plano, TX 75093, USA
| | - Frank Cammisa
- Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA
| | | |
Collapse
|
42
|
Gessner DM, Horn JL, Lowenberg DW. Pain management in the orthopaedic trauma patient: Non-opioid solutions. Injury 2020; 51 Suppl 2:S28-S36. [PMID: 31079833 DOI: 10.1016/j.injury.2019.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 04/18/2019] [Indexed: 02/02/2023]
Abstract
When treating pain in the orthopaedic trauma patient opioids have classically represented the mainstay of treatment. They are relatively inexpensive and modestly effective for basic pain management. However, they are fraught with considerable side effects as well as the very high risk of addiction. Their use in pain management has been implicated in the opioid epidemic. For this reason, as well as their only moderate efficacy, alternative modes of treatment have been sought for both the patient with isolated limb trauma and the patient with poly trauma. We review alternative treatment methods in pain management for those with isolated limb trauma and poly trauma. These methods include topical agents, as well as non steroidal anti-inflammatory medications, acetaminophen, gabapetoids, intravenous agents, varying degrees of local anesthetic infiltration and peripheral nerve blocks, and the newer modality of fascial plane blocks. Often, it is a combination of these analgesic modalities that gives the most optimum treatment for the trauma patient. This also, more frequently than not, must be individually tailored to the patient, as no two patients act the same in this regard. It is therefore of importance that the physician managing such patients's pain be experienced and well-versed in all these treatment modalities. We also provide a basic stepwise algorithm we have found useful in treating those with single extremity or single site trauma versus those patients with poly trauma and resultant multiple sources as pain generators. It is hoped that this breakdown of the different modalities along with a better understanding of each modality's potential benefits and indications will aid the surgeon in providing better care to patients following orthopedic trauma.
Collapse
Affiliation(s)
- Daniel M Gessner
- Department of Anesthesiology, Stanford University School of Medicine, USA
| | - Jean-Louis Horn
- Department of Anesthesiology, Stanford University School of Medicine, USA
| | - David W Lowenberg
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway St., Mailcode 6342, Redwood City, CA, 94063, USA.
| |
Collapse
|
43
|
Thorlund JB, Turkiewicz A, Prieto-Alhambra D, Englund M. Inappropriate opioid dispensing in patients with knee and hip osteoarthritis: a population-based cohort study. Osteoarthritis Cartilage 2020; 28:146-153. [PMID: 31669311 DOI: 10.1016/j.joca.2019.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/16/2019] [Accepted: 10/01/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To estimate inappropriate opioid dispensing in patients with knee or hip osteoarthritis (OA) defined as (1) dispensing of opioids within the first year of diagnosis or (2) long-term opioid use. DESIGN Data from Skåne Healthcare Register was linked with the Swedish Prescribed Drug Register. Incidence proportion of dispensed opioids within first year of incident knee or hip OA diagnosis was determined in knee (n = 399,670) and hip (413,216) OA cohorts without a history of OA. The 1-year period prevalence of long-term opioid dispensing was determined in a prevalence cohort (n = 48,574 with knee and/or hip OA and n = 457,587 without OA). The proportion of OA patients with excess opioid dispensing attributable to OA was estimated using inverse probability weighted regression adjustment. RESULTS In the incident cohorts, 5866 and 2359 developed knee and hip OA, respectively. Within the first year after OA diagnosis 14.7% patients with knee OA and 20.7% with hip OA had an opioid dispensed. The estimated inappropriate dispensing attributable to OA was 7.4% (95% CI 6.5-8.4) for knee OA and 12.8% (95% CI 11.1-14.4) for hip OA. Among persons with prevalent knee, hip or knee and hip OA inappropriate, long-term opioid use attributable to OA was 1.3%, 2.0% and 2.4% of, respectively. CONCLUSIONS More than half the incident opioid dispensations to patients within their first year after knee or hip OA diagnosis are inappropriate according to current treatment guidelines. Furthermore, 2% of patients with prevalent knee or hip OA have inappropriate long-term dispensing of opioids.
Collapse
Affiliation(s)
- J B Thorlund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - A Turkiewicz
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden
| | - D Prieto-Alhambra
- GREMPAL (Grup de Recerca en Epidemiologia de les Malalties Prevalents de l'Aparell Locomotor), Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain; Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine - Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, UK
| | - M Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
44
|
Cannabis Use, a Self-Management Strategy Among Australian Women With Endometriosis: Results From a National Online Survey. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:256-261. [PMID: 31722852 DOI: 10.1016/j.jogc.2019.08.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study sought to determine the prevalence, tolerability, and self-reported effectiveness of cannabis in women with endometriosis. METHODS A cross-sectional online survey was conducted between October and December 2017. Recruitment targeted women with endometriosis through social media postings from endometriosis advocacy groups. Women aged 18 to 45, living in Australia, and with surgically confirmed endometriosis were eligible to participate. Survey questions investigated the types of self-management used, change in symptoms or medication use, costs, and adverse events. RESULTS A total of 484 responses were included for analysis, with 76% of the women reporting the use of general self-management strategies within the last 6 months. Of those using self-management, 13% reported using cannabis for symptom management. Self-reported effectiveness in pain reduction was high (7.6 of 10), with 56% also able to reduce pharmaceutical medications by at least half. Women reported the greatest improvements in sleep and in nausea and vomiting. Adverse effects were infrequent (10%) and minor. CONCLUSION Australian law currently requires legal medicinal cannabis use to follow specific, regulated pathways that limit prescription by this method; however, self-reported illicit use of cannabis remains relatively common in Australian women with endometriosis. Women report good efficacy of cannabis in reducing pain and other symptoms, with few adverse effects reported. Further clinical research is warranted to determine the effectiveness of cannabis in managing endometriosis symptoms. In locations where medicinal cannabis is more accessible, there remains a paucity of evidence for its clinical efficacy with endometriosis-associated symptoms.
Collapse
|
45
|
Al-Kaisy A, Van Buyten JP, Amirdelfan K, Gliner B, Caraway D, Subbaroyan J, Rotte A, Kapural L. Opioid-sparing effects of 10 kHz spinal cord stimulation: a review of clinical evidence. Ann N Y Acad Sci 2019; 1462:53-64. [PMID: 31578744 PMCID: PMC7065058 DOI: 10.1111/nyas.14236] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/26/2019] [Accepted: 08/29/2019] [Indexed: 01/01/2023]
Abstract
Chronic pain is a common condition that affects the physical, emotional, and mental well‐being of patients and can significantly diminish their quality of life. Due to growing concerns about the substantial risks of long‐term opioid use, both governmental agencies and professional societies have recommended prioritizing the use of nonpharmacologic treatments, when suitable, in order to reduce or eliminate the need for opioid use. The use of 10 kHz spinal cord stimulation (10 kHz SCS) is one such nonpharmacologic alternative for the treatment of chronic, intractable pain of the trunk and limbs. This review examines published clinical data regarding the efficacy of 10 kHz SCS for decreasing chronic pain in patients and its potential to reduce or eliminate opioid usage. Multiple prospective and retrospective studies in patients with intractable pain demonstrated that 10 kHz SCS treatment provided ≥50% pain relief in >70% patients after at least 1 year of treatment. Pain relief with 10 kHz SCS therapy ranged from 54% to 87% in the studies. More importantly, the mean daily dose of opioids required by patients in these studies was reduced after 10 kHz SCS treatment, and on average over 60% patients in studies either reduced or eliminated opioids at the last follow‐up.
Collapse
Affiliation(s)
- Adnan Al-Kaisy
- The Pain Management and Neuromodulation Centre, Guy's and St. Thomas' Hospital, London, United Kingdom
| | | | | | | | | | | | | | - Leonardo Kapural
- Carolina's Pain Institute, Winston-Salem, North Carolina.,University of North Carolina, Chapel Hill, North Carolina.,Department of Anesthesiology and Gastroenterology, Wake Forest Baptist Medical Center, Winston-Salem, Chapel Hill, North Carolina
| |
Collapse
|
46
|
Hansen CA, Ernst MT, Stougaard M, Abrahamsen B. Tramadol prescribed use in general and chronic noncancer pain: a nationwide register-based cohort study of all patients above 16 years. Scand J Pain 2019; 20:109-124. [DOI: 10.1515/sjpain-2019-0114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 08/28/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims
In the Western world, it has become clear that we are facing a crisis of overuse, abuse and improperly prescribed use of opioids. As part of the ongoing discussion on opioid use, the use and prescription of tramadol have been addressed in recent years. A significant portion of this discussion should adequately address the risk factors for the use of weak opioid products such as tramadol. The risk factors which characterise the long-term tramadol use are still incompletely understood. Thus, we aimed to describe the characteristics of Danish patients using tramadol in more detail, under different scenarios and determinants of subsequent usage patterns.
Methods
We conducted a nationwide cohort study to identify individuals purchasing tramadol from 01/01/2004 to 31/12/2015 who are age 16 + years old by using data from The Danish National Databases; these databases consist of unique information for all citizens in Denmark. Logistic regression analyses were used to assess the potential risk factors for repeated tramadol use.
Results
The final cancer-free cohort consisted of N = 941,839 tramadol users: 54.4% women, with a mean age of 53.2 years. The number of chronic noncancer pain (CNCP) was 430,641 individuals, and 56% of the total third who repeated the use of tramadol with two + purchased prescriptions were CNCP patients. The increased risk of repeated use for CNCP was, among others, associated with: male sex (HR 1.21), age 69–110 (HR 1.72), back/spine pain men (HR 1.47), women (HR 1.46), spondylopathies (HR 1.24), male osteoporosis (HR 1.22), multimorbid ulcer/skin (HR 1.28), region of municipality Northern Jutland (HR 1.74), Central Jutland (HR 1.75), number of co-medication 4–9 (HR 1.33), dementia (HR 1.27). Factors associated with decreased risk: co-medication ischemic heart disease (HR 0.85), diagnosis headache (HR 0.70), household income highest tertile (HR 0.81), unknown (HR 0.70), single women (HR 0.96).
Conclusions
This study proved a widespread prescribed use of tramadol in Denmark, and, as know from the literature, weak opioid use may lead to long-term use of high potent opioids, this usage is inappropriate, in general, but especially for the treatment of CNCP.
Implications
When striving to reduce the overuse of opioids, focus on the extensive use of tramadol may be essential. The current study indicates an excessive and not appropriately prescribed use of tramadol among Danish CNCP patients. In addition to being inappropriate, such use may also have an impact on the growing problem of an illicit Internet market for this drug. Thus, the situation must be taken seriously. The current study confirms the recent clinical guideline and the National Recommendations in Denmark, which emphasises the risks of problematic use of tramadol. The research may also be relevant in other comparable countries. Caution must especially be taken with CNCP patients with comorbidities like diabetes, lung disease, dementia, and osteoporosis.
Collapse
Affiliation(s)
| | - Martin T. Ernst
- OPEN, Odense Patient Data Explorative Network, University of Southern Denmark , Odense , Denmark
- Clinical Pharmacology and Pharmacy, Department of Public Health , University of Southern Denmark , Odense , Denmark
| | - Maria Stougaard
- OPEN, Odense Patient Data Explorative Network, University of Southern Denmark , Odense , Denmark
| | - Bo Abrahamsen
- OPEN, Odense Patient Data Explorative Network, University of Southern Denmark , Odense , Denmark
- Department of Medicine , Holbæk Hospital , Holbæk , Denmark
| |
Collapse
|
47
|
Buth S, Holzbach R, Martens MS, Neumann-Runde E, Meiners O, Verthein U. Problematic Medication With Benzodiazepines, "Z-drugs", and Opioid Analgesics. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:607-614. [PMID: 32048590 PMCID: PMC6819700 DOI: 10.3238/arztebl.2019.0607] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 12/27/2018] [Accepted: 05/29/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND An estimated 1.4 to 2.6 million people in German suffer from drug dependence. Most of them are long-term users of benzodiazepines (BZD), Z drugs (ZD), or opioid analgesics (OA). METHODS This analysis is based on prescription data from patients of the national statutory health insurance system in the German federal states of Schleswig-Holstein, Hamburg, Bremen, and Lower Saxony. Drug-taking trends, duration, dosage, and long-term use of BZD, ZD, and OA in the years 2006 to 2015 are analyzed; prevalences are estimated for the years 2006 to 2016. RESULTS In 2006, 7.7% of patients received at least one prescription for a BZD, ZD, or OA; in 2016, 7.0% did. Over the period of analysis, a marked drop was seen in prescriptions of BZD and a slight fall in prescriptions of ZD (2006: BZD 3.5%, ZS 1.1%; 2016: BZD 2.0%, ZS 0.8%), but there was also an increase in prescriptions of OA, from 4.2% to 4.9%. The number of defined daily doses (DDD) prescribed per year fell for both BZD and ZD. For OA, the number of DDD prescribed per year rose from 2006 to 2009 and decreased by a small amount in subsequent years. The proportions of BZD and ZD patients who had long-term prescriptions fell over time, while the corresponding percentage of OA patients rose. CONCLUSION Nearly one-fifth of all prescriptions for BZD were long-term prescriptions for an entire year, in violation of the relevant guidelines. The rising prevalence of OA use was in the expected range in view of the aging population, but the number of prescriptions rose among younger patients as well. This trend toward more common treatment with opioid analgesics should be critically examined.
Collapse
Affiliation(s)
- Sven Buth
- Center for Interdisciplinary Addiction Research at the University of Hamburg (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Rüdiger Holzbach
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Hochsauerland Hospital Group, Arnsberg
| | - Marcus-Sebastian Martens
- Center for Interdisciplinary Addiction Research at the University of Hamburg (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Eike Neumann-Runde
- Center for Interdisciplinary Addiction Research at the University of Hamburg (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Ommo Meiners
- North German Pharmacy Data Center/Pharmacy Billing Center (NARZ/AVN)
| | - Uwe Verthein
- Center for Interdisciplinary Addiction Research at the University of Hamburg (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg
| |
Collapse
|
48
|
Daoust R, Paquet J, Cournoyer A, Piette É, Morris J, Lessard J, Castonguay V, Williamson D, Chauny JM. Side effects from opioids used for acute pain after emergency department discharge. Am J Emerg Med 2019; 38:695-701. [PMID: 31182367 DOI: 10.1016/j.ajem.2019.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Opioid side effects are common when treating chronic pain. However, the frequency of opioid side effects has rarely been examined in acute pain conditions, particularly in a post emergency department (ED) setting. The objective of this study was to evaluate the short-term incidence of opioid-induced side effects (constipation, nausea/vomiting, dizziness, drowsiness, sweating, and weakness) in patients discharged from the ED with an opioid prescription. METHODS This is a prospective cohort study of patients aged ≥18 years who visited the ED for an acute pain condition (≤2 weeks) and were discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain medication use and side effects. RESULTS We recruited 386 patients with a median age of 54 years (IQR:43-66); 50% were women. During the 2-week follow-up, 80% of patients consumed opioids. Among the patients who used opioids, 79% (95%CI:75-83) reported side effects compared to 38% (95%CI:27-49) for non-users. Adjusting for age, sex, and pain condition, patients who used opioids were more likely to report constipation (OR:7.5; 95%CI:3.1-17.9), nausea/vomiting (OR:4.1; 95%CI:1.8-9.5), dizziness (OR:5.4; 95%CI: 2.2-13.2), drowsiness (OR:4.6; 95%CI:2.5-8.7), and weakness (OR:4.2; 95%CI:1.6-11.0) compared to non-users. A dose-response trend was observed for constipation but not for the other side effects. Nausea/vomiting (OR:2.0; 95%CI:1.1-3.6) and dizziness (OR:1.9; 95%CI:1.1-3.4) were more often associated with oxycodone than with morphine. CONCLUSION As observed for chronic pain treatment, side effects are highly prevalent during short-term opioid treatment for acute pain. Physicians should inform patients about those side effects and should consider prescribing laxatives.
Collapse
Affiliation(s)
- Raoul Daoust
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montréal, Québec, Canada; Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada.
| | - Jean Paquet
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montréal, Québec, Canada
| | - Alexis Cournoyer
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montréal, Québec, Canada; Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Éric Piette
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montréal, Québec, Canada; Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Judy Morris
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montréal, Québec, Canada; Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Justine Lessard
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montréal, Québec, Canada; Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Véronique Castonguay
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montréal, Québec, Canada; Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - David Williamson
- Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montréal, Québec, Canada; Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Marc Chauny
- Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), Montréal, Québec, Canada; Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
49
|
Veiga DR, Monteiro-Soares M, Mendonça L, Sampaio R, Castro-Lopes JM, Azevedo LF. Effectiveness of Opioids for Chronic Noncancer Pain: A Two-Year Multicenter, Prospective Cohort Study With Propensity Score Matching. THE JOURNAL OF PAIN 2019; 20:706-715. [DOI: 10.1016/j.jpain.2018.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/19/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
|
50
|
Henche Ruiz AI. Uso problemático de los analgésicos opioides de prescripción: clasificación y tratamientos eficaces. Med Clin (Barc) 2019; 152:458-465. [DOI: 10.1016/j.medcli.2018.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/14/2018] [Accepted: 10/16/2018] [Indexed: 10/27/2022]
|