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Hani Abdullah UE, Kelly S, Ricker A, Nabage M, Khazen O, Telkes I, DiMarzio M, Wilson C, Pilitsis JG. Perceptions of pain in aging females undergoing spinal cord stimulation. Pain Manag 2023; 13:701-708. [PMID: 38193309 DOI: 10.2217/pmt-2023-0100] [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] [Indexed: 01/10/2024] Open
Abstract
Aim: Effects of age and sex on chronic pain outcomes following spinal cord stimulation (SCS) have not yet been assessed. Methods: We retrospectively reviewed 1 year outcomes from a database of patients receiving thoracic SCS. Subjects were divided into four cohorts: pre-menopausal and post-menopausal females, and aged-matched males. Improvement using the numerical rating scale, Oswestry Disability Index (ODI), Beck's Depression Inventory (BDI), McGill Pain Questionnaire and Pain Catastrophizing Scale (PCS) was assessed. Results: Older females were notably different from males and females under 60 as they had greater improvements in ODI, BDI and PCS. Further, females ≥60 had greater improvement in PCS compared with males ≥60. Conclusion: Our findings suggest greater improvement with 1 year SCS treatment in post-menopausal females, compared with age-matched males.
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Affiliation(s)
- Umm E Hani Abdullah
- Weldon School of Biomedical Engineering, Purdue University, 206 S Martin Jischke Dr, West Lafayette, IN 47907, USA
| | - Sophie Kelly
- Department of Clinical Neurosciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Boca Raton, FL 33431, USA
| | - Adam Ricker
- Department of Clinical Neurosciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Boca Raton, FL 33431, USA
| | - Melisande Nabage
- Department of Clinical Neurosciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Boca Raton, FL 33431, USA
| | - Olga Khazen
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Boca Raton, FL 33431, USA
| | - Ilknur Telkes
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Boca Raton, FL 33431, USA
| | - Marisa DiMarzio
- Department of Biomedical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Boca Raton, FL 33431, USA
| | - Candy Wilson
- Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431, USA
| | - Julie G Pilitsis
- Department of Clinical Neurosciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Boca Raton, FL 33431, USA
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Turner S, Allen VM, Graves L, Tanguay R, Green CR, Cook JL. Guideline No. 443a: Opioid Use Throughout Women's Lifespan: Fertility, Contraception, Chronic Pain, and Menopause. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102143. [PMID: 37977720 DOI: 10.1016/j.jogc.2023.05.011] [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] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To provide health care providers with the best evidence on opioid use and women's health. Areas of focus include general patterns of opioid use and safety of use; care of women who use opioids; stigma, screening, brief intervention, and referral to treatment; hormonal regulation; reproductive health, including contraception and fertility; sexual function; perimenopausal and menopausal symptoms; and chronic pelvic pain syndromes. TARGET POPULATION The target population includes all women currently using or contemplating using opioids. OUTCOMES Open, evidence-informed dialogue about opioid use will lead to improvements in patient care and overall health. BENEFITS, HARMS, AND COSTS Exploring opioid use through a trauma-informed approach offers the health care provider and patient with an opportunity to build a strong, collaborative, and therapeutic alliance. This alliance empowers women to make informed choices about their own care. It also allows for the diagnosis and possible treatment of opioid use disorders. Use should not be stigmatized, as stigma leads to poor "partnered care" (i.e., the partnership between the patient and care provider). Therefore, health care providers and patients must understand the potential role of opioids in women's health (both positive and negative) to ensure informed decision-making. EVIDENCE A literature search was designed and carried out in PubMed and the Cochrane Library databases from August 2018 until March 2023 using following MeSH terms and keywords (and variants): opioids, illicit drugs, fertility, pregnancy, breastfeeding, and aging. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE All health care providers who care for women. TWEETABLE ABSTRACT Opioid use can affect female reproductive function; health care providers and patients must understand the potential role of opioids in women's health to ensure informed decision-making. SUMMARY STATEMENTS RECOMMENDATIONS.
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Turner S, Allen VM, Graves L, Tanguay R, Green CR, Cook JL. Directive clinique n o 443a : Opioïdes aux différentes étapes de la vie des femmes : Fertilité, contraception, douleur chronique et ménopause. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102145. [PMID: 37977725 DOI: 10.1016/j.jogc.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
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Katon JG, Rodriguez A, Yano EM, Johnson AM, Frayne SM, Hamilton AB, Miller LJ, Williams K, Zephyrin L, Patton EW. Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System. Womens Health Issues 2023; 33:215-221. [PMID: 36702724 DOI: 10.1016/j.whi.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Jodie G Katon
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Adriana Rodriguez
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Elizabeth M Yano
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Health Policy and Management, Jonathan and Karen Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
| | - Amanda M Johnson
- Office of Women's Health, U.S. Department of Veterans Affairs, Washington, District of Columbia
| | - Susan M Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, California; Stanford University School of Medicine, Stanford, California
| | - Alison B Hamilton
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Laura J Miller
- Office of Mental Health and Suicide Prevention, Women's Mental Health, U.S. Department of Veterans Affairs, Washington, District of Columbia; Loyola Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | | | | | - Elizabeth W Patton
- Division of Gynecology, Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts; Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts.
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Gibson CJ, Li Y, Jasuja GK, Keyhani S, Byers AL. Long-term Psychoactive Medications, Polypharmacy, and Risk of Suicide and Unintended Overdose Death Among Midlife and Older Women Veterans. J Gen Intern Med 2022; 37:770-777. [PMID: 36042093 PMCID: PMC9481785 DOI: 10.1007/s11606-022-07592-4] [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] [Received: 06/29/2021] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rates of suicide and unintended overdose death are high among midlife and older women, yet there is paucity of data identifying women at greatest risk. Psychoactive medications, commonly prescribed and co-prescribed in this population, may serve as salient indicators of risk for these outcomes. OBJECTIVE To determine whether long-term psychoactive medications and psychoactive polypharmacy predict risk of suicide and unintended overdose death among midlife and older women Veterans above and beyond other recognized factors. DESIGN Longitudinal cohort study PARTICIPANTS: Women Veterans aged ≥ 50 with at least one Veterans Health Administration (VHA) clinical encounter in FY2012-2013. MAIN MEASURES Long-term psychoactive medications (opioids, benzodiazepines, sedative-hypnotics, antidepressants, antipsychotics, and antiepileptics, prescribed for ≥ 90/180 days) and psychoactive polypharmacy (overlapping for ≥ 1 day) from VHA pharmacy records; suicide and unintended overdose death through December 31, 2018. KEY RESULTS In this national sample of 154,558 midlife and older women Veterans (mean age 63.4, SD 9.3 years), 130 died by suicide and 175 died from unintentional overdose over an average of 5.6 years. In fully adjusted models, long-term opioids (hazard ratio (HR) 2.01, 95% CI 1.21-3.35) and benzodiazepines (HR 2.99, 95% CI 1.82-4.91) were associated with death by suicide; opioids (HR 3.62, 95% CI 2.46-5.34), benzodiazepines (HR 2.77, 95% CI 1.73-4.42), sedative-hypnotics (HR 1.87, 95% CI 1.06-3.29), antidepressants (HR 1.47, 95% CI 1.03-2.12), antipsychotics (HR 1.81, 95% CI 1.02-3.22), and antiepileptics (HR 2.17, 95% CI 1.48-3.19) were associated with unintended overdose death. Women who were co-prescribed ≥ 3 psychoactive medications had over 2-fold increased risk of suicide (HR 2.83, 95% CI 1.65-4.84) and unintended overdose death (HR 2.60, 95% CI 1.72-3.94). CONCLUSIONS Long-term psychoactive medications and psychoactive medication polypharmacy were important indicators of risk for death by suicide and death by unintended overdose among midlife and older women Veterans, even after accounting for psychiatric and substance use disorders.
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Affiliation(s)
- Carolyn J Gibson
- San Francisco VA Health Care System, 4150 Clement Street, 116P, San Francisco, CA, 94121, USA.
- University of California, San Francisco, San Francisco, USA.
| | - Yixia Li
- NCIRE-The Veterans Health Research Institute, San Francisco, USA
| | - Guneet K Jasuja
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford, USA
- Boston University School of Medicine, Boston, USA
| | - Salomeh Keyhani
- San Francisco VA Health Care System, 4150 Clement Street, 116P, San Francisco, CA, 94121, USA
- University of California, San Francisco, San Francisco, USA
| | - Amy L Byers
- San Francisco VA Health Care System, 4150 Clement Street, 116P, San Francisco, CA, 94121, USA
- University of California, San Francisco, San Francisco, USA
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Pavlović JM, Derby CA. Pain in midlife women: a growing problem in need of further research. Womens Midlife Health 2022; 8:4. [PMID: 35509086 PMCID: PMC9068256 DOI: 10.1186/s40695-022-00074-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
More than 10% of American adults experience some level of daily pain, and nearly 40 million (17.6%) experience episodes of severe pain annually. Women are particularly impacted by both episodic and chronic pain with higher prevalence and a greater level of pain-related disability compared to men. Midlife is a critical period for women during which the frequency of pain complaints begins to increase. Although pain is known to be influenced and controlled by sex hormones, it has not been widely recognized as a symptom of the menopausal transition outside of the menopause research community. The recent thematic series in this journal has specifically highlighted pain related conditions including rheumatoid arthritis, migraine and abdominal pain for which the significance among midlife women is not typically recognized. The studies presented in this thematic series present a small fraction of relevant, understudied questions regarding pain and its impact on women in midlife. Addressing the gaps in knowledge will require longitudinal studies that consider the emergence of pain symptomatology in relation to midlife trajectories of other symptoms and health determinants, as well as further study of new and emerging therapies.
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Affiliation(s)
- Jelena M Pavlović
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA. .,Montefiore Headache Center, Montefiore Medical Center, Bronx, NY, USA.
| | - Carol A Derby
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Gibson CJ, Li Y, Jasuja GK, Self KJ, Seal KH, Byers AL. Menopausal Hormone Therapy and Suicide in a National Sample of Midlife and Older Women Veterans. Med Care 2021; 59:S70-S76. [PMID: 33438886 PMCID: PMC8504206 DOI: 10.1097/mlr.0000000000001433] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Among midlife and older women, menopause symptoms and menopausal hormone therapy have been linked to mental health disorders and other comorbidities related to suicide. However, the role of hormone therapy as a prognostic factor of suicide risk is largely unknown. OBJECTIVES To examine associations between menopausal hormone therapy, suicide attempts, and suicide among midlife and older women Veterans. RESEARCH DESIGN In this longitudinal analysis of national Veterans Health Administration data from women Veterans aged 50 years and above, we used Fine-Gray proportional hazards models to examine associations between menopausal hormone therapy (prescribed in 2012-2013) and incident suicide attempts and suicide (index date-2016). MEASURES Menopausal hormone therapy and psychoactive medications from pharmacy records; suicide attempts and suicide from national suicide data repositories; demographic variables, medical and psychiatric diagnoses, and substance use disorders from electronic medical record data and International Classification Diagnoses-9-CM codes. RESULTS In this national sample of 291,709 women Veterans (mean age 60.47, SD 9.81), 6% were prescribed menopausal hormone therapy at baseline. Over an average of 4.5 years, 2673 had an incident suicide attempt (93%) or death by suicide (7%). Adjusting for age, race, and medical diagnoses, menopausal hormone therapy was associated with increased risk of suicide attempt (hazard ratio 1.41; 95% confidence interval, 1.22-1.64) and over 2-fold increased risk of death by suicide (hazard ratio 2.47; 95% confidence interval, 1.58-3.87). Associations with death by suicide remained significant after accounting for psychiatric comorbidity and psychoactive medications. CONCLUSIONS Menopausal hormone therapy may be an important indicator of suicide risk among midlife and older women.
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Affiliation(s)
- Carolyn J. Gibson
- San Francisco VA Health Care System
- Department of Psychiatry, University of California
| | - Yixia Li
- San Francisco VA Health Care System
- NCIRE—The Veterans Health Research Institute, San Francisco, CA
| | - Guneet K. Jasuja
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford
- Boston University School of Public Health, Boston, MA
| | - Kyle J. Self
- San Francisco VA Health Care System
- Department of Psychiatry, University of California
| | - Karen H. Seal
- San Francisco VA Health Care System
- Departments of Medicine and Psychiatry, University of California, San Francisco, CA
| | - Amy L. Byers
- San Francisco VA Health Care System
- Department of Psychiatry, University of California
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Pavlović JM. The impact of midlife on migraine in women: summary of current views. Womens Midlife Health 2020; 6:11. [PMID: 33042563 PMCID: PMC7542111 DOI: 10.1186/s40695-020-00059-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 09/06/2020] [Indexed: 12/20/2022] Open
Abstract
Migraine is three times more common in women than in men and is the 4th leading cause of disability in women. Onset of migraine increases at menarche, with peaks in prevalence in the late 30s, and a rapid decline after menopause. While the prevalence is highest among women of childbearing age the frequency of headache and burden of migraine frequently worsens during midlife. Abundant population data suggest that hormonal factors may trigger headache attacks and influence onset and remission. The midlife worsening of migraine is attributed to hormonal fluctuations characteristic of the menopausal transition. Drops in estrogen presumably lead to increased migraine attacks at the time of menses as well as during the menopausal transition. During the menopausal transition, recommended approaches include both acute and preventive non-hormonal and hormonal options as well as behavioral approaches. Herein, is a brief review on the presentation of migraine in women across the lifespan, with special emphasis on midlife and the menopausal transition and implications for treatment.
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Affiliation(s)
- Jelena M Pavlović
- Albert Einstein College of Medicine, Department of Neurology, 1225 Morris Park Avenue, Van Etten 3C9B, Bronx, NY 10461 USA.,Montefiore Medical Center/Montefiore Headache Center, 1250 Waters place, 8th floor, Bronx, NY 10461 USA
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Callan NGL, Woods NF. Treatment of Midlife Women with Chronic Low Back Pain—Opioids Are a Last-Resort Option. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2020. [DOI: 10.1007/s13669-020-00286-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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