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Moyo P, Merlin JS, George M, Shireman TI, Marshall BD. Association of Opioid Use Disorder Diagnosis With Use of Physical Therapy and Chiropractic Care Among Chronic Low Back Pain Patients: A Group-Based Trajectory Analysis. THE JOURNAL OF PAIN 2024; 25:742-754. [PMID: 37820847 PMCID: PMC10922407 DOI: 10.1016/j.jpain.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
Nonpharmacologic approaches are recommended as first-line treatment for chronic pain, and their importance is heightened among individuals with co-occurring opioid use disorder (OUD), in whom opioid therapies may be particularly detrimental. Our objectives were to assess the receipt and trajectories of nonpharmacologic pain treatment and determine the association of OUD diagnosis with these trajectories. This retrospective cohort study used Medicare claims data from 2016 to 2018 and applied group-based trajectory models to identify distinct patterns of physical therapy (PT) or chiropractic care treatment over the 12 months following a new episode of chronic low back pain. We used logistic regression models to estimate the association of co-occurring OUD with group membership in PT and chiropractic trajectories. Our sample comprised 607,729 beneficiaries at least 18 years of age, of whom 11.4% had a diagnosis of OUD. The 12-month prevalence of PT and chiropractic treatment receipt was 24.7% and 27.1%, respectively, and lower among Medicare beneficiaries with co-occurring OUD (PT: 14.6%; chiropractic: 6.8%). The final models identified 3 distinct trajectories each for PT (no/little use [76.6% of sample], delayed and increasing use [8.2%], and early and declining use [15.2%]); and chiropractic (no/little use [75.0% of sample], early and declining use [17.3%], and early and sustained use [7.7%]). People with OUD were more likely to belong in trajectories with little/no PT or chiropractic care as compared to other trajectories. The findings indicate that people with co-occurring chronic pain and OUD often do not receive early or any nonpharmacologic pain therapies as recommended by practice guidelines. PERSPECTIVE: PT and chiropractic care use were low overall and even lower among Medicare beneficiaries with co-occurring OUD compared with those without OUD. As updated guidelines on pain management are promulgated, targeted interventions (eg, insurance policy, provider, and patient education) are needed to ensure equitable access to guideline-recommended pain therapies.
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Affiliation(s)
- Patience Moyo
- Brown University School of Public Health, Department of Health Services, Policy, and Practice, Providence, RI, USA
| | - Jessica S. Merlin
- Challenges in Managing and Preventing Pain Clinical Research Center, Division of General Internal Medicine, University of Pittsburgh, PA, USA
| | - Miriam George
- Brown University School of Public Health, Department of Health Services, Policy, and Practice, Providence, RI, USA
| | - Theresa I. Shireman
- Brown University School of Public Health, Department of Health Services, Policy, and Practice, Providence, RI, USA
| | - Brandon D.L. Marshall
- Brown University School of Public Health, Department of Epidemiology, Providence, RI, USA
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Wei YJJ, Winterstein AG, Schmidt S, Fillingim RB, Schmidt S, Daniels MJ, DeKosky ST. Short- and long-term safety of discontinuing chronic opioid therapy among older adults with Alzheimer's disease and related dementia. Age Ageing 2024; 53:afae047. [PMID: 38497237 PMCID: PMC10945292 DOI: 10.1093/ageing/afae047] [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: 06/21/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Limited evidence exists on the short- and long-term safety of discontinuing versus continuing chronic opioid therapy (COT) among patients with Alzheimer's disease and related dementias (ADRD). METHODS This cohort study was conducted among 162,677 older residents with ADRD and receipt of COT using a 100% Medicare nursing home sample. Discontinuation of COT was defined as no opioid refills for ≥90 days. Primary outcomes were rates of pain-related hospitalisation, pain-related emergency department visit, injury, opioid use disorder (OUD) and opioid overdose (OD) measured by diagnosis codes at quarterly intervals during 1- and 2-year follow-ups. Poisson regression models were fit using generalised estimating equations with inverse probability of treatment weights to model quarterly outcome rates between residents who discontinued versus continued COT. RESULTS The study sample consisted of 218,040 resident episodes with COT; of these episodes, 180,916 residents (83%) continued COT, whereas 37,124 residents (17%) subsequently discontinued COT. Discontinuing (vs. continuing) COT was associated with higher rates of all outcomes in the first quarter, but these associations attenuated over time. The adjusted rates of injury, OUD and OD were 0, 69 and 60% lower at the 1-year follow-up and 11, 81 and 79% lower at the 2-year follow-up, respectively, for residents who discontinued versus continued COT, with no difference in the adjusted rates of pain-related hospitalisations or emergency department visits. CONCLUSIONS The rates of adverse outcomes were higher in the first quarter but lower or non-differential at 1-year and 2-year follow-ups between COT discontinuers versus continuers among older residents with ADRD.
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Affiliation(s)
- Yu-Jung Jenny Wei
- Division of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus, OH 43210, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL 32610, USA
- Department of Epidemiology, Colleges of Medicine and Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA
| | - Siegfried Schmidt
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Stephan Schmidt
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
| | - Michael J Daniels
- Department of Statistics, College of Liberal Arts and Sciences, University of Florida, Gainesville FL, 32610, USA
| | - Steven T DeKosky
- Department of Neurology, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA
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Mannes ZL, Livne O, Knox J, Hasin DS, Kranzler HR. Prevalence and correlates of DSM-5 opioid withdrawal syndrome in U.S. adults with non-medical use of prescription opioids: results from a national sample. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:799-808. [PMID: 37948571 PMCID: PMC10867630 DOI: 10.1080/00952990.2023.2248646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 08/13/2023] [Indexed: 11/12/2023]
Abstract
Background: In the U.S. non-medical use of prescription opioids (NMOU) is prevalent and often accompanied by opioid withdrawal syndrome (OWS). OWS has not been studied using nationally representative data.Objectives: We examined the prevalence and clinical correlates of OWS among U.S. adults with NMOU.Methods: We used data from 36,309 U.S. adult participants in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, 1,527 of whom reported past 12-month NMOU. Adjusted linear and logistic regression models examined associations between OWS and its clinical correlates, including psychiatric disorders, opioid use disorder (OUD; excluding the withdrawal criterion), medical conditions, and healthcare utilization among people with regular (i.e. ≥3 days/week) NMOU (n = 534).Results: Over half (50.4%) of the sample was male. Approximately 9% of people with NMOU met criteria for DSM-5 OWS, with greater prevalence of OWS (∼20%) among people with regular NMOU. Individuals with bipolar disorder, dysthymia, panic disorder, and borderline personality disorder had greater odds of OWS (aOR range = 2.71-4.63). People with OWS had lower mental health-related quality of life (β=-8.32, p < .001). Individuals with OUD also had greater odds of OWS (aOR range = 26.02-27.77), an association that increased with more severe OUD. People using substance use-related healthcare services also had greater odds of OWS (aOR range = 6.93-7.69).Conclusion: OWS was prevalent among people with OUD and some psychiatric disorders. These findings support screening for OWS in people with NMOU and suggest that providing medication- assisted treatments and behavioral interventions could help to reduce the burden of withdrawal in this patient population.
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Affiliation(s)
- Zachary L. Mannes
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Ofir Livne
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Justin Knox
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 West 168th St. New York, NY, 10032, USA
| | - Deborah S. Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Henry R. Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA, 19104, USA
- Mental Illness Research, Education, and Clinical Center, Crescenz Veterans Affairs Medical Center, 3900 Woodland Ave, Philadelphia, PA, 19104, USA
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Tabanelli R, Brogi S, Calderone V. Targeting Opioid Receptors in Addiction and Drug Withdrawal: Where Are We Going? Int J Mol Sci 2023; 24:10888. [PMID: 37446064 DOI: 10.3390/ijms241310888] [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: 04/29/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
This review article offers an outlook on the use of opioids as therapeutics for treating several diseases, including cancer and non-cancer pain, and focuses the analysis on the opportunity to target opioid receptors for treating opioid use disorder (OUD), drug withdrawal, and addiction. Unfortunately, as has been well established, the use of opioids presents a plethora of side effects, such as tolerance and physical and physiological dependence. Accordingly, considering the great pharmacological potential in targeting opioid receptors, the identification of opioid receptor ligands devoid of most of the adverse effects exhibited by current therapeutic agents is highly necessary. To this end, herein, we analyze some interesting molecules that could potentially be useful for treating OUD, with an in-depth analysis regarding in vivo studies and clinical trials.
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Affiliation(s)
- Rita Tabanelli
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Simone Brogi
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Vincenzo Calderone
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
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5
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Halvorsen U, Bjørnnes AK, Ljosaa TM. Nurse-Led Telephone Follow-Up Intervention for Titrating and Tapering Opioids in Chronic Pain Patients - A Feasibility Study. J Pain Res 2023; 16:1285-1300. [PMID: 37090765 PMCID: PMC10120593 DOI: 10.2147/jpr.s394878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/08/2023] [Indexed: 04/25/2023] Open
Abstract
Background and Purpose Opioids in chronic non-cancer pain are debated, but remain a part of the pain treatment for selected patients. Research is scarce on the relieving and adverse effects of opioids, and how to deliver opioid treatment in this patient group. This study's purpose was to assess the feasibility of a nurse-led telephone follow-up intervention for titrating or tapering opioids, including a pilot study of the intervention outcomes. Patients and Methods The feasibility assessment and process evaluation were performed according to the UK Medical Research Council (MRC) framework for evaluating complex interventions. A pilot study of the intervention outcomes was also performed. With a retrospective, descriptive, and longitudinal approach, we analyzed reports from 32 patients who titrated or tapered opioids. Information on demography, sleep satisfaction, health status, pain intensity/bothersomeness, opioid doses, and side effects was derived from the Oslo Pain Registry. Descriptive statistics, t-tests, and chi-square tests were used to analyze registry data. Results The study findings indicate that the intervention is feasible. Areas of impact were lack of a sound theory basis, unclear allocation criteria, and inconsistent and non-validated measurement tools. Mechanisms of change were interprofessional collaboration, nurses' knowledge and competencies, predictability, and availability. Statistical analyses showed no between-groups differences in demographical-, clinical-, and pain characteristics, except those who titrated opioids were significantly older than patients tapering opioids (P=0.010). All patients reported poor health and side effects at baseline. Those who tapered opioids had a significant reduction in opioid use (P=0.004). Titrating opioids was associated with a significant increase in side effects (P=0.038). Conclusion Considering the limitations and the strengths of the intervention, the present study indicates that the nurse-led telephone follow-up program is a feasible intervention. With the right adjustments and improvements, the intervention is eligible for a larger efficacy study.
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Affiliation(s)
- Unni Halvorsen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
- Correspondence: Unni Halvorsen, Department of Pain Management and Research, Oslo University Hospital, Pb 4950 Nydalen, Oslo, 0424, Norway, Tel + 47 23 02 61 61, Fax + 47 23 02 74 02, Email
| | - Ann Kristin Bjørnnes
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Tone Marte Ljosaa
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
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6
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Torres-Lockhart KE, Lu TY, Weimer MB, Stein MR, Cunningham CO. Clinical Management of Opioid Withdrawal. Addiction 2022; 117:2540-2550. [PMID: 35112746 DOI: 10.1111/add.15818] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
Appropriate clinical management of opioid withdrawal is a crucial bridge to long-term treatment for opioid use disorder (OUD), because it is a high-risk time for potential opioid overdose and relapse. We provide a narrative review of evidence-based opioid withdrawal management strategies applicable to a variety of treatment settings and geographies. The goals of opioid withdrawal management include relieving suffering associated with withdrawal, providing appropriate diagnosis and screening, engaging patients in initiation of OUD treatment, and using harm reduction strategies, all guided by a patient-centered approach to care. In addition, we discuss complex cases, relapse prevention strategies, and new developments in opioid withdrawal management.
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Affiliation(s)
| | - Tiffany Y Lu
- Albert Einstein College of Medicine/Montefiore Health System, Department of Medicine, Bronx, NY, USA
| | - Melissa B Weimer
- Yale School of Medicine and Public Health, New Haven, CT, USA.,Yale School of Public Health, New Haven, CT, USA
| | - Melissa R Stein
- Albert Einstein College of Medicine/Montefiore Health System, Department of Medicine, Bronx, NY, USA
| | - Chinazo O Cunningham
- Albert Einstein College of Medicine/Montefiore Health System, Department of Medicine, Bronx, NY, USA
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7
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Xie A, Hsu YJ, Speed TJ, Villanueva M, Hanna I, Slupek DA, Nguyen J, Shechter R, Hanna MN. Patient engagement and prescription opioid use in perioperative pain management. J Opioid Manag 2022; 18:421-433. [PMID: 36226782 PMCID: PMC10698916 DOI: 10.5055/jom.2022.0736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To examine (1) patient perceptions regarding their engagement and the engagement of their families in perioperative pain management, (2) demographic and clinical characteristics associated with perceived patient and family engagement, and (3) the association between perceived patient and family engagement and patient outcomes. DESIGN A prospective, observational study. SETTING The Personalized Pain Program (PPP) at the Johns Hopkins Hospital in Baltimore, Maryland. PARTICIPANTS Patients having more than one visit to the PPP. INTERVENTIONS n/a. MAIN OUTCOME MEASURES Since the inception of the PPP, patients were surveyed prior to each clinic visit to assess their pain severity and interference using the Brief Pain Inventory. Starting August 22, 2018, two additional questions were added to the survey to assess patient perceptions of their engagement and the engagement of their families in perioperative pain management. In addition, electronic medical records were reviewed to collect data on daily opioid consumption during the first and last PPP visits presurgery and post-surgery. RESULTS The final analysis included 511 survey responses from 155 patients. Perceived engagement of the patient in perioperative pain management improved over time (p < .001) and was significantly associated with reduction in prescription opioid consumption after surgery (coef = 12.7, SE = 5.8, p = .031). CONCLUSIONS Surgical patients and their family members should be actively engaged in perioperative pain management to improve prescription opioid use and the quality and safety of perioperative care.
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Affiliation(s)
- Anping Xie
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yea-Jen Hsu
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Traci J. Speed
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mariel Villanueva
- Helene Fuld Leadership Program, Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Irini Hanna
- University of Maryland School of Dentistry, Baltimore, MD, USA
| | - David A. Slupek
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | - Jaclyn Nguyen
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ronen Shechter
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marie N. Hanna
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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8
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Kleykamp BA, Dworkin RH, Turk DC, Bhagwagar Z, Cowan P, Eccleston C, Ellenberg SS, Evans SR, Farrar JT, Freeman RL, Garrison LP, Gewandter JS, Goli V, Iyengar S, Jadad AR, Jensen MP, Junor R, Katz NP, Kesslak JP, Kopecky EA, Lissin D, Markman JD, McDermott MP, Mease PJ, O'Connor AB, Patel KV, Raja SN, Rowbotham MC, Sampaio C, Singh JA, Steigerwald I, Strand V, Tive LA, Tobias J, Wasan AD, Wilson HD. Benefit-risk assessment and reporting in clinical trials of chronic pain treatments: IMMPACT recommendations. Pain 2022; 163:1006-1018. [PMID: 34510135 PMCID: PMC8904641 DOI: 10.1097/j.pain.0000000000002475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chronic pain clinical trials have historically assessed benefit and risk outcomes separately. However, a growing body of research suggests that a composite metric that accounts for benefit and risk in relation to each other can provide valuable insights into the effects of different treatments. Researchers and regulators have developed a variety of benefit-risk composite metrics, although the extent to which these methods apply to randomized clinical trials (RCTs) of chronic pain has not been evaluated in the published literature. This article was motivated by an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials consensus meeting and is based on the expert opinion of those who attended. In addition, a review of the benefit-risk assessment tools used in published chronic pain RCTs or highlighted by key professional organizations (ie, Cochrane, European Medicines Agency, Outcome Measures in Rheumatology, and U.S. Food and Drug Administration) was completed. Overall, the review found that benefit-risk metrics are not commonly used in RCTs of chronic pain despite the availability of published methods. A primary recommendation is that composite metrics of benefit-risk should be combined at the level of the individual patient, when possible, in addition to the benefit-risk assessment at the treatment group level. Both levels of analysis (individual and group) can provide valuable insights into the relationship between benefits and risks associated with specific treatments across different patient subpopulations. The systematic assessment of benefit-risk in clinical trials has the potential to enhance the clinical meaningfulness of RCT results.
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Affiliation(s)
- Bethea A Kleykamp
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Robert H Dworkin
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, United States
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
- Center for Health and Technology, University of Rochester Medical Center, Rochester, NY, United States
| | - Dennis C Turk
- Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Zubin Bhagwagar
- Department of Psychiatry, Yale School of Medicine, CT, United States
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, CA, United States
| | | | - Susan S Ellenberg
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Scott R Evans
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, United States
| | - John T Farrar
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States
| | - Roy L Freeman
- Harvard Medical School, Center for Autonomic and Peripheral Nerve Disorders, Boston, MA, United States
| | - Louis P Garrison
- School of Pharmacy, University of Washington, Seattle, WA, United States
| | - Jennifer S Gewandter
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Veeraindar Goli
- Pfizer, Inc, New York, NY, United States. Dr. Goli is now with the Emeritus Professor, Duke University School of Medicine, Durham, NC, United States
| | - Smriti Iyengar
- Division of Translational Research, NINDS, NIH, Rockville, MD, United States
| | - Alejandro R Jadad
- Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Beati, Inc, Toronto, ON, Canada
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | | | - Nathaniel P Katz
- Tufts University School of Medicine, Boston, MA, United States
- Analgesic Solutions, Wayland, MA, United States
| | | | | | - Dmitri Lissin
- DURECT Corporation, Cupertino, CA, United States. Dr. Lissin is now woth the Scilex Pharmaceuticals, Inc., San Diego, CA, United States
| | - John D Markman
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United States
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, United States
| | - Philip J Mease
- Division of Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA, United States
| | - Alec B O'Connor
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Kushang V Patel
- Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Srinivasa N Raja
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Michael C Rowbotham
- Department of Anesthesia, UCSF School of Medicine, Research Institute, CPMC Sutter Health, San Francisco, CA, United States
| | - Cristina Sampaio
- Clinical Pharmacology Lab, Faculdade de Medicina de Lisboa, University Lisbon, Lisbon, Portugal
| | - Jasvinder A Singh
- Medicine Service, VA Medical Center, Birmingham, AL, United States
- Department of Medicine at the School of Medicine, University of Alabama (UAB) at Birmingham, Birmingham, AL, United States
- Department of Epidemiology at the UAB School of Public Health, Birmingham, AL, United States
| | - Ilona Steigerwald
- Chief Medical Officer SVP Neumentum, Inc, Morristown NJ, United States
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto CA, United States
| | - Leslie A Tive
- Department of Biopharmaceuticals, Pfizer, Inc, New York, NY, United States
| | | | - Ajay D Wasan
- Departments of Anesthesiology & Perioperative Medicine, and Psychiatry, University of Pittsburgh School of Medicine, United States
| | - Hilary D Wilson
- Patient Affairs and Engagement, Boehringer Ingelheim, Ridgefield, CT, United States
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Alenezi A, Yahyouche A, Paudyal V. Patient Perspectives on the Appropriate Use of Prescribed Opioids in Chronic Non-Malignant Pain: Analysis of Online Forums Using Theoretical Domains Framework. J Pain Res 2022; 15:1567-1583. [PMID: 35668956 PMCID: PMC9166377 DOI: 10.2147/jpr.s357354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/10/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Aziza Alenezi
- University of Birmingham, School of Pharmacy, Institute of Clinical Sciences, Birmingham, B15 2TT, UK
| | - Asma Yahyouche
- University of Birmingham, School of Pharmacy, Institute of Clinical Sciences, Birmingham, B15 2TT, UK
- Correspondence: Asma Yahyouche, School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK, Tel/Fax + 44121 415 8798, Email
| | - Vibhu Paudyal
- University of Birmingham, School of Pharmacy, Institute of Clinical Sciences, Birmingham, B15 2TT, UK
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10
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De Guzman KR, Puljevic C, Snoswell CL. Mental illnesses as a potential risk factor for non‐medical use of prescription opioids: a narrative review. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2022. [DOI: 10.1002/jppr.1781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Keshia R. De Guzman
- Centre for Online Health The University of Queensland Brisbane Australia
- Centre for Health Services Research The University of Queensland Brisbane Australia
- Pharmacy Department The Princess Alexandra Hospital Brisbane Australia
| | - Cheneal Puljevic
- Centre for Health Services Research The University of Queensland Brisbane Australia
- School of Public Health The University of Queensland Brisbane Australia
| | - Centaine L. Snoswell
- Centre for Online Health The University of Queensland Brisbane Australia
- Centre for Health Services Research The University of Queensland Brisbane Australia
- Pharmacy Department The Princess Alexandra Hospital Brisbane Australia
- School of Pharmacy The University of Queensland Brisbane Australia
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11
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Peppin JF, Coleman JJ, Paladini A, Varrassi G. What Your Death Certificate Says About You May Be Wrong: A Narrative Review on CDC's Efforts to Quantify Prescription Opioid Overdose Deaths. Cureus 2021; 13:e18012. [PMID: 34667687 PMCID: PMC8516321 DOI: 10.7759/cureus.18012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/16/2021] [Indexed: 11/09/2022] Open
Abstract
Mortality data in most countries are reported using the International Classification of Diseases (ICD), managed by the WHO. In this paper, we show how the ICD is ill-suited for classifying drug-involved deaths, many of which involve polysubstance abuse and/or illicitly manufactured fentanyl (IMF). Opioids identified in death certificates are categorized according to six ICD T-codes: opium (T40.0), heroin (T40.1), methadone (T40.3), other synthetic narcotics (T40.4), and other and unspecified narcotics (T40.6). Except for opium, heroin, and methadone, all other opioids except those that are unspecified are aggregated in two T-codes (T40.2 and T40.4), depending upon whether they are natural/semisynthetic or synthetic opioids other than methadone. The result is a system that obscures the actual cause of most drug overdose deaths and, instead, just tallies the number of times each drug is mentioned in an overdose situation. We examined the CDC's methodology for coding other controlled substances according to the ICD and found that, besides fentanyl, the ICD does not distinguish between other licit and illicitly manufactured controlled substances. Moreover, we discovered that the CDC codes all methadone-related deaths as resulting from the prescribed form of the drug. These and other anomalies in the CDC's mortality reporting are discussed in this report. We conclude that the CDC was at fault for failing to correct the miscoding of IMF. Finally, we briefly discuss some of the public policy consequences of this error, the misguided focus by public health and safety officials on pharmaceutical opioids, their prescribers and users, and the pressing necessity for the CDC to reassess how it measures and reports drug-involved mortality.
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Affiliation(s)
- John F Peppin
- Osteopathic Medicine, Marian University, Indianapolis, USA
| | - John J Coleman
- Research and Development, DrugWatch International, Inc., Clifton, USA
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12
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Wartko PD, Boudreau DM, Turner JA, Cook AJ, Wellman RD, Fujii MM, Garcia RC, Moser KA, Sullivan MD. STRategies to Improve Pain and Enjoy life (STRIPE): Protocol for a pragmatic randomized trial of pain coping skills training and opioid medication taper guidance for patients on long-term opioid therapy. Contemp Clin Trials 2021; 110:106499. [PMID: 34217889 DOI: 10.1016/j.cct.2021.106499] [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: 02/23/2021] [Revised: 06/05/2021] [Accepted: 06/28/2021] [Indexed: 10/21/2022]
Abstract
High-dose, long-term opioid therapy (LtOT) is associated with risk for serious harms. Rapid opioid discontinuation may lead to increased pain, psychological distress, and illicit opioid use, but gradual, supported opioid taper may reduce these risks. We previously demonstrated that an opioid taper support and pain coping skills training intervention reduced opioid dose more than usual care (43% vs 19% dose reduction from baseline), with no increase in pain intensity and a significant reduction in activity interference. We aim to adapt and test this intervention in the Kaiser Permanente Washington healthcare system with STRategies to Improve Pain and Enjoy life (STRIPE), a pragmatic, randomized trial. Our goal was to randomize 215 participants on moderate-high dose (≥40 morphine milligram equivalent/day) LtOT to either cognitive-behavioral therapy-based pain coping skills training involving 18 telephone sessions over 52 weeks with optional opioid taper support or usual care. Data are collected from electronic health records, claims, and self-report. The primary outcomes are mean daily opioid dose and the pain intensity, interference with enjoyment of life, and interference with general activity (PEG) score at 12 months (primary time point) and 6 months (secondary time point). Secondary outcomes include having ≥30% opioid dose reduction from baseline, and patient-reported problem opioid use, opioid-related difficulties, pain self-efficacy, opioid craving, global impression of change, and anxiety and depressive symptoms at 6 and 12 months. If effective, this treatment could reduce opioid exposure and associated risks to patients, families, and communities while offering patients an alternative for managing pain. Trial registration: The study was first registered at Clinicaltrials.gov on November 16, 2018 (identifier: NCT03743402).
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Affiliation(s)
- Paige D Wartko
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America.
| | - Denise M Boudreau
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America; Department of Pharmacy, University of Washington, Seattle, WA, United States of America; Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Judith A Turner
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America; Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - Robert D Wellman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Monica M Fujii
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Robin C Garcia
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Kathryn A Moser
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Mark D Sullivan
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States of America
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13
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Buonora M, Perez HR, Stumph J, Allen R, Nahvi S, Cunningham CO, Merlin JS, Starrels JL. Medical Record Documentation About Opioid Tapering: Examining Benefit-to-Harm Framework and Patient Engagement. PAIN MEDICINE 2021; 21:2574-2582. [PMID: 32142143 DOI: 10.1093/pm/pnz361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Guidelines recommend that clinicians make decisions about opioid tapering for patients with chronic pain using a benefit-to-harm framework and engaging patients. Studies have not examined clinician documentation about opioid tapering using this framework. DESIGN AND SETTING Thematic and content analysis of clinician documentation about opioid tapering in patients' medical records in a large academic health system. METHODS Medical records were reviewed for patients aged 18 or older, without cancer, who were prescribed stable doses of long-term opioid therapy between 10/2015 and 10/2016 then experienced an opioid taper (dose reduction ≥30%) between 10/2016 and 10/2017. Inductive thematic analysis of clinician documentation within six months of taper initiation was conducted to understand rationale for taper, and deductive content analysis was conducted to determine the frequencies of a priori elements of a benefit-to-harm framework. RESULTS Thematic analysis of 39 patients' records revealed 1) documented rationale for tapering prominently cited potential harms of continuing opioids, rather than observed harms or lack of benefits; 2) patient engagement was variable and disagreement with tapering was prominent. Content analysis found no patients' records with explicit mention of benefit-to-harm assessments. Benefits of continuing opioids were mentioned in 56% of patients' records, observed harms were mentioned in 28%, and potential harms were mentioned in 90%. CONCLUSIONS In this study, documentation of opioid tapering focused on potential harms of continuing opioids, indicated variable patient engagement, and lacked a complete benefit-to-harm framework. Future initiatives should develop standardized ways of incorporating a benefit-to-harm framework and patient engagement into clinician decisions and documentation about opioid tapering.
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Affiliation(s)
- Michele Buonora
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Health System, Bronx, New York
| | - Hector R Perez
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Health System, Bronx, New York
| | - Jordan Stumph
- Department of Physical Medicine and Rehabilitation, New York-Presbyterian Columbia/Cornell, New York, New York
| | - Robert Allen
- Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New York
| | - Shadi Nahvi
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Health System, Bronx, New York
| | - Chinazo O Cunningham
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Health System, Bronx, New York
| | - Jessica S Merlin
- Center for Research on Healthcare, Divisions of General Internal Medicine and Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Joanna L Starrels
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Health System, Bronx, New York
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14
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Jerjir A, Goudman L, Van Buyten JP, De Smedt A, Smet I, Devos M, Moens M. Detoxification of Neuromodulation Eligible Patients by a Standardized Protocol: A Retrospective Pilot Study. Neuromodulation 2021; 25:114-120. [PMID: 33725401 DOI: 10.1111/ner.13384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/28/2021] [Accepted: 02/15/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Patients eligible for spinal cord stimulation (SCS) generally experience excruciating pain, requiring more opioid consumption, which is usually an indication for SCS implantation. After final implantation, SCS has the ability to stabilize or decrease opioid usage in half of the patients. In this study, opioids were actively eliminated prior to implantation of any neuromodulation device with a standardized detoxification protocol. This pilot study aims to explore the feasibility, effectiveness, and safety of this opioid detoxification protocol prior to neuromodulation techniques. MATERIALS AND METHODS In this retrospective pilot study, 70 patients who were taking opioids and who were eligible for neuromodulation techniques, underwent the detoxification program. A combined in- and out-patient clinic protocol was applied, whereby clonidine was the main component of both parts of the program. A multidisciplinary team with pain physicians and psychologists was responsible for performing this detoxification program. Safety and feasibility were systematically recorded during the hospitalization. RESULTS No serious safety issues were reported. At the start of the program, patients reported a mild sedative effect of clonidine. Additionally, most patients presented mild symptoms of opioid withdrawal, which were partially countered by the sedative effect of clonidine. Both patients and the medical staff found this protocol feasible in clinical practice. Concerning the effectiveness, a statistically significant decrease in median morphine milligram equivalents (MMEs) was found with a MME of 175 (Q1-Q3: 118.1-240) at baseline and at the last available follow-up visit the MME was 0 (Q1-Q3: 0-16.88). CONCLUSIONS This standardized detoxification program has proven its effectiveness, safety, and feasibility in this single-center experience pilot study in patients eligible for neuromodulation techniques.
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Affiliation(s)
- Ali Jerjir
- Multidisciplinary Pain Center, Sint-Niklaas, Belgium
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium.,STIMULUS consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Universitair Ziekenhuis Brussel, Jette, Belgium.,Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Jette, Belgium
| | | | - Ann De Smedt
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium.,STIMULUS consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Universitair Ziekenhuis Brussel, Jette, Belgium.,Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Iris Smet
- Multidisciplinary Pain Center, Sint-Niklaas, Belgium
| | - Marieke Devos
- Multidisciplinary Pain Center, Sint-Niklaas, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium.,STIMULUS consortium (reSearch and TeachIng neuroModULation Uz bruSsel), Universitair Ziekenhuis Brussel, Jette, Belgium.,Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Jette, Belgium.,Department of Radiology, Universitair Ziekenhuis Brussel, Jette, Belgium
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15
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Hyland SJ, Brockhaus KK, Vincent WR, Spence NZ, Lucki MM, Howkins MJ, Cleary RK. Perioperative Pain Management and Opioid Stewardship: A Practical Guide. Healthcare (Basel) 2021; 9:333. [PMID: 33809571 PMCID: PMC8001960 DOI: 10.3390/healthcare9030333] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 12/20/2022] Open
Abstract
Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a "roadmap" for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.
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Affiliation(s)
- Sara J. Hyland
- Department of Pharmacy, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA
| | - Kara K. Brockhaus
- Department of Pharmacy, St. Joseph Mercy Hospital Ann Arbor, Ypsilanti, MI 48197, USA;
| | | | - Nicole Z. Spence
- Department of Anesthesiology, Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA;
| | - Michelle M. Lucki
- Department of Orthopedics, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA;
| | - Michael J. Howkins
- Department of Addiction Medicine, Grant Medical Center (OhioHealth), Columbus, OH 43215, USA;
| | - Robert K. Cleary
- Department of Surgery, St. Joseph Mercy Hospital Ann Arbor, Ypsilanti, MI 48197, USA;
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16
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Marinangeli F, Giarratano A, Petrini F. Chronic pain and COVID-19: pathophysiological, clinical and organizational issues. Minerva Anestesiol 2020; 87:828-832. [PMID: 33319953 DOI: 10.23736/s0375-9393.20.15029-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
During the lockdown phase of the COVID-19 pandemic, a call not to neglect the continuum of care of patients who present with chronic diseases, including pain, was made. In the field of pain, COVID-19 had an impact both from a clinical (i.e., the influence of SARS-CoV-2 infection on pain) and organizational (i.e., how patients with chronic pain should be managed in the post-COVID-19 era) perspective. Furthermore, patients with chronic pain are also frequently frail subjects, affected from multiple comorbidities and hence are at increased risk of infection. On these bases, how the necessity to continue pain therapy will be pursued in the post-COVID-19 era? In this paper, we comment on the above-mentioned topics, on the basis of available data and our experience as pain therapists.
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Affiliation(s)
- Franco Marinangeli
- Department of Anesthesiology, Pain Treatment and Palliative Care, University of L'Aquila, L'Aquila, Italy -
| | - Antonio Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Paolo Giaccone Polyclinic Hospital, University of Palermo, Palermo, Italy
| | - Flavia Petrini
- President of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care (SIAARTI), Rome, Italy.,Unit of Anesthesia, Resuscitation, and Intensive Care, SS. Annunziata Hospital, Chieti, Italy.,School of Specialization in Anesthesia, Resuscitation, Intensive Care, and Pain Management, Department of Oral and Medical Sciences and Biotechnologies, Chieti-Pescara University, Chieti, Italy
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17
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Crouch TB, Wedin S, Kilpatrick RL, Christon L, Balliet W, Borckardt J, Barth K. Pain rehabilitation's dual power: Treatment for chronic pain and prevention of opioid-related risks. ACTA ACUST UNITED AC 2020; 75:825-839. [PMID: 32915026 DOI: 10.1037/amp0000663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The purpose of this article is to provide a data-driven exploration of an interdisciplinary pain rehabilitation program (PRP) as a viable option for addressing the dual crises of chronic pain and opioid use. Psychologists are crucial providers in the PRP, in both intervention and leadership roles. There is well-established literature supporting pain rehabilitation as an effective treatment for chronic pain and functioning, but there are few studies examining the effects of pain rehabilitation on opioid misuse risk. We evaluated data from 60 patients with diverse chronic pain conditions who completed an interdisciplinary PRP to evaluate changes in pain, functioning (self-report and objective physical measure), psychological symptoms, and health-related quality of life. To evaluate the effect of pain rehabilitation on opioid-related risks, we examined opioid use and opioid misuse behaviors (measured by the Current Opioid Misuse Measure; COMM) pre- and posttreatment. Results demonstrated statistically significant improvements in all outcomes, with medium effect sizes for pain severity and large effect sizes for functioning, psychological symptoms, and emotional quality of life. Fifty-eight percent of patients were on opioid medications at entry compared with 15% at discharge. Among patients who entered on opioids, mean COMM scores were significantly reduced from above the cutoff for misuse risk (M = 13.57) to below the cutoff (M = 5.86). Overall, this study provided strong support for pain rehabilitation as an effective treatment for chronic pain and related suffering, while also providing a prevention-based opportunity for reducing opioid-related risk. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Taylor B Crouch
- Department of Psychiatry and Behavioral Sciences, Division of Bio-Behavioral Medicine, Medical University of South Carolina
| | - Sharlene Wedin
- Department of Psychiatry and Behavioral Sciences, Division of Bio-Behavioral Medicine, Medical University of South Carolina
| | - Rebecca L Kilpatrick
- Department of Psychiatry and Behavioral Sciences, Division of Bio-Behavioral Medicine, Medical University of South Carolina
| | - Lillian Christon
- Department of Psychiatry and Behavioral Sciences, Division of Bio-Behavioral Medicine, Medical University of South Carolina
| | - Wendy Balliet
- Department of Psychiatry and Behavioral Sciences, Division of Bio-Behavioral Medicine, Medical University of South Carolina
| | - Jeffrey Borckardt
- Department of Psychiatry and Behavioral Sciences, Division of Bio-Behavioral Medicine, Medical University of South Carolina
| | - Kelly Barth
- Department of Psychiatry and Behavioral Sciences, Division of Bio-Behavioral Medicine, Medical University of South Carolina
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18
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Urits I, Patel A, Zusman R, Virgen CG, Mousa M, Berger AA, Kassem H, Jung JW, Hasoon J, Kaye AD, Viswanath O. A Comprehensive Update of Lofexidine for the Management of Opioid Withdrawal Symptoms. PSYCHOPHARMACOLOGY BULLETIN 2020; 50:76-96. [PMID: 32733113 PMCID: PMC7377538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE OF REVIEW This is a comprehensive review of the literature regarding the use of Lofexidine for opiate withdrawal symptoms. It covers the background and necessity of withdrawal programs and the management of withdrawal symptoms and then covers the existing evidence of the use of Lofexidine for this purpose. RECENT FINDINGS Opiate abuse leads to significant pain and suffering. However, withdrawal is difficult and often accompanied by withdrawal symptoms and renewed cravings. These symptoms are driven mostly by signaling in the locus coeruleus and the mesolimbic system and a rebound increase in noradrenaline, producing symptoms such as anxiety, gastrointestinal upset, and tension. Lofexidine, an alpha-2 agonist, can be used to manage acute withdrawal symptoms before starting maintenance treatment with either methadone or buprenorphine. Lofexidine, if FDA approved for management of withdrawal symptoms and has been proved to be both effective and safe. SUMMARY Opiate addiction is increasing and plaguing the western world and specifically the U.S. It takes a large toll on both a personal and societal level and carries a high cost. Withdrawal is difficult, both related to withdrawal symptoms and renewed cravings. Lofexidine has been shown to be effective in reducing the former and could potentially aid in recovery and withdrawal.
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Affiliation(s)
- Ivan Urits
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Anjana Patel
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Robbie Zusman
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Celina Guadalupe Virgen
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Mohammad Mousa
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Amnon A Berger
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Hisham Kassem
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Jai Won Jung
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Jamal Hasoon
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Alan D Kaye
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
| | - Omar Viswanath
- Urits, MD, Berger, MD, PhD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Patel, Won Jung, Georgetown University School of Medicine, Washington, DC. Zusman, Kassem, MD, Mount Sinai Medical Center, Department of Anesthesiology, Miami Beach, FL. Virgen, Mousa, Viswanath, MD, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ. Kaye, MD, PhD, Viswanath, MD, Louisiana State University Health Sciences Center, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE
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Turan A, Sessler DI. Opioid cessation: another teachable moment. Br J Anaesth 2020; 125:219-221. [PMID: 32505336 DOI: 10.1016/j.bja.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Alparslan Turan
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
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Macintyre PE, Roberts LJ, Huxtable CA. Management of Opioid-Tolerant Patients with Acute Pain: Approaching the Challenges. Drugs 2019; 80:9-21. [DOI: 10.1007/s40265-019-01236-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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