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Tefera YG, Gray S, Nielsen S, Gelaw A, Collie A. Impact of Prescription Medicines on Work-Related Outcomes in Workers with Musculoskeletal Disorders or Injuries: A Systematic Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2024; 34:398-414. [PMID: 37934329 PMCID: PMC11180015 DOI: 10.1007/s10926-023-10138-y] [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] [Accepted: 09/10/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Medicines are often prescribed to workers with musculoskeletal disorders (MSDs) and injuries to relieve pain and facilitate their recovery and return to work. However, there is a growing concern that prescription medicines may have adverse effects on work function. This scoping review aimed to summarize the existing empirical evidence on prescription medicine use by workers with MSD or injury and its relationship with work-related outcomes. METHODS We identified studies through structured searching of MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Scopus, Web of Science and Cochrane library databases, and via searching of dissertations, theses, and grey literature databases. Studies that examined the association between prescription medicine and work-related outcomes in working age people with injury or MSDs, and were published in English after the year 2000 were eligible. RESULTS From the 4884 records identified, 65 studies were included for review. Back disorders and opioids were the most commonly studied musculoskeletal conditions and prescription medicines, respectively. Most studies showed a negative relationship between prescription medicines and work outcomes. Opioids, psychotropics and their combination were the most common medicines associated with adverse work outcomes. Opioid prescriptions with early initiation, long-term use, strong and/or high dose and extended pre- and post-operative use in workers' compensation setting were consistently associated with adverse work function. We found emerging but inconsistent evidence that skeletal muscle relaxants and non-steroidal anti-inflammatory drugs were associated with unfavorable work outcomes. CONCLUSION Opioids and other prescription medicines might be associated with adverse work outcomes. However, the evidence is conflicting and there were relatively fewer studies on non-opioid medicines. Further studies with more robust design are required to enable more definitive exploration of causal relationships and settle inconsistent evidence.
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Affiliation(s)
- Yonas Getaye Tefera
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Shannon Gray
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Australia
| | - Asmare Gelaw
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Alex Collie
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Nduka JK, Kelle HI, Ogoko EC. Hazards and risk assessment of heavy metals from consumption of locally manufactured painkiller drugs in Nigeria. Toxicol Rep 2020; 7:1066-1074. [PMID: 33072522 PMCID: PMC7547146 DOI: 10.1016/j.toxrep.2020.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
In the informal sector of Nigeria's economy, jobs are done manually as against automation resulting in body stress and pain, hence the need for painkiller drugs. Thirty different locally manufactured painkiller drugs, with analgesic, antipyretic and anti-inflammatory effects, were randomly sampled from pharmaceutical shops within Awka in October 2016. The drugs were pulverised, sieved and ashed before digestion using conc aqua regia HCl : HNO3 (3:1), carcinogenic heavy metals (arsenic, cadmium, chromium, mercury, nicked and lead) were assayed using Varian AA240 atomic absorption spectrophotometer (AAS). Risk assessment was carried out using US EPA model. The highest levels of arsenic (0.350 mg/kg) were found in samples with code 01, 03 and 020, cadmium (0.107 mg/kg and 0.144 mg/kg) were in samples code 013 and 028, and samples 03 and 011 had chromium levels as 6.637 mg/kg and 5.298 mg/kg. Highest value of mercury (0.470 mg/kg) was in sample code 01. All the painkiller drugs have nickel in the range of 0.046-0.448 mg/kg while highest values of lead were in sample code 05, 025 and 029 as 2.47 mg/kg, 1.11 mg/kg and 1.16 mg/kg. Non-cancer risk ranged as As (Nd -1.60 × 10-3), Cd (Nd-1.97 × 10-4), Cr (Nd-6.06 × 10-6), Hg (Nd-2.15 × 10-4), Ni (9.93 × 10-6-3.34 × 10-5) and Pb (Nd-4.36 × 10-4) while the cancer risk were As (Nd-1.63 × 10-7), Cd (Nd-4.45 × 10-9), Cr (Nd-1.56 × 10-7), Hg (Nd -1.53 × 10-9), Ni (1.50 × 10-10 -1.46 × 10-9) and Pb (Nd-8.82 × 10-9). The total cancer risk (TCR) and total non-cancer risk (TNCR) for all the heavy metals were in the range of 7.21 × 10-13-1.25 × 10-10 and 1.51 × 10-7-5.56 × 10-5 respectively. The TCR was below 1 × 10-6 -1 × 10-4 range while TNCR for heavy metals was below 1; the values established by US EPA. In conclusion, continuous consumption of locally Nigerian made painkiller drugs may expose the subjects to heavy metal toxicity.
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Affiliation(s)
- John Kanayochukwu Nduka
- Environmental Chemistry and Toxicology Research Unit, Pure and Industrial Chemistry Department, Nnamdi Azikiwe University, P.M.B 5025, Awka, Nigeria
| | - Henrietta Ijeoma Kelle
- Department of Pure and Applied Science, Faculty of Sciences, National Open University, Abuja, Nigeria
| | - Emeka Chima Ogoko
- Department of Pure and Applied Science, Faculty of Sciences, National Open University, Abuja, Nigeria
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Lin MH, Yang YL, Sung FC, Liu CS, Lung CH, Wang JY. Risk of mental illness after the diagnosis of occupational injury or disease: a retrospective cohort study. Int Arch Occup Environ Health 2020; 94:55-68. [PMID: 32557008 DOI: 10.1007/s00420-020-01558-x] [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: 11/26/2019] [Accepted: 06/10/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES As studies on mental disorders in victims of occupational injury or disease are limited, this study aims to evaluate the risk of, and factors associated with, the development of mental illness in patients with occupational injury or disease using insurance claims data from Taiwan. METHODS This retrospective cohort study analyzed insurance records in Taiwan to identify 18,285 adults who experienced occupational injury or disease in 2002-2013 and 18,285 adults without occupational injury or disease who were matched by propensity score. The risks of mental disorders during a follow-up period of up to 2 years were estimated and compared between the two cohorts. RESULTS After controlling for other variables, the odds of mental illness in patients with occupational injury or disease was significantly higher compared to patients without occupational injury or disease. Additional factors associated with higher odds of mental disorders included female gender, age ≥ 30 years (vs. 20-29 years), Charlson comorbidity index ≥ 1, occupation category of labor union member, soldier, insured by social security, religious group member (vs. private or government employee), lower premium-based monthly salary (≤ 576 US$), treatment at a district hospital or clinic (vs. medical center), treatment at a publically-owned or consortium-owned hospital (vs. private hospital), and central or southeast geographic location (vs. Taipei). The main types of mental illness were anxiety disorder (2.79%) and other psychoses (3.29%). CONCLUSION The risk of mental illness slightly increased during the 2-year period after the diagnosis of occupational injury or disease.
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Affiliation(s)
- Ming-Hung Lin
- Department of Pharmacy and Master Program, Tajen University, Pingtung, Taiwan.,Department of Public Health, China Medical University, Taichung, Taiwan
| | - Ya-Lun Yang
- Management of Planning and Coordinating Center Yuan's General Hospital, Kaohsiung, Taiwan
| | - Fung-Chung Sung
- Department of Health Services Administration, China Medical University, Taichung, 40402, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of Medicine, China Medical University, Taichung, 40402, Taiwan
| | - Chi-Hsuan Lung
- Department of Social Work, National Quemoy University, Kinmen, 892, Taiwan
| | - Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung, 40402, Taiwan.
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Kowalski-McGraw M, Green-McKenzie J, Pandalai SP, Schulte PA. Characterizing the Interrelationships of Prescription Opioid and Benzodiazepine Drugs With Worker Health and Workplace Hazards. J Occup Environ Med 2018; 59:1114-1126. [PMID: 28930799 DOI: 10.1097/jom.0000000000001154] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Prescription opioid and benzodiazepine drug use, which has risen significantly, can affect worker health. Exploration of the scientific literature assessed (1) interrelationships of such drug use, occupational risk factors, and illness and injury, and (2) occupational and personal risk factor combinations that can affect their use. METHODS The scientific literature from 2000 to 2015 was searched to determine any interrelationships. RESULTS Evidence for eight conceptual models emerged based on the search yield of 133 articles. These models summarize interrelationships among prescription opioid and benzodiazepine use with occupational injury and illness. Factors associated with the use of these drugs included fatigue, impaired cognition, falls, motor vehicle crashes, and the use of multiple providers. CONCLUSION Prescription opioid and benzodiazepine drugs may be both a personal risk factor for work-related injury and a consequence of workplace exposures.
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Affiliation(s)
- Michele Kowalski-McGraw
- The Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (Drs Kowalski-McGraw, Green-McKenzie); Geisinger Health, Wilkes Barre, Pennsylvania (Dr Kowalski-McGraw); and The Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio (Drs Pandalai, Schulte)
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Asih S, Neblett R, Mayer TG, Gatchel RJ. Does the Length of Disability between Injury and Functional Restoration Program Entry Affect Treatment Outcomes for Patients with Chronic Disabling Occupational Musculoskeletal Disorders? JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:57-67. [PMID: 28224414 DOI: 10.1007/s10926-016-9691-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose Functional restoration programs (FRPs), for patients with chronic disabling occupational musculoskeletal disorders (CDOMDs), have consistently demonstrated positive socioeconomic treatment outcomes, including decreased psychosocial distress and increased work return. The pre-treatment length of disability (LOD), or time between injury and treatment admission, has been shown to influence FRP work outcomes. Some studies have found that shorter LOD is associated with better work outcomes. However, few studies have actually examined cohorts with LOD duration longer than 18 months. This present study evaluated the effects of extended LOD (beyond 18 months) on important treatment outcomes. Methods A total cohort of 1413 CDOMD patients entered an FRP. Of those, 312 did not complete the program, so they were eliminated from outcome analyses. The 1101 patients who completed the FRP were classified based on LOD: Late Rehabilitation (LR, 3-6 months, n = 190); Chronic Disability (CD, 7-17 months, n = 494); and Late Chronic Disability (LCD). The LCD, in turn, consisted of four separate subgroups: 18-23 months (LCD-18, n = 110); 24-35 months (LCD-24, n = 123); 36-71 months (LCD-36, n = 74); and 72+ months (LCD-72, n = 110). Patients were evaluated upon admission and were reassessed at discharge. Those patients who chose to pursue work goals post-treatment (n = 912) were assessed 1-year later. Results Longer LOD was associated with less likelihood of completing the FRP (p < .001). Compared to the other LOD groups, a relatively large percentage of patients (47%) in the longest- disability group were receiving social security disability benefits. Associations were found between longer LOD and more severe patient-reported pain, disability, and depressive symptoms at treatment admission. At discharge, symptom severity decreased for these patient-reported variables in all LOD groups (p < .001). Using binary logistic regressions, it was found that LOD significantly predicted work-return (Wald = 11.672, p = .04) and work-retention (Wald = 11.811, p = .04) after controlling for covariates. Based on the LOD groups, the percentage of patients returning to, and retaining work, ranged from 75.6 to 94.1%, and from 66.7 to 86.3%, respectively. The odds of LCD-24 and LCD-72 patients returning to work were 2.9, and 7.4, respectfully, less likely, compared to LR patients. Furthermore, the odds of LCD-24 and LCD-72 patients retaining work were 3.3 and 3.8 times, respectively, less likely, compared to LR patients. Conclusions Long LOD was a risk factor for FRP non-completion, and was associated with more severe patient-reported variables, including pain intensity and perceived disability. Furthermore, long LOD was a significant predictor for work outcomes at 1 year following FRP discharge. Nevertheless, a large percentage of longer LOD (>24 months) patients had returned to work within the year after discharge (above 85%), and had retained at least part-time work 1-year later (above 66%). These results support the effectiveness of the FRP in mitigating the effects of extended LOD in a large percentage of long-term LOD patients.
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Affiliation(s)
- Sali Asih
- Faculty of Psychology, Universitas Indonesia, Jakarta, Indonesia
| | | | - Tom G Mayer
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center at Dallas, 5701 Maple Ave. #100, Dallas, TX, 75235, USA.
| | - Robert J Gatchel
- Department of Psychology, College of Science, University of Texas at Arlington, 301 Life Science Building, Arlington, TX, 76019, USA
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Walters JL, Baxter K, Chapman H, Jackson T, Sethuramachandran A, Couldridge M, Joshi HR, Kundra P, Liu X, Nair D, Sullivan B, Shotwell MS, Jense RJ, Kassebaum NJ, McQueen KAK. Chronic Pain and Associated Factors in India and Nepal: A Pilot Study of the Vanderbilt Global Pain Survey. Anesth Analg 2017; 125:1616-1626. [PMID: 28806206 DOI: 10.1213/ane.0000000000002360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Evaluation and treatment of chronic pain worldwide are limited by the lack of standardized assessment tools incorporating consistent definitions of pain chronicity and specific queries of known social and psychological risk factors for chronic pain. The Vanderbilt Global Pain Survey (VGPS) was developed as a tool to address these concerns, specifically in the low- and middle-income countries where global burden is highest. METHODS The VGPS was developed using standardized and cross-culturally validated metrics, including the Brief Pain Inventory and World Health Organization Disability Assessment Scale, as well as the Pain Catastrophizing Scale, the Fibromyalgia Survey Questionnaire along with queries about pain attitudes to assess the prevalence of chronic pain and disability along with its psychosocial and emotional associations. The VGPS was piloted in both Nepal and India over a 1-month period in 2014, allowing for evaluation of this tool in 2 distinctly diverse cultures. RESULTS Prevalence of chronic pain in Nepal and India was consistent with published data. The Nepali cohort displayed a pain point prevalence of 48%-50% along with some form of disability present in approximately one third of the past 30 days. Additionally, 11% of Nepalis recorded pain in 2 somatic sites and 39% of those surveyed documented a history of a traumatic event. In the Indian cohort, pain point prevalence was approximately 24% to 41% based on the question phrasing, and any form of disability was present in 6 of the last 30 days. Of the Indians surveyed, 11% reported pain in 2 somatic sites, with only 4% reporting a previous traumatic event. Overall, Nepal had significantly higher chronic pain prevalence, symptom severity, widespread pain, and self-reported previous traumatic events, yet lower reported pain severity. CONCLUSIONS Our findings confirm prevalent chronic pain, while revealing pertinent cultural differences and survey limitations that will inform future assessment strategies. Specific areas for improvement identified in this VGPS pilot study included survey translation methodology, redundancy of embedded metrics and cultural limitations in representative sampling and in detecting the prevalence of mental health illness, catastrophizing behavior, and previous traumatic events. International expert consensus is needed.
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Affiliation(s)
- Jenna L Walters
- From the *Department of Anesthesiology and Pain Medicine, Vanderbilt University, Nashville, Tennessee; †University of Washington School of Medicine, Seattle, Washington; ‡Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Institute of National Importance, Pondicherry, India; §Casper, Wyoming; ∥Nepal Medical College, Kathmandu, Nepal; ¶Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee; #Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Institute of National Importance, Pondicherry, India; **Behavioral Neuroscience Program, Western Washington University, Bellingham, Washington; ††Department of Anesthesiology and Pain Medicine and Global Health Adjunct, University of Washington, Seattle, Washington; ‡‡Department of Pediatric Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, Washington; §§Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; and ∥∥Department of Anesthesiology, Director of Vanderbilt Anesthesia Global Health and Development Affiliate Faculty, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
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Psychosocial Factors Related to Functional Restoration Treatment Completion and Return-to-Function for Patients With Chronic Disabling Occupational Musculoskeletal Disorders. J Occup Environ Med 2017; 59:320-326. [PMID: 28267103 DOI: 10.1097/jom.0000000000000953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to identify demographic and psychosocial variables associated with successful completion of a functional restoration program and return-to-function within 3 months of treatment completion. METHODS Three hundred seven patients admitted to the functional restoration program were evaluated for completion status and 200 patients with valid data were assessed for 3-month return-to-function status following completion. Psychosocial and functional status was assessed at baseline. RESULTS Key factors associated with program completion included lower perceived disability, lower pain, lower functional impairment, and lower fear avoidance. Factors associated with 3-month return-to-function included lower perceived disability, lower depression, greater belief that pain is not associated with impairment, and higher quality of life. CONCLUSIONS Psychosocial and functional factors contribute to both functional restoration completion and 3-month return-to-function outcomes.
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Schultz IZ, Law AK, Cruikshank LC. Prediction of occupational disability from psychological and neuropsychological evidence in forensic context. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 49:183-196. [PMID: 27810113 DOI: 10.1016/j.ijlp.2016.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Within the fields of psychiatry, psychology, and neuropsychology, medical examiners are often tasked with providing an opinion about an injured individual's health prognosis and likelihood of returning to work. Traditionally, examiners have conducted such assessments by employing clinical intuition, expert knowledge, and judgment. More recently, however, an accumulation of research on factors predictive of disability has allowed examiners to provide prognostications using specific empirically supported evidence. This paper integrates current evidence for four common clinical issues encountered in forensic assessments-musculoskeletal pain, depression, Posttraumatic Stress Disorder, and traumatic brain injury. It discusses an evidence-informed, cross-diagnostic and multifactorial model of predicting disability that is emerging from the literature synthesis, along with recommendations for best forensic assessment practice.
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Affiliation(s)
- Izabela Z Schultz
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
| | - Ada K Law
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
| | - Leanna C Cruikshank
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
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The Pain Disability Questionnaire (PDQ): evaluation of its utility for presurgical and 1-year postsurgical physical and psychosocial outcomes for patients undergoing total knee arthroplasty. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Predictive factors associated with success and failure for Calmare (Scrambler) therapy: a multicenter analysis. Clin J Pain 2016; 31:750-6. [PMID: 25232861 DOI: 10.1097/ajp.0000000000000155] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Calmare (Scrambler) therapy is a novel therapeutic modality that purports to provide pain relief by "scrambling" afferent pain signals and replacing them with "non-pain" information through conventional lines of neural transmission. The goal of this study is to identify which factors are associated with treatment outcome for Calmare therapy. METHODS Data were garnered from 3 medical centers on 147 patients with various pain conditions who underwent a minimum of either 3 Calmare therapies on consecutive days or 5 therapies overall. A successful outcome was predefined as ≥50% pain relief on a 0 to 10 numerical rating scale that persisted for longer than 1 month after the last treatment. Variables evaluated for their association with outcome included age, sex, study site, baseline pain score, etiology, type of pain, diagnosis, treatment compliance, coexisting psychopathology, opioid use, antidepressant use, and membrane stabilizer use. RESULTS Overall, the success rate was 38.1%. Variables found to be associated with a positive outcome in multivariate logistic regression included the presence of neuropathic (OR=24.78; 95% CI, 2.47-248.97; P=0.006) or mixed (OR=10.52; 95% CI, 1.09-101.28; P=0.042) pain, and treatment at either Walter Reed (OR=6.87; 95% CI, 1.60-29.51; P=0.010) or Seoul National University (OR=12.29; 95% CI, 1.73-87.43; P=0.012). Factors that correlated with treatment failure were disease (OR=0.04; 95% CI, 0.002-0.59; P=0.020) or traumatic/surgical etiologies (OR=0.05; 95% CI, 0.005-0.56; P=0.015) and antidepressant use (OR=0.47; 95% CI, 0.18-1.02; P=0.056). CONCLUSIONS A neuropathic or mixed neuropathic-nociceptive pain condition was associated with a positive treatment outcome. Investigators should consider these findings when developing selection criteria in clinical trials designed to determine the efficacy of Calmare therapy.
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Ahlgren C, Fjellman-Wiklund A, Hamberg K, Johansson EE, Stålnacke BM. The meanings given to gender in studies on multimodal rehabilitation for patients with chronic musculoskeletal pain – a literature review. Disabil Rehabil 2016; 38:2255-70. [DOI: 10.3109/09638288.2015.1127435] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Does Classification of Chronic Musculoskeletal Disorder Patients Into Psychosocial Subgroups Predict Differential Treatment Responsiveness and 1-Year Outcomes After a Functional Restoration Program? Clin J Pain 2015; 31:1036-45. [DOI: 10.1097/ajp.0000000000000216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sullivan MD, Howe CQ. Opioid therapy for chronic pain in the United States: promises and perils. Pain 2013; 154 Suppl 1:S94-S100. [PMID: 24036286 DOI: 10.1016/j.pain.2013.09.009] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 07/31/2013] [Accepted: 09/04/2013] [Indexed: 12/20/2022]
Abstract
Opioid therapy offers the promise of reducing the burden of chronic pain in not just individual patients, but among the broad population of patients with chronic pain. Randomized trials have demonstrated that opioid therapy for up to 12-16weeks is superior to placebo, but have not addressed longer-term use. In the United States, opioid sales have quadrupled during 2000-2010, with parallel increases in opioid accidental overdose deaths and substance abuse admissions. Clinical use of long-term opioid therapy is characterized by a pattern of adverse selection, where high-risk patients are prescribed high-risk opioid regimens. This adverse selection may link these trends in use, abuse, and overdose. Long-term opioid therapy appears to be associated with iatrogenic harm to the patients who receive the prescriptions and to the general population. The United States has, in effect, conducted an experiment of population-wide treatment of chronic pain with long-term opioid therapy. The population-wide benefits have been hard to demonstrate, but the harms are now well demonstrated.
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Affiliation(s)
- Mark D Sullivan
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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