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Mageswaran P, Dufour J, Aurand A, Knapik G, Hani H, Blakaj DM, Khan S, Hussain N, Tiwari M, Vallabh J, Weaver T, Marras WS. Wearable motion-based platform for functional spine health assessment. Reg Anesth Pain Med 2024; 49:518-527. [PMID: 37813527 DOI: 10.1136/rapm-2023-104840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/22/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Low back pain is a significant burden to society and the lack of reliable outcome measures, combined with a prevailing inability to quantify the biopsychosocial elements implicated in the disease, impedes clinical decision-making and distorts treatment efficacy. This paper aims to validate the utility of a biopsychosocial spine platform to provide standardized wearable sensor-derived functional motion assessments to assess spine function and differentiate between healthy controls and patients. Secondarily, we explored the correlation between these motion features and subjective biopsychosocial measures. METHODS An observational study was conducted on healthy controls (n=50) and patients with low back pain (n=50) to validate platform utility. The platform was used to conduct functional assessments along with patient-reported outcome assessments to holistically document cohort differences. Our primary outcomes were motion features; and our secondary outcomes were biopsychosocial measures (pain, function, etc). RESULTS Our results demonstrated statistically significant differences in motion features between healthy and patient cohorts across anatomical planes. Importantly, we found velocity and acceleration in the axial plane showed the largest difference, with healthy controls having 49.7% and 55.7% higher values, respectively, than patients. In addition, we found significant correlations between motion features and biopsychosocial measures for pain, physical function and social role only. CONCLUSIONS Our study validated the use of wearable sensor-derived functional motion metrics in differentiating healthy controls and patients. Collectively, this technology has the potential to facilitate holistic biopsychosocial evaluations to enhance spine care and improve patient outcomes. TRIAL REGISTRATION NUMBER NCT05776771.
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Affiliation(s)
- Prasath Mageswaran
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Jonathan Dufour
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Alexander Aurand
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Gregory Knapik
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Hamed Hani
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Dukagjin M Blakaj
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
- Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Safdar Khan
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
- Orthopedics, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nasir Hussain
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Maneesh Tiwari
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Jayesh Vallabh
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
- Physical Medicine & Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tristan Weaver
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
- Anesthesiology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - William S Marras
- Spine Research Institute, The Ohio State University, Columbus, Ohio, USA
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Hamilton M, Christine Lin CW, Arora S, Harrison M, Tracy M, Nickel B, Shaheed CA, Gnjidic D, Mathieson S. Understanding general practitioners' prescribing choices to patients with chronic low back pain: a discrete choice experiment. Int J Clin Pharm 2024; 46:111-121. [PMID: 37882955 PMCID: PMC10831024 DOI: 10.1007/s11096-023-01649-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/07/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Although NSAIDs are recommended as a first line analgesic treatment, opioids are very commonly prescribed to patients with low back pain (LBP) despite risks of harms. AIM This study aimed to determine factors contributing to general practitioners' (GPs') prescribing choices to patients with chronic LBP in a primary care setting. METHOD This discrete choice experiment (DCE) presented 210 GPs with hypothetical scenarios of a patient with chronic LBP. Participants chose their preferred treatment for each choice set, either the opioid, NSAID or neither. The scenarios varied by two patient attributes; non-specific LBP or LBP with referred leg pain (sciatica) and number of comorbidities. The three treatment attributes also varied, being: the type of opioid or NSAID, degree of pain reduction and number of adverse events. The significance of each attribute in influencing clinical decisions was the primary outcome and the degree to which GPs preferred the alternative based on the number of adverse events or the amount of pain reduction was the secondary outcome. RESULTS Overall, GPs preferred NSAIDs (45.2%, 95% CI 38.7-51.7%) over opioids (28.8%, 95% CI 23.0-34.7%), however there was no difference between the type of NSAID or opioid preferred. Additionally, the attributes of pain reduction and adverse events did not influence a GP's choice between NSAIDs or opioids for patients with chronic LBP. CONCLUSION GPs prefer prescribing NSAIDs over opioids for a patient with chronic low back pain regardless of patient factors of comorbidities or the presence of leg pain (i.e. sciatica).
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Affiliation(s)
- Melanie Hamilton
- Institute for Musculoskeletal Health, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), Missenden Road, PO Box M179, Camperdown, Sydney, NSW, 2050, Australia.
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Chung-Wei Christine Lin
- Institute for Musculoskeletal Health, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), Missenden Road, PO Box M179, Camperdown, Sydney, NSW, 2050, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sheena Arora
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- The Centre for Health Evaluation and Outcomes Sciences (CHEOS) at St. Paul's Hospital, Vancouver, Canada
| | - Marguerite Tracy
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Brooke Nickel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Christina Abdel Shaheed
- Institute for Musculoskeletal Health, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), Missenden Road, PO Box M179, Camperdown, Sydney, NSW, 2050, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie Mathieson
- Institute for Musculoskeletal Health, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), Missenden Road, PO Box M179, Camperdown, Sydney, NSW, 2050, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Lee AH, Lebrett WG, Benhammou J, Prause N, Chang L, Patel AA. Opioid Prescription Patterns and Disparities During Ambulatory Encounters in Patients With Cirrhosis. Clin Gastroenterol Hepatol 2023; 21:3170-3172.e2. [PMID: 36503166 DOI: 10.1016/j.cgh.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Anna H Lee
- Vatche & Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Wendi G Lebrett
- Vatche & Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jihane Benhammou
- Vatche & Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Gastroenterology, West Los Angeles Veterans Affairs, Los Angeles, California
| | - Nicole Prause
- Vatche & Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Lin Chang
- Vatche & Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Arpan A Patel
- Vatche & Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Department of Gastroenterology, West Los Angeles Veterans Affairs, Los Angeles, California.
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Horn ME, Simon CB, Lee HJ, Eucker SA. Associations Between Management Pathway and Opioid Prescriptions for Patients Entering the Emergency Department With Neck and Back Pain. Mayo Clin Proc Innov Qual Outcomes 2023; 7:490-498. [PMID: 37842687 PMCID: PMC10568062 DOI: 10.1016/j.mayocpiqo.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Objective To determine associations between post-emergency department (ED) management pathways and downstream opioid prescriptions in patients seeking care for incident neck and/or back pain. Patients and Methods We identified patients seeking first-time ED care for neck and/or back pain from January 1, 2013, through November 6, 2017. We reported demographic characteristics and opioid prescriptions across management pathways using descriptive statistics and assessed the relative risk of any opioid prescription 12 months post-ED visit among 5 different post-ED management pathways using Poisson regression adjusted for patient demographic characteristics. Results Within 12 months after the index ED visit, 58.0% (n=10,949) were prescribed an opioid, with most patients prescribed an opioid within the first week (average daily morphine milligram equivalents of 6.8 mg (SD 9.6 mg). The morphine milligram equivalents decreased to 0.7 mg (SD 8.2 mg) by week 4 and remained consistently less than 1 mg between week 4 and 12 months. Compared with the ED to primary care provider pathway, the relative risk of opioid prescription between 7 days and 12 months after the index ED visit was similar for the ED to physical therapy pathway, higher for both the ED to hospital admission or repeat ED visit pathway (30% increase; relative risk (RR), 1.3; 95% CI, 1.17-1.44) and the ED to specialist pathway (19% increase; RR, 1.19; 95% CI, 1.07-1.33), and lower in the ED with no follow-up visits pathway (41% decrease; RR, 0.59; 95% CI, 0.54-0.65). Conclusion In general, more conservative care was associated with lower opioid prescription rates, and escalated care was associated with higher opioid prescription rates.
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Affiliation(s)
- Maggie E. Horn
- Department of Orthopaedic Surgery, Division of Physical Therapy, Duke University, Durham, NC
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Corey B. Simon
- Department of Orthopaedic Surgery, Division of Physical Therapy, Duke University, Durham, NC
| | - Hui-Jie Lee
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
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Chen Q, Maher CG, Rogan E, Machado G. Management of low back pain in Australian emergency departments for culturally and linguistically diverse populations from 2016 to 2021. Emerg Med J 2023:emermed-2022-212718. [PMID: 37085180 DOI: 10.1136/emermed-2022-212718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Disparate care in the ED for minority populations with low back pain is a long-standing issue reported in the USA. Our objective was to compare care delivery for low back pain in Australian EDs between culturally and linguistically diverse (CALD) and non-CALD patients. METHODS This is a retrospective review of medical records of the ED of three public hospitals in Sydney, New South Wales, Australia from January 2016 to October 2021. We included adult patients diagnosed with non-serious low back pain at ED discharge. CALD status was defined by country of birth, preferred language and use of interpreter service. The main outcome measures were ambulance transport, lumbar imaging, opioid administration and hospital admission. RESULTS Of the 14 642 included presentations, 7656 patients (52.7%) were born overseas, 3695 (25.2%) preferred communicating in a non-English language and 1224 (8.4%) required an interpreter. Patients born overseas were less likely to arrive by ambulance (adjusted OR (aOR) 0.68, 95% CI 0.63 to 0.73) than Australian-born patients. Patients who preferred a non-English language were also less likely to arrive by ambulance (aOR 0.82, 95% CI 0.75 to 0.90), yet more likely to be imaged (aOR 1.12, 95% CI 1.01 to 1.23) or be admitted to hospital (aOR 1.16, 95% CI 1.04 to 1.29) than Native-English-speaking patients. Patients who required an interpreter were more likely to receive imaging (aOR 1.43, 95% CI 1.25 to 1.64) or be admitted (aOR 1.49, 95% CI 1.29 to 1.73) compared with those who communicated independently. CALD patients were generally less likely to receive weak opioids than non-CALD patients (aOR range 0.76-0.87), yet no difference was found in the use of any opioid or strong opioids. CONCLUSION Patients with low back pain from a CALD background, especially those lacking English proficiency, are significantly more likely to be imaged and admitted in Australian EDs. Future interventions improving the quality of ED care for low back pain should give special consideration to CALD patients.
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Affiliation(s)
- Qiuzhe Chen
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Eileen Rogan
- Canterbury Hospital, Campsie, New South Wales, Australia
| | - Gustavo Machado
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Chen Q, Vella SP, Maher CG, Ferreira GE, Machado GC. Racial and ethnic differences in the use of lumbar imaging, opioid analgesics and spinal surgery for low back pain: A systematic review and meta-analysis. Eur J Pain 2023; 27:476-491. [PMID: 36585947 DOI: 10.1002/ejp.2075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/06/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVE There is a substantial gap between evidence and clinical care for low back pain (LBP) worldwide despite recommendations of best practice specified in clinical practice guidelines. The aim of this systematic review was to identify disparities associated with race or ethnicity in the use of lumbar imaging, opioid analgesics, and spinal surgery in people with LBP. DATABASES AND DATA TREATMENT We included observational studies which compared the use of lumbar imaging, opioid analgesics, and spinal surgery for the management of non-serious LBP between people from different racial/ethnic populations. We searched in MEDLINE, EMBASE and CINAHL from January 2000 to June 2021. Risk of bias of included studies was appraised in six domains. For each type of care, we pooled data stratified by race and ethnicity using random effects models. RESULTS We identified 13 eligible studies; all conducted in the United States. Hispanic/Latino (OR 0.69, 95%CI 0.49-0.96) and Black/African American (OR 0.59, 95%CI 0.46-0.75) people with LBP were less likely to be prescribed opioid analgesics than White people. Black/African Americans were less likely to undergo or be recommended spinal surgery for LBP (OR 0.47, 95%CI 0.33-0.67) than White people. There was a lack of high certainty evidence on racial/ethnic disparities in the use of lumbar imaging. CONCLUSION This review reveals lower rate of the use of guideline-discordant care, especially opioid prescription and spinal surgery, in racial/ethnic minority populations with LBP in the United States. Future studies in other countries evaluating care equity for LBP are warranted. PROSPERO Registration ID: CRD42021260668. SIGNIFICANCE This systematic review and meta-analysis revealed that people with low back pain from the minority racial/ethnic backgrounds were less likely to be prescribed opioid analgesics and undergo spinal surgery than the majority counterparts. Strategic interventions to improve the access to, and the value of, clinical care for minority populations with low back pain are warranted.
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Affiliation(s)
- Qiuzhe Chen
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Simon P Vella
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
| | - Gustavo C Machado
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
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Ibrahim AR, Elgamal ME, Moursi MO, Shraim BA, Shraim MA, Shraim M, Al-Omari B. The Association between Early Opioids Prescribing and the Length of Disability in Acute Lower Back Pain: A Systematic Review and Narrative Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12114. [PMID: 36231416 PMCID: PMC9566201 DOI: 10.3390/ijerph191912114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is conflicting evidence with respect to whether early opioid prescribing (EOP) within the first two weeks of acute Low Back Pain (LBP) onset is associated with the length of disability (LOD). The aim of this systematic review was to examine the relationship between EOP and LOD in individuals with acute LBP. METHODS A systematic search of Medline, EMBASE, and CINAHL was conducted. The Newcastle-Ottawa scale was used to assess the methodological quality of included studies. A narrative synthesis of findings was used owing to between-study heterogeneity. RESULTS Six cohort studies using workers' compensation administrative data on 178,130 adults with LBP were included. Most studies were of good methodological quality. One study reported that LBP cases with EOP had higher LOD by 4 days than cases without EOP. Two studies reported that each 100 mg morphine equivalent amount (MEA) was associated with an increase in mean LOD by 0.4 day (95% confidence interval (CI): 0.3, 0.5) and 0.4 day (95% CI: 0.3, 0.4). One study showed that LBP cases with EOP had a higher hazard of continuation of time loss benefits by 1.94 (95% CI 1.86, 2.02). One study reported a dose-response relationship between MEA of EOP and LOD ranging between 5.2 days (95% CI 14.6, 25.0) for 1-140 mg MEA and 69.1 (95% CI 49.3, 89.0) for 450+ mg MEA. One study reported that LBP cases with EOP had a higher mean LOD by 3.8 days, but there was no statistically significant relationship between EOP and LOD (Hazard ratio 1.02; 95% CI 0.91, 1.13). CONCLUSIONS The use of early opioid in the management of acute uncomplicated LBP is associated with prolonged disability duration. Further research on factors influencing inadequate adherence to evidence-based guidelines and optimal strategies to modify such factors may improve disability outcomes among patients presenting with acute LBP.
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Affiliation(s)
- Ayman R. Ibrahim
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Mohamed E. Elgamal
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Moaz O. Moursi
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Bara A. Shraim
- College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
- Department of Plastic and Reconstruction Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Muath A. Shraim
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Mujahed Shraim
- Department of Public Health, College of Health Sciences, Qatar University, QU Health, Doha P.O. Box 2713, Qatar
| | - Basem Al-Omari
- College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates
- KU Research and Data Intelligence Support Center (RDISC) AW 8474000331, Khalifa University of Science and Technology, Abu Dhabi P.O. Box 127788, United Arab Emirates
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Cruz AJS, Abreu LG, da Rocha Mendes S, de Castilho LS, de Abreu MHNG. Association of sociodemographic factors with the prescription pattern of opioids for dental patients: a systematic review. Evid Based Dent 2022:10.1038/s41432-022-0282-7. [PMID: 36068264 DOI: 10.1038/s41432-022-0282-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aim To evaluate the association of patients' sociodemographic factors (sex, age, ethnicity, income, educational level, living environment and health insurance) with the prescription pattern of opioids provided by oral health practitioners.Methods Observational studies that evaluated the association of patients' sociodemographic factors and the likelihood of receiving an opioid prescription provided by an oral health practitioner were eligible. Electronic searches were conducted in Medline (PubMed), Embase, Scopus, Web of Science, LILACS, SciELO, Google Scholar, and OpenGrey up to March 2021. Two authors independently screened the studies, performed data extraction, and assessed the risk-of-bias using the critical appraisal tools developed by the Joanna Briggs Institute (JBI). Certainty of the evidence was assessed with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).Results Eight studies were included in this systematic review. Publication year ranged from 2011 to 2021. Narrative synthesis showed with very low certainty of evidence that younger individuals were more likely to receive a prescription of opioids than older individuals. Regarding the other sociodemographic factors and the prescriptions of opioids in dentistry, the evidence is controversial. Risk of bias was low for most items assessed in the included studies.Conclusion The available evidence suggests that there is an association between patients' sociodemographic factors and the prescription patterns of opioids provided by oral health practitioners.
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Affiliation(s)
- Alex Junio Silva Cruz
- Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Brazil.
| | - Lucas Guimarães Abreu
- Department of Child´s and Adolescent´s Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Brazil
| | - Suellen da Rocha Mendes
- Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Brazil
| | - Lia Silva de Castilho
- Department of Operative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Brazil
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Acharya M, Chopra D, Smith AM, Fritz JM, Martin BC. Associations Between Early Chiropractic Care and Physical Therapy on Subsequent Opioid Use Among Persons With Low Back Pain in Arkansas. J Chiropr Med 2022; 21:67-76. [PMID: 35774633 PMCID: PMC9237579 DOI: 10.1016/j.jcm.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 12/30/2022] Open
Abstract
Objective The objective of this study was to estimate the association between early use of physical therapy (PT) or chiropractic care and incident opioid use and long-term opioid use in individuals with a low back pain (LBP) diagnosis. Methods A retrospective cohort study was conducted using data from Arkansas All Payers' Claims Database. Adults with incident LBP diagnosed in primary care or emergency departments between July 1, 2013, and June 30, 2017, were identified. Participants were required to be opioid naïve in the 6-month baseline period and without cancer, cauda equina syndrome, osteomyelitis, lumbar fracture, and paraplegia/quadriplegia in the entire study period. PT and chiropractic treatment were documented over the ensuing 30 days starting on the date of LBP. Any opioid use and long-term opioid use (LTOU) in 1-year follow-up were assessed. Multivariable logistic regressions controlling for covariates were estimated. Results A total of 40 929 individuals were included in the final sample, with an average age of 41 years and 65% being women. Only 5% and 6% received PT and chiropractic service, respectively, within the first 30 days. Sixty-four percent had incident opioid use, and 4% had LTOU in the follow-up period. PT was not associated with incident opioid use (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.98-1.18) or LTOU (OR, 1.19; 95% CI, 0.97-1.45). Chiropractic care decreased the odds of opioid use (OR, 0.88; 95% CI, 0.80-0.97) and LTOU (OR, 0.56; 95% CI, 0.40-0.77). Conclusion In this study we found that receipt of chiropractic care, though not PT, may have disrupted the need for opioids and, in particular, LTOU in newly diagnosed LBP.
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Affiliation(s)
- Mahip Acharya
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Divyan Chopra
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Allen M. Smith
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Julie M. Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah
| | - Bradley C. Martin
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas,Corresponding author: Bradley C. Martin, PharmD, PhD, 4301 West Markham Street, Slot 522, Little Rock, AR 72205
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Müskens JL, van Dulmen SA, Wiersma T, Burgers JS, Hek K, Westert GP, Kool RB. Low-value pharmaceutical care among Dutch GPs: a retrospective cohort study. Br J Gen Pract 2022; 72:e369-e377. [PMID: 35314429 PMCID: PMC8966784 DOI: 10.3399/bjgp.2021.0625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/31/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Low-value pharmaceutical care exists in general practice. However, the extent among Dutch GPs remains unknown. AIM To assess the prevalence of low-value pharmaceutical care among Dutch GPs. DESIGN AND SETTING Retrospective cohort study using data from patient records. METHOD The prevalence of three types of pharmaceutical care prescribed by GPs between 2016 and 2019 were examined: topical antibiotics for conjunctivitis, benzodiazepines for non-specific lower back pain, and chronic acid-reducing medication (ARM) prescriptions. Multilevel logistic regression analysis was performed to assess prescribing variation and the influence of patient characteristics on receiving a low-value prescription. RESULTS Large variation in prevalence as well as practice variation was observed among the types of low-value pharmaceutical GP care examined. Between 53% and 61% of patients received an inappropriate antibiotics prescription for conjunctivitis, around 3% of patients with lower back pain received an inappropriate benzodiazepine prescription, and 88% received an inappropriate chronic ARM prescription during the years examined. The odds of receiving an inappropriate antibiotic or benzodiazepine prescription increased with age (P<0.001), but decreased for chronic inappropriate ARM prescriptions (P<0.001). Sex affected only the odds of receiving a non-indicated chronic ARM, with males being at higher risk (P<0.001). The odds of receiving an inappropriate ARM increased with increasing neighbourhood socioeconomic status (P<0.05). Increasing practice size decreased the odds of inappropriate antibiotic and benzodiazepine prescriptions (P<0.001). CONCLUSION The results show that the prevalence of low-value pharmaceutical GP care varies among these three clinical problems. Significant variation in inappropriate prescribing exists between different types of pharmaceutical care - and GP practices.
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Affiliation(s)
- Joris Ljm Müskens
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Centre, Nijmegen
| | - Simone A van Dulmen
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Centre, Nijmegen
| | | | - Jako S Burgers
- Department of General Practice, School CAPHRI, Maastricht University, Maastricht; senior consultant, Dutch College of General Practitioners, Utrecht
| | - Karin Hek
- Nivel, Netherlands Institute for Health Services Research, Utrecht
| | - Gert P Westert
- 'Doen of laten?', IQ Healthcare, Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen
| | - Rudolf B Kool
- 'Doen of laten?', IQ Healthcare, Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen
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11
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Axon DR, Slack M, Barraza L, Lee JK, Warholak T. Nationally Representative Health Care Expenditures of Community-Based Older Adults with Pain in the United States Prescribed Opioids vs Those Not Prescribed Opioids. PAIN MEDICINE 2021; 22:282-291. [PMID: 32358611 DOI: 10.1093/pm/pnaa114] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare health care expenditures between older US adults (≥50 years) with pain who were prescribed opioid medications and those who were not. DESIGN Cross-sectional. SETTING Community-based adults in the 2015 Medical Expenditure Panel Survey (MEPS). SUBJECTS Nationally representative sample of US adults alive for the calendar year, aged 50 years or older, who reported having pain in the past four weeks. METHODS Older US adults (≥50 years) with pain in the 2015 MEPS data were identified. The key independent variable was opioid prescription status (prescribed opioid vs not prescribed opioid). Hierarchical linear regression models assessed health care expenditures (inpatient, outpatient, office-based, emergency room, prescription medications, other, and total) in US dollars for opioid prescription status from a community-dwelling US population perspective, adjusting for covariates. RESULTS The 2015 study cohort provided a national estimate of 50,898,592 noninstitutionalized US adults aged ≥50 years with pain in the past four weeks (prescribed opioid N = 16,757,516 [32.9%], not prescribed opioid N = 34,141,076 [67.1%]). After adjusting for covariates, individuals prescribed an opioid had 61% greater outpatient (β = 0.477, P < 0.0001), 69% greater office-based (β = 0.524, P < 0.0001), 14% greater emergency room (β = 0.131, P = 0.0045), 63% greater prescription medication (β = 0.486, P < 0.0001), 29% greater other (β = 0.251, P = 0.0002), and 105% greater total (β = 0.718, P < 0.0001) health care expenditures. There was no difference in opioid prescription status for inpatient expenditures (P > 0.05). CONCLUSIONS This study raises awareness of the economic impact associated with opioid use among US older adults with pain. Future research should investigate these variables in greater depth, over longer time periods, and in additional populations.
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Affiliation(s)
- David R Axon
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
| | - Marion Slack
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
| | - Leila Barraza
- Community, Environment, and Policy Department, University of Arizona College of Public Health, Tucson, Arizona, USA
| | - Jeannie K Lee
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
| | - Terri Warholak
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona, USA
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12
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Abstract
OBJECTIVE Our objective was to determine the percentage of opioid overdose events among medical and surgical inpatient admissions, and to identify risk factors associated with these events. METHODS We searched PubMed and CINAHL databases from inception through July 30, 2017 and identified additional studies from reference lists and other reviews. Articles were included if they reported original research on the rate of opioid overdoses or opioid-related adverse events, and the adverse events occurred in a general medical hospital during an inpatient stay. We extracted information on study population, design, results, and risk for bias using the Newcastle-Ottawa Quality Assessment Scale. We performed this review in accordance with recently suggested standards and report our findings as per the Meta-Analyses and Systematic Reviews of Observational Studies guidelines. RESULTS Thirteen studies met our eligibility criteria. The percentage of opioid overdoses ranged from 0.06% to 2.50% of hospitalizations. The majority of studies used only 1 method of event detection. Risk factors for overdose included older age, infancy, medical comorbidity, substance use disorder diagnosis, combining opioids with other sedatives, and admission to hospitals with higher opioid-prescribing rates. CONCLUSIONS Opioid overdose in the inpatient setting is a serious preventable harm and is likely underestimated in much of the current literature. Improved detection methods are needed to more accurately measure the rate of inpatient opioid overdose. Refined estimates of opioid overdose should be used to drive safety and quality improvement initiatives in hospitals.
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13
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Ghoshal M, Shapiro H, Todd K, Schatman ME. Chronic Noncancer Pain Management and Systemic Racism: Time to Move Toward Equal Care Standards. J Pain Res 2020; 13:2825-2836. [PMID: 33192090 PMCID: PMC7654542 DOI: 10.2147/jpr.s287314] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Hannah Shapiro
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts, USA
| | - Knox Todd
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center Houston, Texas, USA
| | - Michael E Schatman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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14
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Physical therapy and opioid use for musculoskeletal pain management: competitors or companions? Pain Rep 2020; 5:e827. [PMID: 33490834 PMCID: PMC7808685 DOI: 10.1097/pr9.0000000000000827] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/16/2020] [Accepted: 05/24/2020] [Indexed: 12/29/2022] Open
Abstract
Existing evidence is reviewed and gaps in the literature are identified to better understand how physical therapy has been used to provide exposure to nonpharmacological treatments. Musculoskeletal (MSK) pain conditions are highly prevalent and a leading cause of disability globally. When people with MSK pain seek health care, they often receive treatment not aligned with best practices, including initial management options such as opioids. In recent practice guidelines, nonpharmacological treatments have been emphasized for initial pain management, and physical therapists are providers who routinely deliver nonpharmacological treatments. The purpose of this review is to describe the current and future state for how physical therapy may be used to increase exposure to nonpharmacological treatments for MSK pain conditions. For the current state, we review existing observational evidence investigating early exposure to physical therapy and its influence on subsequent opioid use. For the future state, we propose clinical research questions that could define the role of physical therapy on interdisciplinary teams working towards improving effectiveness of nonpharmacological treatments through more rigorous study designs. These clinical questions are intended to guide health services research and clinical trials when building an evidence base of nonpharmacological care options for MSK pain conditions.
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15
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Abstract
STUDY DESIGN Retrospective cross-sectional study. OBJECTIVES The aim of this study was to examine whether there are racial and ethnic disparities in opioid use for back pain treatment. In addition, we examine whether physical therapy reduces opioid use. SUMMARY OF BACKGROUND DATA Back pain is a common health problem that affects most adults in their lifetime. Opioid and physical therapy are commonly used to treat back pain. While evidence indicates that there are substantial disparities in the receipt of opioids by race and ethnicity in opioid use in the United States, it remains unclear whether these disparities in opioid use exist in the treatment of back pain. METHODS Cross-sectional analysis of the 2010-2012 Medical Expenditures Panel Survey and logistic regression of a sample of about 4000 adults with back pain. RESULTS Logistic regression models showed statistically significant differences in opioids receipt by race among adult patients with back pain. Compared to White patients, Asian and Hispanic patients are less likely to be prescribed opioids. On the other hand, Black patients and patients of other race are more likely to receive an opioid prescription to treat their back pain even after accounting for socioeconomic status, health insurance status, and general health status. Additionally, patients who receive physical therapy treatment are less likely to be prescribed opioids. CONCLUSION These findings suggest that there are racial disparities in the use of opioids and physical therapy may reduce opioid prescription use to treat back pain. These disparities may be contributing to disparities in back pain recovery and long-term health disparities in general. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Christian King
- Department of Health Management and Informatics, University of Central Florida, Orlando, FL
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16
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Martin S, Tallian K, Nguyen VT, van Dyke J, Sikand H. Does early physical therapy intervention reduce opioid burden and improve functionality in the management of chronic lower back pain? Ment Health Clin 2020; 10:215-221. [PMID: 32685332 PMCID: PMC7337997 DOI: 10.9740/mhc.2020.07.215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction Chronic lower back pain is a leading cause of disability in US adults. Opioid use continues to be controversial despite the Centers for Disease Control and Prevention guidance on chronic pain management to use nonpharmacologic and nonopioid pharmacologic interventions. The objectives of the study were to assess the impact of early physical therapy (PT) intervention on improving functionality and reducing opioid burden in patients with chronic lower back pain. Methods A single-center, retrospective chart review of patients receiving ≥6 PT visits and treated with either opioids first (OF) or PT first (PTF) therapy for chronic lower back pain were evaluated. Concomitant use of nonopioid and nonpharmacologic therapy was permitted. The Oswestry Disability Index (ODI), a survey measuring functionality, was recorded for PTF group. Pain scores and medication use including opioids were collected at treatment initiation and completion. Results One hundred and eighty patients were included in three groups: OF group (n = 60), PTF group (n = 60), and PTF + ODI group (n = 60). The PTF + ODI group had mean ODI reduction of 11.9% (P < .001). More OF patients were lost to follow up (68.3%) or failed PT (60%) compared to the PTF group, 38.3% and 3.3% (P < .001). Reduction in both opioid and nonopioid medications as well as pain scores were observed but not statistically significant. Discussion Early PT resulted in improved functionality, decreased pain, and reduced medication use upon PT completion. These findings suggest PT, along with nonopioid modalities, are a viable first-line option for the management of chronic lower back pain.
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Affiliation(s)
- Shedrick Martin
- Clinical Pharmacist Specialist, Santa Rosa Memorial Hospital, Santa Rosa, California
| | - Kimberly Tallian
- Clinical Pharmacist Specialist, Santa Rosa Memorial Hospital, Santa Rosa, California.,Clinical Pharmacist, Providence Little Company of Mary Medical Center, San Pedro, California.,Director of Physical Rehabiliation Services, Family Health Centers of San Diego, San Diego, California.,Director of Clinical Services and Residency Programs, Department of Pharmacy, Scripps Mercy Hospital, San Diego, California
| | - Victoria T Nguyen
- Clinical Pharmacist, Providence Little Company of Mary Medical Center, San Pedro, California
| | - Jason van Dyke
- Director of Physical Rehabiliation Services, Family Health Centers of San Diego, San Diego, California
| | - Harminder Sikand
- Director of Clinical Services and Residency Programs, Department of Pharmacy, Scripps Mercy Hospital, San Diego, California
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17
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Louw A, Landrus R, Podolak J, Benz P, DeLorenzo J, Davis C, Rogers A, Cooper K, Louw C, Zimney K, Puentedura EJ, Landers MR. Behavior Change Following Pain Neuroscience Education in Middle Schools: A Public Health Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124505. [PMID: 32585914 PMCID: PMC7345974 DOI: 10.3390/ijerph17124505] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022]
Abstract
Chronic pain and the opioid epidemic need early, upstream interventions to aim at meaningful downstream behavioral changes. A recent pain neuroscience education (PNE) program was developed and tested for middle-school students to increase pain knowledge and promote healthier beliefs regarding pain. In this study, 668 seventh-grade middle-school students either received a PNE lecture (n = 220); usual curriculum school pain education (UC) (n = 198) or PNE followed by two booster (PNEBoost) sessions (n = 250). Prior to, immediately after and at six-month follow-up, pain knowledge and fear of physical activity was measured. Six months after the initial intervention school, physical education, recess and sports attendance/participation as well as healthcare choices for pain (doctor visits, rehabilitation visits and pain medication use) were measured. Students receiving PNEBoost used 30.6% less pain medication in the last 6 months compared to UC (p = 0.024). PNEBoost was superior to PNE for rehabilitation visits in students experiencing pain (p = 0.01) and UC for attending school in students who have experienced pain > 3 months (p = 0.004). In conclusion, PNEBoost yielded more positive behavioral results in middle school children at six-month follow-up than PNE and UC, including significant reduction in pain medication use.
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Affiliation(s)
| | | | - Jessie Podolak
- Evidence in Motion Pain Fellowship, San Antonio, TX 78232, USA;
| | | | - Jen DeLorenzo
- 180 Therapy and Wellness, Alexandria, VA 22314, USA;
| | - Christine Davis
- St. Croix Regional Medical Center, St Croix Falls, WI 54024, USA;
| | | | - Kathy Cooper
- Physical Therapy of Concordia, Concordia, MO 64020, USA;
| | - Colleen Louw
- Ortho Spine and Pain Clinic, Story City, IA 50248, USA;
| | - Kory Zimney
- Department of Physical Therapy, School of Health Sciences, University of South Dakota, Vermillion, SD 57069, USA;
| | - Emilio J. Puentedura
- Doctor of Physical Therapy Program, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798-7303, USA
- Correspondence:
| | - Merrill R. Landers
- Department of Physical Therapy, School of Allied Health Sciences, University of Nevada Las Vegas, Las Vegas, NV 89154-3029, USA;
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18
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Mathieson S, Wertheimer G, Maher CG, Christine Lin CW, McLachlan AJ, Buchbinder R, Pearson SA, Underwood M. What proportion of patients with chronic noncancer pain are prescribed an opioid medicine? Systematic review and meta-regression of observational studies. J Intern Med 2020; 287:458-474. [PMID: 32100394 DOI: 10.1111/joim.13026] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/09/2019] [Accepted: 01/15/2020] [Indexed: 01/01/2023]
Abstract
Guidelines now discourage opioid analgesics for chronic noncancer pain because the benefits frequently do not outweigh the harms. We aimed to determine the proportion of patients with chronic noncancer pain who are prescribed an opioid, the types prescribed and factors associated with prescribing. Database searches were conducted from inception to 29 October 2018 without language restrictions. We included observational studies of adults with chronic noncancer pain measuring opioid prescribing. Opioids were categorized as weak (e.g. codeine) or strong (e.g. oxycodone). Study quality was assessed using a risk of bias tool designed for observational studies measuring prevalence. Individual study results were pooled using a random-effects model. Meta-regression investigated study-level factors associated with prescribing (e.g. sampling year, geographic region as per World Health Organization). The overall evidence quality was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria. Of the 42 studies (5,059,098 participants) identified, the majority (n = 28) were from the United States of America. Eleven studies were at low risk of bias. The pooled estimate of the proportion of patients with chronic noncancer pain prescribed opioids was 30.7% (95% CI 28.7% to 32.7%, n = 42 studies, moderate-quality evidence). Strong opioids were more frequently prescribed than weak (18.4% (95% CI 16.0-21.0%, n = 15 studies, low-quality evidence), versus 8.5% (95% CI 7.2-9.9%, n = 15 studies, low-quality evidence)). Meta-regression determined that opioid prescribing was associated with year of sampling (more prescribing in recent years) (P = 0.014) and not geographic region (P = 0.056). Opioid prescribing for patients with chronic noncancer pain is common and has increased over time.
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Affiliation(s)
- S Mathieson
- From the, Institute for Musculoskeletal Health, Sydney, NSW, Australia.,Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - G Wertheimer
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - C G Maher
- From the, Institute for Musculoskeletal Health, Sydney, NSW, Australia.,Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - C-W Christine Lin
- From the, Institute for Musculoskeletal Health, Sydney, NSW, Australia.,Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - A J McLachlan
- Faculty of Medicine and Health, Sydney Pharmacy School, The University of Sydney, Sydney, NSW, Australia
| | - R Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Vic.,, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - S-A Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - M Underwood
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.,University Hospitals of Coventry and Warwickshire, Coventry, UK
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19
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Kosik KB, Hoch MC, Villasante‐Tezanos AG, Gribble PA. Visit Characteristics Associated With Opioids Administered or Prescribed During Emergency Department Visits for Ankle Sprain Between 2010 and 2015. PM R 2020; 12:647-654. [DOI: 10.1002/pmrj.12326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/08/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Kyle B. Kosik
- Department of Rehabilitation Sciences, Division of Athletic TrainingUniversity of Kentucky Lexington KY
| | - Matthew C. Hoch
- Department of Rehabilitation Sciences, Division of Athletic TrainingUniversity of Kentucky Lexington KY
| | | | - Phillip A. Gribble
- Department of Rehabilitation Sciences, Division of Athletic TrainingUniversity of Kentucky Lexington KY
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20
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Olfson M, Wang S, Wall MM, Blanco C. Trends In Opioid Prescribing And Self-Reported Pain Among US Adults. Health Aff (Millwood) 2020; 39:146-154. [DOI: 10.1377/hlthaff.2019.00783] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mark Olfson
- Mark Olfson is the Elizabeth K. Dollard Professor of Psychiatry, Medicine, and Law in the Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University; a professor of epidemiology in the Mailman School of Public Health, Columbia University; and a research psychiatrist at the New York State Psychiatric Institute, in New York City
| | - Shuai Wang
- Shuai Wang is a technical specialist in the Department of Psychiatry, Columbia University
| | - Melanie M. Wall
- Melanie M. Wall is a professor of biostatistics (in psychiatry) in the Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University
| | - Carlos Blanco
- Carlos Blanco is director of the Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, in Rockville, Maryland
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21
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Characteristics and Red Flag Correlates of Psychiatric Outpatients in a Mandated-Use Prescription Drug Monitoring Program State: A PBRN Card Study. ADDICTIVE DISORDERS & THEIR TREATMENT 2019; 18:36-43. [PMID: 31073282 DOI: 10.1097/adt.0000000000000147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives All 50 states have implemented a Prescription Drug Monitoring Program (PDMP) in efforts to control prescription drug abuse. Many now mandate PDMP checks before clinicians prescribe controlled substances. The aim of this study was to characterize the associations between patient characteristics, red flags found on PDMP reports, and prescriber behavior at community mental health agencies. Methods Prescribers at 9 practice sites, in five regional community mental health centers, were recruited by a practice-based research network (PBRN) to participate in a Card Study. Prescribers completed a PDMP attitudes survey, and cards were completed for patients who had PDMP reports checked. Data were analyzed using descriptive and inferential statistics. Results Thirty nine providers completed cards for n=249 unique patient encounters. Over 1/3 of all patients reported an addiction disorder (38%) or a diagnosis of chronic pain (34%). Twenty percent of PDMP reports were found to have red flags, most commonly multiple prescribers or multiple pharmacies. Red flags were associated with race (p<.0.05), presence of chronic pain (p<0.01), presence of an addiction diagnosis (p<0.05), use of opioids (p<0.001), and non-adherence with treatment (p<0.006). Among prescribers, red flags were associated with lower prescribing rates (p<0.01), and decisions to decrease dosage (p<0.002). Conclusions Red flags were commonly found on PDMP reports done in community mental health settings, and were associated with important patient characteristics and diagnostic factors. PBRN research methods can be leveraged to obtain real-time observational data about psychiatric prescribers' use of PDMP reports in clinical decision-making in different settings.
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22
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Holliday S, Hayes C, Dunlop A, Morgan S, Tapley A, Henderson K, Larance B, Magin P. Protecting Pain Patients. The Evaluation of a Chronic Pain Educational Intervention. PAIN MEDICINE 2018; 18:2306-2315. [PMID: 28340143 DOI: 10.1093/pm/pnx018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction Advocacy and commercially funded education successfully reduced barriers to the provision of long-term opioid analgesia. The subsequent escalation of opioid prescribing for chronic noncancer pain has seen increasing harms without improved pain outcomes. Methods This was a one-group pretest-posttest design study. A multidisciplinary team developed a chronic pain educational package for general practitioner trainees emphasizing limitations, risk-mitigation, and deprescribing of opioids with transition to active self-care. This educational intervention incorporated prereadings, a resource kit, and a 90-minute interactional video case-based workshop incorporated into an education day. Evaluation was via pre- and postintervention (two months) questionnaires. Differences in management of two clinical vignettes were tested using McNemar's test. Results Of 58 eligible trainees, 47 (response rate = 81.0%) completed both questionnaires (36 of whom attended the workshop). In a primary analysis including these 47 trainees, therapeutic intentions of tapering opioid maintenance for pain (in a paper-based clinical vignette) increased from 37 (80.4%) pre-intervention to 44 (95.7%) postintervention (P = 0.039). In a sensitivity analysis including only trainees attending the workshop, 80.0% pre-intervention and 97.1% postintervention tapered opioids (P = 0.070). Anticipated initiation of any opioids for a chronic osteoarthritic knee pain clinical vignette reduced from 35 (74.5%) to 24 (51.1%; P = 0.012) in the primary analysis and from 80.0% to 41.7% in the sensitivity analysis (P = 0.001). Conclusions Necessary improvements in pain management and opioid harm avoidance are predicated on primary care education being of demonstrable efficacy. This brief educational intervention improved hypothetical management approaches two months subsequently. Further research measuring objective changes in physician behavior, especially opioid prescribing, is indicated.
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Affiliation(s)
- Simon Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, New South Wales, Australia
| | - Chris Hayes
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Integrated Pain Service, New Lambton Heights, New South Wales, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, New South Wales, Australia
| | - Simon Morgan
- General Practice Training Valley to Coast, Mayfield, New South Wales, Australia
| | - Amanda Tapley
- General Practice Training Valley to Coast, Mayfield, New South Wales, Australia
| | - Kim Henderson
- General Practice Training Valley to Coast, Mayfield, New South Wales, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia
| | - Parker Magin
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.,General Practice Training Valley to Coast, Mayfield, New South Wales, Australia
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23
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Maiers M, Agaoglu M, Brown R, Cassirer C, DaSilva K, Lystad RP, Mohammad S, Wong JJ. Chiropractic in Global Health and wellbeing: a white paper describing the public health agenda of the World Federation of Chiropractic. Chiropr Man Therap 2018; 26:26. [PMID: 30026909 PMCID: PMC6048707 DOI: 10.1186/s12998-018-0194-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/21/2018] [Indexed: 12/28/2022] Open
Abstract
The World Federation of Chiropractic supports the involvement of chiropractors in public health initiatives, particularly as it relates to musculoskeletal health. Three topics within public health have been identified that call for a renewed professional focus. These include healthy ageing; opioid misuse; and women's, children's, and adolescents' health. The World Federation of Chiropractic aims to enable chiropractors to proactively participate in health promotion and prevention activities in these areas, through information dissemination and coordinated partnerships. Importantly, this work will align the chiropractic profession with the priorities of the World Health Organization. Successful engagement will support the role of chiropractors as valued partners within the broader healthcare system and contribute to the health and wellbeing of the communities they serve.
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Affiliation(s)
- Michele Maiers
- Northwestern Health Sciences University, 2501 W 84th St, Bloomington, MN 55431 USA
| | - Mustafa Agaoglu
- Bahçeşehir University Health Sciences School of Chiropractic, No:10, Gayrettepe, 34353 Beşiktaş, Istanbul, Turkey
| | - Richard Brown
- World Federation of Chiropractic, 160 Eglinton Avenue East Suite 601, Toronto, ON M4P 3B5 Canada
| | - Christopher Cassirer
- Northwestern Health Sciences University, 2501 W 84th St, Bloomington, MN 55431 USA
| | - Kendrah DaSilva
- Chiropractic Association of South Africa, Crossway Office Park, 240 Lenchen Ave, Centurion, Pretoria, 0157 South Africa
| | - Reidar P. Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sarkaw Mohammad
- Hillcrest Spinal Centre, 174 Cambridge Road Hillcrest Hamilton, Hamilton, 3216 New Zealand
| | - Jessica J. Wong
- Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON M2H 3J1 Canada
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24
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Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA, Maher CG. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet 2018; 391:2368-2383. [PMID: 29573872 DOI: 10.1016/s0140-6736(18)30489-6] [Citation(s) in RCA: 1234] [Impact Index Per Article: 205.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 07/18/2017] [Accepted: 10/20/2017] [Indexed: 12/15/2022]
Abstract
Many clinical practice guidelines recommend similar approaches for the assessment and management of low back pain. Recommendations include use of a biopsychosocial framework to guide management with initial non-pharmacological treatment, including education that supports self-management and resumption of normal activities and exercise, and psychological programmes for those with persistent symptoms. Guidelines recommend prudent use of medication, imaging, and surgery. The recommendations are based on trials almost exclusively from high-income countries, focused mainly on treatments rather than on prevention, with limited data for cost-effectiveness. However, globally, gaps between evidence and practice exist, with limited use of recommended first-line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences. The advances with the greatest potential are arguably those that align practice with the evidence, reduce the focus on spinal abnormalities, and ensure promotion of activity and function, including work participation. We have identified effective, promising, or emerging solutions that could offer new directions, but that need greater attention and further research to determine if they are appropriate for large-scale implementation. These potential solutions include focused strategies to implement best practice, the redesign of clinical pathways, integrated health and occupational interventions to reduce work disability, changes in compensation and disability claims policies, and public health and prevention strategies.
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Affiliation(s)
- Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK.
| | - Johannes R Anema
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, Netherlands
| | - Dan Cherkin
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Roger Chou
- Department of Clinical Epidemiology and Medical Informatics and Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Steven P Cohen
- Johns Hopkins School of Medicine, Baltimore, MD, USA; Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Paulo H Ferreira
- Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Bart W Koes
- Department of General Practice, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Wilco Peul
- Department of Neurosurgery, Leiden University, Leiden, Netherlands
| | - Judith A Turner
- Department of Psychiatry and Behavioral Sciences, and Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Chris G Maher
- Sydney School of Public Health, University of Sydney, NSW, Australia
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Fritz JM, Sharpe JA, Lane E, Santillo D, Greene T, Kawchuk G. Optimizing treatment protocols for spinal manipulative therapy: study protocol for a randomized trial. Trials 2018; 19:306. [PMID: 29866131 PMCID: PMC5987587 DOI: 10.1186/s13063-018-2692-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/17/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Low back pain is a common and costly condition. Spinal manipulative therapy (SMT) is a treatment supported in some guidelines, although most clinical trials examining SMT report small effect sizes. Enhancing the effects of SMT requires an understanding of underlying mechanisms and a systematic approach to leverage understanding of mechanisms to create more effective treatment protocols that are scalable in clinical practice. Prior work has identified effects on spinal stiffness and lumbar multifidus activation as possible mechanisms. This project represents a refinement phase study within the context of a multi-phase optimization strategy (MOST) framework. Our goal is to identify an optimized SMT treatment protocol by examining the impact of using co-intervention exercise strategies that are proposed to accentuate SMT mechanisms. The optimized protocol can then be evaluated in confirmation phase clinical trials and implementation studies. METHODS A phased, factorial randomized trial design will be used to evaluate the effects of three intervention components provided in eight combinations on mechanistic (spinal stiffness and multifidus muscle activation) and patient-reported outcomes (pain and disability). All participants will receive two sessions then will be randomly assigned to receive six additional sessions (or no additional treatment) over the next three weeks with factorial combinations of additional SMT and exercise co-interventions (spine mobilizing and multifidus activating). Outcome assessments occur at baseline, and one week, four weeks, and three months after enrollment. Pre-specified analyses will evaluate main effects for treatment components as well as interaction effects. DISCUSSION Building on preliminary findings identifying possible mechanisms of effects for SMT, this trial represents the next phase in a multiphase strategy towards the ultimate goal of developing an optimized protocol for providing SMT to patients with LBP. If successful, the results of this trial can be tested in future clinical trials in an effort to produce larger treatment benefits and improve patient-centered outcomes for individuals with LBP. TRIAL REGISTRATION ClinicalTrials.gov, NCT02868034 . Registered on 16 August 2016.
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Affiliation(s)
- Julie M Fritz
- College of Health, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA.
| | - Jason A Sharpe
- Department of Physical Therapy & Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Elizabeth Lane
- Department of Physical Therapy & Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Doug Santillo
- Department of Physical Therapy & Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Tom Greene
- Department of Internal Medicine and Director, Population Health Research Study Design and Biostatistics Center, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84132, USA
| | - Gregory Kawchuk
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 3-44 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
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Associations Between Early Care Decisions and the Risk for Long-term Opioid Use for Patients With Low Back Pain With a New Physician Consultation and Initiation of Opioid Therapy. Clin J Pain 2018; 34:552-558. [DOI: 10.1097/ajp.0000000000000571] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Nahin RL. Prevalence and Pharmaceutical Treatment of Plantar Fasciitis in United States Adults. THE JOURNAL OF PAIN 2018; 19:885-896. [PMID: 29597082 DOI: 10.1016/j.jpain.2018.03.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/01/2018] [Accepted: 03/14/2018] [Indexed: 11/25/2022]
Abstract
This study provides prevalence estimates of plantar fasciitis in U.S. adults, as well as the types and frequencies of pharmaceutical treatment specifically for this pain. Data are from the 2013 National Health and Wellness Survey, a large (n = 75,000) internet panel survey designed to approximate the adult U.S. POPULATION Strengths of associations are determined using multivariable logistic regression. It was estimated that .85% (95% confidence interval [CI] = .77-.92) of the sample reported diagnosed plantar fasciitis with pain in the past month. Higher prevalence of plantar fasciitis was seen in women (1.19%; referent) versus men (.47%), in those aged 45 to 64 (1.33%) versus those aged 18 to 44 (.53%; referent) years, and in the obese (1.48%) versus those with a body mass <25 (.29%; referent). Prescription medications for pain were used by 41.04% of plantar fasciitis respondents, but only 6.31% attributed this use specifically to plantar fasciitis pain. Nonsteroidal anti-inflammatory drugs (4.01%) and opioids (2.21%) were the most prevalent prescription drugs used specifically for plantar fasciitis pain. Almost 70% of individuals with plantar fasciitis used over the counter (OTC) analgesics for general pain management, with OTC nonsteroidal anti-inflammatory drugs being used by 49.47% and acetaminophen by 26.93% of respondents. Individuals diagnosed by medical specialists had twice the odds of using prescription drugs as those diagnosed by other providers (odds ratio = 2.12; 95% CI = 1.01-4.46). Non-Hispanic black individuals were more likely to use prescription pain medications specifically for plantar fasciitis pain than non-Hispanic white individuals (odds ratio = 3.02; 95% CI = 1.05-8.70). PERSPECTIVE The current study provides additional insights into the pain and disability associated with plantar fasciitis, as well as the pharmaceutical treatments being used for its management. Prescription as well as OTC medications are used to manage plantar fasciitis symptoms despite limited, if any, clinical trial data supporting their use.
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Affiliation(s)
- Richard L Nahin
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland.
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Opioid Prescription Drug Use and Expenditures in US Outpatient Physician Offices: Evidence from Two Nationally Representative Surveys. CANCER THERAPY & ONCOLOGY INTERNATIONAL JOURNAL 2017; 3. [PMID: 28845476 DOI: 10.19080/ctoij.2017.03.555611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Opioids are widely prescribed for their analgesic properties. Chronic opioid use is a persistent problem in the US. Nevertheless, little is known about its prescribing and utilization patterns and overall expenditures. OBJECTIVE This study examined secular trends in opioid prescription drug utilization and expenditures, along with factors associated with opioid prescription drug use in US physician offices. METHODS National Ambulatory Medical Care Survey (NAMCS) and Medical Expenditure Panel Survey (MEPS) data (2006-2010), both nationally representative surveys, were used to assess the trend, predictors of opioid prescription among US adults (more than 18 years) and the opioid-associated expenditures as a whole and borne by the patients in outpatient settings. RESULTS Opioid prescription drugs use among US adults in outpatient settings, as a percentage of all prescription drugs, showed a gradual increase since 2006, leveling off in 2010. Opioid prescription drug expenditures showed an upward trend from 2009 after declining over three years. Mean out-of-pocket payments per prescription steadily declined over study period. LIMITATIONS Cross-sectional nature and visit based information of NAMCS do not provide the actual prevalence and the reason for opioid prescription. CONCLUSIONS Given the upward trend in opioid prescription drug utilization and associated expenditures, clinicians may benefit from evidence-based methods of monitoring prescription opioid use to prevent misuse, abuse, and other adverse patient outcomes. FUNDING Drs. Qureshi, Haider, Ball, Horner and Bennett's efforts are partially supported by the University of South Carolina's ASPIRE I. Dr. Wooten's effort is funded by the National Institute on Drug Abuse (K01DA037412).
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Mathieson S, Valenti L, Maher CG, Britt H, Li Q, McLachlan AJ, Lin CWC. Worsening trends in analgesics recommended for spinal pain in primary care. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017. [PMID: 28639074 DOI: 10.1007/s00586-017-5178-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE Limited evidence exists on secular trends of analgesics for spinal pain. We investigated general practitioner's (GP) recommendations of analgesic medicines for spinal pain and investigated characteristics associated with their recommendation. METHODS We accessed data on spinal pain consultations from the Bettering the Evaluation and Care of Health (BEACH) database, a nationally representative database on GP activity in Australia. Data extracted included consultation details and management provided. Medicines recommended were grouped as simple analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics or neuropathic pain medicines. Multivariate logistic regression determined if patient characteristics and GP characteristics were associated with medication recommendations. RESULTS We analysed BEACH data for 9100 GPs who managed 39,303 patients with spinal pain between 2004 and 2014. Over the decade, analgesic recommendations increased. After accounting for patient and GP characteristics, there was a significant increase in the rate single-ingredient opioid analgesics [annual relative increase of 6% (RR 1.06 (95% CI 1.05-1.07), P < 0.001)] and neuropathic pain medicines [annual relative increase of 19% (RR 1.19 (95% CI 1.16-1.22), P < 0.001)] were recommended; and a significant decrease in the rate NSAIDs were recommended [annual relative decrease of 4% (RR 0.96 (95% CI 0.95-0.97), P < 0.001)]. Logistic regression identified several patient and GP characteristics associated with medicine recommendations, e.g. stronger opioids were less likely recommended for Indigenous patients [odds ratio 0.15 (95% CI 0.04-0.56)]. CONCLUSIONS GP's analgesic recommendations for spinal pain have become increasingly divergent from guideline recommendations over time.
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Affiliation(s)
- Stephanie Mathieson
- Musculoskeletal Health Sydney, School of Public Health, Sydney Medical School, University of Sydney, Sydney, 2050, Australia.
| | - Lisa Valenti
- Family Medicine Research Centre, Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, 2000, Australia
| | - Christopher G Maher
- Musculoskeletal Health Sydney, School of Public Health, Sydney Medical School, University of Sydney, Sydney, 2050, Australia
| | - Helena Britt
- Family Medicine Research Centre, Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, 2000, Australia
| | - Qiang Li
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Andrew J McLachlan
- Faculty of Pharmacy and Centre for Education and Research on Ageing, The University of Sydney and Concord Hospital, Sydney, NSW, 2006, Australia
| | - Chung-Wei Christine Lin
- Musculoskeletal Health Sydney, School of Public Health, Sydney Medical School, University of Sydney, Sydney, 2050, Australia
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Zheng P, Kao MC, Karayannis NV, Smuck M. Stagnant Physical Therapy Referral Rates Alongside Rising Opioid Prescription Rates in Patients With Low Back Pain in the United States 1997-2010. Spine (Phila Pa 1976) 2017; 42:670-674. [PMID: 28441685 PMCID: PMC9853341 DOI: 10.1097/brs.0000000000001875] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional observational study utilizing the National Ambulatory and National Hospital Ambulatory Medical Care Surveys between 1997 and 2010. OBJECTIVE The aim of this study was to characterize national physical therapy (PT) referral trends during primary care provider (PCP) visits in the United States. SUMMARY OF BACKGROUND DATA Despite guidelines recommending PT for the initial management of low back pain (LBP), national PT referral rates remain low. METHODS Race, ethnicity, age, payer type, and PT referral rates were collected for patients aged 16 to 90 years who were visiting their PCPs. Associations among demographic variables and PT referral were determined using logistic regression. RESULTS Between 1997 and 2010, we estimated 170 million visits for LBP leading to 17.1 million PT referrals. Average proportion of PCP visits associated with PT referrals remained stable at about 10.1% [odds ratio (OR) 1.00, 95% confidence interval (95% CI) 0.96-1.04)], despite our prior finding of increasing number of visits associated with opioid prescriptions in the same timeframe.Lower PT referral rates were observed among visits by patients who were insured by Medicaid (OR 0.48, 95% CI 0.33-0.69) and Medicare (OR 0.50, 95% CI 0.35-0.72). Furthermore, visits not associated with PT referrals were more likely to be associated with opioid prescriptions (OR 1.69, 95% CI 1.22-2.35). CONCLUSION Although therapies delivered by PTs are promoted as a first-line treatment for LBP, PT referral rates remain low. There also exist disparately lower referral rates in populations with more restrictive health plans and simultaneous opioid prescription. Our findings provide a broad overview to PT prescription trend and isolate concerning associations requiring further explorations. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Patricia Zheng
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Ming-Chih Kao
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Redwood City, CA
| | - Nicholas V. Karayannis
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Redwood City, CA
| | - Matthew Smuck
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
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Outcomes Following Surgical Management of Cauda Equina Syndrome: Does Race Matter? J Racial Ethn Health Disparities 2017; 5:287-292. [DOI: 10.1007/s40615-017-0369-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 03/29/2017] [Accepted: 04/03/2017] [Indexed: 01/21/2023]
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Edwards J, Hayden J, Asbridge M, Gregoire B, Magee K. Prevalence of low back pain in emergency settings: a systematic review and meta-analysis. BMC Musculoskelet Disord 2017; 18:143. [PMID: 28376873 PMCID: PMC5379602 DOI: 10.1186/s12891-017-1511-7] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/30/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Low back pain may be having a significant impact on emergency departments around the world. Research suggests low back pain is one of the leading causes of emergency department visits. However, in the peer-reviewed literature, there has been limited focus on the prevalence and management of back pain in the emergency department setting. The aim of the systematic review was to synthesize evidence about the prevalence of low back pain in emergency settings and explore the impact of study characteristics including type of emergency setting and how the study defined low back pain. METHODS Studies were identified from PubMed and EMBASE, grey literature search, and other sources. We selected studies that presented prevalence data for adults presenting to an emergency setting with low back pain. Critical appraisal was conducted using a modified tool developed to assess prevalence studies. Meta-analyses and a meta-regression explored the influence of study-level characteristics on prevalence. RESULTS We screened 1187 citations and included 21 studies, reported between 2000 and 2016 presenting prevalence data from 12 countries. The pooled prevalence estimate from studies of standard emergency settings was 4.39% (95% CI: 3.67-5.18). Prevalence estimates of the included studies ranged from 0.9% to 17.1% and varied with study definition of low back pain and the type of emergency setting. The overall quality of the evidence was judged to be moderate as there was limited generalizability and high heterogeneity in the results. CONCLUSION This is the first systematic review to examine the prevalence of low back pain in emergency settings. Our results indicate that low back pain is consistently a top presenting complaint and that the prevalence of low back pain varies with definition of low back pain and emergency setting. Clinicians and policy decisions makers should be aware of the potential impact of low back pain in their emergency settings.
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Affiliation(s)
- Jordan Edwards
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
| | - Jill Hayden
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Bruce Gregoire
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Kirk Magee
- Department of Emergency Medicine, Charles V. Keating Emergency and Trauma Centre, Halifax, NS, Canada
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Shafrin J, Griffith J, Shim JJ, Huber C, Ganguli A, Aubry W. Geographic Variation in Diagnostic Ability and Quality of Care Metrics: A Case Study of Ankylosing Spondylitis and Low Back Pain. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2017; 54:46958017707873. [PMID: 28548005 PMCID: PMC5798677 DOI: 10.1177/0046958017707873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Studies examining geographic variation in care for low back pain often focus on process and outcome measures conditional on patient diagnosis but generally do not take into account a physician's ability to diagnose the root cause of low back pain. In our case study, we used increased detection of ankylosing spondylitis-a relatively rare inflammatory back disease-as a proxy for diagnostic ability and measured the relationship between ankylosing spondylitis detection, potentially inappropriate low back pain care, and cost. Using 5 years of health insurance claims data, we found significant variation in ankylosing spondylitis detection across metropolitan statistical areas (MSAs), with 8.1% of the variation in detection explained by a region's racial composition. Furthermore, low back pain patients in MSAs with higher ankylosing spondylitis detection had 7.9% lower use of corticosteroids, 9.0% lower use of opioids, and 8.2% lower pharmacy cost, compared with patients living in low-detection MSAs.
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Affiliation(s)
| | | | - Jin Joo Shim
- 1 Precision Health Economics, Los Angeles, CA, USA
| | | | | | - Wade Aubry
- 3 University of California, San Francisco, USA
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Lee HH, Lewis CW, McKinney CM. Disparities in Emergency Department Pain Treatment for Toothache. JDR Clin Trans Res 2016; 1:226-233. [PMID: 28879242 DOI: 10.1177/2380084416655745] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Racial disparities in how pain is treated in the emergency department (ED) for toothache have not been reported. Due to increasing reliance on EDs for dental care, the authors investigated whether race/ethnicity and insurance type are associated with treatment for toothache pain. The authors conducted a nationally representative cross-sectional study of ED toothache visits by adults (19 to 64 y old), using the 2008-2010 National Hospital Ambulatory Medical Care Survey. Multinomial regression models accounted for the complex survey design. Outcomes were pain medicines received: none, nonopioid only, or opioids. After adjusting for sociodemographic factors, black patients had 1.99 greater odds (P < 0.005) than white patients of receiving only a nonopioid pain medicine for toothache. Visits made by patients on Medicare, Medicaid, uninsured, or "other" insurance status had greater odds than the privately insured of receiving only a nonopioid pain medicine rather than an opioid (odds ratios, respectively: 4.8, P < 0.001; 2.1, P ≤ 0.001; 2.3, P < 0.01; and 4.1, P < 0.001). Blacks are less likely than whites to receive opioids in the ED for a toothache, even with similar levels of pain. Nonprivately insured patients have lower odds than the privately insured to receive opioids for toothache pain. A better understanding of the etiology of these disparities could lead to directed interventions. Knowledge Transfer Statement: This study presents findings novel to the body of pain and oral health care literature. Because there is an increasing reliance on the emergency department to address dental pain, disparities in how toothache pain is treated will be of great interest to a growing number of Americans, clinicians, and policy makers.
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Affiliation(s)
- H H Lee
- Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, USA
| | - C W Lewis
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - C M McKinney
- Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
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Holliday S, Morgan S, Tapley A, Dunlop A, Henderson K, van Driel M, Spike N, McArthur L, Ball J, Oldmeadow C, Magin P. The Pattern of Opioid Management by Australian General Practice Trainees. PAIN MEDICINE 2015; 16:1720-31. [PMID: 26118466 DOI: 10.1111/pme.12820] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 04/20/2015] [Accepted: 05/02/2015] [Indexed: 01/12/2023]
Abstract
OBJECTIVE With escalating opioid prescribing come individual and public health harms. To inform quality improvement measures, understanding of opioid prescribing is essential. We aimed to establish consultation-level prevalence and associations of opioid prescribing. DESIGN A cross-sectional secondary analysis from a longitudinal multisite cohort study of general practitioner (GP) vocational trainees: "Registrar Clinical Encounters in Training." SETTING Four of Australia's seventeen GP Regional Training Providers, during 2010-13. SUBJECTS GP trainees. METHODS Practice and trainee demographic data were collected as well as patient, clinical and educational data of 60 consecutive consultations of each trainee, each training term. Outcome factors were any opioid analgesic prescription and initial opioid analgesic prescription for a specific problem for the first time. RESULTS Overall, 645 trainees participated. Opioids comprised 4.3% prescriptions provided for 3.8% of patients. Most frequently prescribed were codeine (39.9%) and oxycodone (33.4%). Prescribing was for acute pain (29.3%), palliative care (2.6%) or other indications (68.1%). Most prescribing involved repeat prescriptions for pre-existing problems (62.7% of total). Other associations included older patients; prescriber and patient male gender; Aboriginal/Torres Strait Islander status; rural and disadvantaged locations; longer consultations; and generation of referrals, follow-up, and imaging requests. Opioid initiation was more likely for new patients with new problems, but otherwise associations were similar. Trainees rarely reported addiction risk-mitigation strategies. CONCLUSIONS Most opioids were prescribed as maintenance therapy for non-cancer pain. Demographic associations with opioid analgesic prescribing resemble those presenting for opioid dependency treatment. Our findings should inform measures by regulators and medical educators supporting multimodal pain management.
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Affiliation(s)
- Simon Holliday
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, NSW, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, NSW, Australia
| | - Simon Morgan
- General Practice Training Valley to Coast, Mayfield, NSW, Australia
| | - Amanda Tapley
- General Practice Training Valley to Coast, Mayfield, NSW, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, NSW, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, NSW, Australia
| | - Kim Henderson
- General Practice Training Valley to Coast, Mayfield, NSW, Australia
| | - Mieke van Driel
- Discipline of General Practice, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Neil Spike
- Department of General Practice, The University of Melbourne, Victoria, Australia.,Director of Medical Education and Training, VMA General Practice Training, Melbourne, Victoria, Australia
| | - Lawrie McArthur
- Director of Medical Education and Training, Adelaide to Outback GP Training, Adelaide, South Australia
| | - Jean Ball
- Clinical Research Design, Information Technology and Statistical Support (CReDITSS), Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Chris Oldmeadow
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW, Australia
| | - Parker Magin
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, NSW, Australia.,General Practice Training Valley to Coast, Mayfield, NSW, Australia
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Steinman MA, Komaiko KDR, Fung KZ, Ritchie CS. Use of opioids and other analgesics by older adults in the United States, 1999-2010. PAIN MEDICINE 2014; 16:319-27. [PMID: 25352175 DOI: 10.1111/pme.12613] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE There has been concern over rising use of prescription opioids in young and middle-aged adults. Much less is known about opioid prescribing in older adults, for whom clinical recommendations and the balance of risks and benefits differ from younger adults. We evaluated changes in use of opioids and other analgesics in a national sample of clinic visits made by older adults between 1999 and 2010. DESIGN, SETTING, AND SUBJECTS Observational study of adults aged 65 and older from the 1999-2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, serial cross-sectional surveys of outpatient visits in the United States. METHODS Medication use was assessed at each study visit and included medications in use prior to the visit and medications newly prescribed at the visit. Results were adjusted for survey weights and design factors to provide nationally representative estimates. RESULTS Mean age was 75 ± 7 years, and 45% of visits occurred in primary care settings. Between 1999-2000 and 2009-2010, the percent of clinic visits at which an opioid was used rose from 4.1% to 9.0% (P < 0.001). Although use of all major opioid classes increased, the largest contributor to increased use was hydrocodone-containing combination opioids, which rose from 1.1% to 3.5% of visits over the study period (P < 0.001). Growth in opioid use was observed across a wide range of patient and clinic characteristics, including in visits for musculoskeletal problems (10.7% of visits in 1999-2000 to 17.0% in 2009-2010, P < 0.001) and in visits for other reasons (2.8% to 7.3%, P < 0.001). CONCLUSIONS Opioid use by older adults visiting clinics more than doubled between 1999 and 2010, and occurred across a wide range of patient characteristics and clinic settings.
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Affiliation(s)
- Michael A Steinman
- Division of Geriatrics, San Francisco VA Medical Center, University of California, San Francisco, California, USA
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Chevalier P, Smulders M, Chavoshi S, Sostek M, LoCasale R. A description of clinical characteristics and treatment patterns observed within prescribed opioid users in Germany and the UK. Pain Manag 2014; 4:267-76. [DOI: 10.2217/pmt.14.26] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Aims: To describe a cohort of new opioid users (adult noncancer patients) in terms of clinical characteristics and treatment patterns in the UK and Germany. Material & methods: Data used were extracted from electronic medical records databases (UK: Clinical Practice Research Database-Hospital Episode Statistics; Germany: IMS Disease Analyzer) covering the 2008–2012 period. Results: Most eligible patients were treated with opioids for less than 6 months (UK: 78.7% and Germany: 93.7%) and indexed on weak opioids (UK: 89.5% and Germany: 88.6%). Most prescribed opioids were codeine (UK) and tramadol (Germany). Most prevalent comorbidities were dorsalgia/depression. Constipation was observed in 16.8%/17.4% (UK/Germany) of chronic users (>6 months). Conclusion: While both populations were highly morbid populations largely initiated on weak opioids, chronic use was less common in Germany.
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Affiliation(s)
| | | | | | - Mark Sostek
- AstraZeneca Pharmaceuticals, Wilmington, DE, USA
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