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Ayandeh A, Farrell N, Sheng AY. Requirement for Discharge in the Care of a Responsible Adult in Procedural Sedation in the Emergency Department: Necessity or Potential Barrier to Health Equity? J Emerg Med 2023; 65:e272-e279. [PMID: 37679283 DOI: 10.1016/j.jemermed.2023.05.010] [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: 11/15/2022] [Revised: 04/06/2023] [Accepted: 05/30/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Procedural sedation is commonly practiced by emergency physicians to facilitate patient care in the emergency department (ED). Although various guidelines have modernized our approach to procedural sedation, many procedural sedation guidelines and practices still often require that patients be discharged into the care of a responsible adult. DISCUSSION Such requirement for discharge often cannot be met by underserved and undomiciled patients. Benzodiazepines, opioids, propofol, ketamine, "ketofol," etomidate, and methohexital have all been utilized for procedural sedation in the ED. For patients who may require discharge without the presence of an accompanying responsible adult, ketamine, propofol, methohexital, "ketofol," and etomidate are ideal agents for procedural sedation given rapid onsets, short durations of action, and rapid recovery times in patients without renal or hepatic impairment. Proper pre- and postprocedure protocols should be utilized when performing procedural sedation to ensure patient safety. Through the use of appropriate medications and observation protocols, patients can safely be discharged 2 to 4 h postprocedure. CONCLUSION There is no pharmacodynamic or pharmacokinetic basis to require discharge in the care of a responsible adult after procedural sedation. Thoughtful medication selection and the use of evidence-based pre- and postprocedure protocols in the ED can help circumvent this requirement, which likely disproportionally impacts patients who are of low socioeconomic status or undomiciled.
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Affiliation(s)
- Armon Ayandeh
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts.
| | - Natalija Farrell
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts
| | - Alexander Y Sheng
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts; Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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2
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Ismail-Callaghan S, Howarth M, Allan R, Davey N, Meddick-Dyson SA. Driving communication forward: improving communication for palliative care patients around driving and opioids - a quality improvement report. BMJ Open Qual 2023; 12:e002138. [PMID: 36754541 PMCID: PMC9923252 DOI: 10.1136/bmjoq-2022-002138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION The number of people requiring palliative care is increasing with an ageing comorbid population. Pain is a prevalent symptom for palliative care patients and is often managed with opioids. Opioids reduce reaction time and can cause drowsiness and visual disturbance. Evidence recommends that driving should be avoided until a stable dose of opioids has been reached. It is vital for patient and public safety that these facts are communicated to patients who are prescribed opioids, as well as the legal consequences if guidance is not followed. These discussions facilitate joint decisions, optimising patient freedom and quality of life. Surprisingly though these important discussions around driving and opioids do not always occur, and so this project sought to develop a systematic approach to integrating them into practice. DESIGN Retrospective case note analysis and prospective interventional quality improvement study. SETTING A 16 bedded specialist palliative care inpatient unit. POPULATION Hospice inpatients with an Eastern Council Oncology Group performance score of 0-3 who had been prescribed opioids. INTERVENTION Three plan-do-study-act cycles were performed. First, the issue was discussed in the daily multidisciplinary team meeting to raise awareness, second a prompt was added to a pre-existing clerking proforma. Finally, a reminder poster was placed in the ward office to promote discussion prior to discharge. OUTCOME MEASURES Primary measures were the proportion of patients with the presence of documented driving status, and the presence of a documented discussion surrounding driving and opioids. RESULTS Baseline data found that 11.5% of patients had a documented driving status and 11.5% had a documented discussion surrounding driving and opioids. Over the course of the study, the proportion improved to 65.2% and 60.9%, respectively. CONCLUSION Use of quality improvement change methods have resulted in the successful integration of new interventions to increase discussions around driving when prescribed opioids. A previously overlooked issue in this facility, thus improving clinical and patient information sharing, and patient empowerment to take charge of their own health.
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Affiliation(s)
| | - Megan Howarth
- University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | - Rebecca Allan
- University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | - Nicola Davey
- Quality Improvement Coaching, Quality Improvement Clinic Ltd, Shedfield, UK
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3
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Assaf R, Mitchnik I, Beer Y, Agar G, Tamir E, Lindner D, Gilat R. Return to Driving After Hip Arthroscopy: A Systematic Review and Meta-analysis. Orthop J Sports Med 2022; 10:23259671221128281. [PMID: 36479461 DOI: 10.1177/23259671221128281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/25/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Hip arthroscopy is an increasingly common procedure; however, recommendations for safely returning to driving after hip arthroscopy vary among surgeons. Purpose: To systematically review and analyze the current available evidence on the optimal time to safely return to driving after hip arthroscopy. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review and meta-analysis was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Two authors independently conducted a literature search throughout August 2021 using the PubMed, Google Scholar, Embase, and Cochrane databases. A total of 1425 articles were reviewed, and 5 articles were included. All included articles used brake reaction time (BRT) as an observer-reported outcome measure. A meta-analysis was performed to compare pre- and postoperative BRT values. Study sample sizes and mean BRT values were collected per each included study. First, data were analyzed for the right and left hips combined; then, a subgroup analysis stratified by laterality was performed. The BRT values were divided according to time periods of measurement: preoperatively and 2, 4, 6, and 8 weeks postoperatively. Results: The included studies evaluated safety to return to driving after hip arthroscopy in 160 patients. Of these, 142 patients were treated for femoroacetabular impingement, while 18 patients underwent hip arthroscopy for other diagnoses. The mean weighted age was 33.7 ± 9.0 years, 47.5% of the patients were female, and the right hip was affected in 71.2%. The preoperative range of BRT was 566 to 1960 ms, and postoperative BRT range was 567 to 1840 ms at 1 to 2 weeks and 523 to 1860 ms at 3 to 12 weeks. Meta-analysis found the studies to be moderately heterogenic ( P = .06). There were no statistically significant differences in BRT between the preoperative period and at 2, 4, 6, and 8 weeks postoperatively. Conclusion: Return to driving is likely safe as early as 2 to 4 weeks after right-sided hip arthroscopy, and 2 weeks after a left-sided procedure, as driving performance returns to the preoperative level. Registration: CRD42021274460 (PROSPERO identifier).
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Affiliation(s)
- Roy Assaf
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Ilan Mitchnik
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Yiftah Beer
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Agar
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Eran Tamir
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Dror Lindner
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Ron Gilat
- Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
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Mayer RS, Engle J. Rehabilitation of Individuals With Cancer. Ann Rehabil Med 2022; 46:60-70. [PMID: 35508925 PMCID: PMC9081390 DOI: 10.5535/arm.22036] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/30/2022] [Indexed: 01/02/2023] Open
Abstract
The survival rate of cancer is increasing as treatment improves. As patients with cancer now live longer, impairments may arise that impact quality of life (QOL) and function. Therefore, a focus on QOL is often as important as survival. An interdisciplinary team can achieve goal-oriented and patient-centered rehabilitation, which can optimize function and QOL, and minimize impairments, restrictions, and activity limitations. In most cases, cancer patients must be active participants in therapy and exhibit carryover. Patients with cancer often have impairments that include fatigue, pain, brain fog, impaired cognition, paresis, mood disorders, difficulty with activities of daily living (ADL), bowel/bladder/sexual dysfunction, and bone and soft tissue involvement. Adaptive equipment, exercise, and ADL training can mitigate restrictions on activity. The trajectory and phase of the disease along the continuum of cancer care may influence the goals of rehabilitation in that time window. QOL is often influenced by participation in vocational, recreational, and home-based activities. A holistic perspective should include an analysis of distress, socioeconomic barriers, and transportation limitations when addressing issues.
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Affiliation(s)
- Robert Samuel Mayer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jessica Engle
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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5
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Jang SE, Bradshaw YS, Carr DB. Comparison of the Impacts of Under-Treated Pain and Opioid Pain Medication on Cognitive Impairment. Cureus 2022; 14:e22037. [PMID: 35155054 PMCID: PMC8824639 DOI: 10.7759/cureus.22037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose: To guide clinicians in balancing the risks and benefits of opioids when treating pain, we conducted two systematic reviews: 1) the impact of pain on cognitive function, and 2) the impact of opioids on cognitive function. Methods: Part one addressed the impact of pain on cognitive impairment; Part two considered the impact of opioids on cognitive impairment. PubMed was used to search for eligible articles. For part one, 1786 articles were identified, of which 23 met our eligibility criteria. For part two, among 584 articles, 18 were found eligible. Results: For part one, 16 studies concluded that patients with chronic pain showed impaired cognitive function; six studies found that chronic pain does not worsen cognitive function; one study concluded that the impact of pain on cognitive function differs based on the underlying cognitive status. For part two, 15 studies found that using opioids to control pain did not cause significant cognitive impairment, while three studies concluded the opposite. Studies evaluating older subjects did not observe different results from those in the whole population for both reviews. Conclusion: The published literature indicates that moderate to severe pain can impair cognitive function, and that careful use of opioid analgesics in such subjects does not necessarily worsen cognition. Although our results are insufficient to support clear guidance due to heterogeneity of cohorts and outcomes, this study may assist primary care providers by rendering explicitly the factors to be considered by providers caring for this population with pain when opioids are considered.
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Seward J, Stavrinos D, Moore D, Attridge N, Trost Z. When driving hurts: characterizing the experience and impact of driving with back pain. Scand J Pain 2021; 21:445-456. [PMID: 33641275 DOI: 10.1515/sjpain-2020-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/07/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Driving is one of the most widespread aspects of daily living to people in the United States and is an active process that requires various cognitive functions, such as attention. Chronic low back pain (CLBP) is one of the more prevalent and costly health conditions in the world, with individuals who report CLBP also reporting significant impairment across different domains of daily life both physically and cognitively. However, despite the prevalence of these two constructs, research detailing the experience of driving in pain remains largely underrepresented. This cross-sectional study sought to characterize the driving experience of people who experience CLBP, focusing on the psychological constructs related to chronic pain like pain catastrophizing, affective responses (irritability, anxiety, fear), and self-reported driving behaviors and outcomes. METHODS This study distributed an online questionnaire measuring pain, disability, and other psychological constructs commonly associated with CLBP like pain catastrophizing through M-turk to 307 U.S. participants with recurring CLBP and regular driving activity. Participants also answered questions regarding driving in pain, affective responses to driving in pain (i.e., irritability, anxiety, and fear), driving behaviors and violations, driving avoidance habits as a result of pain, opioid use, using pain medication while driving, and recent vehicle collisions within the past three years. Bivariate correlations were used to compare study variables, and one-way ANOVA's were used to compare means between participants with and without a collision history within the past three years. RESULTS Findings demonstrated significant positive associations not only between the psychological factors commonly associated with chronic pain, such as pain intensity, pain disability, pain catastrophizing, and the cognitive intrusion by pain, but also statistically significant relationships between these measures and pain intensity while driving, affective responses to driving in pain, driving violations, and driving avoidance habits. Additionally, in comparison to participants with no collision history within the past three years, participants who had been driving during a vehicle collision reported greater pain catastrophizing and cognitive intrusion by pain scores. CONCLUSIONS To our knowledge, the current study is the first to characterize driving experience specifically among individuals with CLBP, with attention to the relationship among key sensory, affective, and cognitive psychological metrics as well as self-reported driving history and behavior. The current findings reinforce multiple associations between pain and cognitive-affective variables that have been observed in literature outside the driving context, including pain intensity, anger, inattention, and behavioral disruption. Given that driving is a pervasive, potentially risky behavior that requires some form of cognitive focus and control, the current findings point to a continued need to examine these associations within this specific life context. We believe we have laid a groundwork for research considering the role of psychological pain variables in a driving performance. However, the nature of our analyses prevents any sort of causality from being inferred, and that future experimental research is warranted to better understand and explain these mechanisms underlying driving in pain while accounting for participant bias and subject interpretation.
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Affiliation(s)
- Joshua Seward
- Department of Psychology, University of Alabama, Birmingham, AL, USA
| | - Despina Stavrinos
- Department of Psychology, University of Alabama, Birmingham, AL, USA
| | - David Moore
- School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK.,Research Centre for Brain and Behaviour, Liverpool John Moores University, Liverpool, UK
| | - Nina Attridge
- School of Science, Loughborough University, Loughborough, UK
| | - Zina Trost
- Virginia Commonwealth University, Richmond, USA
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Divsalar P, Mohammadi M, Divsalar K. Drug use and pattern of injuries sustained by drivers involved in road traffic crashes. TRAFFIC INJURY PREVENTION 2021; 22:195-200. [PMID: 33709853 DOI: 10.1080/15389588.2021.1889528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Road traffic crashes are one of the global public health concerns and remain at high priority in many countries. Driving under the influence of drugs increases the risk of crashes through altering the driver's mental state and reactions. This study was conducted to determine the relationship between driving pattern and substance abuse among drivers in Kerman, a city in Iran, in order to enable policy makers to make the necessary decisions in planning and executing guidelines. METHODS The population of this descriptive study was drivers involved in road traffic crashes admitted to the emergency department of Shahid Bahonar university hospital in summer 2019. After obtaining demographic information, type of vehicle, type of collision and pattern of serious injury, 222 eligible drivers were tested for tramadol, cannabis, amphetamine, methamphetamine, morphine and methadone using one step urine test strips. Chi-square test, Fisher's exact test, Whitney-Mann and Kruskal-Wallis tests and one-way Anova test was performed using SPSS version 22. RESULTS The statistics showed that most drivers were male (90.5%), married (63.5%), age group (18-30) and had positive urine test (76.6%). In addition to uniqueness of dual-drug detection among male drivers (7.7%), the most common substances detected were methadone and morphine with 34.7% and 27.5% respectively. The most common injuries were lower limb and hip injuries mostly among motorcyclists. The results indicated that characteristics of being under 30's, married, school dropout, self-employed and motorcyclist had significant relationship with substance use. CONCLUSIONS Substance use, especially methadone, has undoubtedly a significant role in both road traffic crashes and resulted injuries. The high rate of injuries on drivers influenced by methadone in traffic crashes needs to be screened and prevented. It is recommended to not only authoritatively deal with the excessive supply of methadone in the community but also restricting the driving of people receiving methadone treatment.
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Affiliation(s)
- Parisa Divsalar
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehrnoosh Mohammadi
- Shahid Bahonar hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Kouros Divsalar
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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8
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Babalonis S, Coe MA, Nuzzo PA, Lofwall MR, Ali N, Sloan PA, Fanucchi LC, Walsh SL. Acute administration of oxycodone, alcohol, and their combination on simulated driving-preliminary outcomes in healthy adults. Psychopharmacology (Berl) 2021; 238:539-549. [PMID: 33169203 PMCID: PMC7855562 DOI: 10.1007/s00213-020-05702-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
RATIONALE Epidemiological data indicate that drivers testing positive for an opioid drug are twice as likely to cause a fatal car crash; however, there are limited controlled data available. OBJECTIVES The primary aim of this study was to assess the effects of a therapeutic dose range of oxycodone alone and in combination with alcohol on simulated driving performance. METHODS Healthy participants (n = 10) completed this within-subject, double-blind, placebo-controlled, randomized outpatient study. Six 7-h sessions were completed during which oxycodone (0, 5, 10 mg, p.o.) was administered 30 min before alcohol (0, 0.8 g/kg (15% less for women), p.o.) for a total of 6 test conditions. Driving assessments and participant-, observer-rated, psychomotor and physiological measures were collected in regular intervals before and after drug administration. RESULTS Oxycodone alone (5, 10 mg) did not produce any changes in driving outcomes or psychomotor task performance, relative to placebo (p > 0.05); however, 10 mg oxycodone produced increases in an array of subjective ratings, including sedation and impairment (p < 0.05). Alcohol alone produced driving impairment (e.g., decreased lateral control) (p < 0.05); however, oxycodone did not potentiate alcohol-related driving or subjective effects. CONCLUSIONS These preliminary data suggest that acute doses of oxycodone (5, 10 mg) do not significantly impair acuity on laboratory-based simulated driving models; however, 10 mg oxycodone produced increases in self-reported outcomes that are not compatible with safe driving behavior (e.g., sedation, impairment). Additional controlled research is needed to determine how opioid misuse (higher doses; parenteral routes of administration) impacts driving risk.
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Affiliation(s)
- Shanna Babalonis
- Department of Behavioral Science, University of Kentucky, College of Medicine, Lexington, KY, USA.
- Center on Drug and Alcohol Research, University of Kentucky, College of Medicine, 845 Angliana Avenue, Lexington, 40508, KY, USA.
| | - Marion A Coe
- Center on Drug and Alcohol Research, University of Kentucky, College of Medicine, 845 Angliana Avenue, Lexington, 40508, KY, USA
- Department of Pharmacology, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Paul A Nuzzo
- Center on Drug and Alcohol Research, University of Kentucky, College of Medicine, 845 Angliana Avenue, Lexington, 40508, KY, USA
| | - Michelle R Lofwall
- Department of Behavioral Science, University of Kentucky, College of Medicine, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, College of Medicine, 845 Angliana Avenue, Lexington, 40508, KY, USA
- Department of Psychiatry, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Nur Ali
- Center on Drug and Alcohol Research, University of Kentucky, College of Medicine, 845 Angliana Avenue, Lexington, 40508, KY, USA
| | - Paul A Sloan
- Department of Anesthesiology, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Laura C Fanucchi
- Center on Drug and Alcohol Research, University of Kentucky, College of Medicine, 845 Angliana Avenue, Lexington, 40508, KY, USA
- Department of Internal Medicine, University of Kentucky, College of Medicine, Lexington, KY, USA
| | - Sharon L Walsh
- Department of Behavioral Science, University of Kentucky, College of Medicine, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, College of Medicine, 845 Angliana Avenue, Lexington, 40508, KY, USA
- Department of Pharmacology, University of Kentucky, College of Medicine, Lexington, KY, USA
- Department of Psychiatry, University of Kentucky, College of Medicine, Lexington, KY, USA
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Dora-Laskey AD, Goldstick JE, Arterberry BJ, Roberts SJ, Haffajee RL, Bohnert ASB, Cunningham RM, Carter PM. Prevalence and Predictors of Driving after Prescription Opioid Use in an Adult ED Sample. West J Emerg Med 2020; 21:831-840. [PMID: 32726253 PMCID: PMC7390550 DOI: 10.5811/westjem.2020.3.44844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/08/2020] [Indexed: 02/01/2023] Open
Abstract
Introduction Prescription opioid use and driving is a public health concern given the risks associated with drugged driving, but the issue remains under-studied. We examined the prevalence and correlates of driving after taking prescription opioids (DAPO) among adults seeking emergency department (ED) treatment. Methods Participants (aged 25–60) seeking ED care at a Level I trauma center completed a computerized survey. Validated instruments measured prescription opioid use, driving behaviors, and risky driving. Patients who reported past three-month prescription opioid use and drove at least twice weekly were administered an extended study survey measuring DAPO, depression, pain, and substance use. Results Among participants completing the screening survey (n = 756; mean age = 42.8 [standard deviation {SD} =10.4]), 37.8% reported past three-month prescription opioid use (30.8% of whom used daily), and 14.7% reported past three-month DAPO. Of screened participants, 22.5% (n = 170) were eligible for the extended study survey. Unadjusted analyses demonstrated that participants reporting DAPO were more likely to use opioids daily (51.1% vs 15.9%) and had higher rates of opioid misuse (mean Current Opioid Misuse Measure score 3.4 [SD = 3.8] vs 1.1 [SD = 2.1]) chronic pain (80.7% vs 42.7%), and driving after marijuana or alcohol use (mean intoxicated driving score 2.1 [SD = 1.3] vs 0.3 [SD = 0.8]) compared to patients not reporting DAPO (all p<0.001). Adjusting for age, gender, employment, and insurance in a logistic regression model, participants reporting DAPO were more likely to report a chronic pain diagnosis (odds ratio [OR] = 3.77, 95% confidence interval [CI], 1.55–9.17), daily opioid use (OR = 3.81, 95% CI, 1.64–8.85), and higher levels of intoxicated driving (OR = 1.62, 95% CI, 1.07–2.45). Alcohol and marijuana use, depression, and opioid misuse were not associated with DAPO in adjusted analyses. Conclusion Nearly one in six adult patients seeking ED care reported DAPO. The ED may be an important site for interventions addressing opioid-related drugged driving.
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Affiliation(s)
- Aaron D Dora-Laskey
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan, Department of Psychiatry, Ann Arbor, Michigan.,University of Michigan Addiction Center, Ann Arbor, Michigan
| | - Jason E Goldstick
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan Injury Prevention Center, Ann Arbor, Michigan
| | - Brooke J Arterberry
- University of Michigan Addiction Center, Ann Arbor, Michigan.,Iowa State University, Department of Psychology, Ames, Iowa
| | - Suni Jo Roberts
- University of Michigan, Department of Psychiatry, Ann Arbor, Michigan
| | - Rebecca L Haffajee
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan Injury Prevention Center, Ann Arbor, Michigan.,University of Michigan School of Public Health, Department of Health Management and Policy, Ann Arbor, Michigan and RAND Corporation, Boston, Massachusetts
| | - Amy S B Bohnert
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan, Department of Psychiatry, Ann Arbor, Michigan.,University of Michigan, Department of Anesthesiology, Ann Arbor, Michigan
| | - Rebecca M Cunningham
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan Injury Prevention Center, Ann Arbor, Michigan.,Hurley Medical Center, Department of Emergency Medicine, Flint, Michigan
| | - Patrick M Carter
- University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan.,University of Michigan Injury Prevention Center, Ann Arbor, Michigan
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10
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Kongsgaard UE, Høiseth G. Dynamic assessment of the pupillary reflex in patients on high-dose opioids. Scand J Pain 2020; 19:465-471. [PMID: 31031265 DOI: 10.1515/sjpain-2019-0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/20/2019] [Indexed: 11/15/2022]
Abstract
Background and aims Pupil size and reaction are influenced by opioids, an effect that is not considered to be affected by opioid tolerance. As clinicians have observed patients on high-dose opioids who exhibited seemingly normal pupil sizes, we wanted to dynamically assess the pupillary reflex in cancer patients on high-dose opioids. Methods We performed a dynamic assessment of the pupillary reflex in cancer patients on high-dose opioids and a control group of healthy volunteers using a portable, monocular, infrared pupillometer. We also performed a clinical examination and measured blood concentrations of opioids and their active metabolites. Results Sixty three patients who were on opioids for 2 months (median time) and on an oral morphine equivalent dose of 250 mg (median dose) were investigated. Most patients used more than one opioid. When correcting for age, pupil size in the group that had received no increase of opioid dose over the last 14 days was not significantly different from pupil size in the healthy volunteer group (p = 0.76), while the group that had increased the dose of opioids differed significantly from healthy volunteers (p = 0.006). We found no statistically significant correlation between total oral morphine equivalents and pupillary reactions or between blood opioid or opioid metabolite concentrations and baseline pupillary changes. Conclusion Pupillary changes do take place in patients on opioids. However, tolerance to these changes occurs when medication is not increased over time. Dynamic pupillometry can give additional information about the degree of tolerance to opioids. Implications These findings elucidate previous misconceptions regarding pupillary effects and tolerance to opioids.
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Affiliation(s)
- Ulf E Kongsgaard
- Department of Anaesthesiology, Division of Emergencies and Critical Care, The Norwegian Radium Hospital, Oslo University Hospital, Montebello, 0310 Oslo, Norway.,Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Gudrun Høiseth
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.,Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
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11
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Diasso PDK, Sjøgren P, Højsted J, Nielsen SD, Main KM, Kurita GP. Patient reported outcomes and neuropsychological testing in patients with chronic non-cancer pain in long-term opioid therapy: a pilot study. Scand J Pain 2020; 19:533-543. [PMID: 31031263 DOI: 10.1515/sjpain-2019-0007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/20/2019] [Indexed: 11/15/2022]
Abstract
Background and aims Opioid consumption has increased dramatically in patients with chronic non-cancer pain (CNCP), but long-term consequences are still unclear. The aim of this study is to investigate the effects of long-term opioid treatment on pain, cognition, mood, sleep and quality of life in CNCP patients. Methods In this cross-sectional pilot study, two groups of patients with CNCP treated in a multidisciplinary pain center were selected: (1) opioid group: ≥30 mg morphine equivalent/day for >4 weeks, and (2) control group: no opioid consumption for >4 weeks. Socio-demographic data, alcohol consumption, smoking habits and body mass index (BMI) were registered and pain (brief pain inventory), mood (Hospital Anxiety and Depression Scale), sleep (Pittsburgh Sleep Quality Index) and quality of life (RAND 36-Item Health Survey) were assessed. Continuous Reaction Time and the Digit Span Test were used to evaluate cognitive function. Data was analyzed with a Fisher's exact test and Wilcoxon two-sample test. Results Forty-two patients with CNCP were included (21 in each group). No differences regarding socio-demographics, smoking/alcohol habits and duration, type, or intensity of pain were found. More patients in the opioid group had significantly higher BMI (62% above BMI 25 vs. 33.3%, p = 0.042). Consequently, the subsequent data analyses were controlled for BMI. The two groups did not differ in pain, cognition, anxiety, depression, sleep or quality of life but both showed lower values than the normal standards. Further, the opioid group presented a tendency to lower ratings regarding pain and social function and performed below the normal cut off in the continuous reaction time. Conclusions No significant differences between the two groups were found regarding any of the above-mentioned variables. Interestingly, the patients assessed, regardless of taking opioids or not, could be classified with moderate pain intensity, anxiety and low quality of sleep and life compared to norm standards. Implications The findings of this pilot study suggested that long-term opioid treatment may influence pain and quality of life among CNCP patients. A larger cohort is needed to verify these findings.
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Affiliation(s)
- Pernille D K Diasso
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Per Sjøgren
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jette Højsted
- Multidisciplinary Pain Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Susanne D Nielsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Katharina M Main
- Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Geana P Kurita
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Multidisciplinary Pain Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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12
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Rural-urban differences in cannabis detected in fatally injured drivers in the United States. Prev Med 2020; 132:105975. [PMID: 31899254 DOI: 10.1016/j.ypmed.2019.105975] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/17/2019] [Accepted: 12/28/2019] [Indexed: 11/22/2022]
Abstract
While there is a vast literature on rural and urban differences in substance use, little is known in terms of cannabis positive drug tests among fatally injured drivers. In the present study, we examined rural-urban differences in cannabis detected in fatally-injured drivers. Data were drawn from the 2015-2017 Fatality Analysis Reporting System. Multivariable logistic regression was performed to examine rural-urban differences in the percentage of cannabis detected in fatally-injured drivers. Analyses were stratified by rural-urban classification and sex. A positive cannabis test in fatally-injured drivers was more prevalent in urban locations. Compared to fatally-injured drivers in rural locations, urban drivers had higher odds of a positive test for cannabinoids (aOR: 1.21, 95% CI 1.14-1.28). Non-Hispanic Black drivers had higher odds of testing positive for cannabinoids (aOR: 1.43, 95% CI 1.31-1.55). Those aged at least 25 years had lower odds of a positive test for cannabinoids. Drivers involved in a weekend nighttime crash (aOR: 1.14, 95% CI 1.03-1.26) and weekday nighttime (aOR: 1.15, 95% CI 1.05-1.26) had higher odds of testing positive for cannabinoids compared to drivers involved in a weekend daytime crash. Results showed significant rural-urban differences in the prevalence of cannabis detected in fatally-injured drivers.
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13
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Azagba S, Latham K, Shan L, Qeadan F. Positive drug test trends in fatally-injured drivers in the United States from 2007 to 2017. Subst Abuse Treat Prev Policy 2019; 14:43. [PMID: 31653263 PMCID: PMC6815059 DOI: 10.1186/s13011-019-0228-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022] Open
Abstract
Background The last two decades have seen tremendous changes in the U.S. environment surrounding drugs. Driving under the influence of drugs is a growing public health hazard. The present study examined trends in drug involvement in fatally-injured drivers in the U.S. Methods Data were drawn from the 2007–2017 Fatality Analysis Reporting System. Cochran–Armitage tests were performed to assess the statistical significance of changes in the yearly prevalence of positive drug tests in fatally-injured drivers over time. In addition, analyses were stratified by sex, race, and age. Results The yearly prevalence of positive drug tests in fatally-injured drivers increased significantly from 20.7% in 2007 to 30.7% in 2017, with results showing a higher prevalence among males, those aged 21–44, and Whites. The gap between Blacks and Whites narrowed in 2017. There was a decline in the yearly prevalence in all age groups between 2016 and 2017, although the decrease in the 21–44 age group was much smaller than other age groups. Among drivers who tested positive for drugs, 34.6% had a blood alcohol concentration (BAC) above the threshold of per se evidence for impaired driving, and 63% had a BAC below the threshold. Conclusions Our results indicate that the overall yearly prevalence of fatally-injured drivers who tested positive for drugs increased significantly from 2007 to 2017, with similar results found for subgroups. Findings further highlight that drugged driving remains a public health priority, and more action is needed to stem this disturbing trend.
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Affiliation(s)
- Sunday Azagba
- Department of Family and Preventive Medicine, Division of Public Health, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA.
| | - Keely Latham
- Department of Family and Preventive Medicine, Division of Public Health, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
| | - Lingpeng Shan
- Department of Family and Preventive Medicine, Division of Public Health, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
| | - Fares Qeadan
- Department of Family and Preventive Medicine, Division of Public Health, University of Utah School of Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
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Abstract
Orthopaedic injuries of the upper extremity remain common, often requiring prolonged immobilization after surgical or nonsurgical management. Upper extremity immobilization often has a profound effect on a patient's daily life, including one's ability to safely operate a motor vehicle. Current literature on the safety of driving while immobilized is varied, although above-elbow immobilization of the upper extremity is generally thought to present a particular hazard to safe driving. Unfortunately, as common as this situation is, currently little to no guidance exists for patients, physicians, or lawmakers with regard to deciding whether a patient is safe to return to driving with upper extremity immobilization. Similar discord exists with the issue of patient and physician liability in such cases. In this review, we seek to present both historical precedent and a contemporary update of this complex, though a frequently encountered situation.
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15
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DINI G, BRAGAZZI N, MONTECUCCO A, RAHMANI A, DURANDO P. Psychoactive drug consumption among truck-drivers: a systematic review of the literature with meta-analysis and meta-regression. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E124-E139. [PMID: 31312742 PMCID: PMC6614564 DOI: 10.15167/2421-4248/jpmh2019.60.2.1245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/02/2019] [Indexed: 11/16/2022]
Abstract
Few studies have assessed the extent of psychoactive drug consumption in the occupational setting. The trucking sector, in particular, is an important cause for concern, since psychoactive substance use has a relevant impact on the drivers' health and safety, increasing the risk of injuries and traffic accidents, potentially affecting the general public health as well. A systematic review of the literature and meta-analysis was performed in order to provide Occupational Health Professionals and policy-makers with an updated epidemiological perspective regarding this important issue. The results showed a prevalence of overall drug consumption of 27.6% [95%CI 17.8-40.1], particularly high considering illicit CNS-stimulants (amphetamine consumption of 21.3% [95%CI 15.7-28.1], and cocaine consumption of 2.2% [95%CI 1.2-4.1]). It appears that truck-drivers choose stimulant substances as a form of performance enhancing drug, in order to increase productivity. However, chronic and high dose consumption has been shown to decrease driving skills, placing these professional drivers at risk for health and road safety. Further research is required, particularly in Europe, in order to fill the knowledge gap and improve the strength of evidence.
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Affiliation(s)
- G. DINI
- Department of Health Sciences (DISSAL), Occupational Medicine, University of Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
| | - N.L. BRAGAZZI
- Department of Health Sciences (DISSAL), Occupational Medicine, University of Genoa, Italy
- Correspondence: Nicola Luigi Bragazzi, Dipartimento di Scienze della Salute (DISSAL), Università degli Studi di Genova, l.go R. Benzi 10 (Padiglione 3), 16132 Genova, Italy - E-mail:
| | - A. MONTECUCCO
- Department of Health Sciences (DISSAL), Occupational Medicine, University of Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
| | - A. RAHMANI
- Department of Health Sciences (DISSAL), Occupational Medicine, University of Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
| | - P. DURANDO
- Department of Health Sciences (DISSAL), Occupational Medicine, University of Genoa, Italy
- Occupational Medicine Unit, Policlinico San Martino Hospital IRCCS, Genoa, Italy
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Allegri N, Mennuni S, Rulli E, Vanacore N, Corli O, Floriani I, De Simone I, Allegri M, Govoni S, Vecchi T, Sandrini G, Liccione D, Biagioli E. Systematic Review and Meta‐Analysis on Neuropsychological Effects of Long‐Term Use of Opioids in Patients With Chronic Noncancer Pain. Pain Pract 2018; 19:328-343. [DOI: 10.1111/papr.12741] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/05/2018] [Accepted: 10/05/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Nicola Allegri
- Department of Brain and Behavioral Science University of Pavia Pavia Italy
| | | | - Eliana Rulli
- IRCCS‐Istituto di Ricerche Farmacologiche Mario Negri Milan Italy
| | - Nicola Vanacore
- IRCCS Mondino Foundation Pavia Italy
- National Centre of Epidemiology National Institute of Health Rome Italy
| | - Oscar Corli
- IRCCS‐Istituto di Ricerche Farmacologiche Mario Negri Milan Italy
| | - Irene Floriani
- IRCCS‐Istituto di Ricerche Farmacologiche Mario Negri Milan Italy
| | - Irene De Simone
- IRCCS‐Istituto di Ricerche Farmacologiche Mario Negri Milan Italy
| | - Massimo Allegri
- Pain Therapy Service Policlinico Monza Monza Italy
- Italian Pain Group Milan Italy
| | - Stefano Govoni
- Department of Drug Sciences University of Pavia Pavia Italy
| | - Tomaso Vecchi
- Department of Brain and Behavioral Science University of Pavia Pavia Italy
- IRCCS Mondino Foundation Pavia Italy
| | - Giorgio Sandrini
- Department of Brain and Behavioral Science University of Pavia Pavia Italy
- IRCCS Mondino Foundation Pavia Italy
| | - Davide Liccione
- Department of Brain and Behavioral Science University of Pavia Pavia Italy
| | - Elena Biagioli
- IRCCS‐Istituto di Ricerche Farmacologiche Mario Negri Milan Italy
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17
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Balazs GC, Donohue MA, Brelin AM, Brooks DI, McCabe MP, Anderson TD. Reaction Time and Brake Pedal Depression Following Arthroscopic Hip Surgery: A Prospective Case-Control Study. Arthroscopy 2018; 34:1463-1470.e1. [PMID: 29625800 DOI: 10.1016/j.arthro.2018.02.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 02/07/2018] [Accepted: 02/07/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine whether patients diagnosed with femoroacetabular impingement (FAI) syndrome have prolonged braking times compared with age- and gender-matched controls and how long after surgery braking times return to preoperative baseline. METHODS Fifty-nine patients undergoing arthroscopic hip surgery for FAI and 59 age- and gender-matched controls without FAI were enrolled in a prospective comparative study between September 2015 and October 2016. Total brake reaction time (BRT) and brake pedal depression (BPD) were measured for study patients preoperatively, and at 2, 4, and 6 weeks postoperatively. BRT and BPD were compared between study and control patients and between preoperative and postoperative time periods, using mixed effects models. RESULTS Patients with FAI had significantly prolonged BRT (but not BPD) prior to surgery compared with controls (568 vs 520 msec, P = .002). For study patients undergoing left hip surgery, there was no difference in BRT or BPD between preoperative measurements and any postoperative time point, including the first postoperative appointment at 2 weeks (563 vs 566 msec, P = .89). Patients undergoing right hip surgery had significantly prolonged BRT at 2 weeks postoperatively compared with their preoperative baseline (688 vs 573 msec, P < .001). By 4 weeks postoperatively, study patients undergoing right hip surgery had returned to their preoperative baseline (573 vs 594 msec, P = .28). No significant effect was seen based on visual analog scale pain score, opiate usage, or patient-reported outcome scores. CONCLUSIONS Patients undergoing arthroscopic surgery of the right hip show significantly prolonged BRT until 4 weeks after surgery, while patients undergoing surgery of the left hip show no postoperative impairment in either BRT or BPD. The clinical relevance of this measured difference (an increase in 10 feet of stopping distance at 60 miles per hour) remains an open question. LEVEL OF EVIDENCE Level II, diagnostic, prospective.
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Affiliation(s)
- George C Balazs
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A..
| | - Michael A Donohue
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Alaina M Brelin
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Daniel I Brooks
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Michael P McCabe
- Apex Orthopedics and Sports Medicine, Overland Park, Kansas, U.S.A
| | - Terrence D Anderson
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, Texas, U.S.A
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18
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Ferreira DH, Boland JW, Phillips JL, Lam L, Currow DC. The impact of therapeutic opioid agonists on driving-related psychomotor skills assessed by a driving simulator or an on-road driving task: A systematic review. Palliat Med 2018; 32:786-803. [PMID: 29299954 DOI: 10.1177/0269216317746583] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Driving cessation is associated with poor health-related outcomes. People with chronic diseases are often prescribed long-term opioid agonists that have the potential to impair driving. Studies evaluating the impact of opioids on driving-related psychomotor skills report contradictory results likely due to heterogeneous designs, assessment tools and study populations. A better understanding of the effects of regular therapeutic opioid agonists on driving can help to inform the balance between individual's independence and community safety. AIM To identify the literature assessing the impact of regular therapeutic opioid agonists on driving-related psychomotor skills for people with chronic pain or chronic breathlessness. DESIGN Systematic review reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis statement; PROSPERO Registration CRD42017055909. DATA SOURCES Six electronic databases and grey literature were systematically searched up to January, 2017. Inclusion criteria were as follows: (1) empirical studies reporting data on driving simulation, on-the-road driving tasks or driving outcomes; (2) people with chronic pain or chronic breathlessness; and (3) taking regular therapeutic opioid agonists. Critical appraisal used the National Institutes of Health's quality assessment tools. RESULTS From 3809 records screened, three studies matched the inclusion criteria. All reported data on people with chronic non-malignant pain. No significant impact of regular therapeutic opioid agonists on people's driving-related psychomotor skills was reported. One study reported more intense pain significantly worsened driving performance. CONCLUSION This systematic review does not identify impaired simulated driving performance when people take regular therapeutic opioid agonists for symptom control, although more prospective studies are needed.
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Affiliation(s)
- Diana H Ferreira
- 1 Discipline, Palliative and Supportive Services, Flinders University, Adelaide, SA, Australia
| | - Jason W Boland
- 2 Hull York Medical School, University of Hull, Hull, UK
| | - Jane L Phillips
- 3 IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Lawrence Lam
- 3 IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - David C Currow
- 1 Discipline, Palliative and Supportive Services, Flinders University, Adelaide, SA, Australia.,2 Hull York Medical School, University of Hull, Hull, UK.,3 IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,4 Wolfson Centre for Palliative Care Research, Hull York Medical School, University of Hull, Hull, UK
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Hamnett HJ, Poulsen H. The Effect of Lowering the Legal Drink‐Drive Limit on the Toxicological Findings in Driver Fatalities: A Comparison of Two Jurisdictions
,. J Forensic Sci 2018; 63:1457-1465. [DOI: 10.1111/1556-4029.13747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/27/2017] [Accepted: 01/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Hilary J. Hamnett
- Forensic Medicine & Science School of Medicine, Dentistry & Nursing University of Glasgow University Place Glasgow G12 8QQ U.K
| | - Helen Poulsen
- Environmental Science & Research Limited Kenepuru Science Centre Porirua 5022 New Zealand
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Pollini RA, Waehrer G, Kelley-Baker T. Receipt of Warnings Regarding Potentially Impairing Prescription Medications and Associated Risk Perceptions in a National Sample of U.S. Drivers. J Stud Alcohol Drugs 2017; 78:805-813. [PMID: 29087813 PMCID: PMC5668990 DOI: 10.15288/jsad.2017.78.805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 06/06/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Reducing drug-involved driving is a national policy priority, but little is known about the extent to which drivers receive warnings about the impairment potential of their prescribed medications. We used data from the 2013-2014 National Roadside Survey (NRS) to quantify the proportion of drivers who received warnings regarding potentially impairing medications and the association with driving-related risk perceptions. METHOD Drivers randomly selected at 60 sites completed the self-administered survey, which contained questions on their use of prescription medications. RESULTS Overall, 7,405 drivers completed the prescription drug portion of the NRS. Of these, 19.7% reported recent use (within the past 2 days) of a potentially impairing prescription drug, and 78.2% said the drug had been prescribed for their use. Users of prescribed sedatives (85.8%) and narcotics (85.1%) were most likely to report receiving information about potential impairment, compared with only 57.7% and 62.6% of users of prescribed stimulant and antidepressant medications, respectively. Receipt of warnings varied by sex, race/ethnicity, income, geographic region, and time of day. For a majority of drug categories, drivers who reported receiving warnings had significantly higher odds of perceived risk of impaired driving/crash and criminal justice involvement. CONCLUSIONS Most users of prescription medications reported that the drug was prescribed for their use, but not all reported receiving warnings about driving impairment. Our study provides evidence of missed opportunities for information provision on impaired driving, identifies subgroups that may warrant enhanced interventions, and provides preliminary evidence that receipt of impairment warnings is associated with increased perceptions of driving-related risk.
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Affiliation(s)
- Robin A. Pollini
- Pacific Institute for Research and Evaluation, Calverton, Maryland
- Injury Control Research Center, West Virginia University, Morgantown, West Virginia
| | - Geetha Waehrer
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - Tara Kelley-Baker
- Pacific Institute for Research and Evaluation, Calverton, Maryland
- AAA Foundation for Traffic Safety, Washington, DC
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Kelley-Baker T, Waehrer G, Pollini RA. Prevalence of Self-Reported Prescription Drug Use in a National Sample of U.S. Drivers. J Stud Alcohol Drugs 2017; 78:30-38. [PMID: 27936362 DOI: 10.15288/jsad.2017.78.30] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Drug-involved driving has become an increasing concern. Although the focus has been on illegal drugs, there is evidence that prescribed medications can impair driving ability. The purpose of this study was to determine the self-reported prevalence of prescription drug use, including medical and nonmedical use, among a nationally representative sample of drivers and to report related driver characteristics. METHOD As part of the 2013-2014 National Roadside Survey, drivers from 60 sites were randomly recruited and asked to complete a survey on prescription drug use. RESULTS Almost 20% of drivers reported using a prescription drug within the past 2 days, with the most common drug class being sedatives (8.0%), followed by antidepressants (7.7%), narcotics (7.5%), and stimulants (3.9%). Drivers who reported prescription drug use were significantly more likely to be female, older, non-Hispanic White, and report disability. Three of four drivers who reported medication use (78.2%) said the drug was prescribed for their use; the odds of using without a prescription were significantly higher for males, Black/African American, and Hispanic drivers, and lower for older drivers. Among those with a prescription, taking more than prescribed was most common for narcotics (6.8%), followed by sedatives (4.8%), stimulants (3.8%), and antidepressants (1.5%). CONCLUSIONS These findings help to identify drivers using potentially impairing prescription drugs, both medically and nonmedically, and may inform the targeting of interventions to reduce impaired driving related to medications.
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Affiliation(s)
| | - Geetha Waehrer
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - Robin A Pollini
- Pacific Institute for Research and Evaluation, Calverton, Maryland
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22
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The involvement of prescribed drugs in road trauma. Forensic Sci Int 2016; 265:17-21. [DOI: 10.1016/j.forsciint.2015.12.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 11/22/2022]
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Nagpal A, Xu R, Pangarkar S, Dworkin I, Singh JR. Driving Under the Influence of Opioids. PM R 2016; 8:698-705. [DOI: 10.1016/j.pmrj.2016.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 05/27/2016] [Indexed: 01/26/2023]
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24
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Vearrier D, Vearrier L, McKeever R, Okaneku J, LaSala G, Goldberger D, McCloskey K. Issues in driving impairment. Dis Mon 2016; 62:72-116. [DOI: 10.1016/j.disamonth.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, Dana T, Bougatsos C, Deyo RA. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med 2015; 162:276-86. [PMID: 25581257 DOI: 10.7326/m14-2559] [Citation(s) in RCA: 1094] [Impact Index Per Article: 121.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Increases in prescriptions of opioid medications for chronic pain have been accompanied by increases in opioid overdoses, abuse, and other harms and uncertainty about long-term effectiveness. PURPOSE To evaluate evidence on the effectiveness and harms of long-term (>3 months) opioid therapy for chronic pain in adults. DATA SOURCES MEDLINE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, PsycINFO, and CINAHL (January 2008 through August 2014); relevant studies from a prior review; reference lists; and ClinicalTrials.gov. STUDY SELECTION Randomized trials and observational studies that involved adults with chronic pain who were prescribed long-term opioid therapy and that evaluated opioid therapy versus placebo, no opioid, or nonopioid therapy; different opioid dosing strategies; or risk mitigation strategies. DATA EXTRACTION Dual extraction and quality assessment. DATA SYNTHESIS No study of opioid therapy versus no opioid therapy evaluated long-term (>1 year) outcomes related to pain, function, quality of life, opioid abuse, or addiction. Good- and fair-quality observational studies suggest that opioid therapy for chronic pain is associated with increased risk for overdose, opioid abuse, fractures, myocardial infarction, and markers of sexual dysfunction, although there are few studies for each of these outcomes; for some harms, higher doses are associated with increased risk. Evidence on the effectiveness and harms of different opioid dosing and risk mitigation strategies is limited. LIMITATIONS Non-English-language articles were excluded, meta-analysis could not be done, and publication bias could not be assessed. No placebo-controlled trials met inclusion criteria, evidence was lacking for many comparisons and outcomes, and observational studies were limited in their ability to address potential confounding. CONCLUSION Evidence is insufficient to determine the effectiveness of long-term opioid therapy for improving chronic pain and function. Evidence supports a dose-dependent risk for serious harms. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Affiliation(s)
- Roger Chou
- From Oregon Health & Science University, Portland, Oregon, and University of Washington, Seattle, Washington
| | - Judith A. Turner
- From Oregon Health & Science University, Portland, Oregon, and University of Washington, Seattle, Washington
| | - Emily B. Devine
- From Oregon Health & Science University, Portland, Oregon, and University of Washington, Seattle, Washington
| | - Ryan N. Hansen
- From Oregon Health & Science University, Portland, Oregon, and University of Washington, Seattle, Washington
| | - Sean D. Sullivan
- From Oregon Health & Science University, Portland, Oregon, and University of Washington, Seattle, Washington
| | - Ian Blazina
- From Oregon Health & Science University, Portland, Oregon, and University of Washington, Seattle, Washington
| | - Tracy Dana
- From Oregon Health & Science University, Portland, Oregon, and University of Washington, Seattle, Washington
| | - Christina Bougatsos
- From Oregon Health & Science University, Portland, Oregon, and University of Washington, Seattle, Washington
| | - Richard A. Deyo
- From Oregon Health & Science University, Portland, Oregon, and University of Washington, Seattle, Washington
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Asbridge M, Cartwright J, Langille D. Driving under the influence of opioids among high school students in Atlantic Canada: prevalence, correlates, and the role of medical versus recreational consumption. ACCIDENT; ANALYSIS AND PREVENTION 2015; 75:184-191. [PMID: 25485729 DOI: 10.1016/j.aap.2014.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 11/17/2014] [Accepted: 12/01/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Employing a sample of 3655 senior students (grades 10 and 12, median ages of 16 and 18, respectively) in Atlantic Canada, this paper examines the risk factors associated with driving under the influence of opioids (DUIO), comparing medical versus recreational opioid users. The associations of DUIO with driving under the influence of alcohol, cannabis, and being a passenger of an impaired driver are also examined. METHODS Participants were drawn from the 2012 Student Drug Use Survey in the Atlantic Provinces, an anonymous cross-sectional survey of junior and senior high school students in three Atlantic Canadian provinces. Logistic regression techniques were employed in the analysis of unadjusted and adjusted models. RESULTS Among all senior students, the prevalence of DUIO in the past year was 4.3%. For those who had used a prescription opioid at least once in the past year, the rate of DUIO was 14%, with a higher rate among medical and recreational users (25.1%) compared to those using opioids only for medical purposes (9.6%). The predictors of DUIO were higher SES, higher sensation seeking, lower parental attachment, and being a recreational prescription opioid user. DUIO was strongly associated with other risky driving and passenger behaviours among recreational opioid users. CONCLUSIONS DUIO is an emerging socio-legal and road safety issue, with implications for public health. Prescription opioid use intentions matter, with recreational users exhibiting most risky driving behaviour than medical users. Effort must be placed on educating prescription opioid users about potential impairment while driving.
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Affiliation(s)
- Mark Asbridge
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Avenue, Halifax, NS B3H 1V7, Canada.
| | - Jennifer Cartwright
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Avenue, Halifax, NS B3H 1V7, Canada
| | - Donald Langille
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5790 University Avenue, Halifax, NS B3H 1V7, Canada
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Benotsch EG, Martin AM, Koester S, Mason MJ, Jeffers AJ, Snipes DJ. Driving Under the Influence of Prescription Drugs Used Nonmedically: Associations in a Young Adult Sample. Subst Abus 2015; 36:99-105. [DOI: 10.1080/08897077.2013.854287] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fingelkurts AA, Fingelkurts AA. Present moment, past, and future: mental kaleidoscope. Front Psychol 2014; 5:395. [PMID: 24822050 PMCID: PMC4013454 DOI: 10.3389/fpsyg.2014.00395] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/15/2014] [Indexed: 11/13/2022] Open
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Abstract
OBJECTIVE To describe the association of specific medication classes with driving outcomes and provide clinical recommendations. DATA SOURCES The MEDLINE and EMBASE databases were searched for articles published from January 1973 to June 2013 on classes of medications associated with driving impairment. The search included outcome terms such as automobile driving, motor vehicle crash, driving simulator, and road tests. STUDY SELECTION AND DATA EXTRACTION Only English-language articles that contained findings from observational or interventional designs with ≥ 10 participants were included in this review. Cross-sectional studies, case series, and case reports were excluded. DATA SYNTHESIS Driving is an important task and activity for the majority of adults. Some commonly prescribed medications have been associated with driving impairment measured by road performance, driving simulation, and/or motor vehicle crashes. This review of 30 studies identified findings with barbiturates, benzodiazepines, hypnotics, antidepressants, opioid and nonsteroidal analgesics, anticonvulsants, antipsychotics, antiparkinsonian agents, skeletal muscle relaxants, antihistamines, anticholinergic medications, and hypoglycemic agents. Additional studies of medication impact on sedation, sleep latency, and psychomotor function, as well as the role of alcohol, are also discussed. CONCLUSIONS Psychotropic agents and those with central nervous system side effects were associated with measures of impaired driving performance. It is difficult to determine if such associations are actually a result of medication use or the medical diagnosis itself. Regardless, clinicians should be aware of the increased risk of impaired driving with specific classes of medications, educate their patients, and/or consider safer alternatives.
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Reguly P, Dubois S, Bédard M. Examining the impact of opioid analgesics on crash responsibility in truck drivers involved in fatal crashes. Forensic Sci Int 2013; 234:154-61. [PMID: 24378316 DOI: 10.1016/j.forsciint.2013.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/28/2013] [Accepted: 11/06/2013] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Commercial motor vehicle (CMV) drivers, particularly drivers of large trucks continue to be a population of concern regarding traffic safety despite the reduction in large truck crash rates over the past decade. Medication and drug use while driving is one important risk factor for large truck crashes. Work-related exposures, such as vibration, manual handling and poor ergonomics contribute to an increased risk for injuries and chronic conditions and are common reasons for opioid analgesic (OA) use by CMV truck drivers. The objectives of this study were to examine the role of OA use in CMV truck drivers involved in fatal crashes by: (a) generating prevalence estimates of OA use; (b) documenting the relationship between OA use and crash responsibility. METHODS Case-control study using logistic regression to compare Fatality Analysis Reporting System (1993-2008) record of one or more crash-related unsafe driver actions (UDAs--a proxy measure of responsibility) between drivers with a positive drug test and drivers with a negative drug test for OA, controlling for age, other drug use, and driving history. RESULTS The annual prevalence of OA use among all CMV drivers of large trucks involved in fatal crashes did not exceed 0.46% for any year in the study period and mostly ranged between 0.1 and 0.2%. Male truck drivers using OA had greater odds of committing an UDA (OR: 2.80; 95% CI: 1.64; 4.81). Middle-aged users had greater odds than younger or older users. CONCLUSION The results of our study indicate that the presence of OAs is associated with greater odds of committing an UDA. This association may have implications for the commercial transport industry and traffic safety. However, the limited prevalence of OA use is encouraging and further research is needed to address the limitations of the study.
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Affiliation(s)
- Paula Reguly
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada; Centre for Research on Safe Driving, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada.
| | - Sacha Dubois
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada; Centre for Research on Safe Driving, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada; Research Department, St. Joseph's Care Group, 580 North Algoma Street, Thunder Bay, ON P7B 5G4, Canada; Northern Ontario School of Medicine, Human Sciences Division, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada.
| | - Michel Bédard
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada; Centre for Research on Safe Driving, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada; Research Department, St. Joseph's Care Group, 580 North Algoma Street, Thunder Bay, ON P7B 5G4, Canada; Northern Ontario School of Medicine, Human Sciences Division, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada.
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Krames E, Poree L, Deer T, Levy R. Implementing the SAFE Principles for the Development of Pain Medicine Therapeutic Algorithms That Include Neuromodulation Techniques. Neuromodulation 2013; 12:104-13. [PMID: 22151283 DOI: 10.1111/j.1525-1403.2009.00197.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Currently accepted chronic pain treatment algorithms have positioned therapies according to levels of invasiveness and up-front costs. After reviewing updated literature on efficacy and cost outcomes of care for patients with chronic pain that include interventional implantable technologies, we offer a new model of thinking when formulating algorithms of care that might include more invasive and costly interventions such as spinal cord stimulation, the SAFE principles. These SAFE principles include "safety,""appropriateness,""fiscal neutrality," and "efficacy."
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Affiliation(s)
- Elliot Krames
- Pacific Pain Treatment Centers, San Francisco, CA, USA; Pain Clinic of Monterey Bay, Aptos, CA, USA; Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA, USA; Center for Pain Relief Inc., Charleston, WV, USA; West Virginia University School of Medicine, Morgantown, WV, USA; Departments of Neurologic Surgery and Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Monárrez-Espino J, Möller J, Berg HY, Kalani M, Laflamme L. Analgesics and road traffic crashes in senior drivers: an epidemiological review and explorative meta-analysis on opioids. ACCIDENT; ANALYSIS AND PREVENTION 2013; 57:157-164. [PMID: 23685567 DOI: 10.1016/j.aap.2013.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/03/2013] [Accepted: 04/10/2013] [Indexed: 06/02/2023]
Abstract
AIM To assess the epidemiological evidence associating the use of analgesics with the occurrence of road traffic crashes in senior drivers including a meta-analysis with specific focus on opioids. METHODS Systematic literature review of articles published between 1991 and 2012 retrieved from major databases using relevant key words. Eligible articles were fully reviewed and the main characteristics and results summarized. The methodological quality was assessed using the Newcastle-Ottawa Scale. Heterogeneity tests and forest and funnel plots were used as part of the meta-analysis on opioids. RESULTS From the potentially eligible articles, nine were selected (4 case-control, 1 case-crossover, and 4 cohort studies) of which four were of medium and five of high quality; seven investigated opioids and four non-steroidal anti-inflammatory drugs. Crash involvement (n=7) rather than responsibility (n=2) was investigated. Age and sex were the most common covariates adjusted for. Both opioids and non-steroidal anti-inflammatory drugs showed mixed results including differences across estimates between and within studies. A marginal positive effect was observed in the pooled analyses on opioids (n=6, OR 1.20; 95% CI 1.08-1.32). CONCLUSIONS The evidence is unconvincing in terms of number of studies, control of major confounders, and consistency of the results. The effect seen for opioids can be attributed to the lack of adjustment of key confounders such as concomitant illness or the consumption of alcohol or other psychoactive medications. There is a need for more efficient designs like larger population-based retrospective cohorts and nested case-control or case-crossover studies based on registers of high quality allowing adjustment for these factors and for the selection of unequivocal outcomes (e.g. drivers' responsibility) to produce more persuasive empirical evidence.
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Affiliation(s)
- Joel Monárrez-Espino
- Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, Widerströmska huset, 17177 Stockholm, Sweden.
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Poree L, Krames E, Pope J, Deer TR, Levy R, Schultz L. Spinal cord stimulation as treatment for complex regional pain syndrome should be considered earlier than last resort therapy. Neuromodulation 2013; 16:125-41. [PMID: 23441988 DOI: 10.1111/ner.12035] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 10/30/2012] [Accepted: 11/26/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND Spinal cord stimulation (SCS), by virtue of its historically described up-front costs and level of invasiveness, has been relegated by several complex regional pain syndrome (CRPS) treatment algorithms to a therapy of last resort. Newer information regarding safety, cost, and efficacy leads us to believe that SCS for the treatment of CRPS should be implemented earlier in a treatment algorithm using a more comprehensive approach. METHODS We reviewed the literature on pain care algorithmic thinking and applied the safety, appropriateness, fiscal or cost neutrality, and efficacy (S.A.F.E.) principles to establish an appropriate position for SCS in an algorithm of pain care. RESULTS AND CONCLUSION Based on literature-contingent considerations of safety, efficacy, cost efficacy, and cost neutrality, we conclude that SCS should not be considered a therapy of last resort for CRPS but rather should be applied earlier (e.g., three months) as soon as more conservative therapies have failed.
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Affiliation(s)
- Lawrence Poree
- Department of Anesthesiology, University of California San Francisco, San Francisco, CA, USA
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Burch HJ, Clarke EJ, Hubbard AM, Scott-Ham M. Concentrations of drugs determined in blood samples collected from suspected drugged drivers in England and Wales. J Forensic Leg Med 2012; 20:278-89. [PMID: 23622475 DOI: 10.1016/j.jflm.2012.10.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 08/08/2012] [Accepted: 10/28/2012] [Indexed: 10/27/2022]
Abstract
This communication reports the blood concentrations of alcohol and drugs from 376 cases of alleged driving under the influence of drugs analysed at the Forensic Science Service Chorley and London laboratories between February 2010 and March 2011. The samples were analysed for alcohol, amphetamine, benzodiazepines, cocaine, MDMA, opiates, γ-hydroxybutyrate (GHB), ketamine, methadone and methylmethcathinone (the 4-isomer of which is known as mephedrone). The results were interpreted with respect to the number and type of drugs of abuse detected and the concentrations measured. Alcohol was quantified in 113 cases (30%), and of these a level in excess of the prescribed UK limit for driving of 80 mg% was present in 90 cases. In 80 cases, only the concentration of alcohol was measured, the concentrations of both drugs and alcohol were measured in 33 cases. In the remaining 263 cases, only the concentrations of relevant drugs of abuse were measured. The most common drug of abuse quantified was cocaine which was detected in 92 cases, either as the active drug or as its major metabolite benzoylecgonine, followed by diazepam which was quantified in 76 cases. Concentrations of some new drugs, and drugs rarely reported in driving under the influence cases are also presented.
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Affiliation(s)
- Hilary J Burch
- The Forensic Science Service, London Laboratory, 109 Lambeth Road, London SE1 7LP, UK
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Davis MP. Twelve Reasons for Considering Buprenorphine as a Frontline Analgesic in the Management of Pain. ACTA ACUST UNITED AC 2012; 10:209-19. [DOI: 10.1016/j.suponc.2012.05.002] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 05/14/2012] [Accepted: 05/18/2012] [Indexed: 11/17/2022]
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Systematic Review of the Quality and Generalizability of Studies on the Effects of Opioids on Driving and Cognitive/Psychomotor Performance. Clin J Pain 2012; 28:542-55. [DOI: 10.1097/ajp.0b013e3182385332] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Schisler RE, Groninger H, Rosielle DA. Counseling patients on side effects and driving when starting opioids #248. J Palliat Med 2012; 15:484-5. [PMID: 22500484 DOI: 10.1089/jpm.2012.9596] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Randall E Schisler
- Pain and Palliative Care Service Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA.
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Fan A, Wilson KG, Acharya M, Cranney A, Buenger U, Marshall S. Self-Reported Issues With Driving in Patients With Chronic Pain. PM R 2012; 4:87-95. [DOI: 10.1016/j.pmrj.2011.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 10/08/2011] [Accepted: 10/15/2011] [Indexed: 11/16/2022]
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The impact of long-term maintenance treatment with buprenorphine on complex psychomotor and cognitive function. Drug Alcohol Depend 2011; 117:190-7. [PMID: 21353749 DOI: 10.1016/j.drugalcdep.2011.01.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 01/24/2011] [Accepted: 01/24/2011] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Despite the fact that buprenorphine is effective, well tolerated and due to its pharmacological profile a very safe drug, the impact of long-term buprenorphine substitution therapy on complex psychomotor and cognitive function predicting driving ability is not yet clear. Therefore, a prospective comparison between patients receiving sublingual buprenorphine and a control group of untreated, healthy volunteers was performed. METHODS Treated and untreated subjects were matched for age and sex, with three control subjects selected for every buprenorphine patient. Patients using unreported drugs were included in the intention-to-treat (ITT) analysis; the remaining patients were analysed as the per-protocol (PP) group. The test battery comprised the assessment of: performance during stress, visual orientation, concentration, attention, vigilance and reaction time. The primary endpoint was defined as the sum of the relevant scores of the tests after z-transformation of the individual scores. RESULTS 30 patients with sublingual buprenorphine treatment (7.7±3.9 mg per day) were matched to 90 controls. 19 patients were excluded from the PP-analysis because of additional unreported drug intake. Significant non-inferiority could be demonstrated for the PP-group (p<0.05) as well as for the ITT-group (p<0.001). CONCLUSION Patients receiving a stable dose of sublingual buprenorphine showed no significant impairment of complex psychomotor or cognitive performance as compared to healthy controls. However intake of illicit drugs as well as the lack of social reliability are major problems in this specific patients group. Despite of the absence of a relevant impact of the drug on driving ability, those patients do not seem to be qualified for getting their driving license.
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Krames ES, Monis S, Poree L, Deer T, Levy R. Using the SAFE Principles When Evaluating Electrical Stimulation Therapies for the Pain of Failed Back Surgery Syndrome. Neuromodulation 2011; 14:299-311; discussion 311. [DOI: 10.1111/j.1525-1403.2011.00373.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kendall SE, Sjøgren P, Pimenta CADM, Højsted J, Kurita GP. The cognitive effects of opioids in chronic non-cancer pain. Pain 2010; 150:225-230. [PMID: 20554115 DOI: 10.1016/j.pain.2010.05.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 05/06/2010] [Accepted: 05/14/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Sally Elizabeth Kendall
- Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Cancer Pain Unit, Skåne Oncology Clinic, Lund University and Lund University Hospital, Lund, Sweden Section of Acute Pain Management and Palliative Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark School of Nursing, University of Sao Paulo, Sao Paulo, Brazil The State of Sao Paulo Research Foundation, Sao Paulo, Brazil
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Grace PM, Stanford T, Gentgall M, Rolan PE. Utility of saccadic eye movement analysis as an objective biomarker to detect the sedative interaction between opioids and sleep deprivation in opioid-naive and opioid-tolerant populations. J Psychopharmacol 2010; 24:1631-40. [PMID: 20142307 DOI: 10.1177/0269881109352704] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Analysis of saccadic eye movements (SEMs) has previously been used to detect drug- and sleep-deprivation-induced sedation, but never in combination. We compared the effects of sleep deprivation and opioids on 10 opioid-naive with nine opioid-tolerant participants. The naive-participant study evaluated the effects of sleep deprivation alone, morphine alone and the combination; the tolerant-participant study compared day-to-day effects of alternate-daily-dosed buprenorphine and the combination of buprenorphine on the dosing day with sleep deprivation. Psychomotor impairment was measured using SEMs, a 5-minute pupil adaptation test (PAT), pupil light reflex (PLR) and alertness visual analogue scale (AVAS). The PAT and PLR did not detect sleep deprivation, in contrast to previous studies. Whilst consistently detecting sleep deprivation, the AVAS also detected buprenorphine in the tolerant study, but not morphine in the naive study. SEMs detected morphine alone and sleep deprivation alone as well as an additive interaction in the naive study and the effect of sleep deprivation in the tolerant study. The alternate-day buprenorphine dosing did not alter SEMs. The current study revealed greater SEMs, but not AVAS impairment in tolerant versus naive participants. The current study demonstrates that objective measures provide additional information to subjective measures and thus should be used in combination.
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Affiliation(s)
- Peter M Grace
- Discipline of Pharmacology, School of Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Perez-Alvarez S, Cuenca-Lopez MD, de Mera RMMF, Puerta E, Karachitos A, Bednarczyk P, Kmita H, Aguirre N, Galindo MF, Jordán J. Methadone induces necrotic-like cell death in SH-SY5Y cells by an impairment of mitochondrial ATP synthesis. Biochim Biophys Acta Mol Basis Dis 2010; 1802:1036-47. [DOI: 10.1016/j.bbadis.2010.07.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 07/28/2010] [Accepted: 07/29/2010] [Indexed: 10/19/2022]
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Dubois S, Bédard M, Weaver B. The association between opioid analgesics and unsafe driving actions preceding fatal crashes. ACCIDENT; ANALYSIS AND PREVENTION 2010; 42:30-37. [PMID: 19887141 DOI: 10.1016/j.aap.2009.06.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 06/18/2009] [Accepted: 06/30/2009] [Indexed: 05/28/2023]
Abstract
Currently, most epidemiological research into the impact of opioid analgesics on road safety has focused on the association between opioid use and traffic crash occurrence. Yet, the role of opioid analgesics on crash responsibility is still not properly understood. Therefore, we examined the impact of opioid analgesics on drivers (all had a confirmed BAC=0) involved in fatal crashes (1993-2006) using a case-control design based on data from the Fatality Analysis Reporting System. Cases had one or more crash-related unsafe driving actions (UDA) recorded; controls had none. We calculated adjusted odds ratios (ORs) of any UDA by medication exposure after controlling for age, sex, other medications, and driving record. Compared to drivers who tested negative for opioid analgesics, female drivers who tested positive demonstrated increased odds of performing an UDA from ages 25 (OR: 1.35; 95% CI: 1.05; 1.74) to 55 (OR: 1.30; 95% CI: 1.07; 1.58). For male drivers this was true from ages 25 (OR: 1.66; 95% CI: 1.32; 2.09) to 65 (OR: 1.39; 95% CI: 1.17; 1.67). The detection of opioid analgesics was not associated with greater risk of an UDA for older drivers. Research is necessary to examine why these age differences exist, and if possible, to ensure that opioid analgesics do not contribute to crashes.
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Affiliation(s)
- Sacha Dubois
- St. Joseph's Care Group, Thunder Bay, Ontario, Canada.
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Majdzadeh R, Feiz-Zadeh A, Rajabpour Z, Motevalian A, Hosseini M, Abdollahi M, Ghadirian P. Opium consumption and the risk of traffic injuries in regular users: a case-crossover study in an emergency department. TRAFFIC INJURY PREVENTION 2009; 10:325-329. [PMID: 19593708 DOI: 10.1080/15389580902995380] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The cause-specific annual death rate due to traffic injuries is around 30 in 100,000 in Iran. On the other hand, this country has the highest proportion of opiate users in the world. Little is known about the transient effect of opium on traffic injuries. The objective of this study was to explore the effect of opium consumption on traffic injuries in drivers who use opium. METHODS Seventy-five regular opium users who suffered traffic injuries were studied in a case-crossover investigation. The study subjects had been admitted to the single trauma emergency department in Kerman, a city in southeast Iran. The relative risk (RR) of short-term opium effect was estimated by considering frequency of driving after opium consumption during 6 hours before the accident in comparison to the usual frequency of driving after opium consumption by the same persons. Stratified data analysis was performed by the Mantel-Haenszel method. RESULTS The opium consumption of drivers up to 6 hours before the accident was associated with an increased RR = 3.2, 95 percent confidence interval (CI): 1.9, 5.4. The third hour after consumption had the greatest magnitude of effect considering RR = 4.29, 95 percent CI:2.65, 6.95. CONCLUSIONS These results suggest a heightened risk of traffic injuries after opium consumption in regular users. The RR in the third hour after consumption could be explained by considering the greater probability of driving compared to the immediate hours after use, rather than peak effect time of opiates. The results indicate necessity of regular assessment of all common drivers, especially truck and bus drivers, regarding use of opium.
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Affiliation(s)
- Reza Majdzadeh
- Department of Epidemiology and Biostatistics, School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences, Tehran, Iran.
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Schultheis MT, Weisser V, Manning K, Blasco A, Ang J. Driving Behaviors Among Community-Dwelling Persons With Multiple Sclerosis. Arch Phys Med Rehabil 2009; 90:975-81. [DOI: 10.1016/j.apmr.2008.12.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 12/08/2008] [Accepted: 12/10/2008] [Indexed: 10/20/2022]
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Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. THE JOURNAL OF PAIN 2009; 10:113-30. [PMID: 19187889 DOI: 10.1016/j.jpain.2008.10.008] [Citation(s) in RCA: 1444] [Impact Index Per Article: 96.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 10/28/2008] [Accepted: 10/28/2008] [Indexed: 02/07/2023]
Abstract
UNLABELLED Use of chronic opioid therapy for chronic noncancer pain has increased substantially. The American Pain Society and the American Academy of Pain Medicine commissioned a systematic review of the evidence on chronic opioid therapy for chronic noncancer pain and convened a multidisciplinary expert panel to review the evidence and formulate recommendations. Although evidence is limited, the expert panel concluded that chronic opioid therapy can be an effective therapy for carefully selected and monitored patients with chronic noncancer pain. However, opioids are also associated with potentially serious harms, including opioid-related adverse effects and outcomes related to the abuse potential of opioids. The recommendations presented in this document provide guidance on patient selection and risk stratification; informed consent and opioid management plans; initiation and titration of chronic opioid therapy; use of methadone; monitoring of patients on chronic opioid therapy; dose escalations, high-dose opioid therapy, opioid rotation, and indications for discontinuation of therapy; prevention and management of opioid-related adverse effects; driving and work safety; identifying a medical home and when to obtain consultation; management of breakthrough pain; chronic opioid therapy in pregnancy; and opioid-related policies. PERSPECTIVE Safe and effective chronic opioid therapy for chronic noncancer pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion. Although evidence is limited in many areas related to use of opioids for chronic noncancer pain, this guideline provides recommendations developed by a multidisciplinary expert panel after a systematic review of the evidence.
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Chou R, Ballantyne JC, Fanciullo GJ, Fine PG, Miaskowski C. Research Gaps on Use of Opioids for Chronic Noncancer Pain: Findings From a Review of the Evidence for an American Pain Society and American Academy of Pain Medicine Clinical Practice Guideline. THE JOURNAL OF PAIN 2009; 10:147-59. [DOI: 10.1016/j.jpain.2008.10.007] [Citation(s) in RCA: 214] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 10/03/2008] [Accepted: 10/28/2008] [Indexed: 12/26/2022]
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Abstract
This study aimed to compare cognitive function of cancer pain patients being given opioids during their cancer treatment (n = 14) with that of patients receiving treatment without opioids (n = 12). Correlations between cognitive function, pain intensity, and opioid dose were analyzed. Patients were assessed 3 times in a 1-month period, using the Trail-Making Test, Mini-Mental State Examination, Digit Span, and Brief Cognitive Screening Battery. Opioid use was not associated with clear cognitive impairment. Patients being treated without opioids did perform better in the Digit Span Test reverse-order test (P = .029) and the clock drawing test (P = .023), but the differences arose in just 1 assessment in each case. Pain intensity correlated negatively with scores in the Mini-Mental State Examination (P = .001) and some Brief Cognitive Screening Battery tests (incidental recall, immediate recall, and late recall; P <or= .042) in the group receiving opioids. Opioid dose did not correlate with any of the measures of cognitive performance. However, the patients with the worst performance scores were those with more severe pain. Further studies are needed to clearly distinguish between the effects of opioids versus the effects of pain.
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