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Mahmoud I, Battini V, Carnovale C, Clementi E, Kragholm K, Sessa M. New data-driven method to predict the therapeutic indication of redeemed prescriptions in secondary data sources: a case study on antiseizure medications users aged ≥65 identified in Danish registries. BMJ Open 2024; 14:e080126. [PMID: 38844392 PMCID: PMC11163620 DOI: 10.1136/bmjopen-2023-080126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 05/09/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVES We aimed to develop a new data-driven method to predict the therapeutic indication of redeemed prescriptions in secondary data sources using antiepileptic drugs among individuals aged ≥65 identified in Danish registries. DESIGN This was an incident new-user register-based cohort study using Danish registers. SETTING The study setting was Denmark and the study period was 2005-2017. PARTICIPANTS Participants included antiepileptic drug users in Denmark aged ≥65 with a confirmed diagnosis of epilepsy. PRIMARY AND SECONDARY OUTCOME MEASURES Sensitivity served as the performance measure of the algorithm. RESULTS The study population comprised 8609 incident new users of antiepileptic drugs. The sensitivity of the algorithm in correctly predicting the therapeutic indication of antiepileptic drugs in the study population was 65.3% (95% CI 64.4 to 66.2). CONCLUSIONS The algorithm demonstrated promising properties in terms of overall sensitivity for predicting the therapeutic indication of redeemed antiepileptic drugs by older individuals with epilepsy, correctly identifying the therapeutic indication for 6 out of 10 individuals using antiepileptic drugs for epilepsy.
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Affiliation(s)
- Israa Mahmoud
- Department of Drug Design and Pharmacology, University of Copenhagen, Kobenhavn, Denmark
| | - Vera Battini
- Department of Drug Design and Pharmacology, University of Copenhagen, Kobenhavn, Denmark
- Università degli Studi di Milano, Milano, Italy
| | | | | | - Kristian Kragholm
- Unit of Epidemiology and Biostatistics, Aalborg Universitetshospital, Aalborg, Denmark
| | - Maurizio Sessa
- Department of Drug Design and Pharmacology, University of Copenhagen, Kobenhavn, Denmark
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Varney B, Zoega H, Gillies MB, Gisev N, Weston Shand A, Pearson SA, Havard A. Prevalence and Persistence of Prescription Opioid Use Following Hospital Discharge After Childbirth: An Australian Population-Based Cohort Study. Anesth Analg 2024; 138:970-979. [PMID: 37319031 DOI: 10.1213/ane.0000000000006582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Opioid analgesics are used for acute postpartum pain relief but carry risks, including persistent long-term opioid use. Our primary objective was to estimate the prevalence of persistent use following hospital discharge after childbirth. METHODS We conducted a population-based cohort study of women discharged from public or private hospitals in New South Wales, Australia, between 2012 and 2018 following vaginal birth (VB) or cesarean delivery (CD). We used linked hospitalization and medicine dispensing data to calculate the prevalence of opioid use within 14 days of hospital discharge for childbirth using an external estimate of the total number of hospital admissions for childbirth per year as the denominator. Among women dispensed an opioid postdischarge, we estimated the prevalence of persistent use defined as ≥3 dispensings between 30- and 365-days postdischarge. To calculate the odds of persistent opioid use, we performed a series of logistic regressions each including a single characteristic of interest. Included characteristics were maternal and birth characteristics, maternal medical conditions, prior use of certain medicines, and the initial opioid dispensed following discharge for childbirth. RESULTS The final cohort comprised of 38,832 women who were dispensed an opioid in the 14 days following discharge after childbirth. Between 2012 and 2018, the prevalence of opioid use was increased following CD (public hospital 16.6%-21.0%; private hospital 9.8%-19.5%) compared with VB (public hospital 1.5%-1.5%; private hospital 1.2%-1.4%) and was higher following discharge from public hospitals compared with private. The most commonly dispensed opioids following discharge for childbirth were oxycodone (44.8%; 95% confidence interval [CI], 44.3-45.3), codeine (42.1%; 95% CI, 41.6-42.6), and tramadol (12.9%; 95% CI, 12.6-13.2). Among women dispensed an opioid, the prevalence of persistent opioid use was 5.4% (95% CI, 5.1-5.6). This prevalence was 11.4% (95% CI, 10.5-12.3) following a VB as compared with 4.3% (95% CI, 4.1-4.6) among those who underwent a CD ( P < .001). Characteristics associated with persistent opioid use included smoking during pregnancy, age <25 years, living in remote areas, discharged from a public hospital, history of opioid use disorder, other substance use disorder, mental health diagnosis, or prior use of prescription opioids, nonopioid analgesics, or benzodiazepines. CONCLUSIONS The results of this cohort study indicate that Australian women have a higher prevalence of opioid use following CD compared to VB. One in 19 women dispensed an opioid postdischarge used opioids persistently. Careful monitoring of opioid therapy following childbirth is warranted, particularly among women with characteristics we identified as high risk for persistent opioid use.
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Affiliation(s)
- Bianca Varney
- From the School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Helga Zoega
- From the School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Malcolm Bjørn Gillies
- From the School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Antonia Weston Shand
- Department of Maternal Fetal Medicine, Royal Hospital for Women, Randwick, Sydney, Australia
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- From the School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Alys Havard
- From the School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- National Drug and Alcohol Research Centre, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
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Angarita-Fonseca A, Lacasse A, Choinière M, Kaboré JL, Sylvestre MP, Dinkou GDT, Bruneau J, Martel MO, Hovey R, Motulsky A, Rahme E, Pagé MG. Trajectories of opioid consumption as predictors of patient-reported outcomes among individuals attending multidisciplinary pain treatment clinics. Pharmacoepidemiol Drug Saf 2024; 33:e5706. [PMID: 37800356 DOI: 10.1002/pds.5706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/28/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE This study aimed to identify opioid consumption trajectories among persons living with chronic pain (CP) and put them in relation to patient-reported outcomes 6 months after initiating multidisciplinary pain treatment. METHODS This study used data from the Quebec Pain Registry (2008-2014) linked to longitudinal Quebec health insurance databases. We included adults diagnosed with CP and covered by the Quebec public prescription drug insurance plan. The daily cumulative opioid doses in the first 6 months after initiating multidisciplinary pain treatment were transformed into morphine milligram equivalents. An individual-centered approach involving principal factor and cluster analyses applied to longitudinal statistical indicators of opioid use was conducted to classify trajectories. Multivariate regression models were applied to evaluate the associations between trajectory group membership and outcomes at 6-month follow-up (pain intensity, pain interference, depression, and physical and mental health-related quality of life). RESULTS We identified three trajectories of opioid consumption: "no or very low and stable" opioid consumption (n = 2067, 96.3%), "increasing" opioid consumption (n = 40, 1.9%), and "decreasing" opioid consumption (n = 39, 1.8%). Patients in the "no or very low and stable" trajectory were less likely to be current smokers, experience polypharmacy, use opioids or benzodiazepine preceding their first visit, or experience pain interference at treatment initiation. Patients in the "increasing" opioid consumption group had significantly greater depression scores at 6-month compared to patients in the "no or very low and stable" trajectory group. CONCLUSION Opioid consumption trajectories do not seem to be important determinants of most PROs 6 months after initiating multidisciplinary pain treatment.
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Affiliation(s)
- Adriana Angarita-Fonseca
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn Noranda, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn Noranda, Canada
| | - Manon Choinière
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Canada
| | - Jean-Luc Kaboré
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Biomedical Sciences, Université de Montréal, Montreal, Canada
| | - Marie-Pierre Sylvestre
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada
| | | | - Julie Bruneau
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Marc O Martel
- Department of Anesthesia, McGill University, Montreal, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Richard Hovey
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Aude Motulsky
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- School of Public Health, Université de Montréal, Montreal, Canada
| | - Elham Rahme
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - M Gabrielle Pagé
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Canada
- Department of Psychology, Université de Montréal, Montreal, Canada
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Kerckhove N, Bornier N, Mulliez A, Elyn A, Teixeira S, Authier N, Bertin C, Chenaf C. Prevalence of Chronic Pain Among People with Dementia: A Nationwide Study Using French Administrative Data. Am J Geriatr Psychiatry 2023; 31:1149-1163. [PMID: 37468390 DOI: 10.1016/j.jagp.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/02/2023] [Accepted: 06/24/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Alzheimer's disease or Related Dementia (ADRD) is known to disturb pain perception and reduce the ability to report it, resulting in underestimation by practitioners and sub-optimal medical management. The aim of this study was to estimate the prevalence of all types of CP among people with ADRD. DESIGN Nationwide cross-sectional study. SETTINGS French community-dwelling and nursing home residents. PARTICIPANTS People with ADRD, >40 years old, treated with cholinesterase inhibitors or memantine, or with a diagnosis/long-term illness of ADRD and matched with a comparison sample. SETTINGS French community-dwelling and nursing home residents. PARTICIPANTS People with ADRD, >40 years old, treated with cognitive stimulants (cholinesterase inhibitors and memantine) or with a diagnosis/long-term illness of ADRD and matched with a comparison sample (non-ADRD). MEASUREMENTS The capture-recapture method was performed to provide estimates of the prevalence of CP. People treated with analgesic drugs for ≥6 months consecutively or with a medical diagnosis of CP (ICD-10 codes) or referred to a pain center were considered as having CP. RESULTS A total of 48,288 individuals were included, of which 16,096 had ADRD and 32,192 without ADRD. The estimated prevalence of CP in people with ADRD was from 57.7% [52.9;63.3] to 57.9%[53.0;63.9], and slightly higher than the non-ADRD sample (from 49.9%[47.0;53.2] to 50.4%[47.3;53.9], p <0.001). CONCLUSIONS The prevalence of CP among people living with ADRD was at least the same as or better than individuals without ADRD. This result should alert practitioners' attention to the need for effective pain assessment and management in this population who has difficulties to express and feel pain.
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Affiliation(s)
- Nicolas Kerckhove
- Service de Pharmacologie médicale (NK, NB, ST, NA, CB, CC), Centres Addictovigilance et Pharmacovigilance, Centre d'Evaluation et de Traitement de la Douleur, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM, NEURO-DOL, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne (NK, NA, CB, CC), Institut Analgesia, Clermont-Ferrand, France.
| | - Nadège Bornier
- Service de Pharmacologie médicale (NK, NB, ST, NA, CB, CC), Centres Addictovigilance et Pharmacovigilance, Centre d'Evaluation et de Traitement de la Douleur, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM, NEURO-DOL, F-63000 Clermont-Ferrand, France
| | - Aurélien Mulliez
- Direction de la recherche clinique et de l'innovation (AM), Clermont-Ferrand, France
| | - Antoine Elyn
- Centre d'Évaluation et de Traitement de la Douleur (AE), Service de Neurochirurgie, Pôle Neuroscience, Hôpital Purpan, Pierre Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Place du Dr Joseph Baylac, Toulouse, France; RECaP F-CRIN, Groupe « Soins Primaires » (AE), Réseau national de Recherche en Épidémiologie Clinique et en Santé Publique, Inserm, France
| | - Sarah Teixeira
- Service de Pharmacologie médicale (NK, NB, ST, NA, CB, CC), Centres Addictovigilance et Pharmacovigilance, Centre d'Evaluation et de Traitement de la Douleur, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM, NEURO-DOL, F-63000 Clermont-Ferrand, France
| | - Nicolas Authier
- Service de Pharmacologie médicale (NK, NB, ST, NA, CB, CC), Centres Addictovigilance et Pharmacovigilance, Centre d'Evaluation et de Traitement de la Douleur, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM, NEURO-DOL, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne (NK, NA, CB, CC), Institut Analgesia, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) (NA, CB, CC), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Célian Bertin
- Service de Pharmacologie médicale (NK, NB, ST, NA, CB, CC), Centres Addictovigilance et Pharmacovigilance, Centre d'Evaluation et de Traitement de la Douleur, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM, NEURO-DOL, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne (NK, NA, CB, CC), Institut Analgesia, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) (NA, CB, CC), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Chouki Chenaf
- Service de Pharmacologie médicale (NK, NB, ST, NA, CB, CC), Centres Addictovigilance et Pharmacovigilance, Centre d'Evaluation et de Traitement de la Douleur, Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM, NEURO-DOL, F-63000 Clermont-Ferrand, France; Université Clermont Auvergne (NK, NA, CB, CC), Institut Analgesia, Clermont-Ferrand, France; Observatoire Français des Médicaments Antalgiques (OFMA) (NA, CB, CC), Université Clermont Auvergne, Clermont-Ferrand, France
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Bornier N, Mulliez A, Chenaf C, Elyn A, Teixeira S, Authier N, Bertin C, Kerckhove N. Chronic pain is a risk factor for incident Alzheimer's disease: a nationwide propensity-matched cohort using administrative data. Front Aging Neurosci 2023; 15:1193108. [PMID: 37842123 PMCID: PMC10575742 DOI: 10.3389/fnagi.2023.1193108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/29/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Chronic pain (CP) is one of the most disabling conditions in the elderly and seems to be a risk factor for the development of Alzheimer's disease and related dementias (ADRD). Only one study, using national administrative health databases, assessed and demonstrated that chronic pain (all types of pain) was a risk factor for dementia, but without assessing the impact of pain medications. Method To assess the impact of all types of chronic pain and the long-term use of pain medications on the person-years incidence of ADRD, a retrospective nationwide healthcare administrative data study was performed using the national inter-regime health insurance information system (SNIIRAM) to the French national health data system (SNDS). Incident people >50 years old with chronic pain, defined by at least 6-months duration analgesics treatment or by a diagnosis/long-term illness of chronic pain between 2006 and 2010, were included. Chronic pain individuals were matched with non-CP individuals by a propensity score. Individuals were followed up from 9 to 13 years to identify occurrences of ADRD from 2006. Results Among 64,496 French individuals, the incidence of ADRD was higher in the chronic pain population than control (1.13% vs. 0.95%, p <0.001). Chronic pain increases the risk of ADRD (HR = 1.23) and the incidence of ADRD was higher for women and increased significantly with age. Discussion Our study highlights the importance of prevention, diagnosis, and management of chronic pain in elderly to reduce the risk of development and/or worsening of dementia.
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Affiliation(s)
- Nadège Bornier
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de L’Innovation, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Aurélien Mulliez
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de L’Innovation, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Chouki Chenaf
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de L’Innovation, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Clermont-Ferrand, France
| | - Antoine Elyn
- Centre D’Évaluation et de Traitement de la Douleur, Service de Neurochirurgie, Pôle Neuroscience, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sarah Teixeira
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de L’Innovation, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Nicolas Authier
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de L’Innovation, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Clermont-Ferrand, France
| | - Célian Bertin
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de L’Innovation, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Clermont-Ferrand, France
| | - Nicolas Kerckhove
- Service de Pharmacologie Médicale, Direction de la Recherche Clinique et de L’Innovation, Université Clermont Auvergne, Clermont-Ferrand, France
- Institut Analgesia, Clermont-Ferrand, France
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Lacasse A, Nguena Nguefack HL, Page G, Choinière M, Samb OM, Katz J, Ménard N, Vissandjée B, Zerriouh M. Sex and gender differences in healthcare utilisation trajectories: a cohort study among Quebec workers living with chronic pain. BMJ Open 2023; 13:e070509. [PMID: 37518085 PMCID: PMC10387645 DOI: 10.1136/bmjopen-2022-070509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVES Chronic pain (CP) is a poorly recognised and frequently inadequately treated condition affecting one in five adults. Reflecting on sociodemographic disparities as barriers to CP care in Canada was recently established as a federal priority. The objective of this study was to assess sex and gender differences in healthcare utilisation trajectories among workers living with CP. DESIGN Retrospective cohort study. PARTICIPANTS This study was conducted using the TorSaDE Cohort which links the 2007-2016 Canadian Community Health Surveys and Quebec administrative databases (longitudinal claims). Among 2955 workers living with CP, the annual number of healthcare contacts was computed during the 3 years after survey completion. OUTCOME Group-based trajectory modelling was used to identify subgroups of individuals with similar patterns of healthcare utilisation over time (healthcare utilisation trajectories). RESULTS Across the study population, three distinct 3-year healthcare utilisation trajectories were found: (1) low healthcare users (59.9%), (2) moderate healthcare users (33.6%) and (3) heavy healthcare users (6.4%). Sex and gender differences were found in the number of distinct trajectories and the stability of the number of healthcare contacts over time. Multivariable analysis revealed that independent of other sociodemographic characteristics and severity of health condition, sex-but not gender-was associated with the heavy healthcare utilisation longitudinal trajectory (with females showing a greater likelihood; OR 2.6, 95% CI 1.6 to 4.1). CONCLUSIONS Our results underline the importance of assessing sex-based disparities in help-seeking behaviours, access to healthcare and resource utilisation among persons living with CP.
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Affiliation(s)
- Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
- Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Hermine Lore Nguena Nguefack
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
- Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - G Page
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Manon Choinière
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Oumar Mallé Samb
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Nancy Ménard
- Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Bilkis Vissandjée
- Faculty of Nursing and Public Health Research Institute (CReSP), Université de Montréal, Montreal, Quebec, Canada
- SHERPA Research Centre, Montreal, Quebec, Canada
| | - Meriem Zerriouh
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
- Chronic Pain Epidemiology Laboratory, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
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Thapa I, De Souza E, Ward A, Bambos N, Anderson TA. Association of Common Pediatric Surgeries With New Onset Chronic Pain in Patients 0-21 Years of Age in the United States. THE JOURNAL OF PAIN 2023; 24:320-331. [PMID: 36216129 DOI: 10.1016/j.jpain.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/24/2022] [Accepted: 09/13/2022] [Indexed: 11/07/2022]
Abstract
Chronic pain (CP) is a major public health issue. While new onset CP is known to occur frequently after some pediatric surgeries, its incidence after the most common pediatric surgeries is unknown. This retrospective cohort study used insurance claims data from 2002 to 2017 for patients 0 to 21 years of age. The primary outcome was CP 90 to 365 days after each of the 20 most frequent surgeries in 5 age categories (identified using CP ICD codes). Multivariable logistic regression identified surgeries and risk factors associated with CP after surgery. A total of 424,590 surgical patients aged 0 to 21 were included, 22,361 of whom developed CP in the 90 to 365 days after surgery. The incidences of CP after surgery were: 1.1% in age group 0 to 1 years; 3.0% in 2 to 5 years; 5.6% in 6 to 11 years; 10.1% in 12 to 18 years; 9.9% in 19 to 21 years. Some surgeries and patient variables were associated with CP. Approximately 1 in 10 adolescents who underwent the most common surgeries developed CP, as did a striking percentage of children in other age groups. Given the long-term consequences of CP, resources should be allocated toward identification of high-risk pediatric patients and strategies to prevent CP after surgery. PERSPECTIVE: This study identifies the incidences of and risk factors for chronic pain after common surgeries in patients 0 to 21 years of age. Our findings suggest that resources should be allocated toward the identification of high-risk pediatric patients and strategies to prevent CP after surgery.
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Affiliation(s)
- Isha Thapa
- Department of Management Science and Engineering, Stanford University, Stanford, California.
| | - Elizabeth De Souza
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Andrew Ward
- Department of Electrical Engineering, Stanford University, Stanford, California
| | - Nicholas Bambos
- Department of Electrical Engineering and Department of Management Science & Engineering, Stanford University, Stanford, California
| | - Thomas Anthony Anderson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Candon M, Strominger J, Gerlach LB, Maust DT. Antiepileptic prescribing to persons living with dementia residing in nursing homes: A tale of two indications. J Am Geriatr Soc 2023; 71:89-97. [PMID: 36349528 PMCID: PMC9870979 DOI: 10.1111/jgs.18119] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/14/2022] [Accepted: 09/05/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Antiepileptics are commonly prescribed to nursing home residents with Alzheimer's disease and related dementias (ADRD) but there is little scientific support for their use in this population. It is unclear whether different antiepileptics are targeting different indications. METHODS Using the Minimum Data Set and Medicare data, including Part D pharmacy claims, we constructed annual cohorts of residents with ADRD with long-term stays in nursing homes from 2015 to 2019. For each year, we measured the proportion of residents with ADRD in nursing homes nationwide with at least one antiepileptic prescription. We also measured trends in valproic acid, gabapentin, antipsychotic, and opioid prescribing. Finally, we examined how prescribing rates differed based on whether residents with ADRD had disruptive behaviors or reported pain. RESULTS Our study sample includes 973,074 persons living with ADRD who had a long-term stay in a nursing home, which was defined as at least 3 months. The proportion of residents with ADRD with at least one antiepileptic prescription increased from 29.5% in 2015 to 31.3% in 2019, which was driven by increases in the rate of valproic acid and gabapentin prescribing. Conversely, antipsychotic prescribing rates declined from 32.1% to 27.9% and opioid prescribing rates declined from 39.8% to 31.7%. The risk of valproic acid prescribing was 10.9 percentage points higher among residents with ADRD with disruptive behaviors, while the risk of being prescribed gabapentin was 13.9 percentage points higher among residents with ADRD reporting pain. CONCLUSIONS Antiepileptic prescribing among nursing home residents with ADRD is increasing, while antipsychotic and opioid prescribing is declining. Examining antiepileptic prescribing to residents with ADRD who had disruptive behaviors and/or reported pain suggests that two of the most common antiepileptics, valproic acid and gabapentin, are being used in clinically distinct ways. Antiepileptic prescribing of questionable risk-benefit for dementia care warrants further scrutiny.
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Affiliation(s)
- Molly Candon
- Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Julie Strominger
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | | | - Donovan T. Maust
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
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9
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Johnson A, Milne B, Jamali N, Pasquali M, Gilron I, Mann S, Moore K, Graves E, Parlow J. Chronic opioid use after joint replacement surgery in seniors is associated with increased healthcare utilization and costs: a historical cohort study. Can J Anaesth 2022; 69:963-973. [DOI: 10.1007/s12630-022-02240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 10/18/2022] Open
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10
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Irwin MN, Smith MA. Validation of ICD-9 Codes for Identification of Chronic Overlapping Pain Conditions. J Pain Palliat Care Pharmacother 2022; 36:166-177. [PMID: 35900230 DOI: 10.1080/15360288.2022.2089437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Chronic overlapping pain conditions (COPCs) are a collection of chronic pain syndromes that often co-occur and are thought to share underlying nociplastic pathophysiology. Since they can manifest as seemingly unrelated syndromes they have historically been studied in isolation. Use of International Classification of Diseases (ICD) codes in medical records has been proposed as a means to identify and study trends in COPCs at the population level, however validated code sets are needed. Recently, a code set comprising ICD-10 codes as proxies for 11 COPCs was validated. The goal of this project was to validate a code set composed of ICD-9 codes for the identification of COPCs in administrative datasets. Data was extracted using the Electronic Medical Record Search Engine at the University of Michigan Health System from January 1st, 2011 to January 1st, 2015. The source population were patients with one of the candidate ICD-9 codes corresponding to various COPCs. Natural language searches were used as a reference standard. If code sets met a pre-specified threshold of agreement between ICD-9 codes and natural language searches (≥ 70%), they were retained and diagnostic accuracy statistics were calculated for each code set. Validated ICD-9 code sets were generated for 10 of the 11 COPCs evaluated. The majority had high levels of diagnostic accuracy, with all but one code set achieving ≥ 80% specificity, sensitivity, and predictive values. This code set may be used by pain researchers to identify COPCs using ICD-9 codes in administrative datasets.
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11
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Foley HE, Knight JC, Ploughman M, Asghari S, Audas R. Association of chronic pain with comorbidities and health care utilization: a retrospective cohort study using health administrative data. Pain 2021; 162:2737-2749. [PMID: 33902092 DOI: 10.1097/j.pain.0000000000002264] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Health administrative data provide a potentially robust information source regarding the substantial burden chronic pain exerts on individuals and the health care system. This study aimed to use health administrative data to estimate comorbidity prevalence and annual health care utilization associated with chronic pain in Newfoundland and Labrador, Canada. Applying the validated Chronic Pain Algorithm to provincial Fee-for-Service Physician Claims File data (1999-2009) established the Chronic Pain (n = 184,580) and No Chronic Pain (n = 320,113) comparator groups. Applying the Canadian Chronic Disease Surveillance System coding algorithms to Claims File and Provincial Discharge Abstract Data (1999-2009) determined the prevalence of 16 comorbidities. The 2009/2010 risk and person-year rate of physician and diagnostic imaging visits and hospital admissions were calculated and adjusted using the robust Poisson model with log link function (risks) and negative binomial model (rates). Results indicated a significantly higher prevalence of all comorbidities and up to 4 times the odds of multimorbidity in the Chronic Pain Group (P-value < 0.001). Chronic Pain Group members accounted for 58.8% of all physician visits, 57.6% of all diagnostic imaging visits, and 54.2% of all hospital admissions in 2009/2010, but only 12% to 16% of these were for pain-related conditions as per recorded diagnostic codes. The Chronic Pain Group had significantly higher rates of physician visits and high-cost hospital admission/diagnostic imaging visits (P-value < 0.001) when adjusted for demographics and comorbidities. Observations made using this methodology supported that people identified as having chronic pain have higher prevalence of comorbidities and use significantly more publicly funded health services.
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Affiliation(s)
- Heather E Foley
- Centre for Pain and Disability Management, Adult Rehabilitation, Geriatrics and Palliative Care Program, Eastern Regional Health Authority, St. John's, NL, Canada
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - John C Knight
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Analytics and Information Services Department, Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada
| | - Michelle Ploughman
- Division of Biomedical Sciences, Physical Medicine and Rehabilitation, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Shabnam Asghari
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
- Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Richard Audas
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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12
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Lacasse A, Gagnon V, Nguena Nguefack HL, Gosselin M, Pagé MG, Blais L, Guénette L. Chronic pain patients' willingness to share personal identifiers on the web for the linkage of medico-administrative claims and patient-reported data: The chronic pain treatment cohort. Pharmacoepidemiol Drug Saf 2021; 30:1012-1026. [PMID: 33901339 PMCID: PMC8360172 DOI: 10.1002/pds.5255] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 04/20/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE The linkage between patient-reported data and medico-administrative claims is of great interest for epidemiologic research. The goal of this study was to assess the willingness of people living with chronic pain to share personal identifiers on the web for the linkage of medico-administrative and patient-reported data. METHODS This methodological investigation was achieved in the context of the implementation of the chronic pain treatment (COPE) cohort. A web-based recruitment initiative targeting adults living with chronic pain was conducted in the province of Quebec (Canada). RESULTS A total of 1935 participants completed the questionnaire (mean age: 49.86 ± 13.27; females: 83.69%), 921 (47.60%) of which agreed to data linkage and shared their personal identifiers (name, date of birth, health insurance number online). The most common reasons for refusal were: (1) concerns regarding data security/privacy (25.71%) and (2) the belief that the requested data were too personal/intrusive (13.52%). Some participants did not understand the relevance of data linkage (11.81%). Participants from the COPE cohort and those from the subsample who agreed to data linkage were comparable to other random samples of chronic pain individuals in terms of age and pain characteristics. CONCLUSIONS Although approximately half of the participants refused data linkage, our approach allowed for the implementation of a data platform that contains a diverse and substantial sample. This investigation has also led to the formulation of recommendations for web-based data linkage, including placing items designed to assess willingness to share personal identifiers at the end of the questionnaire, adding explanatory videos, and using a mixed-mode questionnaire.
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Affiliation(s)
- Anaïs Lacasse
- Département des sciences de la santéUniversité du Québec en Abitibi‐Témiscamingue (UQAT)Rouyn‐NorandaCanada
| | - Véronique Gagnon
- Département des sciences de la santéUniversité du Québec en Abitibi‐Témiscamingue (UQAT)Rouyn‐NorandaCanada
| | | | - Mélissa Gosselin
- Département des sciences de la santéUniversité du Québec en Abitibi‐Témiscamingue (UQAT)Rouyn‐NorandaCanada
| | - M. Gabrielle Pagé
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM)MontréalQuébecCanada
- Département d'anesthésiologie et de médecine de la douleur, Faculté de médecineUniversité de MontréalMontréalQuébecCanada
| | - Lucie Blais
- Faculté de pharmacieUniversité de MontréalMontréalCanada
| | - Line Guénette
- Faculté de pharmacieUniversité LavalQuébecQuébecCanada
- Centre de recherche du CHU de Québec – Université LavalQuébecQuébecCanada
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13
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Foley HE, Knight JC, Ploughman M, Asghari S, Audas R. Identifying cases of chronic pain using health administrative data: A validation study. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2020; 4:252-267. [PMID: 33987504 PMCID: PMC7967902 DOI: 10.1080/24740527.2020.1820857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Most prevalence estimates of chronic pain are derived from surveys and vary widely, both globally (2%–54%) and in Canada (6.5%–44%). Health administrative data are increasingly used for chronic disease surveillance, but their validity as a source to ascertain chronic pain cases is understudied. Aim The aim of this study was to derive and validate an algorithm to identify cases of chronic pain as a single chronic disease using provincial health administrative data. Methods A reference standard was developed and applied to the electronic medical records data of a Newfoundland and Labrador general population sample participating in the Canadian Primary Care Sentinel Surveillance Network. Chronic pain algorithms were created from the administrative data of patient populations with chronic pain, and their classification performance was compared to that of the reference standard via statistical tests of selection accuracy. Results The most performant algorithm for chronic pain case ascertainment from the Medical Care Plan Fee-for-Service Physicians Claims File was one anesthesiology encounter ever recording a chronic pain clinic procedure code OR five physician encounter dates recording any pain-related diagnostic code in 5 years with more than 183 days separating at least two encounters. The algorithm demonstrated 0.703 (95% confidence interval [CI], 0.685–0.722) sensitivity, 0.668 (95% CI, 0.657–0.678) specificity, and 0.408 (95% CI, 0.393–0.423) positive predictive value. The chronic pain algorithm selected 37.6% of a Newfoundland and Labrador provincial cohort. Conclusions A health administrative data algorithm was derived and validated to identify chronic pain cases and estimate disease burden in residents attending fee-for-service physician encounters in Newfoundland and Labrador.
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Affiliation(s)
- Heather E Foley
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - John C Knight
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.,Primary Health Care Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Michelle Ploughman
- Physical Medicine & Rehabilitation, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Rick Audas
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
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