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Olson R, Hess JA, Turk D, Marino M, Donovan C, Stoffregen SA, De Anda I, Springer R, Nguyen-Kearns E. Translating an Intervention to Address Chronic Pain among Home Care Workers: The COMPASS-NP Pilot. J Occup Environ Med 2024; 66:757-765. [PMID: 38769073 DOI: 10.1097/jom.0000000000003152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To pilot test the COMmunity of Practice And Safety Support for Navigating Pain (COMPASS-NP) intervention for home care workers experiencing chronic pain. METHODS Home care workers with chronic pain participated (n = 19; 2 groups) in a 10-week online group program focused on workplace safety and pain self-management. Primary outcomes were changes in pain interference with work and life. Other outcomes related to ergonomics, pain levels, opioid misuse risk, mental health, sleep, and physical activity. RESULTS The intervention produced a large reduction in pain interference with life ( d = -0.85) and a moderate reduction in pain interference with work time demands ( d = -0.61). Secondary outcomes showed favorable effect sizes, including a substantial increase in the use of ergonomic tools and techniques ( d = 1.47). CONCLUSION Findings were strongly encouraging. The effectiveness of COMPASS-NP will be evaluated in a future randomized controlled trial.
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Affiliation(s)
- Ryan Olson
- From the Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, Oregon (R.O., C.D., S.A.S., I.D.A.); School of Public Health, Oregon Health & Science University-Portland State University (PSU), Portland, Oregon (R.O.); Department of Psychology, Portland State University, Portland, Oregon (R.O.); Labor Education and Research Center, University of Oregon, Eugene, Oregon (J.A.H.); Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; GSK/Novartis, Brentford, Middlesex, United Kingdom; and Vertex, Boston MA; Clinical Journal of Pain, Philadelphia, PA; Analgesic, Anesthetic, and Addiction Clinical Trials, Innovation, Opportunities and Network (ACTION), Rochester, NY; FDA Public-Private Partnership (D.T.); Department of Family Medicine, Oregon Health & Science University, Portland, OR (M.M., R.S.); and Service Employees International Union 775 Benefits Group, Seattle, Washington (E.N.-K.)
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Sani AR, Zin CS. Factors Associated with an Increased Risk of Opioid Misuse Among Patients with Non-Cancer Pain in Malaysian Pain Clinic Settings. J Psychoactive Drugs 2024:1-11. [PMID: 39101200 DOI: 10.1080/02791072.2024.2387602] [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: 01/24/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 08/06/2024]
Abstract
This study examined the factors associated with a high risk of opioid misuse among patients receiving opioid treatment for their non-cancer pain in Malaysian pain clinics. The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R), a validated instrument for predicting the risk of aberrant drug-related behaviors, were used as a proxy to indicate risk of opioid misuse. Data analysis was stratified into high-risk and low-risk patient groups. Patient factors assessed included pain intensity, pain interference with daily activities, and health-related quality of life. Prescription opioid exposure was examined via patient medical and prescription records review. Among the 61 patients recruited, 62.3% scored ≥18 on the SOAPP-R, which indicates a high risk for opioid misuse. Factors associated with a high risk of opioid misuse were found to be high level of pain interference with daily activities, poorer mental health, and younger age. High-risk patients were found to be prescribed a lower mean daily opioid dose of <20 mg/day compared to low-risk patients (20-49 mg/day). This highlights the need for further research to distinguish aberrant drug-related behaviors due to inadequate pain management from that of actual prescription opioid misuse among non-cancer pain patients attending pain clinics.
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Affiliation(s)
- Asween R Sani
- Pharmacy Practice Department, Kulliyyah of Pharmacy, International Islamic University Malaysia (IIUM), Kuantan, Pahang, Malaysia
- Basic Health Sciences & Pharmacology Department, Faculty of Pharmacy, University College MAIWP International (UCMI), Batu Caves, Kuala Lumpur, Malaysia
| | - Che Suraya Zin
- Pharmacy Practice Department, Kulliyyah of Pharmacy, International Islamic University Malaysia (IIUM), Kuantan, Pahang, Malaysia
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Frumkin MR, Carpenter RW, Rodebaugh TL. Heterogeneity in Temporal Dynamics of Pain and Affect Among Individuals With Chronic Back Pain and Associations With Risk for Future Opioid-Related Problems. Clin Psychol Sci 2024; 12:706-720. [PMID: 39184840 PMCID: PMC11343473 DOI: 10.1177/21677026231196121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Chronic low back pain (CLBP) is a biopsychosocial phenomenon involving complex relationships between pain and psychosocial factors. In preregistered analyses, we examined dynamic relationships between pain and negative affect among individuals with CLBP (N = 87). We found that increased negative affect was concurrently and prospectively associated with increased pain for individuals on average. However, there was significant and meaningful between-persons variability in these effects such that risk for future opioid-related problems was positively associated with the within-persons correlation between pain and negative affect (β = 0.290, 95% credible interval [CI] = [0.071, 0.485]), the degree to which pain predicted increased negative affect (β = 0.439, 95% CI = [0.044, 0.717]), and the autoregressive effect of negative affect over 4-hr lags (β = 0.255, 95% CI = [0.007, 0.478]). These results suggest that variability in within-persons symptom dynamics may help identify chronic pain patients who are at greater risk of opioid-related problems.
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Affiliation(s)
- Madelyn R. Frumkin
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Ryan W. Carpenter
- Department of Psychological Sciences, University of Missouri St. Louis
| | - Thomas L. Rodebaugh
- Department of Psychological and Brain Sciences, Washington University in St. Louis
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Eschliman EL, Choe K, Fei YC, Kang C, Koetje J, Harocopos A, Harris MN, DeWalt J, Christopher SA, Jackson VW, Yang LH. Evaluation of Two Videos that Apply Evidence-Based Strategies to Increase Self-Efficacy and Reduce Opioid-Related Stigma Among Medical Students. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024; 48:123-134. [PMID: 38388788 PMCID: PMC10954387 DOI: 10.1007/s40596-024-01945-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE This study evaluated the video-based application of evidence-based stigma reduction strategies to increase medical students' screening-diagnostic self-efficacy for opioid use disorder (OUD) and reduce stigma toward opioid use. METHODS Formative qualitative research informed development of two videos for medical students. One uses an education strategy by including education regarding non-stigmatizing language use and OUD screening and diagnosis (Video A); the other uses an interpersonal contact strategy by presenting narratives regarding opioid use from three people who have a history of opioid use and three physicians (Video B). Both videos were administered to all respondents, with video order randomized. Effects on outcomes were evaluated using a pre-/post-test design with a 1-month follow-up. Participants also provided feedback on video content and design. RESULTS Medical students (N = 103) watched the videos and completed the pre-/post-test, with 99% (N = 102) completing follow-up 1 month after viewing both videos. Self-efficacy increased directly following viewing Video A, and this increase was sustained at 1-month follow-up. Stigma toward opioid use decreased directly following viewing Video B, and this decrease was sustained at 1-month follow-up for participants who watched Video B first. Statistically significant improvements were observed in most secondary outcomes (e.g., harm reduction acceptability) directly following watching each video and most were sustained at 1-month follow-up. Feedback about the videos suggested the delivery of evidence-based strategies in each video was appropriate. CONCLUSIONS Video-based applications of these evidence-based strategies were found acceptable by medical students and have potential to elicit sustained improvement in their screening-diagnostic self-efficacy and opioid-related stigma.
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Affiliation(s)
- Evan L Eschliman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Karen Choe
- School of Global Public Health, New York University, New York, NY, USA
| | - Y Christine Fei
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chris Kang
- School of Global Public Health, New York University, New York, NY, USA
| | - Jeffrey Koetje
- American Medical Student Association, Washington, DC, USA
| | - Alex Harocopos
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Melanie N Harris
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Julia DeWalt
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | | | | | - Lawrence H Yang
- School of Global Public Health, New York University, New York, NY, USA
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Abdulmalek S, Hardiman G. Genetic and epigenetic studies of opioid abuse disorder - the potential for future diagnostics. Expert Rev Mol Diagn 2023; 23:361-373. [PMID: 37078260 PMCID: PMC10257799 DOI: 10.1080/14737159.2023.2190022] [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: 01/03/2023] [Accepted: 03/08/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Opioid use disorder (OUD) is a global problem that often begins with prescribed medications. The available treatment and maintenance plans offer solutions for the consumption rate by individuals leaving the outstanding problem of relapse, which is a major factor hindering the long-term efficacy of treatments. AREAS COVERED Understanding the neurobiology of addiction and relapse would help identifying the core causes of relapse and distinguish vulnerable from resilient individuals, which would lead to more targeted and effective treatment and provide diagnostics to screen individuals who have a propensity to OUD. In this review, we cover the neurobiology of the reward system highlighting the role of multiple brain regions and opioid receptors in the development of the disorder. We also review the current knowledge of the epigenetics of addiction and the available screening tools for aberrant use of opioids. EXPERT OPINION Relapse remains an anticipated limitation in the way of recovery even after long period of abstinence. This highlights the need for diagnostic tools that identify vulnerable patients and prevent the cycle of addiction. Finally, we discuss the limitations of the available screening tools and propose possible solutions for the discovery of addiction diagnostics.
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Affiliation(s)
- Sarah Abdulmalek
- Faculty of Medicine, Health and Life Sciences, School of Biological Sciences, Queen’s University Belfast, NI, UK
| | - Gary Hardiman
- Faculty of Medicine, Health and Life Sciences, School of Biological Sciences, Queen’s University Belfast, NI, UK
- Department of Medicine, Medical University of South Carolina (MUSC), 135 Cannon Street, Charleston, SC 29425
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Olson R, Hess JA, Turk D, Marino M, Greenspan L, Alley L, Donovan C, Rice SPM. COMMunity of Practice And Safety Support for Navigating Pain (COMPASS-NP): study protocol for a randomized controlled trial with home care workers. Trials 2023; 24:264. [PMID: 37038235 PMCID: PMC10088173 DOI: 10.1186/s13063-023-07149-8] [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: 01/05/2023] [Accepted: 02/08/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Chronic pain is a prevalent and costly problem that often has occupational origins. Home care workers (HCWs) are at high risk for work-related injuries, pain, and disability. Current treatments for chronic pain emphasize medications, which are an inadequate stand-alone treatment and can produce significant adverse effects. METHODS In this translational study, we will adapt an established work-based injury prevention and health promotion program (COMmunity of Practice And Safety Support: COMPASS) to address the needs of HCWs experiencing chronic pain. COMPASS employs peer-led, scripted group meetings that include educational content, activities, goal setting, and structured social support. The translated intervention, named COMPASS for Navigating Pain (COMPASS-NP), will be delivered in an online group format. Safety protections will be strengthened through an ergonomic self-assessment and vouchers for purchasing ergonomic tools. Educational content will integrate a self-management approach to chronic pain using proven cognitive-behavioral therapy (CBT) principles. We will use a mixed-methods hybrid type 2 evaluation approach to assess effectiveness and implementation. A cluster-randomized waitlist control design will involve 14 groups of 10 HCWs (n = 140) recruited from Washington, Oregon, and Idaho. Half of the groups will be randomly selected to complete the intervention during the first 10 weeks, while the waitlist groups serve as controls. During weeks 10-20, the waitlist groups will complete the intervention while the original intervention groups complete a follow-up period without further intervention. Our primary hypothesis is that COMPASS-NP will reduce pain interference with work and life. Secondary outcomes include injury and pain prevention behaviors, pain severity, changes in medication use, risk for opioid misuse, well-being, physical activity, and sleep. Qualitative data, including phone interviews with group facilitators and organizational partners, will evaluate the implementation and guide dissemination. DISCUSSION The results will advance the use and knowledge of secondary prevention interventions such as ergonomic tools and cognitive behavior therapy, to reduce injury, pain, and disability and to encourage appropriate uses of analgesic medications among HCWs. TRIAL REGISTRATION ClinicalTrials.gov NCT05492903. Registered on 08 August 2022.
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Affiliation(s)
- Ryan Olson
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, 3222 SW Research Drive, Portland, OR, 97239-3098, USA
- Oregon Health & Science University-Portland State University School of Public Health, VPT, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
- Department of Psychology, Portland State University, P.O. Box 751, Portland, OR, 97207-0751, USA
| | - Jennifer A Hess
- Labor Education & Research Center, University of Oregon, 1675 Agate Street, Eugene, OR, 97403-1289, USA.
| | - Dennis Turk
- Department of Anesthesiology & Pain Medicine, University of Washington, BB 1425 HSC, Box 356540, 1949 NE Pacific Street, Seattle, WA, 98195-6540, USA
| | - Miguel Marino
- Oregon Health & Science University-Portland State University School of Public Health, VPT, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
- Family Medicine, School of Medicine, Oregon Health & Science University, FM, 3181 SW Sam Jackson Park, Portland, OR, 97239, USA
| | - Leah Greenspan
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, 3222 SW Research Drive, Portland, OR, 97239-3098, USA
| | - Lindsey Alley
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, 3222 SW Research Drive, Portland, OR, 97239-3098, USA
| | - Courtney Donovan
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, 3222 SW Research Drive, Portland, OR, 97239-3098, USA
| | - Sean P M Rice
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, 3222 SW Research Drive, Portland, OR, 97239-3098, USA
- Oregon Health & Science University-Portland State University School of Public Health, VPT, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
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Kashyap A, Callison-Burch C, Boland MR. A deep learning method to detect opioid prescription and opioid use disorder from electronic health records. Int J Med Inform 2023; 171:104979. [PMID: 36621078 PMCID: PMC9898169 DOI: 10.1016/j.ijmedinf.2022.104979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 12/12/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE As the opioid epidemic continues across the United States, methods are needed to accurately and quickly identify patients at risk for opioid use disorder (OUD). The purpose of this study is to develop two predictive algorithms: one to predict opioid prescription and one to predict OUD. MATERIALS AND METHODS We developed an informatics algorithm that trains two deep learning models over patient Electronic Health Records (EHRs) using the MIMIC-III database. We utilize both the structured and unstructured parts of the EHR and show that it is possible to predict both challenging outcomes. RESULTS Our deep learning models incorporate elements from EHRs to predict opioid prescription with an F1-score of 0.88 ± 0.003 and an AUC-ROC of 0.93 ± 0.002. We also constructed a model to predict OUD diagnosis achieving an F1-score of 0.82 ± 0.05 and AUC-ROC of 0.94 ± 0.008. DISCUSSION Our model for OUD prediction outperformed prior algorithms for specificity, F1 score and AUC-ROC while achieving equivalent sensitivity. This demonstrates the importance of a) deep learning approaches in predicting OUD and b) incorporating both structured and unstructured data for this prediction task. No prediction models for opioid prescription as an outcome were found in the literature and therefore our model is the first to predict opioid prescribing behavior. CONCLUSION Algorithms such as those described in this paper will become increasingly important to understand the drivers underlying this national epidemic.
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Affiliation(s)
- Aditya Kashyap
- Department of Computer Science, University of Pennsylvania, United States of America
| | - Chris Callison-Burch
- Department of Computer Science, University of Pennsylvania, United States of America
| | - Mary Regina Boland
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, United States of America; Institute for Biomedical Informatics, University of Pennsylvania, United States of America; Center for Excellence in Environmental Toxicology, University of Pennsylvania, United States of America; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, United States of America.
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Strigo IA, Murphy E, Mitchell JM, Spadoni AD. Learning from addiction: Craving of prescription opioids in chronic pain sufferers. Neurosci Biobehav Rev 2022; 142:104904. [PMID: 36202255 PMCID: PMC10917419 DOI: 10.1016/j.neubiorev.2022.104904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 01/19/2023]
Abstract
Prescription opioids are a primary driver of opioid-related deaths. Although craving is a substantial component of OUD, the degree to which craving leads to misuse among chronic pain patients on long-term prescription opioids is unknown. A clear understanding of the factors that lead to misuse in this vulnerable population is needed for the development of safe and effective practices for opioid taper. This narrative review summarizes the relevant literature on the role of craving in addiction and chronic pain through epidemiological and behavioral studies. The first part of this review examines the role of craving in predicting opioid use/misuse in individuals with chronic pain with and without OUD. The second part covers methods on how craving is evaluated experimentally using both subjective and objective measures and provides related findings. The overall goal of this review is to facilitate the development of a population-specific description of craving in those who use opioids to control chronic pain and to describe how it may be mechanistically linked to patterns of opioid (mis)use.
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Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Healthcare Center, 4150 Clement Street, San Francisco, CA 94121, USA; Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Emily Murphy
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Healthcare Center, 4150 Clement Street, San Francisco, CA 94121, USA
| | - Jennifer M Mitchell
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA; Department of Neurology, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA
| | - Andrea D Spadoni
- San Diego Veterans Affairs Healthcare Center, 3350 La Jolla Village Drive, San Diego, CA 92121, USA; Department of Psychiatry, University of California San Diego, San Diego, CA 92300, USA
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Reyes-Pérez Á, López-Martínez AE, Esteve R, Ramírez-Maestre C. Spanish Validation of the COMM Scale to Assess the Misuse of Prescription Opioids in Patients with Chronic Noncancer Pain. Int J Ment Health Addict 2022; 21:1-15. [PMID: 35342377 PMCID: PMC8936043 DOI: 10.1007/s11469-022-00803-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 02/08/2023] Open
Abstract
The Current Opioid Misuse Measure (COMM) is a questionnaire used to identify and monitor chronic pain patients on opioid therapy who may be misusing their prescription opioids. The aim of the present study was to adapt the questionnaire for its use in Spanish-speaking populations. A total of 171 individuals (131 women and 40 men) with nononcological chronic pain participated in this cross-sectional study. The most frequent pain diagnoses in the sample were fibromyalgia, herniated disc, and rheumatoid arthritis. Systematic sampling was used. All individuals were interviewed at their clinic between March 2018 and February 2020. The dimensionality of the COMM-SV items was evaluated using an optimal implementation of parallel analysis (PA) and an exploratory factor analysis. Internal consistency, test-retest reliability, and criterion and convergent validity were calculated. The COMM-SV comprises five factors: problematic interpersonal behaviour, searching for more medication than prescribed, medication misuse and self-injurious thoughts, emergency use, and memory and attention problems. It has good reliability and adequate test-retest stability. The results support its criterion and convergent validity. Given the increasing use and abuse of opioids, a valid and reliable instrument is needed in Spanish settings to identify patients with chronic pain who present aberrant behaviour related to the use of these medications. The COMM-SV enables Spanish clinicians to do that.
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Affiliation(s)
- Ángela Reyes-Pérez
- Departamento de PersonalidadEvaluación Y Tratamiento PsicológicoFacultad de Psicología Y Logopedia, Universidad de Málaga, Málaga, Spain
| | - Alicia E. López-Martínez
- Departamento de PersonalidadEvaluación Y Tratamiento PsicológicoFacultad de Psicología Y Logopedia, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Campus de Teatinos, 29071 Málaga, S/N Spain
| | - Rosa Esteve
- Departamento de PersonalidadEvaluación Y Tratamiento PsicológicoFacultad de Psicología Y Logopedia, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Campus de Teatinos, 29071 Málaga, S/N Spain
| | - Carmen Ramírez-Maestre
- Departamento de PersonalidadEvaluación Y Tratamiento PsicológicoFacultad de Psicología Y Logopedia, Universidad de Málaga, Instituto de Investigaciones Biomédicas de Málaga (IBIMA), Campus de Teatinos, 29071 Málaga, S/N Spain
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A systematic review of assessment approaches to predict opioid misuse in people with cancer. Support Care Cancer 2022; 30:5645-5658. [PMID: 35166898 PMCID: PMC9135805 DOI: 10.1007/s00520-022-06895-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 02/02/2022] [Indexed: 11/11/2022]
Abstract
Context Cancer prevalence is increasing, with many patients requiring opioid analgesia. Clinicians need to ensure patients receive adequate pain relief. However, opioid misuse is widespread, and cancer patients are at risk. Objectives This study aims (1) to identify screening approaches that have been used to assess and monitor risk of opioid misuse in patients with cancer; (2) to compare the prevalence of risk estimated by each of these screening approaches; and (3) to compare risk factors among demographic and clinical variables associated with a positive screen on each of the approaches. Methods Medline, Cochrane Controlled Trial Register, PubMed, PsycINFO, and Embase databases were searched for articles reporting opioid misuse screening in cancer patients, along with handsearching the reference list of included articles. Bias was assessed using tools from the Joanna Briggs Suite. Results Eighteen studies met the eligibility criteria, evaluating seven approaches: Urine Drug Test (UDT) (n = 8); the Screener and Opioid Assessment for Patients with Pain (SOAPP) and two variants, Revised and Short Form (n = 6); the Cut-down, Annoyed, Guilty, Eye-opener (CAGE) tool and one variant, Adapted to Include Drugs (n = 6); the Opioid Risk Tool (ORT) (n = 4); Prescription Monitoring Program (PMP) (n = 3); the Screen for Opioid-Associated Aberrant Behavior Risk (SOABR) (n = 1); and structured/specialist interviews (n = 1). Eight studies compared two or more approaches. The rates of risk of opioid misuse in the studied populations ranged from 6 to 65%, acknowledging that estimates are likely to have varied partly because of how specific to opioids the screening approaches were and whether a single or multi-step approach was used. UDT prompted by an intervention or observation of aberrant opioid behaviors (AOB) were conclusive of actual opioid misuse found to be 6.5–24%. Younger age, found in 8/10 studies; personal or family history of anxiety or other mental ill health, found in 6/8 studies; and history of illicit drug use, found in 4/6 studies, showed an increased risk of misuse. Conclusions Younger age, personal or familial mental health history, and history of illicit drug use consistently showed an increased risk of opioid misuse. Clinical suspicion of opioid misuse may be raised by data from PMP or any of the standardized list of AOBs. Clinicians may use SOAPP-R, CAGE-AID, or ORT to screen for increased risk and may use UDT to confirm suspicion of opioid misuse or monitor adherence. More research into this important area is required. Significance of results This systematic review summarized the literature on the use of opioid misuse risk approaches in people with cancer. The rates of reported risk range from 6 to 65%; however, true rate may be closer to 6.5–24%. Younger age, personal or familial mental health history, and history of illicit drug use consistently showed an increased risk of opioid misuse. Clinicians may choose from several approaches. Limited data are available on feasibility and patient experience. PROSPERO registration number. CRD42020163385.
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Diagnostic and Predictive Capacity of the Spanish Versions of the Opioid Risk Tool and the Screener and Opioid Assessment for Patients with Pain-Revised: A Preliminary Investigation in a Sample of People with Noncancer Chronic Pain. Pain Ther 2022; 11:493-510. [PMID: 35128624 PMCID: PMC9098780 DOI: 10.1007/s40122-022-00356-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/17/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Accurate assessment of the risk of opioid abuse and misuse in people with noncancer chronic pain is crucial for their prevention. This study aimed to provide preliminary evidence of the diagnostic and predictive capacity of the Spanish versions of the Opioid Risk Tool (ORT) and the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). METHODS We used the Current Opioid Misuse Measure (COMM) as criterion measure to assess the capacity of each tool to identify patients misusing opioids at the time of the assessment. Eighteen months later, we used the COMM and the Drug Abuse Screening Test-10 (DAST-10) to assess their predictive capacity. In total, 147 people with noncancer chronic pain participated in the diagnostic study, and 42 in the predictive study. RESULTS Receiver operating curve analysis showed that the SOAPP-R had an excellent capacity to identify participants who were misusing opioids at the time of assessment (area under the curve [AUC] = 0.827). The diagnostic capacity of the ORT was close to acceptable (AUC = 0.649-0.669), whereas its predictive capacity was poor (AUC = 0.522-0.554). The predictive capacity of the SOAPP-R was close to acceptable regarding misuse (AUC = 0.672) and poor regarding abuse (AUC = 0.423). CONCLUSION In the setting of Spanish-speaking communities, clinicians should be cautious when using these instruments to make decisions on opioid administration. Further research is needed on the diagnostic and predictive capacity of the Spanish versions of both instruments.
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Wulff-Burchfield E. Supportive and Palliative Care for Genitourinary Malignancies. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Vunikili R, Glicksberg BS, Johnson KW, Dudley JT, Subramanian L, Shameer K. Predictive Modelling of Susceptibility to Substance Abuse, Mortality and Drug-Drug Interactions in Opioid Patients. Front Artif Intell 2021; 4:742723. [PMID: 34957391 PMCID: PMC8702828 DOI: 10.3389/frai.2021.742723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/25/2021] [Indexed: 01/16/2023] Open
Abstract
Objective: Opioids are a class of drugs that are known for their use as pain relievers. They bind to opioid receptors on nerve cells in the brain and the nervous system to mitigate pain. Addiction is one of the chronic and primary adverse events of prolonged usage of opioids. They may also cause psychological disorders, muscle pain, depression, anxiety attacks etc. In this study, we present a collection of predictive models to identify patients at risk of opioid abuse and mortality by using their prescription histories. Also, we discover particularly threatening drug-drug interactions in the context of opioid usage. Methods and Materials: Using a publicly available dataset from MIMIC-III, two models were trained, Logistic Regression with L2 regularization (baseline) and Extreme Gradient Boosting (enhanced model), to classify the patients of interest into two categories based on their susceptibility to opioid abuse. We’ve also used K-Means clustering, an unsupervised algorithm, to explore drug-drug interactions that might be of concern. Results: The baseline model for classifying patients susceptible to opioid abuse has an F1 score of 76.64% (accuracy 77.16%) while the enhanced model has an F1 score of 94.45% (accuracy 94.35%). These models can be used as a preliminary step towards inferring the causal effect of opioid usage and can help monitor the prescription practices to minimize the opioid abuse. Discussion and Conclusion: Results suggest that the enhanced model provides a promising approach in preemptive identification of patients at risk for opioid abuse. By discovering and correlating the patterns contributing to opioid overdose or abuse among a variety of patients, machine learning models can be used as an efficient tool to help uncover the existing gaps and/or fraudulent practices in prescription writing. To quote an example of one such incidental finding, our study discovered that insulin might possibly be interacting with opioids in an unfavourable way leading to complications in diabetic patients. This indicates that diabetic patients under long term opioid usage might need to take increased amounts of insulin to make it more effective. This observation backs up prior research studies done on a similar aspect. To increase the translational value of our work, the predictive models and the associated software code are made available under the MIT License.
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Affiliation(s)
- Ramya Vunikili
- Department of Computer Science, Courant Institute of Mathematical Sciences, New York University, New York, NY, United States.,Department of Information Services, Center for Research Informatics and Innovation, Northwell Health, New York, NY, United States
| | - Benjamin S Glicksberg
- Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Kipp W Johnson
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, NY, United States
| | - Joel T Dudley
- Institute for Next Generation Healthcare, Mount Sinai Health System, New York, NY, United States
| | - Lakshminarayanan Subramanian
- Department of Computer Science, Courant Institute of Mathematical Sciences, New York University, New York, NY, United States
| | - Khader Shameer
- Department of Information Services, Center for Research Informatics and Innovation, Northwell Health, New York, NY, United States.,Institute for Next Generation Healthcare, Mount Sinai Health System, New York, NY, United States
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14
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Abstract
Efforts to minimize the impact of prescribed opioids on future adverse outcomes are reliant on emergency care providers' ability to screen and detect opioid use disorder (OUD). Many prescriptions are initiated in the emergency department (ED) for acute pain; thus, validated measures are especially needed. Our systematic review describes the available opioid-related screening measures identified through search of the available literature. Measures were categorized by intent and applied clinical setting. We found 44 articles, identifying 15 screening measures. Of these, nine were developed to screen for current opioid misuse and five to screen for risk of future opioid misuse. None were created for use outside of a chronic pain setting. Many measures were applied differently from intended purpose. Although several measures are available, screening for adverse opioid outcomes in the ED is hampered by lack of validated instruments. Development of clarified conceptual models and ED-specific research is necessary to limit OUD.
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15
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Hah J. Risk factors and screening for opioid misuse: current clinical implications for prescription opioid therapy. Pain Manag 2021; 11:625-630. [PMID: 34155912 DOI: 10.2217/pmt-2021-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jennifer Hah
- Division of Pain Medicine, Department of Anesthesiology, Perioperative, & Pain Medicine, Stanford University, 1070 Arastradero Road, Suite 200, Palo Alto, CA 94304, USA
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16
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Flowers KM, Patton ME, Hruschak VJ, Fields KG, Schwartz E, Zeballos J, Kang JD, Edwards RR, Kaptchuk TJ, Schreiber KL. Conditioned open-label placebo for opioid reduction after spine surgery: a randomized controlled trial. Pain 2021; 162:1828-1839. [PMID: 33449503 PMCID: PMC8378225 DOI: 10.1097/j.pain.0000000000002185] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
ABSTRACT Placebo effects have traditionally involved concealment or deception. However, recent evidence suggests that placebo effects can also be elicited when prescribed transparently as "open-label placebos" (OLPs), and that the pairing of an unconditioned stimulus (eg, opioid analgesic) with a conditioned stimulus (eg, placebo pill) can lead to the conditioned stimulus alone reducing pain. In this randomized control trial, we investigated whether combining conditioning with an OLP (COLP) in the immediate postoperative period could reduce daily opioid use and postsurgical pain among patients recovering from spine surgery. Patients were randomized to COLP or treatment as usual, with both groups receiving unrestricted access to a typical opioid-based postoperative analgesic regimen. The generalized estimating equations method was used to assess the treatment effect of COLP on daily opioid consumption and pain during postoperative period from postoperative day (POD) 1 to POD 17. Patients in the COLP group consumed approximately 30% less daily morphine milligram equivalents compared with patients in the treatment as usual group during POD 1 to 17 (-14.5 daily morphine milligram equivalents; 95% CI: [-26.8, -2.2]). Daily worst pain scores were also lower in the COLP group (-1.0 point on the 10-point scale; 95% CI: [-2.0, -0.1]), although a significant difference was not detected in average daily pain between the groups (-0.8 point; 95% CI: [-1.7, 0.2]). These findings suggest that COLP may serve as a potential adjuvant analgesic therapy to decrease opioid consumption in the early postoperative period, without increasing pain.
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Affiliation(s)
- Kelsey M. Flowers
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Megan E. Patton
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Valerie J. Hruschak
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Kara G. Fields
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Emily Schwartz
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Jose Zeballos
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - James D. Kang
- Departments of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Rob R. Edwards
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Ted J. Kaptchuk
- Program in Placebo Studies and Therapeutic Encounter, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Kristin L. Schreiber
- Departments of Anesthesiology, Perioperative, and Pain Medicine Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
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17
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Analgesic Opioid Misuse and Opioid Use Disorder among Patients with Chronic Non-Cancer Pain and Prescribed Opioids in a Pain Centre in France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042097. [PMID: 33670004 PMCID: PMC7926319 DOI: 10.3390/ijerph18042097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 02/06/2023]
Abstract
(1) Background: Chronic non-cancer pain (CNCP) remains a public health challenge around the world. Opioids (PO) have been increasingly used in the treatment of CNCP in the last 20 years. This study aimed to assess the prevalence of opioid misuse and prescribed-opioid use disorder (p-OUD) among patients with CNCP in a pain centre in France, and to analyse risk factors for moderate or severe p-OUD. (2) Method: A cross-sectional study was conducted, including patients consulting for pain management in the pain centre of Brest University Hospital. A self-questionnaire was administered (sociodemographic data, medical data, PO misuse, and p-OUD according the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) criteria). Descriptive, univariate, and multivariate analyses were conducted, together with a principal component analysis, in order to identify factors associated with p-OUD. (3) Results: In total, 115 patients were included, the majority of whom were women, with a mean age of 52 years old [18–82]; 64.3% (n = 74) had a current prescription for opioid analgesics (weak or strong). In this group, 56.7% (n = 42) had no or only mild p-OUD and 43.3% (n = 32) had current moderate or severe p-OUD. Patients with moderate or severe p-OUD were more likely to have a current antidepressant prescription, to have had psychotherapy, to currently use strong opioids and oxycodone, and to report taking more frequent doses than prescribed and feeling dependent. (4) Conclusions: We showed that the prevalence of current moderate/severe p-OUD concerned 43.3% of the patients with a CNCP seeking treatment in a pain centre. According to these results, several measures are relevant in managing p-OUD among patients with CNCP.
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18
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Greenspan LS, Alley L, Rice SPM, Olson R. Exploring biopsychosocial correlates of pain, pain management strategies, and risk for opioid misuse among home care workers in Washington State. Home Health Care Serv Q 2020; 40:54-74. [PMID: 32972327 DOI: 10.1080/01621424.2020.1810191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Home care workers (HCWs) are at high risk for musculoskeletal pain and injury, and they are an important population for pain management research and intervention. The purpose of this study was to gather novel data on HCWs' work characteristics, pain experiences, pain management strategies, and risk for opioid misuse. A survey invitation was e-mailed to a random sub-sample of HCWs in Washington State, and 421 responded. Over half (54.2%) reported chronic or currently elevated pain. Pharmacological pain management strategies were used by 67.3% of all respondents with 4.8% reporting prescription opioid use. Biopsychosocial factors like injuries, interpersonal conflict, financial strain, and anxiety were associated with increased opioid misuse risk. Multimodal primary and secondary interventions are recommended to improve HCWs' pain management.
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Affiliation(s)
- Leah S Greenspan
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University , Portland, Oregon, USA
| | - Lindsey Alley
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University , Portland, Oregon, USA
| | - Sean P M Rice
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University , Portland, Oregon, USA
| | - Ryan Olson
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University , Portland, Oregon, USA.,School of Public Health, Oregon Health & Science University and Portland State University , Portland, Oregon, USA.,Department of Psychology, Portland State University , Portland, Oregon, USA
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19
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Rodrigue D, Winkelmann J, Price M, Kalandranis E, Klempner L, Kapoor-Hintzen N. Opioid Misuse: An Organizational Response While Managing Cancer-Related Pain. Clin J Oncol Nurs 2020; 24:170-176. [PMID: 32196013 DOI: 10.1188/20.cjon.170-176] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Opioids are commonly prescribed to manage cancer pain. Similar to the general population, patients with cancer are not excluded from the risk for opioid misuse and dependence. This situation can contribute to clinician reluctance to prescribe and manage pain using opioids. OBJECTIVES The purpose of this article is to provide an overview of how opioid misuse may affect pain management in patients with cancer and to describe a comprehensive cancer center's approach to safely managing cancer pain. METHODS Based on a literature review, the project team developed a stewardship program. Project components included selecting a validated screening tool for risk of opioid misuse, determining if a history of addiction affects pain management in patients with cancer, and establishing a task force to focus on the opioid crisis and to follow the Joint Commission's revised pain assessment and management standards. FINDINGS The project established a hospitalwide opioid stewardship program. Through the use of a multidisciplinary, universal precautions approach to assessing misuse in all patients with cancer who are prescribed opioids, healthcare teams can potentially reduce risks associated with misuse while safely managing cancer pain.
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Affiliation(s)
| | | | - Maura Price
- Lehigh Valley Health Network Cancer Institute
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20
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Finkelman MD, Jamison RN, Kulich RJ, Butler SF, Smits N, Weiner SG. A Comparison of Short Forms of the Screener and Opioid Assessment for Patients With Pain – Revised (SOAPP-R). EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2020. [DOI: 10.1027/1015-5759/a000519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. The Screener and Opioid Assessment for Patients with Pain – Revised (SOAPP-R) is a 24-item self-report questionnaire that assesses risk of aberrant medication-related behavior among chronic pain patients. Recently, an 8-item version of the SOAPP-R that weights items differentially was proposed. However, no previous study had compared the 8-item form with other short versions of the SOAPP-R, including a static 12-item short form and computer-based versions customizing the test length to the individual respondent. Moreover, no prior research had investigated combining the 8-item short form with customized computer-based stopping rules to further enhance efficiency. The objectives of this study were to compare the 8-item version with previously recommended short forms of the SOAPP-R, and to develop and evaluate a new version of the SOAPP-R combining the 8-item version with computer-based stopping rules. Versions were compared via sensitivity, specificity, and mean test length using real-data simulation of three datasets. Although results varied across datasets, the 8-item SOAPP-R compared favorably to previously recommended forms. Combining the 8-item form with computer-based stopping rules reduced the mean test length without affecting sensitivity or specificity; thus, the combined approach is recommended. The methodology used to shorten questionnaires via computer-based testing can also be applied to other instruments.
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Affiliation(s)
- Matthew D. Finkelman
- Department of Public Health and Community Service, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Robert N. Jamison
- Departments of Anesthesiology and Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ronald J. Kulich
- Craniofacial Pain and Headache Center, Tufts University School of Dental Medicine, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Niels Smits
- Department of Methods and Statistics, Research Institute of Child Development and Education, University of Amsterdam, The Netherlands
| | - Scott G. Weiner
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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21
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Cohen SP, Hooten WM. Balancing the Risks and Benefits of Opioid Therapy: The Pill and the Pendulum. Mayo Clin Proc 2019; 94:2385-2389. [PMID: 31806096 PMCID: PMC6911683 DOI: 10.1016/j.mayocp.2019.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 09/04/2019] [Accepted: 10/09/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Department of Neurology, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Anesthesiology and Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - W Michael Hooten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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22
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Acuña JP. RIESGO DE ADICCIÓN A ANALGÉSICOS OPIOIDES EN EL TRATAMIENTO DE DOLOR CRÓNICO NO ONCOLÓGICO. REVISTA MÉDICA CLÍNICA LAS CONDES 2019. [DOI: 10.1016/j.rmclc.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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23
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Meisel ZF, Lupulescu-Mann N, Charlesworth CJ, Kim H, Sun BC. Conversion to Persistent or High-Risk Opioid Use After a New Prescription From the Emergency Department: Evidence From Washington Medicaid Beneficiaries. Ann Emerg Med 2019; 74:611-621. [PMID: 31229392 PMCID: PMC6864746 DOI: 10.1016/j.annemergmed.2019.04.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/05/2019] [Accepted: 04/08/2019] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE We describe the overall risk and factors associated with transitioning to persistent opioid or high-risk use after an initial emergency department (ED) opioid prescription. METHODS A retrospective cohort study of Washington Medicaid beneficiaries was performed with linked Medicaid and prescription drug monitoring program files. We identified adults who had no record of opioid prescriptions in the previous 12 months, and who filled a new opioid prescription within 1 day of an ED discharge in 2014. We assessed the risk of persistent opioid use or high-risk prescription fills within 12 months after the index visit. Logistic regression was used to assess the association between pertinent variables and conversion to persistent or high-risk use. RESULTS Among 202,807 index ED visits, 23,381 resulted in a new opioid prescription. Of these, 13.7% led to persistent or high-risk opioid prescription fills within 12 months compared with 3.2% for patients who received no opioids at the index visit. Factors associated with increased likelihood of persistent opioid or high-risk prescription fills included a history of skeletal or connective-tissue disorder; neck, back, or dental pain; and a history of prescribed benzodiazepines. The highest conversion rates (37.3%) were observed among visits in which greater than or equal to 350 morphine milligram equivalents were prescribed. Conversion rates remained greater than 10% even among visits resulting in lower-dose opioid prescriptions. CONCLUSION Medicaid recipients are at moderate risk for conversion to persistent or high-risk opioid use after a new ED prescription. Longer or higher-dose prescriptions are associated with increased risk for conversion; however, even visits that lead to guideline-concordant prescriptions bear some risk for long-term or high-risk use.
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Affiliation(s)
- Zachary F Meisel
- Center for Emergency Care Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, and the Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA; Center for Health Economics for Treatment Interventions of Substance Use Disorder, HIV, HCV.
| | | | | | - Hyunjee Kim
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR
| | - Benjamin C Sun
- Center for Emergency Care Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, and the Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA; Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR
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24
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Nusrat M, Parkes A, Kieser R, Hu B, Farhat D, Rieber A, Ma H. Standardizing Opioid Prescribing Practices for Cancer-Related Pain Via a Novel Interactive Documentation Template at a Public Hospital. J Oncol Pract 2019; 15:e989-e996. [DOI: 10.1200/jop.18.00789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE: Opioid misuse during cancer pain management places patients at risk for harm and physicians for legal liability. Identifying and monitoring patients who are at risk is challenging given the lack of validated clinical tools and evidence-based guidelines. In the current study, we aimed to standardize opioid prescribing practices at a community oncology clinic to help ensure patient safety and physician compliance with Texas state regulations. METHODS: We used the Plan-Do-Study-Act methodology. In the planning phase, current practices of assessing opioid efficacy, toxicity, and misuse were determined by surveying clinic physicians and reviewing patients’ charts. We developed a new standardized process that incorporated published literature, the Texas Administrative Code, and expert opinion. Two interactive documentation templates (SmartPhrases) were designed to implement the standardized process. The intervention was studied using repeat physician surveys and chart reviews, which prompted action for refinement and sustainability. RESULTS: At baseline, 9% of providers followed a systematic approach to prescribing opioids and 86% expressed an interest in process standardization. We noted high interprovider variability in the opioid risk stratification and refill process. At 2 months and 6 months postimplementation, provider satisfaction with the intervention was 83% and 75%, whereas compliance with SmartPhrase use was 70% and 54%, respectively. The frequency of state database check improved from 36% to 94% at 6 months. Improvement was also noted in assessment and documentation of baseline risk, chemical coping, and toxicity. CONCLUSION: We implemented a systematic approach for assessing opioid misuse, toxicity, and efficacy during cancer pain management at a community oncology clinic. The approach resulted in notable improvement in provider practices and documentation compliance.
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Affiliation(s)
- Maliha Nusrat
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amanda Parkes
- The University of Texas MD Anderson Cancer Center, Houston, TX
- Carbone Comprehensive Cancer Center, University of Wisconsin, Madison, WI
| | - Ryan Kieser
- University of Texas Health Science Center at Houston, Houston, TX
| | - Bei Hu
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dalia Farhat
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alyssa Rieber
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hilary Ma
- The University of Texas MD Anderson Cancer Center, Houston, TX
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25
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Umberger W, Gaddis L. The Science of Addiction Through the Lens of Opioid Treatment for Chronic Noncancer Pain. Pain Manag Nurs 2019; 21:57-64. [PMID: 31606310 DOI: 10.1016/j.pmn.2019.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/05/2019] [Accepted: 09/05/2019] [Indexed: 10/25/2022]
Abstract
Addiction is a chronic, relapsing brain disease. It is not the same as physical dependence (i.e., withdrawal) and tolerance, but is characterized by loss of control over the use of the substance, continued use despite consequences, compulsive use, and cravings. Addiction involves functional changes to brain pathways involved in reward, stress and learning, and these changes can last a long time after the addictive substance is no longer used. Repeated interruption of normal brain function from repetitive use of addictive substances can hijack normal reward mechanisms resulting in fundamental alterations in brain structure and function. Over time, addictive substances can bring about a false fixed prediction error that cannot be rectified during learning. And, for individuals who develop an addiction, initial impulsive drug use progresses to compulsive drug use and this progression also has neurobiological underpinnings. Drug addiction is partly heritable, although there is no single gene coding specifically for the disease of addiction. Genetic factors contribute to a vulnerability to develop both addiction and addiction comorbidities, and play an appreciable role in responses to and metabolism of addictive substances, and most likely, the experience of rewarding effects. Patients with pain who are addicted to opioids have, in addition to the pain disorder, a chronic relapsing brain disease that can be life-threatening. Addiction can be treated and controlled, but not cured. Treatment of pain in individuals with addiction is a complex clinical challenge. Holistic assessment, interprofessional approaches, use of established guidelines, and non-pharmacological complementary modalities are needed.
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Affiliation(s)
- Wendy Umberger
- College of Nursing, Kent State University, Kent, Ohio, USA.
| | - Lynn Gaddis
- College of Nursing, Kent State University, Kent, Ohio, USA
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26
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DiBenedetto DJ, Weed VF, Wawrzyniak KM, Finkelman M, Paolini J, Schatman ME, Herrera D, Kulich RJ. The Association Between Cannabis Use and Aberrant Behaviors During Chronic Opioid Therapy for Chronic Pain. PAIN MEDICINE 2019; 19:1997-2008. [PMID: 29947796 DOI: 10.1093/pm/pnx222] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Health care providers are likely to see an increase in the concomitant use of cannabis and opioids, particularly with the increased liberalization and ongoing research into the possible role of medical marijuana for chronic pain. Recent literature reports a prevalence of concurrent use ranging from 8.9% to 31.8%. The primary aim of this study was to determine the relationship between cannabis use and aberrant drug behaviors in noncancer pain patients receiving chronic opioid therapy. Design Retrospective chart review. Setting Community-based, interdisciplinary pain management center. Subjects Data from 209 patients who were evaluated for a medication management program between October 1, 2011, and January 1, 2014, and met inclusion criteria. Forty-four were positive for cannabis in their initial random urine drug toxicology. Methods Data from electronic health records, including demographics, urine drug toxicology, disability, opioid dose, opioid risk assessment data, and pain severity were analyzed to examine differences among cannabis users and noncannabis users. Results Subjects with cannabis in their initial urine drug toxicology were more likely to have a future occurrence of an opioid-related aberrancy (P < 0.001), be male (P = 0.047), have a history of substance abuse (P = 0.013), and be enrolled into a higher level of clinical monitoring of opioid medication use (P = 0.008). No other associations with demographic and clinical variables reached statistical significance. Conclusions Concurrent use of cannabis and opioids by patients with chronic pain appears to indicate higher risk for opioid misuse. Closer monitoring for opioid-related aberrancy is indicated for this group of patients.
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Affiliation(s)
- David J DiBenedetto
- Department of Diagnostic Sciences, Boston Pain Care, Tufts University School of Dental Medicine, Boston, Massachusetts
| | | | - Kelly M Wawrzyniak
- Department of Diagnostic Sciences, Boston Pain Care, Tufts University School of Dental Medicine, Boston, Massachusetts
| | - Matthew Finkelman
- Division of Biostatistics and Experimental Design, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Michael E Schatman
- Department of Public Health and Community Medicine, Boston Pain Care, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Ronald J Kulich
- Department of Diagnostic Sciences, Tufts University of School Dental Medicine, Boston, Massachusetts.,Department of Anesthesia Critical Care and Pain Medicine, Harvard Medical School/Massachusetts General Hospital Boston, Massachusetts, USA
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27
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Weiner SG, Hoppe JA, Finkelman MD. Techniques to Shorten a Screening Tool for Emergency Department Patients. West J Emerg Med 2019; 20:804-809. [PMID: 31539338 PMCID: PMC6754189 DOI: 10.5811/westjem.2019.7.42938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 07/09/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction Screening of patients for opioid risk has been recommended prior to opioid prescribing. Opioids are prescribed frequently in the emergency department (ED) setting, but screening tools are often of significant length and therefore limited in their utility. We describe and evaluate three approaches to shortening a screening tool: creation of a short form; curtailment; and stochastic curtailment. Methods To demonstrate the various shortening techniques, this retrospective study used data from two studies of ED patients for whom the provider was considering providing an opioid prescription and who completed the Screener and Opioid Assessment for Patients with Pain-Revised, a 24-item assessment. High-risk criteria from patients’ prescription drug monitoring program data were used as an endpoint. Using real-data simulation, we determined the sensitivity, specificity, and test length of each shortening technique. Results We included data from 188 ED patients. The original screener had a test length of 24 questions, a sensitivity of 44% and a specificity of 76%. The 12-question short form had a sensitivity of 41% and specificity of 75%. Curtailment and stochastic curtailment reduced the question length (mean test length ranging from 8.1–19.7 questions) with no reduction in sensitivity or specificity. Conclusion In an ED population completing computer-based screening, the techniques of curtailment and stochastic curtailment markedly reduced the screening tool’s length but had no effect on test characteristics. These techniques can be applied to improve efficiency of screening patients in the busy ED environment without sacrificing sensitivity or specificity.
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Affiliation(s)
- Scott G Weiner
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Jason A Hoppe
- University of Colorado Denver School of Medicine, Department of Emergency Medicine, Aurora, Colorado
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Arthur J, Bruera E. Balancing opioid analgesia with the risk of nonmedical opioid use in patients with cancer. Nat Rev Clin Oncol 2019; 16:213-226. [PMID: 30514978 DOI: 10.1038/s41571-018-0143-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The current opioid crisis has brought renewed attention and scrutiny to opioid prescriptions. When patients receiving opioid therapy for pain engage in nonmedical opioid use (NMOU) or diversion, untoward consequences can occur. New evidence suggests that patients with cancer might be at a higher risk of NMOU than was previously thought, but clinical evidence still supports the use of opioid analgesics as the gold standard to treat cancer-related pain, creating a dilemma in patient management. Clinicians are encouraged to adopt a universal precautions approach to patients with cancer receiving opioids, which includes screening all patients; discussing the risks, benefits, adverse effects and alternatives of opioid therapy; and providing education on safe use, storage and disposal. Use of urine drug tests, prescription drug monitoring programmes and close observation of behaviours related to opioid use help to ensure treatment adherence, detect NMOU and support therapeutic decision-making. These measures can optimize the risk-benefit ratio while supporting safe opioid use. In this Review, we examine the role of opioids in cancer pain, the risk of substance use disorder and methods to achieve the right balance between the two in order to ensure safe opioid use.
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Affiliation(s)
- Joseph Arthur
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer, Houston, TX, USA.
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Pergolizzi JV, Lequang JA, Passik S, Coluzzi F. Using opioid therapy for pain in clinically challenging situations: questions for clinicians. Minerva Anestesiol 2019; 85:899-908. [DOI: 10.23736/s0375-9393.19.13321-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Koyyalagunta D, Bruera E, Engle MP, Driver L, Dong W, Demaree C, Novy DM. Compliance with Opioid Therapy: Distinguishing Clinical Characteristics and Demographics Among Patients with Cancer Pain. PAIN MEDICINE 2019; 19:1469-1477. [PMID: 29016951 DOI: 10.1093/pm/pnx178] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Because an increase of patients who misuse opioids has been identified in our cancer clinical setting through urine drug testing (UDT) and the Screener and Opioid Assessment for Patient's with Pain-Short Form (SOAPP-SF), we conducted this retrospective cohort study to identify patient characteristics that are associated with UDT that indicates noncompliance. Methods Over a two-year period, 167 of 8,727 patients (2.4%) seen in the pain clinic and who underwent UDT were evaluated to determine compliance with prescribed opioid regimens. Descriptive clinical and demographic data were collected, and group differences based on compliance with opioid therapy were evaluated. Results Fifty-eight percent of the patients were noncompliant with their prescribed opioid therapy. Noncompliant patients were younger than compliant patients, with a median age of 46 vs 49 years (P = 0.0408). Noncompliant patients were more likely to have higher morphine equivalent daily doses; however, the difference was not statistically significant. Patients with a history of alcohol (ETOH) (P = 0.0332), illicit drug use (P = 0.1014), and smoking (P = 0.4184) were more likely noncompliant. Univariate regression analysis showed that a history of ETOH use (P = 0.034), a history of anxiety (P = 0.027), younger age (P = 0.07), and a SOAPP-SF score of 4 or higher (P = 0.05) were associated with an abnormal UDT. Conclusions History of ETOH use, anxiety, high SOAPP-SF score, and younger age were associated with UDT that indicates noncompliance. Given the very small percentage of UDT testing, it is quite likely that a significant number of patients who did not undergo UDT were also nonadherent with treatment recommendations.
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Affiliation(s)
| | | | | | | | - Wenli Dong
- Statistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chris Demaree
- Tulane University School of Medicine, New Orleans, Louisiana, USA
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Wawrzyniak KM, Finkelman M, Schatman ME, Kulich RJ, Weed VF, Myrta E, DiBenedetto DJ. The World Health Organization Disability Assessment Schedule-2.0 (WHODAS 2.0) in a chronic pain population being considered for chronic opioid therapy. J Pain Res 2019; 12:1855-1862. [PMID: 31354334 PMCID: PMC6573777 DOI: 10.2147/jpr.s207870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 05/23/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose To examine the validity of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for the assessment of function in a community-based sample of patients with chronic pain conditions undergoing evaluation for chronic opioid therapy. Patients and methods One hundred nine of 124 patients were evaluated for a chronic opioid therapy program between December 1, 2014 and April 10, 2015, inclusive, at one community-based interdisciplinary pain management practice. Measures included: demographic data; the WHODAS 2.0; a modified version of the Roland Morris Disability Questionnaire (RMDQ-m); the Patient Health Questionnaire-9 item (PHQ-9); the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R); the Current Opioid Misuse Measure (COMM), the Opioid Risk Tool (ORT); opioid dose. These data were collected as part of routine care, and this retrospective chart review study examined the data from this convenience sample, comparing the results of each assessment tool to the results of the WHODAS 2.0. Results Median score on the WHODAS 2.0 was 25.69 (IQR=16.01 to 35.28). WHODAS 2.0 score was significantly correlated with the RMDQ-m (rs=0.69, p<0.001), the PHQ-9 (rs=0.68, p<0.001), the COMM (rs=0.52, p<0.001) and the SOAPP-R (rs=0.51, p<0.001). There was no significant correlation between the WHODAS 2.0 and the ORT (rs=0.14, p=0.12) or opioid dose (rs=0.07, p=0.47). Conclusions The WHODAS 2.0 was significantly positively correlated with other measures, including measures of disability, risk of opioid misuse, and depression among patients being evaluated for chronic opioid therapy. The WHODAS 2.0 may be a useful measure of disability across a number of important domains when discussing expectations of both patients and providers at initiation of opioid therapy for chronic pain management. This assessment and discussion is crucial, particularly given the focus on function, rather than analgesia alone, when evaluating the effectiveness of opioid treatment.
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Affiliation(s)
- Kelly M Wawrzyniak
- Boston PainCare Center, Waltham, MA 02451, USA.,Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA 02111, USA
| | - Matthew Finkelman
- Division of Biostatistics and Experimental Design, Tufts University School of Dental Medicine, Boston, MA 02111, USA
| | - Michael E Schatman
- Boston PainCare Center, Waltham, MA 02451, USA.,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Ronald J Kulich
- Boston PainCare Center, Waltham, MA 02451, USA.,Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA 02111, USA
| | - Valerie F Weed
- Primary Care Psychology Associates, LLC, Northbrook, IL 60062, USA
| | - Eura Myrta
- Boston PainCare Center, Waltham, MA 02451, USA
| | - David J DiBenedetto
- Boston PainCare Center, Waltham, MA 02451, USA.,Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA 02111, USA
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Abstract
PURPOSE OF REVIEW The purpose of this review is to explore the effects of the opioid crisis on pediatric patients in the postoperative setting and provide recommendations for well-tolerated opioid prescribing practices. RECENT FINDINGS Opioid overdoses have increased among all age groups, predominantly related to overprescribing and accessibility of opioids in the home. Adverse risks of prescribed opioids include respiratory depression, gastrointestinal distress, accidental ingestion, intentional misuse, new chronic use, diversion to another user, and overdose. Well-tolerated opioid prescribing practices include multimodal pain management; prescribing guided by patient need; risk assessment for potential misuse; and comprehensive patient and family education on risks, safe storage, and disposal practices. Evolving state laws will affect varying institutional policies; thus, providers must ensure their prescribing practices are current and compliant. SUMMARY All age groups have been affected by the opioid crisis, including children and adolescents. When managing postoperative pain, clinicians must balance appropriate pain management with well-tolerated opioid stewardship to minimize harm related to postoperative care.
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Alzeer AH, Jones J, Bair MJ. Review of Factors, Methods, and Outcome Definition in Designing Opioid Abuse Predictive Models. PAIN MEDICINE 2019; 19:997-1009. [PMID: 29016966 DOI: 10.1093/pm/pnx149] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective Several opioid risk assessment tools are available to prescribers to evaluate opioid analgesic abuse among chronic patients. The objectives of this study are to 1) identify variables available in the literature to predict opioid abuse; 2) explore and compare methods (population, database, and analysis) used to develop statistical models that predict opioid abuse; and 3) understand how outcomes were defined in each statistical model predicting opioid abuse. Design The OVID database was searched for this study. The search was limited to articles written in English and published from January 1990 to April 2016. This search generated 1,409 articles. Only seven studies and nine models met our inclusion-exclusion criteria. Results We found nine models and identified 75 distinct variables. Three studies used administrative claims data, and four studies used electronic health record data. The majority, four out of seven articles (six out of nine models), were primarily dependent on the presence or absence of opioid abuse or dependence (ICD-9 diagnosis code) to define opioid abuse. However, two articles used a predefined list of opioid-related aberrant behaviors. Conclusions We identified variables used to predict opioid abuse from electronic health records and administrative data. Medication variables are the recurrent variables in the articles reviewed (33 variables). Age and gender are the most consistent demographic variables in predicting opioid abuse. Overall, there is similarity in the sampling method and inclusion/exclusion criteria (age, number of prescriptions, follow-up period, and data analysis methods). Intuitive research to utilize unstructured data may increase opioid abuse models' accuracy.
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Affiliation(s)
- Abdullah H Alzeer
- Indiana University School of Informatics and Computing, Indianapolis, Indiana
| | - Josette Jones
- Indiana University School of Informatics and Computing, Indianapolis, Indiana.,Regenstrief Institute, Indianapolis, Indiana.,Indiana University School of Nursing, Indianapolis, Indiana
| | - Matthew J Bair
- Regenstrief Institute, Indianapolis, Indiana.,Richard L. Roudebush VA Medical Center, Center for Health Information and Communication (CHIC), Indianapolis, Indiana.,Indiana University School of Medicine, Indianapolis, Indiana, USA
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Abstract
PURPOSE We aimed to produce comprehensive guidelines and recommendations that can be utilized by orthopaedic practices as well as other specialties to improve the management of acute pain following musculoskeletal injury. METHODS A panel of 15 members with expertise in orthopaedic trauma, pain management, or both was convened to review the literature and develop recommendations on acute musculoskeletal pain management. The methods described by the Grading of Recommendations Assessment, Development, and Evaluation Working Group were applied to each recommendation. The guideline was submitted to the Orthopaedic Trauma Association (OTA) for review and was approved on October 16, 2018. RESULTS We present evidence-based best practice recommendations and pain medication recommendations with the hope that they can be utilized by orthopaedic practices as well as other specialties to improve the management of acute pain following musculoskeletal injury. Recommendations are presented regarding pain management, cognitive strategies, physical strategies, strategies for patients on long term opioids at presentation, and system implementation strategies. We recommend the use of multimodal analgesia, prescribing the lowest effective immediate-release opioid for the shortest period possible, and considering regional anesthesia. We also recommend connecting patients to psychosocial interventions as indicated and considering anxiety reduction strategies such as aromatherapy. Finally, we also recommend physical strategies including ice, elevation, and transcutaneous electrical stimulation. Prescribing for patients on long term opioids at presentation should be limited to one prescriber. Both pain and sedation should be assessed regularly for inpatients with short, validated tools. Finally, the group supports querying the relevant regional and state prescription drug monitoring program, development of clinical decision support, opioid education efforts for prescribers and patients, and implementing a department or organization pain medication prescribing strategy or policy. CONCLUSIONS Balancing comfort and patient safety following acute musculoskeletal injury is possible when utilizing a true multimodal approach including cognitive, physical, and pharmaceutical strategies. In this guideline, we attempt to provide practical, evidence-based guidance for clinicians in both the operative and non-operative settings to address acute pain from musculoskeletal injury. We also organized and graded the evidence to both support recommendations and identify gap areas for future research.
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Lawrence R, Mogford D, Colvin L. Systematic review to determine which validated measurement tools can be used to assess risk of problematic analgesic use in patients with chronic pain. Br J Anaesth 2019; 119:1092-1109. [PMID: 28981581 DOI: 10.1093/bja/aex316] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2017] [Indexed: 12/27/2022] Open
Abstract
Background Misuse of prescription opioids, and other drugs prescribed for chronic pain, has increased, with major concerns about harm. This review was undertaken to identify validated measurement tools for risk assessment and monitoring of chronic non-cancer pain patients being considered for, or currently prescribed, analgesic drugs with abuse potential. Methods Selected databases (Embase, Medline, Cochrane library/CENTRAL, PsycINFO, PubMed, CINAHL) were systematically searched for studies evaluating tools for risk of analgesic misuse, either before, or during, analgesic therapy for chronic pain, using predetermined inclusion/exclusion criteria. Two independent reviewers assessed abstracts, selected full texts, extracted data and assessed quality. Results 30 studies from 1844 met inclusion criteria, including three systematic reviews, with an additional four studies from bibliography review. The studies covered 14 tools pertaining to opioid use, with none for non-opioid analgesics. Conclusions For predicting prescription opioid misuse, the pain medication questionnaire (PMQ) and the screener and opioid assessment for patients with pain (SOAPP) had the best evidence; both developed and validated in five separate studies (four each of acceptable quality). The current opioid misuse measure (COMM) performed best screening for current misuse, developed and validated in three studies of acceptable quality. A small number of tools may accurately predict, or identify, opioid misuse. There are none for non-opioid analgesics, where there is a potential need.
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Affiliation(s)
- R Lawrence
- Ritson Clinic, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh EH10 5HF, UK
| | - D Mogford
- Ritson Clinic, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh EH10 5HF, UK
| | - L Colvin
- Department of Anaesthesia, Critical Care & Pain Medicine, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh EH4 2XU, UK
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Guillou Landreat M, Deriennic J, Brunault P, Challet Bouju G, Gallopel Morvan K, Grall Bronnec M. [Gambling marketing: a public health concern ?]. Presse Med 2019; 48:347-352. [PMID: 30956038 DOI: 10.1016/j.lpm.2019.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 10/18/2018] [Accepted: 02/11/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Morgane Guillou Landreat
- Hôpital de la Cavale Blanche, addictologie de liaison, boulevard Tanguy Prigent, 29200 Brest, France.
| | - Jeremy Deriennic
- EA 7479 SPURBO, Faculté de médecine de brest, rue camille-desmoulins, 29200 Brest, France
| | - Paul Brunault
- Addictologie, CHRU tours, 37044 Tours cedex 9, France
| | | | - Karine Gallopel Morvan
- Hôpital de la Cavale Blanche, addictologie de liaison, boulevard Tanguy Prigent, 29200 Brest, France
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Arthur J, Reddy A. Opioid Prescribing in an Opioid Crisis: What Basic Skills Should an Oncologist Have Regarding Opioid Therapy? Curr Treat Options Oncol 2019; 20:39. [PMID: 30937544 DOI: 10.1007/s11864-019-0636-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OPINION STATEMENT Although clinical evidence supports the use of opioids for cancer-related pain, doing so amidst the current opioid crisis remains a challenge. A proportion of opioid-related deaths in the USA are attributable to prescription opioids, which implicates health care providers as one of the major contributors. It is therefore even more important now for all clinicians to follow safe and effective opioid prescribing practices. Oncologists are often in the frontline of cancer pain management. They are encouraged to use validated tools to screen all patients receiving opioids for high risk behaviors. Those identified as high risk for potential abuse of opioids should be monitored closely. When aberrant behavior is detected, the clinician will need to openly discuss the issue and its possible implications. Oncologists may then implement measures such as limiting the dose and quantity of opioids prescribed, shortening interval between follow-ups for refills to allow for increased monitoring, setting boundaries/limitations, weaning off opioid analgesics, or/and referring to a pain or palliative medicine or drug addiction expert for co-management when necessary. These efforts may aid oncologists in safely managing cancer pain in the environment of national opioid crisis.
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Affiliation(s)
- Joseph Arthur
- Department of Palliative, Rehabilitation, & Integrative Medicine, The University of Texas MD Anderson Cancer, Unit 1414, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Akhila Reddy
- Department of Palliative, Rehabilitation, & Integrative Medicine, The University of Texas MD Anderson Cancer, Unit 1414, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
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Bruehl S, Stone AL, Palmer C, Edwards DA, Buvanendran A, Gupta R, Chont M, Kennedy M, Burns JW. Self-reported cumulative medical opioid exposure and subjective responses on first use of opioids predict analgesic and subjective responses to placebo-controlled opioid administration. Reg Anesth Pain Med 2019; 44:92-99. [PMID: 30640659 PMCID: PMC10853921 DOI: 10.1136/rapm-2018-000008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/11/2018] [Accepted: 05/16/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES To expand the evidence base needed to enable personalized pain medicine, we evaluated whether self-reported cumulative exposure to medical opioids and subjective responses on first opioid use predicted responses to placebo-controlled opioid administration. METHODS In study 1, a survey assessing cumulative medical opioid exposure and subjective responses on first opioid use was created (History of Opioid Medical Exposure (HOME)) and psychometric features documented in a general sample of 307 working adults. In study 2, 49 patients with chronic low back pain completed the HOME and subsequently rated back pain intensity and subjective opioid effects four times after receiving saline placebo or intravenous morphine (four incremental doses) in two separate double-blinded laboratory sessions. Placebo-controlled morphine effects were derived for all outcomes. RESULTS Two HOME subscales were supported: cumulative opioid exposure and euphoric response, both demonstrating high test-retest reliability (Intraclass Correlation Coefficients > 0.93) and adequate internal consistency (Revelle's Omega Total = 0.73-0.77). In study 2, higher cumulative opioid exposure scores were associated with significantly greater morphine-related reductions in back pain intensity (p=0.02), but not with subjective drug effects. Higher euphoric response subscale scores were associated with significantly lower overall perceived morphine effect (p=0.003), less sedation (p=0.04), greater euphoria (p=0.03) and greater desire to take morphine again (p=0.02). DISCUSSION Self-reports of past exposure and responses to medical opioid analgesics may have utility for predicting subsequent analgesic responses and subjective effects. Further research is needed to establish the potential clinical and research utility of the HOME. TRIAL REGISTRATION NUMBER NCT02469077.
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Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amanda L Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Cassandra Palmer
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David A Edwards
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Rajnish Gupta
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melissa Chont
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mary Kennedy
- Department of Behavioral Science, Rush University, Chicago, Illinois, USA
| | - John W Burns
- Department of Behavioral Science, Rush University, Chicago, Illinois, USA
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Dalal S, Bruera E. Pain Management for Patients With Advanced Cancer in the Opioid Epidemic Era. Am Soc Clin Oncol Educ Book 2019; 39:24-35. [PMID: 31099619 DOI: 10.1200/edbk_100020] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Use of opioids for the treatment of pain is necessary for the majority of patients with advanced cancer, however its use has become challenging in the face of the opioid epidemic and the emerging evidence that patients with cancer are also at risk for nonmedical opioid use. This article proposes an assessment and treatment plan that incorporates universal screening with monitoring for all patients with cancer who are considered for opioid treatment to assess their risk for opioid misuse and harm. Timely identification with appropriate management, including referral of at-risk patients, will allow oncology professionals to optimize the risk-to-benefit and support the safe use of opioids for patients with cancer.
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Affiliation(s)
- Shalini Dalal
- 1 From the Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- 1 From the Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Varney SM, Perez CA, Araña AA, Carey KR, Ganem VJ, Zarzabal LA, Ramos RG, Bebarta VS. Detecting aberrant opioid behavior in the emergency department: a prospective study using the screener and Opioid Assessment for Patients with Pain-Revised (SOAPP ®-R), Current Opioid Misuse Measure (COMM)™, and provider gestalt. Intern Emerg Med 2018; 13:1239-1247. [PMID: 29502329 DOI: 10.1007/s11739-018-1804-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 02/25/2018] [Indexed: 01/13/2023]
Abstract
Emergency department (ED) providers have limited time to evaluate patients at risk for opioid misuse. A validated tool to assess the risk for aberrant opioid behavior may mitigate adverse sequelae associated with prescription opioid misuse. We sought to determine if SOAPP-R, COMM, and provider gestalt were able to identify patients at risk for prescription opioid misuse as determined by pharmacy records at 12 months. We conducted a prospective observational study of adult patients in a high volume US ED. Patients completed the SOAPP-R and COMM, and treating EM providers evaluated patients' opioid misuse risk. We performed variable-centered, person-centered, and hierarchical cluster analyses to determine whether provider gestalt, SOAPP-R, or COMM, or a combination, predicted higher misuse risk. The primary outcome was the number of opioid prescriptions at 12 months according to pharmacy records. For 169 patients (mean age 43 years, 51% female, 73% white), correlation analysis showed a strong relationship between SOAPP-R and COMM with predicting the number of opioid prescriptions dispensed at 12 months. Provider scores estimating opioid misuse were not related to SOAPP-R and only weakly associated with COMM. In our adjusted regression models, provider gestalt and SOAPP-R uniquely predicted opioid prescriptions at 6 and 12 months. Using designated cutoff scores, only SOAPP-R detected a difference in the number of opioid prescriptions. Cluster analysis revealed that provider gestalt, SOAPP-R, and COMM scores jointly predicted opioid prescriptions. Provider gestalt and self-report instruments uniquely predicted the number of opioid prescriptions in ED patients. A combination of gestalt and self-assessment scores can be used to identify at-risk patients who otherwise miss the cutoff scores for SOAPP-R and COMM.
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Affiliation(s)
- Shawn M Varney
- University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229-3900, USA.
| | - Crystal A Perez
- USAF En Route Care Research Center, U.S. Army Institute of Surgical Research, 3698 Chambers Pass STE B, JBSA Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Allyson A Araña
- USAF En Route Care Research Center, U.S. Army Institute of Surgical Research, 3698 Chambers Pass STE B, JBSA Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Katherine R Carey
- The Geneva Foundation, San Antonio Military Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA
| | - Victoria J Ganem
- The Geneva Foundation, San Antonio Military Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA
| | - Lee A Zarzabal
- STS Systems Integration, 1077 Central Pkwy S, San Antonio, TX, 78232, USA
| | - Rosemarie G Ramos
- University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229-3900, USA
| | - Vikhyat S Bebarta
- University of Colorado-Denver-Anschutz Medical Campus, 13001 E 17th Place, Aurora, CO, 80045, USA
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Peck KR, Harman JL, Anghelescu DL. Provision of Adequate Pain Management to a Young Adult Oncology Patient Presenting with Aberrant Opioid-Associated Behavior: A Case Study. J Adolesc Young Adult Oncol 2018; 8:221-224. [PMID: 30335554 DOI: 10.1089/jayao.2018.0093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Pain and emotional distress are relevant risk factors as clinicians assess for aberrant opioid-associated behavior and provide adequate and responsible pain relief to patients who engage in behaviors that may be interpreted as drug seeking in nature. The present case illustrates how undertreated pain and treatment-related anxiety affected the opioid use of a young adult with cancer. Because these risk factors were identified during the initial consult, the treatment team was able to implement a multimodal and multidisciplinary treatment approach that provided the patient with better analgesia and coping skills for anxiety.
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Affiliation(s)
- Kelly R Peck
- 1 Department of Psychology, University of Mississippi , University, Mississippi.,2 Vermont Center on Behavior and Health, University of Vermont , Burlington, Vermont
| | - Jennifer L Harman
- 3 Department of Psychology, St. Jude Children's Research Hospital , Memphis, Tennessee
| | - Doralina L Anghelescu
- 4 Division of Anesthesiology, Department of Pediatric Medicine, St. Jude Children's Research Hospital , Memphis, Tennessee
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A Biopsychosocial Approach to Managing HIV-Related Pain and Associated Substance Abuse in Older Adults: a Review. AGEING INTERNATIONAL 2018. [DOI: 10.1007/s12126-018-9333-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Black RA, McCaffrey SA, Villapiano AJ, Jamison RN, Butler SF. Development and Validation of an Eight-Item Brief Form of the SOAPP-R (SOAPP-8). PAIN MEDICINE 2018; 19:1982-1987. [PMID: 29024987 DOI: 10.1093/pm/pnx194] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective Although the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) has become a widely used screener for aberrant opioid-related behavior in adults, the length of the instrument may limit its utility. The purpose of the current study was to develop a short form of the SOAPP-R by retaining as few items as possible while maximizing predictive accuracy. Methods Participants (N = 555), recruited from pain clinics, completed the 24-item SOAPP-R and participated in a five-month follow-up visit to evaluate aberrant drug-related behaviors. Opioid aberrant-related behavior was determined through self-report, physician report, and urine toxicology screen. The optimal subset of SOAPP-R items to predict aberrant opioid-related behavior was identified empirically by employing the LASSO selection method and the leave-one-out cross-validation (LOOCV) method offered in the GLMSELECT procedure in SAS 9.4 in conjunction with content expertise. Results Eight items were identified before the selection method stopped. The receiver operating characteristic curve generated from the predicted probabilities from the model produced an area under the curve (AUC) value greater than the AUC value produced by the 24-item SOAPP-R total score and yielded a sensitivity of 0.74 and a specificity of 0.66. Conclusions These results provide strong preliminary support for the SOAPP-8 as a brief screening tool of aberrant opioid-related behavior in chronic pain patients.
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Affiliation(s)
| | | | | | - Robert N Jamison
- Anesthesia and Psychiatry, Brigham and Women's Hospital, Boston, MA
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King M. Working to Address the Loneliness Epidemic: Perspective-Taking, Presence, and Self-Disclosure. Am J Health Promot 2018; 32:1315-1317. [DOI: 10.1177/0890117118776735c] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bruce RD, Merlin J, Lum PJ, Ahmed E, Alexander C, Corbett AH, Foley K, Leonard K, Treisman GJ, Selwyn P. 2017 HIVMA of IDSA Clinical Practice Guideline for the Management of Chronic Pain in Patients Living With HIV. Clin Infect Dis 2018; 65:e1-e37. [PMID: 29020263 DOI: 10.1093/cid/cix636] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/19/2017] [Indexed: 12/27/2022] Open
Abstract
Pain has always been an important part of human immunodeficiency virus (HIV) disease and its experience for patients. In this guideline, we review the types of chronic pain commonly seen among persons living with HIV (PLWH) and review the limited evidence base for treatment of chronic noncancer pain in this population. We also review the management of chronic pain in special populations of PLWH, including persons with substance use and mental health disorders. Finally, a general review of possible pharmacokinetic interactions is included to assist the HIV clinician in the treatment of chronic pain in this population.It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of American considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- R Douglas Bruce
- Department of Medicine, Cornell Scott-Hill Health Center and Yale University, New Haven, Connecticut
| | - Jessica Merlin
- Divisions of Infectious Diseases and Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham
| | - Paula J Lum
- Division of HIV, Infectious Disease, and Global Medicine, University of California San Francisco
| | - Ebtesam Ahmed
- St. Johns University College of Pharmacy and Health Sciences, Metropolitan Jewish Health System Institute for Innovation in Palliative Care, New York
| | - Carla Alexander
- University of Maryland School of Medicine, Institute of Human Virology, Baltimore
| | - Amanda H Corbett
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Kathleen Foley
- Attending Neurologist Emeritus, Memorial Sloan Kettering Cancer Center, New York
| | - Kate Leonard
- Division of Neuroscience and Clinical Pharmacology, Cornell University, New York, New York
| | | | - Peter Selwyn
- Department of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Finkelman MD, Smits N, Kulich RJ, Zacharoff KL, Magnuson BE, Chang H, Dong J, Butler SF. Development of Short-Form Versions of the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R): A Proof-of-Principle Study. PAIN MEDICINE 2018; 18:1292-1302. [PMID: 27605589 DOI: 10.1093/pm/pnw210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) is a 24-item questionnaire designed to assess risk of aberrant medication-related behaviors in chronic pain patients. The introduction of short forms of the SOAPP-R may save time and increase utilization by practitioners. Objective To develop and evaluate candidate SOAPP-R short forms. Design Retrospective study. Setting Pain centers. Subjects Four hundred and twenty-eight patients with chronic noncancer pain. Methods Subjects had previously been administered the full-length version of the SOAPP-R and been categorized as positive or negative for aberrant medication-related behaviors via the Aberrant Drug Behavior Index (ADBI). Short forms of the SOAPP-R were developed using lasso logistic regression. Sensitivity, specificity, and area under the curve (AUC) of all forms were calculated with respect to the ADBI using the complete data set, training-test analysis, and 10-fold cross-validation. The coefficient alpha of each form was also calculated. An external set of 12 pain practitioners reviewed the forms for content. Results In the complete data set analysis, a form of 12 items exhibited sensitivity, specificity, and AUC greater than or equal to those of the full-length SOAPP-R (which were 0.74, 0.67, and 0.76, respectively). The short form had a coefficient alpha of 0.76. In the training-test analysis and 10-fold cross-validation, it exhibited an AUC value within 0.01 of that of the full-length SOAPP-R. The majority of external practitioners reported a preference for this short form. Conclusions The 12-item version of the SOAPP-R has potential as a short risk screener and should be tested prospectively.
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Affiliation(s)
- Matthew D Finkelman
- Department of Public Health and Community Service, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Niels Smits
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Ronald J Kulich
- Craniofacial Pain and Headache Center, Tufts University School of Dental Medicine, Boston, Massachusetts, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Britta E Magnuson
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Hong Chang
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jinghui Dong
- Sackler School of Graduate Biomedical Sciences, Boston, Massachusetts, USA
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Ramzan AA, Fischer S, Buss MK, Urban RR, Patsner B, Duska LR, Fisher CM, Lefkowits C. Opioid use in gynecologic oncology in the age of the opioid epidemic: Part II – Balancing safety & accessibility. Gynecol Oncol 2018; 149:401-409. [DOI: 10.1016/j.ygyno.2018.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/09/2018] [Accepted: 02/12/2018] [Indexed: 12/15/2022]
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Pergolizzi JV, Taylor R, LeQuang JA, Raffa RB. Managing severe pain and abuse potential: the potential impact of a new abuse-deterrent formulation oxycodone/naltrexone extended-release product. J Pain Res 2018; 11:301-311. [PMID: 29445297 PMCID: PMC5810535 DOI: 10.2147/jpr.s127602] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Proper management of severe pain represents one of the most challenging clinical dilemmas. Two equally important goals must be attained: the humanitarian/medical goal to relieve suffering and the societal/legal goal to not contribute to the drug abuse problem. This is an age-old problem, and the prevailing emphasis placed on one or the other goal has resulted in pendulum swings that have resulted in either undertreatment of pain or the current epidemic of misuse and abuse. In an effort to provide efficacious strong pain relievers (opioids) that are more difficult to abuse by the most dangerous routes of administration, pharmaceutical companies are developing products in which the opioid is manufactured in a formulation that is designed to be tamper resistant. Such a product is known as an abuse-deterrent formulation (ADF). ADF opioid products are designed to deter or resist abuse by making it difficult to tamper with the product and extracting the opioid for inhalation or injection. To date, less than a dozen opioid formulations have been approved by the US Food and Drug Administration to carry specific ADF labeling, but this number will likely increase in the coming years. Most of these products are extended-release formulations.
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Affiliation(s)
| | | | | | - Robert B Raffa
- University of Arizona College of Pharmacy, Tucson, AZ, USA.,Temple University School of Pharmacy, Philadelphia, PA, USA
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Peck KR, Harman JL, Anghelescu DL. Family and Peer-Group Substance Abuse as a Risk-Factor for Opioid Misuse Behaviors for a Young Adult with Cancer-Related Pain—A Case Study. J Adolesc Young Adult Oncol 2018; 7:137-140. [DOI: 10.1089/jayao.2017.0055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kelly R. Peck
- Department of Psychology, University of Mississippi, University, Mississippi
| | - Jennifer L. Harman
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Doralina L. Anghelescu
- Division of Anesthesiology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
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Averill LA, Averill CL, Staley LA, Ozawa-Kirk JL, Kauwe JS, Henrie-Barrus P. The Opioid Abuse Risk Screener predicts aberrant same-day urine drug tests and 1-year controlled substance database checks: A brief report. Health Psychol Open 2018; 4:2055102917748459. [PMID: 29379630 PMCID: PMC5779942 DOI: 10.1177/2055102917748459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The Opioid Abuse Risk Screener was developed to support well-informed decision-making in opioid analgesic prescribing by extending the breadth of psychiatric risk factors evaluated relative to other non–clinician-administered measures. We examined the preliminary predictive validity of the Opioid Abuse Risk Screener relative to the widely used Screener and Opioid Assessment for Patients with Pain–Revised in predicting aberrant urine drug tests and controlled substance database checks. The Opioid Abuse Risk Screener is significantly different from the Screener and Opioid Assessment for Patients with Pain–Revised in predicting aberrant same-day urine drug tests (Z = 2.912, p = 0.0036) and controlled substance database checks within 1 year of assessment (Z = 3.731, p = 0.0002). Promising preliminary analyses using machine learning methods are also discussed.
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