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Brannon KJ, Felix ZP, Meyers KR, Stamey HM, Spilman SK. Nursing and Chaplain Partnership for Pain Management: A Survey of Nurses. Pain Manag Nurs 2024:S1524-9042(24)00184-X. [PMID: 38906727 DOI: 10.1016/j.pmn.2024.05.011] [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: 02/27/2024] [Revised: 05/08/2024] [Accepted: 05/19/2024] [Indexed: 06/23/2024]
Abstract
PURPOSE Pain is a universal experience for hospitalized patients, with physical, psychological, spiritual, and cognitive implications. As hospitals seek to identify nonpharmaceutical options for managing acute pain, the role of chaplains has been overlooked. The purpose of this study was to evaluate the perceptions of nurses regarding chaplain involvement in pain management. METHODS A survey was distributed to nurses to determine if they would request spiritual care services in various patient and family scenarios. Respondents were dichotomized into two groups based on self-report of whether they would contact a chaplain for patients with uncontrolled pain. Differences between groups were calculated using chi-square tests. RESULTS Of 45 nurse respondents, 27 (60%) reported they would not contact a chaplain for patients with uncontrolled pain. Nurses who would consult the chaplain for pain management did not differ from nurses who would not consult the chaplain in terms of their own religious identification, knowledge of patient religious documentation in the medical record, or past experience with chaplain services. CONCLUSIONS Study findings suggest that nurses' perceptions of chaplain involvement in pain management must be addressed prior to implementing a new hospital pain management protocol. CLINICAL IMPLICATIONS When developing and implementing new pain protocols based on holistic care of patients, hospitals should ensure that nursing staff are educated on when and how to incorporate chaplains as part of a holistic approach to managing acute pain.
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Beaulieu-Jones BR, Berrigan MT, Marwaha JS, Robinson KA, Nathanson LA, Fleishman A, Brat GA. Postoperative Opioid Prescribing via Rule-Based Guidelines Derived from In-Hospital Consumption: An Assessment of Efficacy Based on Postdischarge Opioid Use. J Am Coll Surg 2024; 238:1001-1010. [PMID: 38525970 DOI: 10.1097/xcs.0000000000001084] [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: 03/26/2024]
Abstract
BACKGROUND Many institutions have developed operation-specific guidelines for opioid prescribing. These guidelines rarely incorporate in-hospital opioid consumption, which is highly correlated with consumption. We compare outcomes of several patient-centered approaches to prescribing that are derived from in-hospital consumption, including several experimental, rule-based prescribing guidelines and our current institutional guideline. STUDY DESIGN We performed a retrospective, cohort study of all adults undergoing surgery at a single-academic medical center. Several rule-based guidelines, derived from in-hospital consumption (quantity of opioids consumed within 24 hours of discharge), were used to specify the theoretical quantity of opioid prescribed on discharge. The efficacy of the experimental guidelines was compared with 3 references: an approximation of our institution's tailored prescribing guideline; prescribing all patients the typical quantity of opioids consumed for patients undergoing the same operation; and a representative rule-based, tiered framework. For each scenario, we calculated the penalized residual sum of squares (reflecting the composite deviation from actual patient consumption, with 15% penalty for overprescribing) and the proportion of opioids consumed relative to prescribed. RESULTS A total of 1,048 patients met inclusion criteria. Mean (SD) and median (interquartile range [IQR]) quantity of opioids consumed within 24 hours of discharge were 11.2 (26.9) morphine milligram equivalents and 0 (0 to 15) morphine milligram equivalents. Median (IQR) postdischarge consumption was 16 (0 to 150) morphine milligram equivalents. Our institutional guideline and the previously validated rule-based guideline outperform alternate approaches, with median (IQR) differences in prescribed vs consumed opioids of 0 (-60 to 27.25) and 37.5 (-37.5 to 37.5), respectively, corresponding to penalized residual sum of squares of 39,817,602 and 38,336,895, respectively. CONCLUSIONS Rather than relying on fixed quantities for defined operations, rule-based guidelines offer a simple yet effective method for tailoring opioid prescribing to in-hospital consumption.
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Affiliation(s)
- Brendin R Beaulieu-Jones
- From the Departments of Surgery (Beaulieu-Jones, Berrigan, Marwaha, Robinson, Fleishman, Brat), Beth Israel Deaconess Medical Center, Boston, MA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA (Beaulieu-Jones, Marwaha, Brat)
| | - Margaret T Berrigan
- From the Departments of Surgery (Beaulieu-Jones, Berrigan, Marwaha, Robinson, Fleishman, Brat), Beth Israel Deaconess Medical Center, Boston, MA
| | - Jayson S Marwaha
- From the Departments of Surgery (Beaulieu-Jones, Berrigan, Marwaha, Robinson, Fleishman, Brat), Beth Israel Deaconess Medical Center, Boston, MA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA (Beaulieu-Jones, Marwaha, Brat)
| | - Kortney A Robinson
- From the Departments of Surgery (Beaulieu-Jones, Berrigan, Marwaha, Robinson, Fleishman, Brat), Beth Israel Deaconess Medical Center, Boston, MA
| | - Larry A Nathanson
- Emergency Medicine (Nathanson), Beth Israel Deaconess Medical Center, Boston, MA
| | - Aaron Fleishman
- From the Departments of Surgery (Beaulieu-Jones, Berrigan, Marwaha, Robinson, Fleishman, Brat), Beth Israel Deaconess Medical Center, Boston, MA
| | - Gabriel A Brat
- From the Departments of Surgery (Beaulieu-Jones, Berrigan, Marwaha, Robinson, Fleishman, Brat), Beth Israel Deaconess Medical Center, Boston, MA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA (Beaulieu-Jones, Marwaha, Brat)
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Briley JD, Washington D, Westermeyer HD, Posner LP, Chiavaccini L. Comparison of a blind and an ultrasound-guided technique for Retrobulbar anesthesia in dogs undergoing unilateral subconjunctival enucleation. Vet Ophthalmol 2024; 27:79-85. [PMID: 37021439 DOI: 10.1111/vop.13092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/16/2023] [Accepted: 03/16/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE This study compared the quality of retrobulbar anesthesia using a blind inferior-temporal palpebral approach (ITP) with an ultrasound-guided supratemporal (ST) technique in dogs undergoing unilateral enucleation. ANIMAL STUDIED Twenty-one client-owned dogs were undergoing enucleation. PROCEDURES Dogs were randomly assigned to receive ITP (n = 10) or ST (n = 11) with 0.5% ropivacaine at 0.1 mL/cm of neurocranial length. The anesthetist was blinded to the technique. Intraoperative data included cardiopulmonary variables, inhalant anesthetics requirement, and requirement for rescue analgesia (intravenous fentanyl 2.5 mcg/kg). Postoperative data included pain scores, sedation scores, and need for intravenous hydromorphone (0.05 mg/kg). Treatments were compared using Wilcoxon's rank sum test or Fisher's exact test as appropriate. Comparison of variables over time were tested using a mixed effect linear model on rank. Significance was set at p = 0.05. RESULTS Intraoperative cardiopulmonary variables and inhalant requirements were not different between groups. Dogs receiving ITP required median (interquartile range, IQR) 1.25 (0, 2.5) mcg/kg intraoperative fentanyl while those receiving ST required none (p < 0.01). Intraoperative fentanyl was required in 5/10 and 0/11 of dogs in the ITP and ST groups, respectively (p = 0.01). Postoperative analgesia requirements were not significantly different between groups; 2/10 and 1/10 dogs in the ITP and ST groups, respectively. Sedation score negatively affected pain score (p < 0.01). CONCLUSIONS The ultrasound-guided ST technique was more effective at decreasing intraoperative opioid requirements than the blind ITP approach in dogs undergoing unilateral enucleation.
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Affiliation(s)
- Jessica D Briley
- Department of Molecular Biomedical Sciences, Anesthesiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | | | - Hans D Westermeyer
- Department of Clinical Sciences, Comparative Ophthalmology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Lysa P Posner
- Department of Molecular Biomedical Sciences, Anesthesiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Ludovica Chiavaccini
- Department of Comparative, Diagnostic and Population Medicine, Anesthesiology, College of Veterinary Medicine, University of Florida, Florida, Gainesville, USA
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King'uyu DN, Nti-Kyemereh L, Bonin JL, Feustel PJ, Tram M, MacNamara KC, Kopec AM. The effect of morphine on rat microglial phagocytic activity: An in vitro study of brain region-, plating density-, sex-, morphine concentration-, and receptor-dependency. J Neuroimmunol 2023; 384:578204. [PMID: 37774553 DOI: 10.1016/j.jneuroim.2023.578204] [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: 04/07/2023] [Revised: 07/24/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Abstract
Opioids have long been used for clinical pain management, but also have addictive properties that have contributed to the ongoing opioid epidemic. While opioid activation of opioid receptors is well known to contribute to reward and reinforcement, data now also suggest that opioid activation of immune signaling via toll-like receptor 4 (TLR4) may also play a role in addiction-like processes. TLR4 expression is enriched in immune cells, and in the nervous system is primarily expressed in microglia. Microglial phagocytosis is important for developmental, homeostatic, and pathological processes. To examine how morphine impacts microglial phagocytosis, we isolated microglia from adult male and female rat cortex and striatum and plated them in vitro at 10,000 (10K) or 50,000 cells/well densities. Microglia were incubated with neutral fluorescent microbeads to stimulate phagocytosis in the presence of one of four morphine concentrations. We found that the brain region from which microglia are isolated and plating density, but not morphine concentration, impacts cell survival in vitro. We found that 10-12 M morphine, but not higher concentrations, increases phagocytosis in striatal microglia in vitro independent of sex and plating density, while 10-12 M morphine increased phagocytosis in cortical microglia in vitro independent of sex, but contingent on a plating density. Finally, we demonstrate that the effect of 10-12 M morphine in striatal microglia plated at 10 K density is mediated via TLR4, and not μORs. Overall, our data suggest that in rats, a morphine-TLR4 signaling pathway increases phagocytic activity in microglia independent of sex. This may is useful information for better understanding the possible neural outcomes associated with morphine exposures.
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Affiliation(s)
- David N King'uyu
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY 12208, United States of America.
| | - Lily Nti-Kyemereh
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY 12208, United States of America; Siena College, Loudonville, NY 12211, United States of America
| | - Jesse L Bonin
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, NY 12208, United States of America
| | - Paul J Feustel
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY 12208, United States of America
| | - Michelle Tram
- Siena College, Loudonville, NY 12211, United States of America
| | - Katherine C MacNamara
- Department of Immunology and Microbial Disease, Albany Medical College, Albany, NY 12208, United States of America
| | - Ashley M Kopec
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY 12208, United States of America
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Ganaway A, Tatsuta K, Castillo VCG, Okada R, Sunaga Y, Ohta Y, Ohta J, Ohsawa M, Akay M, Akay YM. Investigating the Influence of Morphine and Cocaine on the Mesolimbic Pathway Using a Novel Microimaging Platform. Int J Mol Sci 2023; 24:16303. [PMID: 38003493 PMCID: PMC10671016 DOI: 10.3390/ijms242216303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
Dopamine (DA)'s relationship with addiction is complex, and the related pathways in the mesocorticolimbic system are used to deliver DA, regulating both behavioral and perceptual actions. Specifically, the mesolimbic pathway connecting the ventral tegmental area (VTA) and the nucleus accumbens (NAc) is crucial in regulating memory, emotion, motivation, and behavior due to its responsibility to modulate dopamine. To better investigate the relationship between DA and addiction, more advanced mapping methods are necessary to monitor its production and propagation accurately and efficiently. In this study, we incorporate dLight1.2 adeno-associated virus (AAV) into our latest CMOS (complementary metal-oxide semiconductor) imaging platform to investigate the effects of two pharmacological substances, morphine and cocaine, in the NAc using adult mice. By implanting our self-fabricated CMOS imaging device into the deep brain, fluorescence imaging of the NAc using the dLight1.2 AAV allows for the visualization of DA molecules delivered from the VTA in real time. Our results suggest that changes in extracellular DA can be observed with this adapted system, showing potential for new applications and methods for approaching addiction studies. Additionally, we can identify the unique characteristic trend of DA release for both morphine and cocaine, further validating the underlying biochemical mechanisms used to modulate dopaminergic activation.
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Affiliation(s)
- Austin Ganaway
- Biomedical Engineering Department, University of Houston, 3517 Cullen Blvd, Houston, TX 77204, USA; (A.G.); (M.A.)
| | - Kousuke Tatsuta
- Department of Neuropharmacology, Faculty of Pharmaceutical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (K.T.); (M.O.)
| | - Virgil Christian Garcia Castillo
- Division of Materials Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma 630-0101, Japan; (V.C.G.C.); (R.O.); (Y.S.); (Y.O.); (J.O.)
| | - Ryoma Okada
- Division of Materials Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma 630-0101, Japan; (V.C.G.C.); (R.O.); (Y.S.); (Y.O.); (J.O.)
| | - Yoshinori Sunaga
- Division of Materials Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma 630-0101, Japan; (V.C.G.C.); (R.O.); (Y.S.); (Y.O.); (J.O.)
| | - Yasumi Ohta
- Division of Materials Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma 630-0101, Japan; (V.C.G.C.); (R.O.); (Y.S.); (Y.O.); (J.O.)
| | - Jun Ohta
- Division of Materials Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, Ikoma 630-0101, Japan; (V.C.G.C.); (R.O.); (Y.S.); (Y.O.); (J.O.)
| | - Masahiro Ohsawa
- Department of Neuropharmacology, Faculty of Pharmaceutical Sciences, Nagoya City University, Nagoya 467-8601, Japan; (K.T.); (M.O.)
| | - Metin Akay
- Biomedical Engineering Department, University of Houston, 3517 Cullen Blvd, Houston, TX 77204, USA; (A.G.); (M.A.)
| | - Yasemin M. Akay
- Biomedical Engineering Department, University of Houston, 3517 Cullen Blvd, Houston, TX 77204, USA; (A.G.); (M.A.)
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Xie RG, Xu GY, Wu SX, Luo C. Presynaptic glutamate receptors in nociception. Pharmacol Ther 2023; 251:108539. [PMID: 37783347 DOI: 10.1016/j.pharmthera.2023.108539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/19/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
Chronic pain is a frequent, distressing and poorly understood health problem. Plasticity of synaptic transmission in the nociceptive pathways after inflammation or injury is assumed to be an important cellular basis for chronic, pathological pain. Glutamate serves as the main excitatory neurotransmitter at key synapses in the somatosensory nociceptive pathways, in which it acts on both ionotropic and metabotropic glutamate receptors. Although conventionally postsynaptic, compelling anatomical and physiological evidence demonstrates the presence of presynaptic glutamate receptors in the nociceptive pathways. Presynaptic glutamate receptors play crucial roles in nociceptive synaptic transmission and plasticity. They modulate presynaptic neurotransmitter release and synaptic plasticity, which in turn regulates pain sensitization. In this review, we summarize the latest understanding of the expression of presynaptic glutamate receptors in the nociceptive pathways, and how they contribute to nociceptive information processing and pain hypersensitivity associated with inflammation / injury. We uncover the cellular and molecular mechanisms of presynaptic glutamate receptors in shaping synaptic transmission and plasticity to mediate pain chronicity, which may provide therapeutic approaches for treatment of chronic pain.
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Affiliation(s)
- Rou-Gang Xie
- Department of Neurobiology, Fourth Military Medical University, Xi'an 710032, China.
| | - Guang-Yin Xu
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Institute of Neuroscience, Soochow University, Suzhou 215123, China
| | - Sheng-Xi Wu
- Department of Neurobiology, Fourth Military Medical University, Xi'an 710032, China.
| | - Ceng Luo
- Department of Neurobiology, Fourth Military Medical University, Xi'an 710032, China.
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Jeske AH, Anderson A, Do KA, Ning J, Ma J, Bruera E. Patterns of opioid use among Texas dental practitioners during the COVID-19 pandemic. J Opioid Manag 2023; 19:523-532. [PMID: 38189194 DOI: 10.5055/jom.0837] [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: 01/09/2024]
Abstract
OBJECTIVE The primary objective of this study is to assess factors that influence opioid prescribing by dentists and the role of these factors in the practice of dental pain control. DESIGN A 25-question survey instrument was distributed to the study population for anonymous responses, covering dentist and practice demographics and opioid prescribing characteristics. SETTING Private solo and group practice settings, including general practitioners and dental specialists. PARTICIPANTS Potential participants included all active members of a large state dental professional association. MAIN OUTCOME MEASURES They were practitioner and practice demographic traits, types of opioids prescribed, and statistical correlations. Outcome variables included practice type, practitioner gender, practice location, practice model, and years in practice. Categorical covariates were summarized statistically by frequencies and percentages, and continuous covariates were summarized by means, medians, ranges, and standard deviations. RESULTS Strongest correlations with opioid prescribing included general practitioner (vs specialist) and male gender. The coronavirus disease 2019 pandemic was confirmed as having exerted a significant impact on opioid prescribing among the survey respondents. CONCLUSIONS Further research is warranted to assess post-pandemic opioid prescribing patterns, and additional educational strategies regarding limitations of opioid prescriptions should be applied to general, rather than specialty, dental practitioners.
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Affiliation(s)
- Arthur H Jeske
- University of Texas School of Dentistry at Houston, Houston, Texas
| | - Aimee Anderson
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas. ORCID: https://orcid.org/0000-0002-2464-5343
| | - Kim-Anh Do
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas. ORCID: https://orcid.org/0000-0001-8710-7131
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Junsheng Ma
- Department of Data Science, Sumitomo Dainippon Pharma Oncology, Inc., Cambridge, Massachusetts. ORCID: https://orcid.org/0000-0003-1704-7019
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas. ORCID: https://orcid.org/0000-0002-8745-0412
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Brady BR, Taj EA, Cameron E, Yoder AM, De La Rosa JS. A Diagram of the Social-Ecological Conditions of Opioid Misuse and Overdose. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6950. [PMID: 37887688 PMCID: PMC10606085 DOI: 10.3390/ijerph20206950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023]
Abstract
The United States is experiencing a crisis of opioid misuse and overdose. To understand the underlying factors, researchers have begun looking upstream to identify social and structural determinants. However, no study has yet aggregated these into a comprehensive ecology of opioid overdose. We scoped 68 literature sources and compiled a master list of opioid misuse and overdose conditions. We grouped the conditions and used the Social Ecological Model to organize them into a diagram. We reviewed the diagram with nine subject matter experts (SMEs) who provided feedback on its content, design, and usefulness. From a literature search and SME interviews, we identified 80 unique conditions of opioid overdose and grouped them into 16 categories. In the final diagram, we incorporated 40 SME-recommended changes. In commenting on the diagram's usefulness, SMEs explained that the diagram could improve intervention planning by demonstrating the complexity of opioid overdose and highlighting structural factors. However, care is required to strike a balance between comprehensiveness and legibility. Multiple design formats may be useful, depending on the communication purpose and audience. This ecological diagram offers a visual perspective of the conditions of opioid overdose.
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Affiliation(s)
- Benjamin R. Brady
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ 85721, USA; (E.A.T.); (E.C.); (J.S.D.L.R.)
- School of Interdisciplinary Health Programs, College of Health and Human Services, Western Michigan University, Kalamazoo, MI 49008, USA
| | - Ehmer A. Taj
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ 85721, USA; (E.A.T.); (E.C.); (J.S.D.L.R.)
| | - Elena Cameron
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ 85721, USA; (E.A.T.); (E.C.); (J.S.D.L.R.)
| | - Aaron M. Yoder
- Comagine Health, Seattle, WA 98133, USA;
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado, Aurora, CO 80045, USA
| | - Jennifer S. De La Rosa
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ 85721, USA; (E.A.T.); (E.C.); (J.S.D.L.R.)
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ 85721, USA
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9
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Tibbs GR, Uprety R, Warren JD, Beyer NP, Joyce RL, Ferrer MA, Mellado W, Wong VSC, Goldberg DC, Cohen MW, Costa CJ, Li Z, Zhang G, Dephoure NE, Barman DN, Sun D, Ingólfsson HI, Sauve AA, Willis DE, Goldstein PA. An anchor-tether 'hindered' HCN1 inhibitor is antihyperalgesic in a rat spared nerve injury neuropathic pain model. Br J Anaesth 2023; 131:745-763. [PMID: 37567808 PMCID: PMC10541997 DOI: 10.1016/j.bja.2023.06.067] [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: 04/13/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Neuropathic pain impairs quality of life, is widely prevalent, and incurs significant costs. Current pharmacological therapies have poor/no efficacy and significant adverse effects; safe and effective alternatives are needed. Hyperpolarisation-activated cyclic nucleotide-regulated (HCN) channels are causally implicated in some forms of peripherally mediated neuropathic pain. Whilst 2,6-substituted phenols, such as 2,6-di-tert-butylphenol (26DTB-P), selectively inhibit HCN1 gating and are antihyperalgesic, the development of therapeutically tolerable, HCN-selective antihyperalgesics based on their inverse agonist activity requires that such drugs spare the cardiac isoforms and do not cross the blood-brain barrier. METHODS In silico molecular dynamics simulation, in vitro electrophysiology, and in vivo rat spared nerve injury methods were used to test whether 'hindered' variants of 26DTB-P (wherein a hydrophilic 'anchor' is attached in the para-position of 26DTB-P via an acyl chain 'tether') had the desired properties. RESULTS Molecular dynamics simulation showed that membrane penetration of hindered 26DTB-Ps is controlled by a tethered diol anchor without elimination of head group rotational freedom. In vitro and in vivo analysis showed that BP4L-18:1:1, a variant wherein a diol anchor is attached to 26DTB-P via an 18-carbon tether, is an HCN1 inverse agonist and an orally available antihyperalgesic. With a CNS multiparameter optimisation score of 2.25, a >100-fold lower drug load in the brain vs blood, and an absence of adverse cardiovascular or CNS effects, BP4L-18:1:1 was shown to be poorly CNS penetrant and cardiac sparing. CONCLUSIONS These findings provide a proof-of-concept demonstration that anchor-tethered drugs are a new chemotype for treatment of disorders involving membrane targets.
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Affiliation(s)
- Gareth R Tibbs
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Rajendra Uprety
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
| | - J David Warren
- Department of Biochemistry, Weill Cornell Medicine, New York, NY, USA
| | - Nicole P Beyer
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Rebecca L Joyce
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Matthew A Ferrer
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | | | | | | | | | | | - Zhucui Li
- Department of Biochemistry, Weill Cornell Medicine, New York, NY, USA
| | - Guoan Zhang
- Department of Biochemistry, Weill Cornell Medicine, New York, NY, USA
| | - Noah E Dephoure
- Department of Biochemistry, Weill Cornell Medicine, New York, NY, USA; Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Dipti N Barman
- Department of Biochemistry, Weill Cornell Medicine, New York, NY, USA
| | - Delin Sun
- Lawrence Livermore National Laboratory, Livermore, CA, USA
| | | | - Anthony A Sauve
- Department of Pharmacology, Weill Cornell Medicine, New York, NY, USA
| | - Dianna E Willis
- Burke Neurological Institute, White Plains, NY, USA; Feil Family Brain & Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
| | - Peter A Goldstein
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Feil Family Brain & Mind Research Institute, Weill Cornell Medicine, New York, NY, USA; Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
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10
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Chen D, Toutkoushian E, Sun H, Warner DO, Macario A, Deiner SG, Keegan MT. Career decisions, training priorities, and perceived challenges for anesthesiology residents in the United States. J Clin Anesth 2023; 89:111155. [PMID: 37290294 DOI: 10.1016/j.jclinane.2023.111155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/12/2023] [Accepted: 05/21/2023] [Indexed: 06/10/2023]
Abstract
STUDY OBJECTIVE This study sought to understand the timing and important factors identified by residents regarding their decision to pursue a career in anesthesiology, training areas deemed important to their future success, perceived greatest challenges facing the profession of anesthesiology, and their post-residency plans. DESIGN The American Board of Anesthesiology administered voluntary, anonymous, repeated cross-sectional surveys to residents who began clinical anesthesia training in the U.S. from 2013 to 2016 and were subsequently followed up yearly until the completion of their residency. The analyses included data from 12 surveys (4 cohorts from clinical anesthesia years 1 to 3), including multiple-choice questions, rankings, Likert scales, and free text responses. Free responses were analyzed using an iterative inductive coding process to determine the main themes. MAIN RESULTS The overall response rate was 36% (6480 responses to 17,793 invitations). Forty-five percent of residents chose anesthesiology during the 3rd year of medical school. "Nature of the clinical practice of anesthesiology" was the most important factor influencing their decision (average ranking of 5.93 out of 8 factors, 1 [least important] to 8 [most important]), followed by "ability to use pharmacology to acutely manipulate physiology" (5.75) and "favorable lifestyle" (5.22). "Practice management" and "political advocacy for anesthesiologists" (average rating 4.46 and 4.42, respectively, on a scale of 1 [very unimportant] to 5 [very important]) were considered the most important non-traditional training areas, followed by "anesthesiologists as leaders of the perioperative surgical home" (4.32), "structure and financing of the healthcare system" (4.27), and "principles of quality improvement" (4.26). Three out of 5 residents desired to pursue a fellowship; pain medicine, pediatric anesthesiology, and cardiac anesthesiology were the most popular choices, each accounting for approximately 20% of prospective fellows. Perceived greatest challenges facing the profession of anesthesiology included workforce competition from non-physician anesthesia providers and lack of advocacy for anesthesiologist values (referenced by 96% of respondents), changes and uncertainty in healthcare systems (30%), and personal challenges such as psychological well-being (3%). CONCLUSIONS Most residents identified anesthesiology as their career choice during medical school. Interest in non-traditional subjects and fellowship training was common. Competition from non-physician providers, healthcare system changes, and compromised psychological well-being were perceived concerns.
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Affiliation(s)
- Dandan Chen
- The American Board of Anesthesiology, Raleigh, NC, USA.
| | | | - Huaping Sun
- The American Board of Anesthesiology, Raleigh, NC, USA.
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Alex Macario
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA.
| | - Stacie G Deiner
- Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.
| | - Mark T Keegan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
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Johnson ZD, Connors SW, Christian Z, Badejo O, Adeyemo E, Pernik MN, Barrie U, Caruso JP, Kafka B, Neeley OJ, Hall K, El Ahmadieh TY, Dahdaleh NS, Reisch JS, Aoun SG, Bagley CA. Development and Internal Validation of the Postoperative Analgesic Intake Needs Score: A Predictive Model for Post-Operative Narcotic Requirement after Spine Surgery. Global Spine J 2023; 13:2135-2143. [PMID: 35050806 PMCID: PMC10538320 DOI: 10.1177/21925682211072490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVE The aim of this study was to develop a clinical tool to pre-operatively risk-stratify patients undergoing spine surgery based on their likelihood to have high postoperative analgesic requirements. METHODS A total of 1199 consecutive patients undergoing elective spine surgery over a 2-year period at a single center were included. Patients not requiring inpatient admission, those who received epidural analgesia, those who had two surgeries at separate sites under one anesthesia event, and those with a length of stay greater than 10 days were excluded. The remaining 860 patients were divided into a derivation and validation cohort. Pre-operative factors were collected by review of the electronic medical record. Total postoperative inpatient opioid intake requirements were converted into morphine milligram equivalents to standardize postoperative analgesic requirements. RESULTS The postoperative analgesic intake needs (PAIN) score was developed after the following predictor variables were identified: age, race, history of depression/anxiety, smoking status, active pre-operative benzodiazepine use and pre-operative opioid use, and surgical type. Patients were risk-stratified based on their score with the high-risk group being more likely to have high opioid consumption postoperatively compared to the moderate and low-risk groups in both the derivation and validation cohorts. CONCLUSION The PAIN Score is a pre-operative clinical tool for patients undergoing spine surgery to risk stratify them based on their likelihood for high analgesic requirements. The information can be used to individualize a multi-modal analgesic regimen rather than utilizing a "one-size fits all" approach.
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Affiliation(s)
- Zachary D. Johnson
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Scott W. Connors
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Zachary Christian
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Olatunde Badejo
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Emmanuel Adeyemo
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mark N. Pernik
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Umaru Barrie
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James P. Caruso
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin Kafka
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Om J Neeley
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kristen Hall
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Northwestern University Medical Center, Dallas, TX, USA
| | - Joan S. Reisch
- Department of Population and Data Sciences, Division of Biostatistics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Salah G. Aoun
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Carlos A. Bagley
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Orthopedic Surgery, The University Texas Southwestern Medical Center, Dallas, TX, USA
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Lepore M, Hessler J, Mitchell A, Kameg B, Howe R, Cassidy C, Germack H. The impact of syringe decriminalization within the Pennsylvania harm reduction community. Arch Psychiatr Nurs 2023; 46:26-32. [PMID: 37813500 DOI: 10.1016/j.apnu.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/21/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Syringe decriminalization is a harm reduction approach to decrease deaths and disease related to drug use. The purpose of this study was to develop an understanding of the impact of syringe decriminalization on the harm reduction community in Pennsylvania. METHODS Semi-structured interviews were conducted with ten participants identified as harm reduction experts. ANALYSIS Narrative content analysis to the point of thematic saturation was used to generate themes around harm reduction and syringe decriminalization in Pennsylvania, specifically the meaning of harm reduction, the importance of harm reduction, and the opinions on syringe decriminalization. RESULTS The following themes reflect the meaning of harm reduction: human compassion; meeting people where they are at; minimizing the risk; and shifting power to the person. The themes of being personally impacted, human compassion, innate imperfection, and respecting human autonomy reflect why participants care about harm reduction. All ten participants support syringe decriminalization in Pennsylvania citing the following rationales: improved health outcomes; decreased costs to society; less involvement of the criminal justice system; and increased engagement into treatment. CONCLUSIONS Harm reduction is a pioneering approach to drug use that empowers individuals to make positive impacts in their lives. Harm reduction experts in Pennsylvania support syringe decriminalization as a cost-effective way to increase the engagement and improve health outcomes of people who use drugs.
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Affiliation(s)
| | | | - Ann Mitchell
- University of Pittsburgh, United States of America.
| | | | - Ryan Howe
- Main Line Health, United States of America.
| | | | - Hayley Germack
- The Janssen Pharmaceutical Companies of Johnson & Johnson, United States of America
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13
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Heung Y, Clark M, Tschanz J, Bruera E. Opioid Prescription Denials by Community Pharmacies for Cancer-Related Pain: A Case Series. J Pain Symptom Manage 2023; 66:e431-e435. [PMID: 37356595 DOI: 10.1016/j.jpainsymman.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
Pain is one of the most common symptoms experienced by patients living with cancer. Guidelines recommend opioids as the mainstay in the management of cancer-related pain. However, the opioid epidemic has resulted in policymakers recommending limitations on opioid prescribing which led to community pharmacies implementing various parameters. These restrictions have created barriers for patients with cancer-related pain attempting to fill opioid prescriptions from their community pharmacies. Additionally, in the setting of the opioid epidemic, there have been reports of systemic bias within community pharmacies, leading to experiences with embarrassment and shame for patients with cancer-related pain. This case series presents specific examples of community pharmacies declining to fill opioid prescriptions for patients with cancer-related pain and associated patient suffering.
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Affiliation(s)
- Yvonne Heung
- Department of Palliative Care, Rehabilitation, and Integrative Medicine (Y.H., J.T., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Matthew Clark
- Pharmacy Clinical Programs (M.C.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jacqueline Tschanz
- Department of Palliative Care, Rehabilitation, and Integrative Medicine (Y.H., J.T., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine (Y.H., J.T., E.B.), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Dennis A, Deng C, Yang P, Bonham AJ, Carlin AM, Varban OA. Evaluating the impact of metabolic surgery on patients with prior opioid use. Surg Obes Relat Dis 2023; 19:889-896. [PMID: 36872158 DOI: 10.1016/j.soard.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/14/2023] [Accepted: 01/29/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Metabolic surgery is the most effective treatment for obesity and may improve obesity-related pain syndromes. However, the effect of surgery on the persistent use of opioids in patients with a history of prior opioid use remains unclear. OBJECTIVE To determine the effect of metabolic surgery on opioid use behaviors in patients with prior opioid use. SETTING A consortium of public and private hospitals in Michigan. METHODS Using a statewide metabolic-specific data registry, we identified 16,820 patients who self-reported opioid use before undergoing metabolic surgery between 2006 and 2020 and analyzed the 8506 (50.6%) patients who responded to 1-year follow-up. We compared patient characteristics, risk-adjusted 30-day postoperative outcomes, and weight loss between patients who self-reported discontinuing opioid use 1 year after surgery and those who did not. RESULTS Among patients who self-reported using opioids before metabolic surgery, 3864 (45.4%) discontinued use 1 year after surgery. Predictors of persistent opioid use included an annual income of <$10,000 (odds ratio [OR] = 1.24; 95% confidence interval [CI], 1.06-1.44; P = .006), Medicare insurance (OR = 1.48; 95% CI, 1.32-1.66; P < .0001), and preoperative tobacco use (OR = 1.36; 95% CI, 1.16-1.59; P = .0001). Patients with persistent use were more likely to have a surgical complication (9.6% versus 7.5%, P = .0328) and less percent excess weight loss (61.6% versus 64.4%, P < .0001) than patients who discontinued opioids after surgery. There were no differences in the morphine milligram equivalents prescribed within the first 30 days following surgery between groups (122.3 versus 126.5, P = .3181). CONCLUSIONS Nearly half of patients who reported taking opioids before metabolic surgery discontinued use at 1 year. Targeted interventions aimed at high-risk patients may increase the number of patients who discontinue opioid use after metabolic surgery.
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Affiliation(s)
| | - Callie Deng
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Phillip Yang
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Aaron J Bonham
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | | | - Oliver A Varban
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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Charron E, Brooks JH, Peterson KT, Akinwolere OG, Winhusen T, Cochran G. Mapping prescription drug monitoring program data to self-report measures of non-medical prescription opioid use in community pharmacy settings. Res Social Adm Pharm 2023; 19:1171-1177. [PMID: 37142474 PMCID: PMC10523937 DOI: 10.1016/j.sapharm.2023.04.121] [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: 10/10/2022] [Revised: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Community pharmacists are well-positioned to identify patients engaged in non-medical prescription opioid use (NMPOU) through Prescription Drug Monitoring Program (PDMP) databases. Integrating patient-reported outcomes with PDMP data may improve the interpretability of PDMP information to support clinical decision-making. OBJECTIVE This study linked patient-reported clinical measures of substance use with PDMP data to examine relationships between average daily opioid dose in morphine milligram equivalents (MME) and visits to multiple pharmacies/prescribers with self-reported NMPOU. METHODS Data from a cross-sectional health assessment given to patients aged ≥18 years filling opioid prescriptions were linked to PDMP records. NMPOU in the past three months was assessed on a continuous scale (range 0-39) using an adapted version of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). PDMP measures included average daily MME and number of distinct pharmacies/prescribers visited in the past 180 days. Univariable and multivariable zero-inflated negative binomial models estimated associations between PDMP measures and any NMPOU and severity of use. RESULTS The sample included 1421 participants. In multivariable models adjusted for sociodemographic, mental health, and physical health characteristics, any NMPOU was associated with higher average daily MME (adjusted OR = 1.22, 95% CI = 1.05-1.39) and number of distinct prescribers visited (adjusted OR = 1.15, 95% CI = 1.01-1.30). Higher average daily MME (adjusted mean ratio (MR) = 1.12, 95% CI = 1.08-1.15), number of distinct pharmacies visited (adjusted MR = 1.11, 95% CI = 1.04-1.18), and number of distinct prescribers visited (adjusted MR = 1.07, 95% CI = 1.02-1.11) were associated with increased NMPOU severity. CONCLUSIONS We observed significant, positive associations between average daily MME and visits to multiple pharmacies/prescribers with any NMPOU and severity of use. This study demonstrates self-report clinical measures of substance use can be cross-walked to PDMP data and translated into clinically interpretable information.
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Affiliation(s)
- Elizabeth Charron
- Hudson College of Public Health, University of Oklahoma Health Sciences Center, Schusterman Center, Tulsa OK, USA; Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA) Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Jennifer H Brooks
- Children's National Hospital, Washington, DC, USA; Friends Research Institute, Baltimore, MD, USA
| | - Keegan T Peterson
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | | | - T Winhusen
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Gerald Cochran
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA) Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
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16
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Sarker A, Lakamana S, Guo Y, Ge Y, Leslie A, Okunromade O, Gonzalez-Polledo E, Perrone J, McKenzie-Brown AM. #ChronicPain: Automated Building of a Chronic Pain Cohort from Twitter Using Machine Learning. HEALTH DATA SCIENCE 2023; 3:0078. [PMID: 38333075 PMCID: PMC10852024 DOI: 10.34133/hds.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/12/2023] [Indexed: 02/10/2024]
Abstract
Background Due to the high burden of chronic pain, and the detrimental public health consequences of its treatment with opioids, there is a high-priority need to identify effective alternative therapies. Social media is a potentially valuable resource for knowledge about self-reported therapies by chronic pain sufferers. Methods We attempted to (a) verify the presence of large-scale chronic pain-related chatter on Twitter, (b) develop natural language processing and machine learning methods for automatically detecting self-disclosures, (c) collect longitudinal data posted by them, and (d) semiautomatically analyze the types of chronic pain-related information reported by them. We collected data using chronic pain-related hashtags and keywords and manually annotated 4,998 posts to indicate if they were self-reports of chronic pain experiences. We trained and evaluated several state-of-the-art supervised text classification models and deployed the best-performing classifier. We collected all publicly available posts from detected cohort members and conducted manual and natural language processing-driven descriptive analyses. Results Interannotator agreement for the binary annotation was 0.82 (Cohen's kappa). The RoBERTa model performed best (F1 score: 0.84; 95% confidence interval: 0.80 to 0.89), and we used this model to classify all collected unlabeled posts. We discovered 22,795 self-reported chronic pain sufferers and collected over 3 million of their past posts. Further analyses revealed information about, but not limited to, alternative treatments, patient sentiments about treatments, side effects, and self-management strategies. Conclusion Our social media based approach will result in an automatically growing large cohort over time, and the data can be leveraged to identify effective opioid-alternative therapies for diverse chronic pain types.
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Affiliation(s)
- Abeed Sarker
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Sahithi Lakamana
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Yuting Guo
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Yao Ge
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Abimbola Leslie
- Department of Radiology, Robert Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Omolola Okunromade
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | | | - Jeanmarie Perrone
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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17
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Treister-Goltzman Y, Peleg R, Sagy I, Menashe I. Medication use and factors associated with opiate use among patients with diagnosed fibromyalgia from two ethnic sectors in southern Israel. J Pharm Policy Pract 2023; 16:78. [PMID: 37365657 DOI: 10.1186/s40545-023-00586-5] [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: 04/03/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Our aims were to compare fibromyalgia (FM) rate, drug treatment and factors associated with the use of opiates in two ethnic sectors. METHODS A retrospective cross-sectional study in southern district of Israel was performed on diagnosed FM patients in 2019-2020 [7686 members (1.50%)]. Descriptive analyses were conducted and multivariable models for the use of opiates were developed. RESULTS There were significant differences between the two ethnic groups in FM prevalence at 1.63% and 0.91% in the Jewish and Arab groups, respectively. Only 32% of the patients used recommended medications and about 44% purchased opiates. Age, BMI, psychiatric co-morbidity, and treatment with a recommended drug were similarly associated with an increased risk for opiate use in both ethnic groups. However, male gender was associated with × 2 times reduced risk to use opiates only among the Bedouins (aOR = 0.552, 95%CI = 0.333-0.911). In addition, while in both of ethnic groups the existence of another localized pain syndrome was associated with an increased risk for opiates use, this risk was 4 times higher in the Bedouin group (aOR = 8.500, 95%CI = 2.023-59.293 and aOR = 2.079, 95%CI = 1.556-2.814). CONCLUSIONS The study showed underdiagnosis of FM in the minority Arab ethnicity. Female Arab FM patients in low or high, compared to middle socio-economic status, were a risk group for excess opiate use. Increased use of opiates and very low rate of purchase of recommended drugs point to a lack of effectiveness of these drugs. Future research should assess whether the treatment of treatable factors can reduce the dangerous use of opiates.
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Affiliation(s)
- Yulia Treister-Goltzman
- Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel.
- Clalit Health Services, Southern District, Israel.
| | - Roni Peleg
- Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
- Clalit Health Services, Southern District, Israel
| | - Iftach Sagy
- Rheumatology Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Idan Menashe
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Rohaj A, Bulaj G. Digital Therapeutics (DTx) Expand Multimodal Treatment Options for Chronic Low Back Pain: The Nexus of Precision Medicine, Patient Education, and Public Health. Healthcare (Basel) 2023; 11:healthcare11101469. [PMID: 37239755 DOI: 10.3390/healthcare11101469] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Digital therapeutics (DTx, software as a medical device) provide personalized treatments for chronic diseases and expand precision medicine beyond pharmacogenomics-based pharmacotherapies. In this perspective article, we describe how DTx for chronic low back pain (CLBP) can be integrated with pharmaceutical drugs (e.g., NSAIDs, opioids), physical therapy (PT), cognitive behavioral therapy (CBT), and patient empowerment. An example of an FDA-authorized DTx for CLBP is RelieVRx, a prescription virtual reality (VR) app that reduces pain severity as an adjunct treatment for moderate to severe low back pain. RelieVRx is an immersive VR system that delivers at-home pain management modalities, including relaxation, self-awareness, pain distraction, guided breathing, and patient education. The mechanism of action of DTx is aligned with recommendations from the American College of Physicians to use non-pharmacological modalities as the first-line therapy for CLBP. Herein, we discuss how DTx can provide multimodal therapy options integrating conventional treatments with exposome-responsive, just-in-time adaptive interventions (JITAI). Given the flexibility of software-based therapies to accommodate diverse digital content, we also suggest that music-induced analgesia can increase the clinical effectiveness of digital interventions for chronic pain. DTx offers opportunities to simultaneously address the chronic pain crisis and opioid epidemic while supporting patients and healthcare providers to improve therapy outcomes.
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Affiliation(s)
- Aarushi Rohaj
- The Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
- Department of Medicinal Chemistry, L.S. Skaggs College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, L.S. Skaggs College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
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Wilkerson AH, Sharma M, Davis RE, Stephens PM, Kim RW, Bhati D, Nahar VK. Predisposing, enabling and reinforcing factors associated with opioid addiction helping behaviour in tri-state Appalachian counties: application of the PRECEDE-PROCEED model-cross-sectional analysis. BMJ Open 2023; 13:e066147. [PMID: 37192792 DOI: 10.1136/bmjopen-2022-066147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES The overdose epidemic was designated a 'Public Health Emergency' in the USA on 26 October 2017, bringing attention to the severity of this public health problem. The Appalachian region remains substantially impacted by the effects from years of overprescription of opioids, and subsequently opioid non-medical use and addiction. This study aims to examine the utility of the PRECEDE-PROCEED model constructs (ie, predisposing, reinforcing and enabling factors) to explain opioid addiction helping behaviour (ie, helping someone who has an opioid addiction) among members of the public living in tri-state Appalachian counties. DESIGN Cross-sectional study. SETTING Rural county in the Appalachian region of the USA. PARTICIPANTS A total of 213 participants from a retail mall in a rural Appalachian Kentucky county completed the survey. Most participants were between the ages of 18 and 30 years (n=68; 31.9%) and identified as men (n=139; 65.3%). PRIMARY OUTCOME MEASURE Opioid addiction helping behaviour. RESULTS The regression model was significant (F (6, 180)=26.191, p<0.001) and explained 44.8% of the variance in opioid addiction helping behaviour (R2=0.448). Attitude towards helping someone with opioid addiction (B=0.335; p<0.001), behavioural skills (B=0.208; p=0.003), reinforcing factors (B=0.190; p=0.015) and enabling factors (B=0.195; p=0.009) were all significantly associated with opioid addiction helping behaviour. CONCLUSIONS PRECEDE-PROCEED model constructs have utility to explain opioid addiction helping behaviour among individuals in a region greatly impacted by the overdose epidemic. This study provides an empirically tested framework for future programmes addressing helping behaviour related to opioid non-medical use.
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Affiliation(s)
- Amanda H Wilkerson
- Department of Health Science, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Manoj Sharma
- Department of Social and Behavioral Health, Department of Internal Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Robert E Davis
- Substance Use and Mental Health Laboratory, Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
| | - Philip M Stephens
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Center for Animal and Human Health in Appalachia, College of Veterinary Medicine, Lincoln Memorial University, Harrogate, Tennessee, USA
| | - Richard W Kim
- Center for Animal and Human Health in Appalachia, College of Veterinary Medicine, Lincoln Memorial University, Harrogate, Tennessee, USA
- Department of Physical Medicine and Rehabilitation, New York-Presbyterian Hospital, Columbia University Medical Center and Weill Cornell Medical Center, New York City, New York, USA
| | - Deepak Bhati
- Casualty Section, All India Institute of Ayurveda, New Delhi, India
| | - Vinayak K Nahar
- Department of Dermatology, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Preventive Medicine, School of Medicine/John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Kim H, Song EJ, Windsor L. Longitudinal changes in the county-level relationship between opioid prescriptions and child maltreatment reports, United States, 2009-2018. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2023; 93:375-388. [PMID: 37184964 PMCID: PMC10527856 DOI: 10.1037/ort0000682] [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] [Indexed: 05/16/2023]
Abstract
This article examines whether county opioid prescription rates were associated with county child maltreatment report (CMR) rates in the United States and whether this relationship changed over time. We linked multiple national data sets to assemble retail opioid prescription data, CMR data, rural-urban codes (to control for urbanicity), and census data (to control for other community characteristics, such as poverty rates) covering 2009-2018. Multilevel linear modeling analyzed the linked data. We found that the strength of the county-level relationship between opioid prescription rates and CMR rates increased almost linearly during the study period. The relationship was not significant in 2009-2011; it became significant in 2012 and grew stronger in the next 6 years. In 2012, there was one more CMR per 1,000 children in a county for every 14.3 more opioid prescriptions per 100 people. In 2018, the number of prescriptions related to this effect was 3.6. In other words, the county-level relationship between opioid prescriptions and CMRs was four times as strong in 2018 as it had been in 2012. This trend was also observed within all subgroups of child age and sex. By type, this trend was somewhat more pronounced for neglect, but somewhat less for sexual abuse. Our findings suggest a growing need for greater efforts to prevent child maltreatment in communities with high opioid prescription rates. Further research is warranted to reveal the underlying factors for this concerning trend. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Hyunil Kim
- School of Social Work, University of Illinois at Urbana-Champaign
| | - Eun-Jee Song
- School of Social Work, University of Illinois at Urbana-Champaign
| | - Liliane Windsor
- School of Social Work, University of Illinois at Urbana-Champaign
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21
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Kyei EF, Leveille S. Opioid Misuse and Opioid Overdose Mortality Among the Black Population in the United States: An Integrative Review. Policy Polit Nurs Pract 2023:15271544231164323. [PMID: 37013355 DOI: 10.1177/15271544231164323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Opioid misuse is a growing public health concern in the United States (U.S.). This problem continues to claim many lives and has affected the life expectancy of the U.S. population. In the past few years, the Black population has witnessed an increased rate of overdose deaths compared to their white counterparts. This review seeks to characterize recent trends in opioid prescription practices and overdose deaths among the Black population in the U.S. An integrative review was conducted with a literature search from CINHAL, MEDLINE, and PsycINFO databases. The literature search identified 11 articles for the analysis. All studies were quantitative. Six studies focused on overdose mortality and five on opioid prescription practices. The results indicate a rising trend in opioid overdose mortality among Black people due to the availability of synthetic opioids on the illegal drug market. Black people receive fewer opioid prescriptions and experience higher rates of opioid dose reduction compared to Whites. The Black population has experienced an increase in opioid overdose mortality compared to the White population within the last two decades. Opioid overdose deaths among Black people are highly associated with the proliferation of synthetic opioids, and Black men have been more affected than Black women. Black people experience lower rates of opioid prescription during E.R. visits compared to Whites. The issue of low opioid prescribing among Black people needs to be addressed since it affects their health outcomes and is a factor that contributes to the use of illicit synthetic opioids.
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Affiliation(s)
- Evans F Kyei
- Department of Nursing, Manning College of Nursing and Health Sciences, 14708University of Massachusetts Boston, MA, USA
| | - Suzanne Leveille
- Department of Nursing, Manning College of Nursing and Health Sciences, 14708University of Massachusetts Boston, MA, USA
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22
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Jones IA, Piple AS, Yan PY, Longjohn DB, Gilbert PK, Lieberman JR, Gucev GV, Oakes DA, Ratto CE, Christ AB, Heckmann ND. A double-blinded, placebo-controlled, randomized study to evaluate the efficacy of perioperative dextromethorphan compared to placebo for the treatment of postoperative pain: a study protocol. Trials 2023; 24:238. [PMID: 36991450 DOI: 10.1186/s13063-023-07240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Pain management is a critical component of comprehensive postsurgical care, as it influences patient safety and outcomes, and inadequate control has been associated with the development of chronic pain syndromes. Despite recent improvements, the management of postoperative pain following total knee arthroplasty (TKA) remains a challenge. The use of opioid-sparing, multimodal analgesic regimens has broad support, but there is a paucity of high-quality evidence regarding optimal postoperative protocols and novel approaches are needed. Dextromethorphan stands out among both well-studied and emerging pharmacological adjuncts for postoperative pain due its robust safety profile and unique pharmacology. The purpose of this study is to evaluate the efficacy of multi-dose dextromethorphan for postoperative pain control following TKA.
Methods
This is a single-center, multi-dose, randomized, double-blinded, placebo-controlled trial. A total of 160 participants will be randomized 1:1 to receive either 60 mg oral dextromethorphan hydrobromide preoperatively, as well as 30 mg 8 h and 16 h postoperatively, or matching placebo. Outcome data will be obtained at baseline, during the first 48 h, and the first two follow-up visits. The primary outcome measure will be total opioid consumption at 24 h postoperatively. Secondary outcomes related to pain, function, and quality of life will be evaluated using standard pain scales, the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) questionnaire, the Patient-Reported Outcomes Measurement Information System (PROMIS-29) questionnaire, and clinical anchors.
Discussion
This study has a number of strengths including adequate power, a randomized controlled design, and an evidence-based dosing schedule. As such, it will provide the most robust evidence to date on dextromethorphan utilization for postoperative pain control following TKA. Limitations include not obtaining serum samples for pharmacokinetic analysis and the single-center study design.
Trial registration
This trial has been registered on the National Institute of Health’s ClinicalTrials.gov (NCT number: NCT05278494). Registered on March 14, 2022.
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23
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Westcott SL, Wojahn A, Morrison TC, Leslie E. Ketamine decreased opiate use in US military combat operations from 2010 to 2019. BMJ Mil Health 2023:e002291. [PMID: 36849196 DOI: 10.1136/military-2022-002291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/08/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Ketamine is a dissociative anaesthetic currently used in a variety of healthcare applications. Effects are dose dependent and cause escalating levels of euphoria, analgesia, dissociation and amnesia. Ketamine can be given via intravenous, intramuscular, nasal, oral and aerosolised routes. A 2012 memorandum and the 2014 Tactical Combat Casualty Care (TCCC) guidelines included ketamine as part of the 'Triple Option' for analgesia. This study investigated the effect of ketamine adoption by the US military TCCC guidelines on opioid use between 2010 and 2019. METHODS This was a retrospective review of deidentified Department of Defense Trauma Registry data. The study was approved by the Institutional Review Board of Naval Medical Center San Diego (NMCSD) and facilitated by a data sharing agreement between NMCSD and the Defense Health Agency. Patient encounters from all US military operations from January 2010 to December 2019 were queried. All administrations of any pain medications via any route were included. RESULTS 5965 patients with a total of 8607 pain medication administrations were included. Between 2010 and 2019, the yearly percentage of ketamine administrations rose from 14.2% to 52.6% (p<0.001). The percentage of opioid administrations decreased from 85.8% to 47.4% (p<0.001). Among the 4104 patients who received a single dose of pain medication, the mean Injury Severity Score for those who received ketamine was higher than for those who received an opioid (mean=13.1 vs 9.8, p<0.001). CONCLUSION Military opioid use declined as ketamine use increased over 10 years of combat. Ketamine is generally used first for more severely injured patients and has increasingly been employed by the US military as the primary analgesic for combat casualties.
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Affiliation(s)
- Sally L Westcott
- Emergency Department, Combat Trauma Research Group, NMCSD, San Diego, California, USA
- Emergency Department, Naval Hospital Guam, Agana Heights, Guam
| | - A Wojahn
- Emergency Department, Combat Trauma Research Group, NMCSD, San Diego, California, USA
- Shock Trauma Platoon, Combat Logistics Battalion 13, 13th Marine Expeditionary Unit, Marine Corps Base Camp Pendleton, Camp Pendleton, California, USA
| | - T C Morrison
- Emergency Department, Combat Trauma Research Group, NMCSD, San Diego, California, USA
| | - E Leslie
- Emergency Department, Combat Trauma Research Group, NMCSD, San Diego, California, USA
- 1st Medical Battalion, 1st Marine Logistics Group, 1st Marine Expeditionary Unit, Marine Corps Base Camp Pendleton, Camp Pendleton, California, USA
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24
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Ayres JM, Dallman J, Nolte JA, Higginbotham N, Baker J, Horton G, Salava J, Sojka J, Templeton KJ, Malancea RI, Heddings A. Managing Post-Operative Pain in Orthopedic Patients: An International Comparison. Kans J Med 2023; 16:56-60. [PMID: 36845259 PMCID: PMC9957592 DOI: 10.17161/kjm.vol16.18744] [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: 12/03/2022] [Accepted: 01/26/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction Opioids play a crucial role in post-operative pain management in America, but not in some other countries. We sought to determine if a discrepancy in opioid use between the United States (U.S.) and Romania, a country that administers opioids in a conservative fashion, would show in subjective pain control differences. Methods Between May 23, 2019, and November 23, 2019, 244 Romanian patients and 184 American patients underwent total hip arthroplasty or the surgical treatment of the following fractures: bimalleolar ankle, distal radius, femoral neck, intertrochanteric, and tibial-fibular. Opioid and non-opioid analgesic medication use and subjective pain scores during the first and second 24 hours after surgery were analyzed. Results Subjective pain scores for the first 24 hours were higher among patients in Romania compared to the U.S. (p < 0.0001), but Romanians reported lower pain scores than U.S. patients in the second 24-hours (p < 0.0001). The quantity of opioids given to U.S. patients did not differ significantly based on sex (p = 0.4258) or age (p = 0.0975). However, females reported higher pain scores than male patients following the studied procedures (p = 0.0181). No sex-based differences in pain scores were noted among Romanian patients. Conclusions Higher pain scores in American females, despite equivalent amounts of narcotics to their male counterparts, and the absence of a difference in Romanians suggested that the current American post-operative pain regimen may be tailored to the needs of male patients. In addition, it pointed to the impacts of gender, compared to sex, in pain experiences. Future research should look for the safest, most efficacious pain regimen suitable for all patients.
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Affiliation(s)
- Jack M. Ayres
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Johnathan Dallman
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Jack A. Nolte
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Nicholas Higginbotham
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Jordan Baker
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Greg Horton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Jonathon Salava
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - John Sojka
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Kimberly J. Templeton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Radu Ioan Malancea
- Department of Orthopedic Surgery, Spitalul Judetean de Urgenta Mavromati Botosani, Botosani, Romania
| | - Archie Heddings
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
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25
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Murphy PB, Kasotakis G, Haut ER, Miller A, Harvey E, Hasenboehler E, Higgins T, Hoegler J, Mir H, Cantrell S, Obremskey WT, Wally M, Attum B, Seymour R, Patel N, Ricci W, Freeman JJ, Haines KL, Yorkgitis BK, Padilla-Jones BB. Efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute pain after orthopedic trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma and the Orthopedic Trauma Association. Trauma Surg Acute Care Open 2023; 8:e001056. [PMID: 36844371 PMCID: PMC9945020 DOI: 10.1136/tsaco-2022-001056] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/09/2023] [Indexed: 02/25/2023] Open
Abstract
Objectives Fracture is a common injury after a traumatic event. The efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs) to treat acute pain related to fractures is not well established. Methods Clinically relevant questions were determined regarding NSAID use in the setting of trauma-induced fractures with clearly defined patient populations, interventions, comparisons and appropriately selected outcomes (PICO). These questions centered around efficacy (pain control, reduction in opioid use) and safety (non-union, kidney injury). A systematic review including literature search and meta-analysis was performed, and the quality of evidence was graded per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The working group reached consensus on the final evidence-based recommendations. Results A total of 19 studies were identified for analysis. Not all outcomes identified as critically important were reported in all studies, and the outcome of pain control was too heterogenous to perform a meta-analysis. Nine studies reported on non-union (three randomized control trials), six of which reported no association with NSAIDs. The overall incidence of non-union in patients receiving NSAIDs compared with patients not receiving NSAIDs was 2.99% and 2.19% (p=0.04), respectively. Of studies reporting on pain control and reduction of opioids, the use of NSAIDs reduced pain and the need for opioids after traumatic fracture. One study reported on the outcome of acute kidney injury and found no association with NSAID use. Conclusions In patients with traumatic fractures, NSAIDs appear to reduce post-trauma pain, reduce the need for opioids and have a small effect on non-union. We conditionally recommend the use of NSAIDs in patients suffering from traumatic fractures as the benefit appears to outweigh the small potential risks.
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Affiliation(s)
- Patrick B Murphy
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - George Kasotakis
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Elliott R Haut
- Department of Surgery, Johns Hopkins Univ, Baltimore, Maryland, USA
| | - Anna Miller
- Department of Orthopaedic Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Edward Harvey
- Department of Surgery, McGill University, Montreal, Québec, Canada
| | - Eric Hasenboehler
- Holy Spirit Hospital Penn State Health, Camp Hill, Pennsylvania, USA
| | - Thomas Higgins
- Department of Orthopaedics, University of Utah Health, Salt Lake City, Utah, USA
| | - Joseph Hoegler
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hassan Mir
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
| | - Sarah Cantrell
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - William T Obremskey
- The Vanderbilt Orthopaedic Institute Center for Health Policy, Nashville, Tennessee, USA
| | - Meghan Wally
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Basem Attum
- Institute Center for Health Policy, Nashville, Tennessee, USA
| | - Rachel Seymour
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Nimitt Patel
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - William Ricci
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Jennifer J Freeman
- Department of Surgery, TCU and UNTHSC School of Medicine, Fort Worth, Texas, USA
| | - Krista L Haines
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Brian K Yorkgitis
- Department of Surgery, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, USA
| | - Brandy B Padilla-Jones
- Department of General Surgery, Sunrise Hospital and Medical Center, Las Vegas, Nevada, USA
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26
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Paschen-Wolff MM, Kidd JD, Paine EA. The State of the Research on Opioid Outcomes Among Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexuality- and Gender-Diverse Populations: A Scoping Review. LGBT Health 2023; 10:1-17. [PMID: 36318023 PMCID: PMC10081720 DOI: 10.1089/lgbt.2022.0036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: Research on opioid misuse, opioid use disorder (OUD), and overdose (i.e., opioid outcomes) among lesbian, gay, bisexual, transgender, queer, and other populations within the LGBTQ umbrella (LGBTQ+) remains sparse. The purpose of this scoping review was to characterize the state of the research on opioid outcomes among LGBTQ+ populations, and identify gaps in the extant literature and areas for future research. Methods: We conducted a scoping review of peer-reviewed, English language articles published between 2011 and 2020 that examined opioid outcomes among LGBTQ+ populations in the CINAHL, Embase, PubMed, and PsycINFO databases. We extracted data from articles that focused on opioid outcomes within their specific aims or purpose. We include a general summary for articles that secondarily described opioid outcomes among LGBTQ+ populations. Results: Of 113 published studies that examined opioid outcomes among LGBTQ+ populations, 10% (n = 11) were specifically designed to focus on this topic. Across studies, bisexual populations, particularly women, were at highest risk for opioid misuse and OUD. Few studies examined opioid outcomes by more than one dimension of sexual orientation (n = 3, 27%), race and/or ethnicity (n = 3, 27%), or age (n = 5, 45%). Only two included transgender or gender diverse samples; only one explicitly measured gender identity. Conclusions: Future research is needed to understand the impact of the opioid epidemic on LGBTQ+ people, particularly transgender and other gender diverse individuals, and the intersectional role of race, ethnicity, and age in opioid disparities among LGBTQ+ individuals. Additional research could contribute to the development of much-needed affirming OUD treatment and other services for LGBTQ+ people.
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Affiliation(s)
- Margaret M Paschen-Wolff
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center at New York State Psychiatric Institute, New York, New York, USA
| | - Jeremy D Kidd
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center at New York State Psychiatric Institute, New York, New York, USA
| | - Emily Allen Paine
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, New York, USA
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Cunningham DJ, Wixted CM, Allen NB, Hanselman AE, Adams SB. The Impact of Time and State Opioid Legislation on Opioid Prescription Filling in Total Ankle Arthroplasty. J Foot Ankle Surg 2022; 62:156-161. [PMID: 35798644 DOI: 10.1053/j.jfas.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/29/2022] [Accepted: 06/04/2022] [Indexed: 02/03/2023]
Abstract
Total ankle arthroplasty (TAA) is an increasingly utilized treatment for ankle arthritis, and opioids are commonly used as part of perioperative pain control. However, many states have enacted opioid-limiting legislation to reduce perioperative opioid prescribing. The aim of this study was to evaluate the impact of time and state legislation on perioperative opioid prescribing in TAA. This study is a retrospective, observational review of 90-day perioperative opioid prescribing in 1,829 patients undergoing TAA throughout the United States using a large insurance database. Initial and cumulative volumes and rates of opioid prescription filling were recorded along with baseline patient and operative characteristics. Dates of state legislation enactment were also recorded. Student t-tests, analysis of variance, and multivariable linear and logistic regression were utilized to analyze the impact of time and state legislation on opioid prescription filling. In the 90-day perioperative time period, initial and cumulative opioid prescription filling in oxycodone 5-mg equivalents has decreased significantly from 2010 (63.8 initial and 163.3 cumulative) to 2019 (41.1 initial and 67.2 cumulative). States with opioid-limiting legislation saw larger and more significant reductions in initial and cumulative opioid prescription filling preact to postact (63.3-50.6 with legislation vs 61.4-51.9 without legislation initial and 146.4-93.3 with legislation vs 125.1-108.6 without legislation cumulative). This study demonstrates that foot and ankle surgeons in states with opioid-limiting legislation have responded by significantly reducing 90-day perioperative opioid prescribing in TAA. These results encourage states without legislation to enact opioid-specific laws to reduce opioid prescribing.
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Affiliation(s)
| | - Colleen M Wixted
- Medical Student, Department of Orthopaedic Surgery, Duke University, Durham, NC
| | - Nicholas B Allen
- Research Assistant, Department of Orthopaedic Surgery, Duke University, Durham, NC
| | - Andrew E Hanselman
- Assistant Professor, Department of Orthopaedic Surgery, Duke University, Durham, NC
| | - Samuel B Adams
- Associate Professor, Department of Orthopaedic Surgery, Duke University, Durham, NC
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28
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Ouyang H, Zhang J, Chi D, Zhang K, Huang Y, Huang J, Huang W, Bai X. The YTHDF1-TRAF6 pathway regulates the neuroinflammatory response and contributes to morphine tolerance and hyperalgesia in the periaqueductal gray. J Neuroinflammation 2022; 19:310. [PMID: 36550542 PMCID: PMC9784087 DOI: 10.1186/s12974-022-02672-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Long-term use of opioids such as morphine has negative side effects, such as morphine analgesic tolerance and morphine-induced hyperalgesia (MIH). These side effects limit the clinical use and analgesic efficacy of morphine. Elucidation of the mechanisms and identification of feasible and effective methods or treatment targets to solve this clinical phenomenon are important. Here, we discovered that YTHDF1 and TNF receptor-associated factor 6 (TRAF6) are crucial for morphine analgesic tolerance and MIH. The m6A reader YTHDF1 positively regulated the translation of TRAF6 mRNA, and chronic morphine treatments enhanced the m6A modification of TRAF6 mRNA. TRAF6 protein expression was drastically reduced by YTHDF1 knockdown, although TRAF6 mRNA levels were unaffected. By reducing inflammatory markers such as IL-1β, IL-6, TNF-α and NF-κB, targeted reduction of YTHDF1 or suppression of TRAF6 activity in ventrolateral periaqueductal gray (vlPAG) slows the development of morphine analgesic tolerance and MIH. Our findings provide new insights into the mechanism of morphine analgesic tolerance and MIH indicating that YTHDF1 regulates inflammatory factors such as IL-1β, IL-6, TNF-α and NF-κB by enhancing TRAF6 protein expression.
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Affiliation(s)
- Handong Ouyang
- grid.488530.20000 0004 1803 6191Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd East, Guangzhou, China
| | - Jianxing Zhang
- grid.488530.20000 0004 1803 6191Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd East, Guangzhou, China
| | - Dongmei Chi
- grid.488530.20000 0004 1803 6191Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd East, Guangzhou, China
| | - Kun Zhang
- grid.488530.20000 0004 1803 6191Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd East, Guangzhou, China
| | - Yongtian Huang
- grid.488530.20000 0004 1803 6191Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd East, Guangzhou, China
| | - Jingxiu Huang
- grid.488530.20000 0004 1803 6191Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd East, Guangzhou, China
| | - Wan Huang
- grid.488530.20000 0004 1803 6191Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd East, Guangzhou, China
| | - Xiaohui Bai
- grid.488530.20000 0004 1803 6191Department of Anesthesiology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd East, Guangzhou, China ,grid.412536.70000 0004 1791 7851Department of Anesthesiology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yangjiang Road West, Guangzhou, China
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29
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Clobes TA, Palmier LA, Gagnon M, Klaiman C, Arellano M. The impact of education on attitudes toward medical cannabis. PEC INNOVATION 2022; 1:100009. [PMID: 37364019 PMCID: PMC10194214 DOI: 10.1016/j.pecinn.2021.100009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 06/28/2023]
Abstract
Objective This research explores the impact of patient education on reducing historical and current stigma. Methods Participants were recruited through social media, parenting with community organizations, and snowball sampling. A pretest posttest method was utilized. Participants viewed five balanced educational videos about medicinal cannabis. Attitudes toward medical cannabis were measured with a modified version of the medical component of the Recreational and Medical Cannabis Attitudes Scale (RMCAS). In total, 111 participants completed all requirements of the study. Results Results of a Wilcoxon Sign Rank Test demonstrated a significant increase in the modified medical component of the RMCAS (1.18, p = 0.029). Conclusion Health education is an effective intervention to reduce stigma associated with medical cannabis. Future health policies must take a balanced, education-focused, and proactive stance in reducing barriers to care that exist due to the negative stigma associated with cannabis use.Innovation: Historically, patient education has focused on areas such as tobacco, automobile safety, vaccinations, obesity, and the like. This research applied patient education to the area of medical cannabis to improve attitudes toward it and improve patient access.
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Affiliation(s)
- Thomas A. Clobes
- California State University, Channel Islands 1 University Dr., Camarillo, CA 93012, USA
| | - Lauren A. Palmier
- The University of Health Sciences and Pharmacy in St. Louis 1 Pharmacy, Pl, St. Louis, MO 63110, USA
| | - Matin Gagnon
- California State University, Channel Islands 1 University Dr., Camarillo, CA 93012, USA
| | - Colby Klaiman
- California State University, Channel Islands 1 University Dr., Camarillo, CA 93012, USA
| | - Mya Arellano
- California State University, Channel Islands 1 University Dr., Camarillo, CA 93012, USA
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30
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Clobes TA, Gagnon M. Demographic factors that impact attitudes toward medical cannabis. PEC INNOVATION 2022; 1:100085. [PMID: 37213732 PMCID: PMC10194315 DOI: 10.1016/j.pecinn.2022.100085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/03/2022] [Accepted: 09/13/2022] [Indexed: 05/23/2023]
Abstract
Objective This study aims to identify pertinent demographic characteristics that influence attitudes toward medical cannabis. Methods Survey respondents were recruited through social media posts, partnering with community organizations, and snowball sampling. Attitudes were measured with a modified version of the medical component of the Recreational and Medical Cannabis Attitudes Scale (MMCAS). Data were analyzed using a one-way ANOVA or one-way Welch ANOVA to determine differences within demographic characteristics. A Tukey-Kramer, or Games-Howell, post-hoc analysis was conducted to determine specific groups within the independent variables that significantly impacted medical cannabis attitudes. Results A total of 645 participants completed the survey. Significant variation in MMCAS was noted between groups based on race, political party affiliation, political view, religion, state legal status, and past/current cannabis use. There were no significant variations noted in MMCAS for apolitical factors. Conclusion Political, religious, and legal demographic factors impact attitudes toward medical cannabis. Innovation The use of health education targeted at the groups of people who continue to harbor antiquated attitudes toward medical cannabis will help to improve patient access and, thus, patient outcomes. Cannabis advocates can innovatively apply health education efforts to groups of people who are aligned with the demographic factors identified in this current work.
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Acharya M, Hayes CJ, Li C, Painter JT, Dayer L, Martin BC. Development of a potential opioid misuse measure from administrative dispensing data and contrasting opioid misuse among individuals on long-term tramadol, long-term short-acting hydrocodone or long-term short-acting oxycodone therapy in Arkansas. Curr Med Res Opin 2022; 38:1947-1957. [PMID: 36000252 PMCID: PMC10507676 DOI: 10.1080/03007995.2022.2112874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study sought to: (1) construct and validate a composite potential opioid misuse score; and (2) compare potential opioid misuse among individuals prescribed long-term therapy on tramadol, short-acting hydrocodone or short-acting oxycodone. METHODS A retrospective cohort study was conducted using Arkansas All-Payer Claims Database (APCD; 2013-2018) linked to Arkansas Prescription Drug Monitoring Program (PDMP; 2014-2017) and state death certificate data (2013-2018). The study subjects were ambulatory, cancer-free adults with incident long-term therapy on tramadol, short-acting hydrocodone or short-acting oxycodone. The number of opioid prescribers/pharmacies, cash payment for opioid prescriptions, overlapping prescribers/pharmacies and a composite misuse score (derived from opioid prescribers/pharmacies and cash payment) were assessed in two 180 day windows as potential measures of misuse. The composite score was developed based on associations observed with opioid overdose and opioid-related injuries. RESULTS A total of 17,816 (tramadol), 23,660 (hydrocodone) and 4799 (oxycodone) persons were included. The composite score had modest discrimination for overdose (c-index = 0.65). In the first 180 day period, the average composite misuse scores were 1.28 (tramadol), 1.93 (hydrocodone) and 2.18 (oxycodone). Compared to long-term hydrocodone, long-term tramadol had lower misuse (IRR [95% CI]: 0.75 [0.73-0.76]), and long-term oxycodone had higher misuse (1.09 [1.07-1.11]) in adjusted analyses. Qualitatively similar associations were observed for nearly all individual component measures of misuse. CONCLUSION A composite measure of potential opioid misuse had modest levels of discrimination in detecting overdose. In comparison to long-term hydrocodone therapy, long-term oxycodone had higher and tramadol had lower risk of potential opioid misuse.
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Affiliation(s)
- Mahip Acharya
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Corey J Hayes
- Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare Systems, North Little Rock, AR, USA
| | - Chenghui Li
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jacob T Painter
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare Systems, North Little Rock, AR, USA
| | - Lindsey Dayer
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bradley C Martin
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Muacevic A, Adler JR, Lindsey W, Ramos O, Cheng W, Danisa O. Preoperative Cannabis Use Associated With an Increased Rate of Reoperation and Postoperative Opioid Use Following Anterior Cervical Decompression and Fusion. Cureus 2022; 14:e31285. [PMID: 36514630 PMCID: PMC9733193 DOI: 10.7759/cureus.31285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives The objective of this retrospective cohort study was to evaluate the associations among preoperative cannabis use, postoperative opioid use, and postoperative outcomes following elective anterior cervical decompression and fusion (ACDF). Methods Patients who underwent one- or two-level ACDF were characterized preoperatively as active cannabis users, former users, or nonusers. Patients were also classified based on history of preoperative opioid use as chronic users, acute users, or nonusers. Groups were compared based on outcomes including the rate of emergency department visits six months postoperatively, rate of readmissions one year postoperatively, rate of reoperation two years postoperatively, and daily postoperative opioid use measured in milligram morphine equivalents (MMEs) at 0-6 months and 6-12 months postoperatively. Results Of the 198 patients included in this study, 13 (6.6%) were active cannabis users, 11 (5.6%) were former users, and 174 (87.8%) were nonusers. The rate of reoperation within two years was 23.1% for active cannabis users, 0% for former users, and 4.0% for nonusers (p=0.0075). The average daily opioid use in MMEs 6-12 months postoperatively was 49.4 for active cannabis users, 4.1 for former users, and 13.3 for nonusers (p=0.0014). For chronic opioid users, acute users, and nonusers, the average daily opioid use in MMEs 6-12 months postoperatively was 39.9, 18.4, and 5.7, respectively (p<.0001). Conclusions History of cannabis use is associated with increased postoperative opioid use and increased rate of reoperation following elective ACDF.
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Hsu JW, Tsai SJ, Bai YM, Huang KL, Su TP, Chen TJ, Chen MH. Risk of exposure to prescription opioids in children and adolescents with autism spectrum disorder: A nationwide longitudinal study. Autism Res 2022; 15:2192-2199. [PMID: 36054259 DOI: 10.1002/aur.2806] [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: 09/21/2021] [Accepted: 08/15/2022] [Indexed: 12/15/2022]
Abstract
Whether children and adolescents with autism spectrum disorder (ASD) are more likely to be exposed to prescription opioids than others remains unknown. The Taiwan National Health Insurance Research Database was employed, and 14,849 children and adolescents with ASD and 148,490 age- and sex-matched non-ASD controls were enrolled between 2001 and 2009 and followed up till the end of 2011. Those exposed to prescription opioids during the follow-up period were identified. Patients with ASD were more likely to be exposed to prescription opioids (hazard ratio [HR]: 4.95, 95% confidence interval [CI]: 4.50-5.45), including intravenous or intramuscular opioids (HR: 5.80, 95% CI: 5.23-6.43) and oral or transcutaneous opioids (HR: 2.32, 95% CI: 1.87-2.89), than were non-ASD controls. Furthermore, the ASD cohort had the increased likelihood of cumulative exposure of >14 days (HR: 6.19, 95% CI: 4.91-7.79) and >30 days (HR: 7.17, 95% CI: 5.19-9.90) to prescription opioids compared with the control cohort. ASD was a risk factor for exposure to prescription opioids. Close monitoring of prescription opioid use is necessary for at-risk children and adolescents with ASD, such as those having with or chronic pain. We found that patients with ASD were more likely to be exposed to prescription opioids, including intravenous or intramuscular opioids and oral or transcutaneous opioids, than were non-ASD controls. We suggest that close monitoring of prescription opioid use is necessary for at-risk children and adolescents with ASD, such as those having with or chronic pain.
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Affiliation(s)
- Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kai-Lin Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Psychiatry, General Cheng Hsin Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Psychiatry, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Hernández-Sánchez S, Poveda-Pagán EJ, Toledo-Marhuenda JV, Lozano-Quijada C. Dealing with Chronic Pain: Tips to Teach Undergraduate Health Sciences Students. J Pain Res 2022; 15:3223-3232. [PMID: 36281308 PMCID: PMC9587724 DOI: 10.2147/jpr.s377124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/21/2022] [Indexed: 11/23/2022] Open
Abstract
Chronic pain is a significant and costly problem all over the world that negatively impacts the quality of life of sufferers. There are clear discrepancies between the prevalence of chronic pain in society and the low priority assigned to educating future physicians about the complexities of pain. This condition also occurs in other undergraduate health science students, although research in this area has not been studied as much as in medical schools. Based on the International Association for the Study of Pain (IASP) Pain Curriculum Outline, a systematic search of the available literature, and the authors' own experiences, we highlight some relevant tips to educate health science trainees in the management of patients with chronic pain. These tips highlight current international recommendations for a comprehensive approach to this prevalent problem in society, which should be learnt during the university training of health professionals.
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Affiliation(s)
- Sergio Hernández-Sánchez
- Center for Translational Research in Physiotherapy, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernandez University, Alicante, Spain
| | - Emilio José Poveda-Pagán
- Center for Translational Research in Physiotherapy, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernandez University, Alicante, Spain
| | - Jose Vicente Toledo-Marhuenda
- Center for Translational Research in Physiotherapy, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernandez University, Alicante, Spain,Correspondence: Jose Vicente Toledo-Marhuenda, Center for Translational Research in Physiotherapy, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernandez University, Alicante, Spain, Tel +34 965919204, Email
| | - Carlos Lozano-Quijada
- Center for Translational Research in Physiotherapy, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernandez University, Alicante, Spain
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Butler KE, Baker ES. A High-Throughput Ion Mobility Spectrometry-Mass Spectrometry Screening Method for Opioid Profiling. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2022; 33:1904-1913. [PMID: 36136315 PMCID: PMC9616473 DOI: 10.1021/jasms.2c00186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In 2017, the United States Department of Health and Human Services declared the widespread misuse and abuse of prescription and illicit opioids an epidemic. However, this epidemic dates back to the 1990s when opioids were extensively prescribed for pain management. Currently, opioids are still recommended for pain management, and given their abuse potential, rapid screening is imperative for patient treatment. Of particular importance is assessing pain management patient compliance, where evaluating drug use is crucial for preventing opioid abuse and potential overdoses. In this work, we utilized drift tube ion mobility spectrometry coupled with mass spectrometry (DTIMS-MS) to develop a rapid screening method for 33 target opioids and opioid urinary metabolites. Collision cross section values were determined for all target molecules using a flow-injection DTIMS-MS method, and clear differentiation of 27 out of the 33 opioids without prior chromatographic separation was observed when utilizing a high resolution demultiplexing screening approach. An automated solid phase extraction (SPE) platform was then coupled to DTIMS-MS for 10 s sample-to-sample analyses. This SPE-IMS-MS approach enabled the rapid screening of urine samples for opioids and presents a major improvement in sample throughput compared to traditional chromatographic analyses coupled with MS, which routinely take several minutes per sample. Overall, this vast reduction in analysis time facilitates a faster turn-around for patient samples, providing great benefits to clinical applications.
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Affiliation(s)
- Karen E Butler
- Department of Chemistry, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Erin S Baker
- Department of Chemistry, North Carolina State University, Raleigh, North Carolina 27695, United States
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina 27695, United States
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina 27695, United States
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Infiltration of Bupivacaine and Triamcinolone in Surgical Wounds of Milligan-Morgan Hemorrhoidectomy for Postoperative Pain Control: A Double-Blind Randomized Controlled Trial. Dis Colon Rectum 2022; 65:1034-1041. [PMID: 35714359 DOI: 10.1097/dcr.0000000000002250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pain management after hemorrhoidectomy continues to be challenging. OBJECTIVE The aim of this study was to evaluate the effectiveness of infiltration of bupivacaine hydrochloride and triamcinolone acetonide in surgical wounds of Milligan-Morgan hemorrhoidectomy for postoperative pain relief. DESIGN A double-blind randomized controlled clinical trial was conducted between May 2015 and June 2019. SETTINGS This study was carried out in a secondary referral hospital center in Spain. PATIENTS Patients who underwent an elective Milligan-Morgan hemorrhoidectomy for grade III-IV hemorrhoids were included. INTERVENTIONS Patients allocated in the intervention group received a single infiltration of bupivacaine and triamcinolone and patients allocated in the control group did not receive any intervention. MAIN OUTCOMES MEASURES The primary end point was the median of maximum pain by visual analog scale during the 48 hours of hospital stay. Secondary end points were pain at follow-up, pain during defecation, analgesic requirements, wound healing rate, and complications. RESULTS A total of 128 patients were randomly assigned (64 in each group). The median of maximum pain score at 48 hours was 3 points in the intervention group and 6 points in the control group, which was significantly different ( p < 0.05). No differences were observed regarding pain during defecation. Morphine requirements were significant lower in the intervention group (6.3% vs 21.9% patients; p = 0.01; 5 vs 23 cumulative doses; p = 0.01). Wound healing and complication rates were similar in both groups. LIMITATIONS Use of placebo was not considered in the control group ("intervention group" vs "control group" clinical trial). Data regarding pain or other complications at 48 hours postoperatively were pooled and expressed as median of values. CONCLUSIONS Infiltration of surgical wounds with bupivacaine and triamcinolone decreases postoperative pain and reduces morphine requirements in Milligan-Morgan hemorrhoidectomies. See Video Abstract at http://links.lww.com/DCR/B867 .Clinical trial registration: European Registry of Clinical Trials. EUDRACT 2014- 003043-35. INFILTRACIN DE BUPIVACANA Y TRIAMCINOLONA EN HERIDAS QUIRRGICAS DE HEMORROIDECTOMA DE MILLIGANMORGAN PARA EL CONTROL DEL DOLOR POSOPERATORIO ENSAYO CLNICO DOBLE CIEGO, ALEATORIZADO Y CONTROLADO ANTECEDENTES:El manejo del dolor posterior a una hemorroidectomía sigue siendo un desafío.OBJETIVO:El objetivo de este estudio fue evaluar la efectividad de la infiltración de bupivacaína y triamcinolona en heridas quirúrgicas de hemorroidectomía de Milligan-Morgan para el alivio del dolor posoperatorio.DISEÑO:Se realizó un ensayo clínico controlado, aleatorizado, doble ciego entre mayo del 2015 y junio del 2019.ENTORNO CLINICO:Este estudio se llevó a cabo en un centro hospitalario de referencia secundaria en España.PACIENTES:Se incluyeron pacientes que se sometieron a una hemorroidectomía de Milligan-Morgan electiva por hemorroides de grado III-IV.INTERVENCIONES:Los pacientes asignados al grupo de intervención recibieron una única infiltración de bupivacaína y triamcinolona y los pacientes asignados al grupo de control no recibieron ninguna intervención.PRINCIPALES RESULTADOS RESULTADOS:El factor de valoración principal fue la mediana del dolor máximo según la escala análoga visual durante las 48 horas de estancia hospitalaria. Las variables secundarias fueron dolor durante el seguimiento, dolor durante la defecación, requerimientos de analgésicos, tasa de cicatrización de heridas y complicaciones.RESULTADOS:Se asignó aleatoriamente a un total de 128 pacientes (64 en cada grupo). La mediana de puntuación máxima de dolor a las 48 horas fue de 3 puntos en el grupo de intervención y de 6 puntos en el grupo de control con diferencias significativas (p < 0,05). No se observaron diferencias en cuanto al dolor durante la defecación. Las necesidades de morfina fueron significativamente menores en el grupo de intervención (6,3% versus 21,9% de los pacientes; p = 0,01; 5 versus 23 dosis acumuladas; p = 0,01). Las tasas de curación de heridas y complicaciones fueron similares en ambos grupos.LIMITACIONES:No se consideró el uso de placebo en el grupo de control (ensayo clínico: "grupo de intervención" versus "grupo control"). Los datos con respecto al dolor u otras complicaciones después de 48 horas postoperatorias se agruparon y expresaron como mediana de los valores.CONCLUSIONES:La infiltración de heridas quirúrgicas con bupivacaína y triamcinolona disminuye el dolor posoperatorio y reduce los requerimientos de morfina en la hemorroidectomía de Milligan-Morgan. Consulte Video Resumen en http://links.lww.com/DCR/B867 . (Traducción- Dr. Francisco M. Abarca-Rendon).Registro de ensayos clínicos: Registro europeo de ensayos clínicos. EUDRACT 2014- 003043-35.
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Turcotte B, Jacques E, Tremblay S, Toren P, Caumartin Y, Lodde M. Opioid use after uro-oncologic surgeries in time of opioid crisis. Can Urol Assoc J 2022; 16:E432-E436. [PMID: 35302470 PMCID: PMC9343155 DOI: 10.5489/cuaj.7633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Recent literature emphasizes how overprescription and lack of guidelines contribute to wide variation in opioid prescribing practices and opioid-related harms. We conducted a prospective, observational study to evaluate opioid prescriptions among uro-oncologic patients discharged following elective in-patient surgery. METHODS Patients who underwent four surgeries were included: open retropubic radical prostatectomy, robot-assisted radical prostatectomy, laparoscopic radical nephrectomy, and laparoscopic partial nephrectomy. The primary outcome was the dose of opioids used after discharge (in oral morphine equivalents [MEq]). Secondary outcomes included: opioid requirements for 80% of the patients, management of unused opioids, opioid use three months postoperative, opioid prescription refills, and guidance about opioid disposal. RESULTS Sixty patients were included for analysis. Patients used a mean of 30 MEq (95% confidence interval 17.8-42.2) at home and 80% of the patients used 50 MEq or less. A mean of 40.4 MEq per patient was overprescribed. Fifty percent of the patients kept the remaining opioids at home, with only 20.0% returning them to their pharmacy. After three months, 5.0% of the patients were using opioids at least occasionally. Three patients needed a new opioid prescription. Forty percent reported having received information regarding management of unused opioids. CONCLUSIONS We found 60% of opioids prescribed were unused, with half of our patients keeping these unused tablets at home. Our results suggest appropriate opioid prescription amounts needed for urological cancer surgery, with 80% of the patients using 50 MEq or less of morphine equivalents.
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Affiliation(s)
- Bruno Turcotte
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Emma Jacques
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Samuel Tremblay
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Paul Toren
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Yves Caumartin
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Michele Lodde
- Division of Urology, Department of Surgery, CHU de Québec-Université Laval, Quebec, QC, Canada
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update of the recently published randomized controlled trials in the field of digital health interventions for substance use disorders. RECENT FINDINGS Over the past 2 years, five cannabis-specific and seven polysubstance-focused randomized controlled trials were published. No studies were found that focused on opioid or psychostimulant use disorders. Most studies examined feasibility but were underpowered to assess effectiveness. Given the optimistic results of the studies in regards to feasibility more fully powered trials should be conducted. In addition, the literature is in need for an increased focus on comorbidity and outcome standardization. SUMMARY Although the number of studies targeting new target groups, technologies and new delivery settings has increased - future studies should consider the identified gaps and suggestions to further strengthen the evidence of digital interventions targeting substance use disorders.
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Wu FCW. Ageing male (part 2): Management of functional hypogonadism in older men, a patient-centric holistic approach. Best Pract Res Clin Endocrinol Metab 2022; 36:101626. [PMID: 35461757 DOI: 10.1016/j.beem.2022.101626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The diagnosis of functional hypogonadism should prompt a thorough assessment and optimization of general health, including lifestyle changes, weight reduction, care of comorbidities and cessation of offending medications, some of which can lead to meaningful gains in endogenous testosterone (T) concentrations. Having excluded or addressed reversible causes and contra-indications, patients with functional hypogonadism can be offered a trial of testosterone replacement therapy (TRT) after full discussion on the anticipated benefits and potential risks. T treatment improves libido but may be less effective for erectile dysfunction (ED). T treatment can also have modest positive effects on insulin resistance, bone strength, some measures of physical strength, and mild depressive symptoms but the clinical significance of these relatively short-term improvements remain uncertain in terms of longer-term patient-important outcomes. Initiation of TRT is a joint decision between patient and clinician since longer-term benefits and risks have not been adequately defined.
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Affiliation(s)
- Frederick C W Wu
- Division of Endocrinology, Diabetes & Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9WL, UK.
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Lischka A, Lassuthova P, Çakar A, Record CJ, Van Lent J, Baets J, Dohrn MF, Senderek J, Lampert A, Bennett DL, Wood JN, Timmerman V, Hornemann T, Auer-Grumbach M, Parman Y, Hübner CA, Elbracht M, Eggermann K, Geoffrey Woods C, Cox JJ, Reilly MM, Kurth I. Genetic pain loss disorders. Nat Rev Dis Primers 2022; 8:41. [PMID: 35710757 DOI: 10.1038/s41572-022-00365-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 01/05/2023]
Abstract
Genetic pain loss includes congenital insensitivity to pain (CIP), hereditary sensory neuropathies and, if autonomic nerves are involved, hereditary sensory and autonomic neuropathy (HSAN). This heterogeneous group of disorders highlights the essential role of nociception in protecting against tissue damage. Patients with genetic pain loss have recurrent injuries, burns and poorly healing wounds as disease hallmarks. CIP and HSAN are caused by pathogenic genetic variants in >20 genes that lead to developmental defects, neurodegeneration or altered neuronal excitability of peripheral damage-sensing neurons. These genetic variants lead to hyperactivity of sodium channels, disturbed haem metabolism, altered clathrin-mediated transport and impaired gene regulatory mechanisms affecting epigenetic marks, long non-coding RNAs and repetitive elements. Therapies for pain loss disorders are mainly symptomatic but the first targeted therapies are being tested. Conversely, chronic pain remains one of the greatest unresolved medical challenges, and the genes and mechanisms associated with pain loss offer new targets for analgesics. Given the progress that has been made, the coming years are promising both in terms of targeted treatments for pain loss disorders and the development of innovative pain medicines based on knowledge of these genetic diseases.
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Affiliation(s)
- Annette Lischka
- Institute of Human Genetics, Medical Faculty, Uniklinik RWTH Aachen University, Aachen, Germany
| | - Petra Lassuthova
- Department of Paediatric Neurology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Arman Çakar
- Neuromuscular Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Christopher J Record
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Jonas Van Lent
- Peripheral Neuropathy Research Group, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,Laboratory of Neuromuscular Pathology, Institute Born Bunge, Antwerp, Belgium
| | - Jonathan Baets
- Laboratory of Neuromuscular Pathology, Institute Born Bunge, Antwerp, Belgium.,Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Neuromuscular Reference Centre, Department of Neurology, Antwerp University Hospital, Antwerp, Belgium
| | - Maike F Dohrn
- Department of Neurology, Medical Faculty, Uniklinik RWTH Aachen University, Aachen, Germany.,Dr. John T. Macdonald Foundation, Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Jan Senderek
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Angelika Lampert
- Institute of Physiology, Medical Faculty, Uniklinik RWTH Aachen University, Aachen, Germany
| | - David L Bennett
- Nuffield Department of Clinical Neuroscience, Oxford University, Oxford, UK
| | - John N Wood
- Molecular Nociception Group, Wolfson Institute for Biomedical Research, University College London, London, UK
| | - Vincent Timmerman
- Peripheral Neuropathy Research Group, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium.,Laboratory of Neuromuscular Pathology, Institute Born Bunge, Antwerp, Belgium
| | - Thorsten Hornemann
- Department of Clinical Chemistry, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michaela Auer-Grumbach
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Yesim Parman
- Neuromuscular Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Miriam Elbracht
- Institute of Human Genetics, Medical Faculty, Uniklinik RWTH Aachen University, Aachen, Germany
| | - Katja Eggermann
- Institute of Human Genetics, Medical Faculty, Uniklinik RWTH Aachen University, Aachen, Germany
| | - C Geoffrey Woods
- Cambridge Institute for Medical Research, Keith Peters Building, Cambridge Biomedical Campus, Cambridge, UK
| | - James J Cox
- Molecular Nociception Group, Wolfson Institute for Biomedical Research, University College London, London, UK
| | - Mary M Reilly
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Ingo Kurth
- Institute of Human Genetics, Medical Faculty, Uniklinik RWTH Aachen University, Aachen, Germany.
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Giravi HY, Biskupiak Z, Tyler LS, Bulaj G. Adjunct Digital Interventions Improve Opioid-Based Pain Management: Impact of Virtual Reality and Mobile Applications on Patient-Centered Pharmacy Care. Front Digit Health 2022; 4:884047. [PMID: 35770137 PMCID: PMC9234128 DOI: 10.3389/fdgth.2022.884047] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Digital therapeutics (DTx, mobile medical apps, software as a medical device) are rapidly emerging as clinically effective treatments for diverse chronic diseases. For example, the Food and Drug Administration (FDA) has recently authorized a prescription virtual reality (VR) app for treatment of moderate to severe low back pain. The FDA has also approved an adjunct digital therapy in conjunction with buprenorphine for opioid use disorder, further illustrating opportunities to integrate digital therapeutics with pharmacotherapies. There are ongoing needs to disseminate knowledge about advances in digital interventions among health care professionals, policymakers, and the public at large. This mini-review summarizes accumulating clinical evidence of digital interventions delivered via virtual reality and mobile apps to improve opioid-based analgesia. We identified relevant randomized controlled trials (RCTs) using Embase and PubMed databases which reported pain scores with a validated pain scale (e.g., visual analog scales, graphic rating scale, numeric rating scale) and use of a digital intervention in conjunction with opiates. Among identified RCTs, the majority of studies reported improved pain scores in the digital intervention group, as compared to “treatment as usual” group. Our work suggests that VR and mobile apps can be used as adjunct digital therapies for pain management. We discuss these findings in the context of how digital health technologies can transform patient-centered pharmacy care.
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Affiliation(s)
- Hayam Y. Giravi
- University of Utah College of Pharmacy, Salt Lake City, UT, United States
- *Correspondence: Hayam Y. Giravi
| | - Zack Biskupiak
- Department of Medicinal Chemistry, L.S. Skaggs College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Linda S. Tyler
- Department of Pharmacotherapy, L.S. Skaggs College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, L.S. Skaggs College of Pharmacy, University of Utah, Salt Lake City, UT, United States
- Grzegorz Bulaj
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Vallecillo G, Durán X, Canosa I, Roquer A, Martinez MC, Perelló R. COVID
‐19 vaccination coverage and vaccine hesitancy among people with opioid use disorder in Barcelona, Spain. Drug Alcohol Rev 2022; 41:1311-1318. [PMID: 35668697 PMCID: PMC9348033 DOI: 10.1111/dar.13502] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 02/06/2023]
Abstract
Introduction People with substance use disorders are considered a priority group for SARS‐CoV‐2 vaccination as they are at elevated risk of COVID‐19 and its severe complications. However, data are scarce about vaccination coverage in a real‐world setting. Methods A descriptive study was conducted in people with opioid use disorder (OUD) from three public centres for outpatient drug addiction treatment in Barcelona, Spain, who received brief medical advice and were referred to vaccination clinic sites. Results Three hundred and sixty‐two individuals were included: 277 (77%) were men with a mean age of 48.1 ± 8.9 years and 77% were Spanish. Most (90%) participants engaged in polysubstance use and all individuals were on opioid agonist therapy. Psychiatric comorbidity was present in 56% subjects and 32% individuals had ≥1 chronic disease, 30% had HIV and 13% hepatitis C. There were 258 fully vaccinated individuals (71%; 95% confidence interval [CI] 67, 76). Age (odds ratio [OR] 1.04; 95% CI 1.01, 1.08; P < 0.01) and Charlson Comorbidity Index (OR 1.67; 95% CI 1.11, 2.5; P < 0.01) were associated with full vaccination. The vaccination hesitancy causes cited were complacency (53, 51%), convenience (40, 39%) and confidence (11, 10%). Discussion and Conclusions More than two‐thirds of our sample of people with OUD were fully vaccinated. Complacency and convenience represented a significant barrier to complete vaccination among people with OUD on opioid agonist therapy referred to vaccination clinic sites. Additional measures are necessary to increase vaccination, especially for younger individuals and those with less medical comorbidity. Integrating vaccination services in drug outpatient centres could be a useful alternative.
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Affiliation(s)
- Gabriel Vallecillo
- Institute of Neuropsychiatry and Addictions Hospital del Mar Barcelona Spain
- Addiction Research Group, Neuroscience Research Program Hospital del Mar Medical Research Institute Barcelona Spain
| | - Xavier Durán
- Statistics Department Hospital del Mar Medical Research Institute Barcelona Spain
| | - Irene Canosa
- Institute of Neuropsychiatry and Addictions Hospital del Mar Barcelona Spain
| | - Albert Roquer
- Institute of Neuropsychiatry and Addictions Hospital del Mar Barcelona Spain
| | - Maria C. Martinez
- Institute of Neuropsychiatry and Addictions Hospital del Mar Barcelona Spain
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Luria S, Liba G, Zimmerman D, Polliack G, Volk I, Calderon-Margalit R. Nationwide community based emergency centers reveal scale of hand trauma. Injury 2022; 53:2102-2109. [PMID: 35184819 DOI: 10.1016/j.injury.2022.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/08/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION This study describes the characteristics of hand trauma treated in community-based emergency centers (CBECs) in Israel. It was hypothesized that the rate of hand trauma, as well as patient and injury characteristics, would differ from a recent study of patients treated in hospital emergency departments (EDs) in Jerusalem. METHODS Data on all hand injury patients treated at any of the CBECs belonging to a large nationwide chain in 2017 were retrieved from the electronic medical records of the treatment centers, including demographic and clinical characteristics. RESULTS Over the course of 2017, 53,574 individuals were treated for forearm, wrist and hand injuries (35% of all trauma patients treated during this period). The majority of the patients were male (62%). Contusions and fractures were common (80%) with a minority of lacerations (10%). Crush injuries and amputations were rare. Dog bites accounted for 1.5% of the injuries under the age of 10. Females were treated more with painkillers and opioids, especially over the age of 65, with variability between centers. Although the rate of fractures was similar between teens and the elderly, the elderly were treated with immobilization less frequently, and were referred to EDs for further care. Hospital referral rates differed significantly between centers. DISCUSSION A higher rate of hand trauma was found in the CBECs in comparison to the hospital ED report (35% vs. 20% of all trauma patients, respectively). Patients treated at the CBECs, in comparison to the ED, were less often male, less often young adults, and differed in terms of type of injury. In the CBECs there were more contusions, as well as fewer lacerations and open wound injuries. In contrast, dog bites in children were found to be much more prevalent than previously reported. Hospital referral indications, the use of immobilization and pain management were found to vary according to age, gender and treatment center. Due to the high rate of hand trauma in CBECs, specific protocols are needed for these patients. The use of opioids should be specifically addressed, considering recent changes in treatment protocols. Thus, the prevalence and characteristics of hand trauma may be biased in studies based on hospital records.
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Affiliation(s)
- Shai Luria
- Hand and Microvascular Surgery Unit, Department of Orthopedics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
| | - Guy Liba
- Hand and Microvascular Surgery Unit, Department of Orthopedics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | | | | | - Ido Volk
- Hand and Microvascular Surgery Unit, Department of Orthopedics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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Niznik JD, Collins BJ, Armistead LT, Larson CK, Kelley CJ, Hughes TD, Sanders KA, Carlson R, Ferreri SP. Pharmacist interventions to deprescribe opioids and benzodiazepines in older adults: A rapid review. Res Social Adm Pharm 2022; 18:2913-2921. [PMID: 34281786 PMCID: PMC8836277 DOI: 10.1016/j.sapharm.2021.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many older adults are prescribed opioids and benzodiazepines (BZDs), despite increased susceptibility to adverse events. Challenges of deprescribing include fragmented care and lack of knowledge or time. Pharmacists are well-positioned to overcome these challenges and facilitate deprescribing of these medications. OBJECTIVES We sought to evaluate interventions utilizing pharmacists to deprescribe opioids and BZDs in older adults. METHODS We conducted a rapid review following a comprehensive literature search to identify interventions with pharmacist involvement for deprescribing opioids and BZDs in older adults. Studies were included based on: (1) inclusion of patients ≥ 65 years old receiving BZDs and/or opioids, (2) evaluation of feasibility or outcomes following deprescribing (3) pharmacists as part of the intervention. We included randomized, observational, cohort, and pilot studies. Studies that did not report specific results for BZD or opioids were excluded. RESULTS We screened 687 abstracts and included 17 studies. Most (n = 13) focused on BZD deprescribing. Few studies focused on opioids (n = 2) or co-prescribing of opioids and BZDs (n = 2). The most common intervention was educational brochures (n = 8), majority being the EMPOWER brochure for deprescribing BZDs. Other interventions included chart review with electronic notes (n = 4), pharmacist-led programs/services (n = 2), and multifactorial interventions (n = 3). Many studies were underpowered or lacked suitable control groups. Generally speaking, interventions utilizing educational materials and those in which pharmacists engaged with patients and providers were more effective. Interventions relying on electronic communication by pharmacists were less successful, due to low acceptance or acknowledgement. CONCLUSIONS We identified a number of feasible interventions to reduce BZD use, but fewer interventions to reduce opioid use in older adults. An optimal approach for deprescribing likely requires pharmacists to engage directly with patients and providers. Larger well-designed studies are needed to evaluate the effectiveness of deprescribing interventions beyond feasibility.
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Affiliation(s)
- Joshua D Niznik
- University of North Carolina School of Medicine, Division of Geriatric Medicine and Center for Aging and Health, Chapel Hill, NC, USA; University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA; VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA, USA.
| | - Brendan J Collins
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Lori T Armistead
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Claire K Larson
- University of North Carolina School of Medicine, Division of Geriatric Medicine and Center for Aging and Health, Chapel Hill, NC, USA
| | - Casey J Kelley
- University of North Carolina School of Medicine, Division of Geriatric Medicine and Center for Aging and Health, Chapel Hill, NC, USA
| | - Tamera D Hughes
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Kimberly A Sanders
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Rebecca Carlson
- University of North Carolina, Health Sciences Library, Chapel Hill, NC, USA
| | - Stefanie P Ferreri
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
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Cai J, He L, Wang H, Rong X, Chen M, Shen Q, Li X, Li M, Peng Y. Genetic liability for prescription opioid use and risk of cardiovascular diseases: a multivariable Mendelian randomization study. Addiction 2022; 117:1382-1391. [PMID: 34859517 DOI: 10.1111/add.15767] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Observational studies have yielded conflicting results on the association of prescription opioid use (POU) with the risk of cardiovascular diseases (CVD). Residual confounding and potential reverse causality are inevitable in such conventional observational studies. This study used Mendelian randomization (MR) design to estimate the causal effect of POU on the risk of CVD, including coronary heart disease (CHD), myocardial infarction (MI) and ischemic stroke (IS), as well as their common risk factors. DESIGN We estimated the causal effect of genetic liability for POU on CVD in a two-sample MR framework. Complementary sensitivity analyses were conducted to test the robustness of our results. SETTING Genome-wide association studies (GWAS) that were based on predominantly European ancestry. PARTICIPANTS The sample sizes of the GWAS used in this study ranged from 69 033 to 757 601 participants. MEASUREMENTS Genetic variants predictive of the POU and their corresponding summary-level information in the outcomes were retrieved and extracted from the respective GWAS. FINDINGS Using univariable MR, we found evidence for a causal effect of genetic liability for POU on an increased risk of CHD [odds ratio (OR) = 1.09; 95% confidence interval (CI) = 1.02-1.16; P = 0.008] and MI (OR = 1.13; 95% CI = 1.04-1.22; P = 0.002). In multivariable MR, the association remained after accounting for comorbid pain conditions, but was attenuated with adjustment for potential mediators, including body mass index (BMI), waist circumference (WC) and type 2 diabetes (T2D). CONCLUSION Mendelian randomization estimates provide robust evidence for the causal effects of genetic liability for prescription opioid use on an increased risk of coronary heart disease and myocardial infarction, which might be mediated by obesity-related traits.
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Affiliation(s)
- Jiahao Cai
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lei He
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongxuan Wang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming Chen
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qingyu Shen
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiangpen Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mei Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Peng
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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The Potential of Methocinnamox as a Future Treatment for Opioid Use Disorder: A Narrative Review. PHARMACY 2022; 10:pharmacy10030048. [PMID: 35645327 PMCID: PMC9149874 DOI: 10.3390/pharmacy10030048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 02/01/2023] Open
Abstract
The opioid epidemic is an ongoing public health crisis, and the United States health system is overwhelmed with increasing numbers of opioid-related overdoses. Methocinnamox (MCAM) is a novel mu opioid receptor antagonist with an extended duration of action. MCAM has potential to reduce the burden of the opioid epidemic by being used as an overdose rescue treatment and a long-term treatment for opioid use disorder (OUD). The currently available treatments for OUD include naloxone, naltrexone, and methadone. These treatments have certain limitations, which include short duration of action, patient non-compliance, and diversion. A narrative review was conducted using PubMed and Google Scholar databases covering the history of the opioid epidemic, pain receptors, current OUD treatments and the novel drug MCAM. MCAM could potentially be used as both a rescue and long-term treatment for opioid misuse. This is due to its pseudo-irreversible antagonism of the mu opioid receptor, abnormally long duration of action of nearly two weeks, and the possibility of using kappa or delta opioid receptor agonists for pain management during OUD treatment. MCAM’s novel pharmacokinetic and pharmacodynamic properties open a new avenue for treating opioid misuse.
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De Ridder D, Vanneste S, Smith M, Adhia D. Pain and the Triple Network Model. Front Neurol 2022; 13:757241. [PMID: 35321511 PMCID: PMC8934778 DOI: 10.3389/fneur.2022.757241] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/28/2022] [Indexed: 12/15/2022] Open
Abstract
Acute pain is a physiological response that causes an unpleasant sensory and emotional experience in the presence of actual or potential tissue injury. Anatomically and symptomatically, chronic pathological pain can be divided into three distinct but interconnected pathways, a lateral “painfulness” pathway, a medial “suffering” pathway and a descending pain inhibitory circuit. Pain (fullness) can exist without suffering and suffering can exist without pain (fullness). The triple network model is offering a generic unifying framework that may be used to understand a variety of neuropsychiatric illnesses. It claims that brain disorders are caused by aberrant interactions within and between three cardinal brain networks: the self-representational default mode network, the behavioral relevance encoding salience network and the goal oriented central executive network. A painful stimulus usually leads to a negative cognitive, emotional, and autonomic response, phenomenologically expressed as pain related suffering, processed by the medial pathway. This anatomically overlaps with the salience network, which encodes behavioral relevance of the painful stimuli and the central sympathetic control network. When pain lasts longer than the healing time and becomes chronic, the pain- associated somatosensory cortex activity may become functionally connected to the self-representational default mode network, i.e., it becomes an intrinsic part of the self-percept. This is most likely an evolutionary adaptation to save energy, by separating pain from sympathetic energy-consuming action. By interacting with the frontoparietal central executive network, this can eventually lead to functional impairment. In conclusion, the three well-known pain pathways can be combined into the triple network model explaining the whole range of pain related co-morbidities. This paves the path for the creation of new customized and personalized treatment methods.
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Affiliation(s)
- Dirk De Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- *Correspondence: Dirk De Ridder
| | - Sven Vanneste
- School of Psychology, Global Brain Health Institute, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Mark Smith
- Neurofeedbackservices of New York, New York, NY, United States
| | - Divya Adhia
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Devlin LA, Young LW, Kraft WK, Wachman EM, Czynski A, Merhar SL, Winhusen T, Jones HE, Poindexter BB, Wakschlag LS, Salisbury AL, Matthews AG, Davis JM. Neonatal opioid withdrawal syndrome: a review of the science and a look toward the use of buprenorphine for affected infants. J Perinatol 2022; 42:300-306. [PMID: 34556799 PMCID: PMC8459143 DOI: 10.1038/s41372-021-01206-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/17/2021] [Accepted: 09/03/2021] [Indexed: 02/08/2023]
Abstract
Neonates born to mothers taking opioids during pregnancy are at risk for neonatal opioid withdrawal syndrome (NOWS), for which there is no recognized standard approach to care. Nonpharmacologic treatment is typically used as a first-line approach for management, and pharmacologic treatment is added when clinical signs are not responding to nonpharmacologic measures alone. Although morphine and methadone are the most commonly used pharmacotherapies for NOWS, buprenorphine has emerged as a treatment option based on its pharmacologic profile and results from initial single site clinical trials. The objective of this report is to provide an overview of NOWS including a summary of ongoing work in the field and to review the state of the science, knowledge gaps, and practical considerations specific to the use of buprenorphine for the treatment of NOWS as discussed by a panel of experts during a virtual workshop hosted by the National Institutes of Health.
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Affiliation(s)
- Lori A Devlin
- Department of Pediatrics, Division of Neonatal Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
| | - Leslie W Young
- Department of Pediatrics, The Robert Larner, MD, College of Medicine, University of Vermont, Burlington, VT, USA
| | - Walter K Kraft
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Elisha M Wachman
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Adam Czynski
- Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Stephanie L Merhar
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - T Winhusen
- Department of Psychiatry and Behavioral Neuroscience, Center for Addiction Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hendrée E Jones
- Department of Obstetrics and Gynecology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Brenda B Poindexter
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine & Institute for Innovations in Developmental Sciences, Northwestern University, Evanston, IL, USA
| | - Amy L Salisbury
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | | | - Jonathan M Davis
- Department of Pediatrics and the Tufts Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, MA, USA
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Carelli C, Radogna A, Bolcato V, Vignali C, Moretti M, Merli D, Morini L. Old and New Synthetic and Semi-synthetic Opioids Analysis in Hair: A Review. TALANTA OPEN 2022. [DOI: 10.1016/j.talo.2022.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Cheng AL, Brady BK, Bradley EC, Calfee RP, Klesges LM, Colditz GA, Prather H. Opioid use and social disadvantage in patients with chronic musculoskeletal pain. PM R 2022; 14:309-319. [PMID: 33773068 PMCID: PMC8464618 DOI: 10.1002/pmrj.12596] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Historically, marginalized patients were prescribed less opioid medication than affluent, white patients. However, because of persistent differential access to nonopioid pain treatments, this direction of disparity in opioid prescribing may have reversed. OBJECTIVE To compare social disadvantage and health in patients with chronic pain who were managed with versus without chronic opioid therapy. It was hypothesized that patients routinely prescribed opioids would be more likely to live in socially disadvantaged communities and report worse health. DESIGN Cross-sectional analysis of a retrospective cohort defined from medical records from 2000 to 2019. SETTING Single tertiary safety net medical center. PATIENTS Adult patients with chronic musculoskeletal pain who were managed longitudinally by a physiatric group practice from at least 2011 to 2015 (n = 1173), subgrouped by chronic (≥4 years) adherent opioid usage (n = 356) versus no chronic opioid usage (n = 817). INTERVENTION Not applicable. MAIN OUTCOME MEASURES The primary outcome was the unadjusted between-group difference in social disadvantage, defined by living in the worst national quartile of the Area Deprivation Index (ADI). An adjusted effect size was also calculated using logistic regression, with age, sex, race, and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Physical Function scores as covariates. Secondary outcomes included adjusted differences in health by chronic opioid use (measured by PROMIS). RESULTS Patients managed with chronic opioid therapy were more likely to live in a zip code within the most socially disadvantaged national quartile (34.9%; 95% confidence interval [CI] 29.9-39.9%; vs. 24.9%; 95% CI 21.9-28.0%; P < .001), and social disadvantage was independently associated with chronic opioid use (odds ratio [OR] 1.01 per ADI percentile [1.01-1.02]). Opioid use was also associated with meaningfully worse PROMIS Depression (3.8 points [2.4-5.1]), Anxiety (3.0 [1.4-4.5]), and Pain Interference (2.6 [1.7-3.5]) scores. CONCLUSIONS Patients prescribed chronic opioid treatment were more likely to live in socially disadvantaged neighborhoods, and chronic opioid use was independently associated with worse behavioral health. Improving access to multidisciplinary, nonopioid treatments for chronic pain may be key to successfully overcoming the opioid crisis.
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Affiliation(s)
- Abby L Cheng
- Department of Orthopaedic Surgery, Division of Physical
Medicine and Rehabilitation, Washington University in St. Louis School of Medicine,
St. Louis, Missouri
| | - Brian K Brady
- Washington University in St. Louis School of Medicine, St.
Louis, Missouri
| | - Ethan C Bradley
- The Brown School of Social Work, Washington University in
St. Louis, St. Louis, Missouri
| | - Ryan P Calfee
- Department of Orthopaedic Surgery, Division of Hand and
Microsurgery, Washington University in St. Louis School of Medicine, St. Louis,
Missouri
| | - Lisa M Klesges
- Department of Surgery, Division of Public Health Sciences,
Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Graham A Colditz
- Department of Surgery, Division of Public Health Sciences,
Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Heidi Prather
- Department of Orthopaedic Surgery, Division of Physical
Medicine and Rehabilitation, Washington University in St. Louis School of Medicine,
St. Louis, Missouri
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