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Alshammari HS, Alshammari AS, Alshammari SA, Ahamed SS. Prevalence of Chronic Pain After Spinal Surgery: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e41841. [PMID: 37575867 PMCID: PMC10423077 DOI: 10.7759/cureus.41841] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Degenerative disc disease and low back pain are common challenges that persist even after a discectomy. However, characterizations and quantifications of these illnesses from the patients' perspective are insufficient. We aimed to perform a systematic review of the literature and meta-analysis to determine the frequency of chronic pain after spinal surgery. We searched MEDLINE (PubMed), Google Scholar, and the Saudi Digital Library to retrieve research articles describing the frequency of persistent back pain, reoccurring disc herniation, and undergoing another operation following primary lumbar discectomy. We excluded articles that did not disclose the proportion of patients who experienced ongoing back or leg pain for over six months after the operation. We included 16 studies evaluating 85,643 patients. The pooled prevalence of persistent pain was 14.97% (95% confidence interval: 12.38-17.76). With all advancements in technology and operation techniques, many patients (14.97%) still have failed back surgery syndrome. Appropriate preoperative communication and multidisciplinary and coordinated treatment strategies yielded the best results.
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Affiliation(s)
- Hotoon S Alshammari
- College of Medicine, King Saud University, Riyadh, SAU
- College of Medicine, AlMaarefa University, Riyadh, SAU
| | | | - Sulaiman A Alshammari
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, SAU
| | - Shaik Shaffi Ahamed
- Department of Family and Community Medicine (Biostatistics), College of Medicine, King Saud University, Riyadh, SAU
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Bettinger JJ, Amarquaye W, Fudin J, Schatman ME. Misinterpretation of the “Overdose Crisis” Continues to Fuel Misunderstanding of the Role of Prescription Opioids. J Pain Res 2022; 15:949-958. [PMID: 35414752 PMCID: PMC8994995 DOI: 10.2147/jpr.s367753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
| | | | - Jeffrey Fudin
- President, Remitigate Therapeutics, Delmar, NY, USA
- Department of Pharmacy Practice, Albany College of Pharmacy & Health Sciences, Albany, NY, USA
- Department of Pharmacy Practice, Western New England University College of Pharmacy, Springfield, MA, USA
- Department of Pharmacy and Pain Management, Stratton VA Medical Center, Albany, NY, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
- School of Social Work, North Carolina State University, Raleigh, NC, USA
- Correspondence: Michael E Schatman, Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, 550 1st Ave., New York, NY, 10016, USA, Tel +425-647-4880, Email
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Petersen EA, Schatman ME, Sayed D, Deer T. Persistent Spinal Pain Syndrome: New Terminology for a New Era. J Pain Res 2021; 14:1627-1630. [PMID: 34135626 PMCID: PMC8197591 DOI: 10.2147/jpr.s320923] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael E Schatman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- School of Social Work, North Carolina State University, Raleigh, NC, USA
| | - Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Timothy Deer
- Spine and Nerve Center of the Virginias, Charleston, WV, USA
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Slat S, Yaganti A, Thomas J, Helminski D, Heisler M, Bohnert A, Lagisetty P. Opioid Policy and Chronic Pain Treatment Access Experiences: A Multi-Stakeholder Qualitative Analysis and Conceptual Model. J Pain Res 2021; 14:1161-1169. [PMID: 33948090 PMCID: PMC8088411 DOI: 10.2147/jpr.s282228] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/11/2021] [Indexed: 01/17/2023] Open
Abstract
Purpose Patients on long-term opioid therapy (LTOT) for pain have difficulty accessing primary care clinicians who are willing to prescribe opioids or provide multimodal pain treatment. Recent treatment guidelines and statewide policies aimed at reducing inappropriate prescribing may exacerbate these access issues, but further research is needed on this issue. This study aimed to understand barriers to primary care access and multimodal treatment for chronic pain from the perspective of multiple stakeholders. Methods Qualitative, semi-structured phone interviews were conducted with adult patients with chronic pain, primary care clinicians, and clinic office staff in Michigan. Interview questions covered stakeholder experiences with prescription opioids, opioid-related policies, and access to care for chronic pain. Interviews were coded using inductive and deductive methods for thematic analysis. Results A total of 25 interviews were conducted (15 patients, 7 primary care clinicians, and 3 office staff). Barriers to treatment access were attributed to six themes: (1) reduced clinic willingness to manage prescribed opioids for new patients; (2) lack of time and reimbursement for quality opioid-related care; (3) paucity of multimodal care and coordination between providers; (4) fear of liability and use of new guidelines to justify not prescribing opioids; (5) delayed prescription receipt due to prior authorization and pharmacy issues; and (6) poor availability of effective non-opioid treatments. Conclusion Issues of policy, logistics, and clinic-level resources converge to disrupt treatment access for patients with chronic pain, as many clinics both do not offer multimodal pain care and are unwilling to prescribe LTOT. The resulting conceptual model can inform the development of policy interventions to help mitigate these access barriers.
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Affiliation(s)
- Stephanie Slat
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Avani Yaganti
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer Thomas
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Danielle Helminski
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Center for Clinical Management and Research, Ann Arbor VA Hospital, Ann Arbor, MI, USA.,Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Amy Bohnert
- Center for Clinical Management and Research, Ann Arbor VA Hospital, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Departments of Anesthesiology and Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Pooja Lagisetty
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Center for Clinical Management and Research, Ann Arbor VA Hospital, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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Schatman ME, Shapiro H, Fudin J. The Repeal of the Affordable Care Act and Its Likely Impact on Chronic Pain Patients: "Have You No Shame?". J Pain Res 2020; 13:2757-2761. [PMID: 33154666 PMCID: PMC7608115 DOI: 10.2147/jpr.s289114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Michael E Schatman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA.,Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Hannah Shapiro
- McLean Hospital, Division of Alcohol, Drugs, and Addiction, Harvard Medical School, Boston, MA, USA
| | - Jeffrey Fudin
- Remitigate Therapeutics, Delmar, NY, USA.,Department of Pharmacy Practice, Albany College of Pharmacy, Albany, NY, USA.,Department of Pharmacy Practice, Western New England University, Springfield, MA, USA.,Stratton VA Medical Center, Albany, NY, USA
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Ivsins A, Boyd J, Beletsky L, McNeil R. Tackling the overdose crisis: The role of safe supply. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 80:102769. [PMID: 32446183 PMCID: PMC7252037 DOI: 10.1016/j.drugpo.2020.102769] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022]
Abstract
North America is experiencing an unprecedented overdose crisis driven by the proliferation of fentanyl and its analogues in the illicit drug supply. In 2018 there were 67,367 drug overdose deaths in the United States, and since 2016, there have been more than 14,700 overdose deaths in Canada, with most related to fentanyl. Despite concerted efforts and some positive progress, current public health, substance use treatment, and harm reduction interventions (such as widespread naloxone distribution and implementation of supervised consumption sites) have not been able to rapidly decrease overdose fatalities. In view of the persistent gaps in services and the limitations of available options, immediate scale-up of low-barrier opioid distribution programs are urgently needed. This includes "off-label" prescription of pharmaceutical grade opioids (e.g., hydromorphone) to disrupt the toxic drug supply and make safer opioids widely available to people at high risk of fatal overdose.
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Affiliation(s)
- Andrew Ivsins
- Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada; British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, BC, V6Z 2A9, Canada.
| | - Jade Boyd
- Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada; British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, BC, V6Z 2A9, Canada
| | - Leo Beletsky
- Health in Justice Action Lab, Northeastern University, 360 Huntington Ave, Boston, MA 02115, United States; UC San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA 92093, United States
| | - Ryan McNeil
- Department of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada; British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, BC, V6Z 2A9, Canada; General Internal Medicine, Yale School of Medicine, 367 Cedar St, New Haven, CA 06510, United States; Program in Addiction Medicine, Yale School of Medicine, 367 Cedar St, New Haven, CA 06510, United States
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