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Zgierska AE, Burzinski CA, Garland EL, Barrett B, Lennon RP, Brown RL, Schiefelbein AR, Nakamura Y, Stahlman B, Jamison RN, Edwards RR. Experiences of adults with opioid-treated chronic low back pain during the COVID-19 pandemic: A cross-sectional survey study. Medicine (Baltimore) 2023; 102:e34885. [PMID: 37832078 PMCID: PMC10578753 DOI: 10.1097/md.0000000000034885] [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: 05/03/2023] [Accepted: 08/02/2023] [Indexed: 10/15/2023] Open
Abstract
This study aimed to evaluate the impact of the COVID-19 pandemic on adults with opioid-treated chronic low back pain (CLBP), an understudied area. Participants in a "parent" clinical trial of non-pharmacologic treatments for CLBP were invited to complete a one-time survey on the perceived pandemic impact across several CLBP- and opioid therapy-related domains. Participant clinical and other characteristics were derived from the parent study's data. Descriptive statistics and latent class analysis analyzed quantitative data; qualitative thematic analysis was applied to qualitative data. The survey was completed by 480 respondents from June 2020 to August 2021. The majority reported a negative pandemic impact on their life (84.8%), with worsened enjoyment of life (74.6%), mental health (74.4%), pain (53.8%), pain-coping skills (49.7%), and finances (45.3%). One-fifth (19.4%) of respondents noted increased use of prescribed opioids; at the same time, decreased access to medication and overall healthcare was reported by 11.3% and 61.6% of respondents, respectively. Latent class analysis of the COVID-19 survey responses revealed 2 patterns of pandemic-related impact; those with worse pandemic-associated harms (n = 106) had an overall worse health profile compared to those with a lesser pandemic impact. The pandemic substantially affected all domains of relevant health-related outcomes as well as healthcare access, general wellbeing, and financial stability among adults with opioid-treated CLBP. A more nuanced evaluation revealed a heterogeneity of experiences, underscoring the need for both increased overall support for this population and for an individualized approach to mitigate harms induced by pandemic or similar crises.
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Affiliation(s)
- Aleksandra E. Zgierska
- Departments of Family and Community Medicine, Public Health Sciences, and Anesthesiology and Perioperative Medicine, Pennsylvania State University College of Medicine, Hershey, PA
| | - Cindy A. Burzinski
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI
| | - Eric L. Garland
- University of Utah, College of Social Work, Salt Lake City, UT
| | - Bruce Barrett
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Family Medicine and Community Health, Madison, WI
| | - Robert P. Lennon
- Department of Family and Community Medicine, and Law School, Pennsylvania State University College of Medicine, Hershey, PA
| | - Roger L. Brown
- University of Wisconsin-Madison, School of Nursing, Madison, WI
| | | | - Yoshio Nakamura
- Department of Anesthesiology, Division of Pain Medicine, Pain Research Center, University of Utah School of Medicine, Salt Lake City, UT
| | - Barbara Stahlman
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, Hershey, PA
| | - Robert N. Jamison
- Departments of Anesthesiology, Perioperative and Pain Medicine and Psychiatry, Harvard Medical School, Brigham and Women’s Hospital, Chestnut Hill, MA
| | - Robert R. Edwards
- Departments of Anesthesiology, Perioperative and Pain Medicine and Psychiatry, Harvard Medical School, Brigham and Women’s Hospital, Chestnut Hill, MA
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Hartz SM, Culverhouse RC, Mintz CM, Ellis MS, Kasper ZA, Cavazos-Rehg P, Grucza RA, Bierut LJ, Cicero TJ. Association between recent overdose and chronic pain among individuals in treatment for opioid use disorder. PLoS One 2022; 17:e0271379. [PMID: 36441691 PMCID: PMC9704550 DOI: 10.1371/journal.pone.0271379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022] Open
Abstract
Chronic pain increases risk for opioid overdose among individuals with opioid use disorder. The purpose of this study is to evaluate the relationship between recent overdose and whether or not chronic pain is active. 3,577 individuals in treatment for opioid use disorder in 2017 or 2018 were surveyed regarding recent overdoses and chronic pain. Demographics from the 2017 Treatment Episode Data Set, which includes all U.S. facilities licensed or certified to provide substance use care, were used to evaluate the generalizability of the sample. χ2 tests and logistic regression models were used to compare associations between recent overdoses and chronic pain. Specifically, active chronic pain was associated with opioid overdose among people in treatment for opioid use disorder. Individuals with active chronic pain were more likely to have had a past month opioid overdose than those with no history chronic pain (adjusted OR = 1.55, 95% CI 1.16-2.08, p = 0.0003). In contrast, individuals with prior chronic pain, but no symptoms in the past 30 days, had a risk of past month opioid overdose similar to those with no history of chronic pain (adjusted OR = 0.88, 95% CI 0.66-1.17, p = 0.38). This suggests that the incorporation of treatment for chronic pain into treatment for opioid use disorder may reduce opioid overdoses.
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Affiliation(s)
- Sarah M. Hartz
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Robert C. Culverhouse
- Department of Medicine and Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Carrie M. Mintz
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Matthew S. Ellis
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Zachary A. Kasper
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Richard A. Grucza
- Department of Family & Community Medicine, St. Louis University School of Medicine, St. Louis, Missouri, United States of America
| | - Laura J. Bierut
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Theodore J. Cicero
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
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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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