Opioid analgesic effects on subjective well-being in the operating theatre

Exposure to opioid analgesics due to surgery increases the risk of new persistent opioid use. A mechanistic hypothesis for opioids' abuse liability rests on the belief that, in addition to pain relief, acute opioid treatment improves well-being (e.g. via euphoria) and relieves anxiety. However, opioids do not consistently improve mood in laboratory studies of healthy non-opioid users. This observational study determined how two commonly used opioid analgesics affected patients' subjective well-being in standard clinical practice. Day surgery patients rated how good and how anxious they felt before and after an open-label infusion of remifentanil (n = 159) or oxycodone (n = 110) in the operating theatre before general anaesthesia. One minute after drug injection, patients reported feeling intoxicated (> 6/10 points). Anxiety was reduced after opioids, but this anxiolytic effect was modest (remifentanil Cohen's d = 0.21; oxycodone d = 0.31). There was moderate to strong evidence against a concurrent improvement in well-being (Bayes factors > 6). After remifentanil, ratings of 'feeling good' were significantly reduced from pre-drug ratings (d = 0.28). After oxycodone, one in three participants felt better than pre-drug. Exploratory ordered logistic regressions revealed a link between previous opioid exposure and opioid effects on well-being, as only 14 of the 80 opioid-naïve patients reported feeling better after opioid injection. The odds of improved well-being ratings after opioids were higher in patients with previous opioid exposure and highest in patients with > 2 weeks previous opioid use (adjusted OR = 4.4). These data suggest that opioid-induced improvement of well-being is infrequent in opioid-naïve patients. We speculate that peri-operative exposure could increase risk of persistent use by rendering subsequent positive opioid effects on well-being more likely.

Effect of health-promoting posters placed on the platforms of two train stations in Copenhagen, Denmark, on the choice between taking the stairs or the escalators: a secondary publication

OBJECTIVE

The purpose of this study was to determine whether posters placed on the platforms of two train stations in Copenhagen, promoting use of the stairs, would encourage people to use the stairs rather than the adjacent escalator. An additional purpose was to see if the effect of the intervention was maintained for a week after the poster was removed.

MEASUREMENTS

The number of people using stairs and escalators at Copenhagen Central Station and Østerport Train Station in Copenhagen was recorded before and during posters promoting stair use were placed on the platforms, and a week after the posters were removed. Two years after the posters were removed, data were collected for 1 week at Østerport Train Station (long-term post-intervention).

RESULTS

At Copenhagen Central Station, the overall stair use increased from 12% before the intervention to 16% (P<0.0001) during the intervention, giving an odds ratio (OR) of 1.5 for stair use. At Østerport Train Station in Copenhagen, the overall stair use increased from 23 to 31% during the intervention (P<0.0001), and dropped to 27% (P<0.0001) after the intervention (during the intervention, OR=1.5 (P<0.0001); after the intervention, OR=1.2 (P<0.0001)). At the long-term post-intervention recording, the overall stair use was 25%, which was not significantly different from the stair use found before the intervention.

DISCUSSION

Posters promoting stair use placed on the platforms of train stations can result in increased stair use, during and after 1 week of intervention, and thereby seem useful only when up and immediately following intervention in changing health-promoting behavior among Danish men and women. These results agree well with results from other countries.