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Darnall BD, Juurlink D, Kerns RD, Mackey S, Van Dorsten B, Humphreys K, Gonzalez-Sotomayor JA, Furlan A, Gordon AJ, Gordon DB, Hoffman DE, Katz J, Kertesz SG, Satel S, Lawhern RA, Nicholson KM, Polomano RC, Williamson OD, McAnally H, Kao MC, Schug S, Twillman R, Lewis TA, Stieg RL, Lorig K, Mallick-Searle T, West RW, Gray S, Ariens SR, Sharpe Potter J, Cowan P, Kollas CD, Laird D, Ingle B, Julian Grove J, Wilson M, Lockman K, Hodson F, Palackdharry CS, Fillingim RB, Fudin J, Barnhouse J, Manhapra A, Henson SR, Singer B, Ljosenvoor M, Griffith M, Doctor JN, Hardin K, London C, Mankowski J, Anderson A, Ellsworth L, Davis Budzinski L, Brandt B, Hartley G, Nickels Heck D, Zobrosky MJ, Cheek C, Wilson M, Laux CE, Datz G, Dunaway J, Schonfeld E, Cady M, LeDantec-Boswell T, Craigie M, Sturgeon J, Flood P, Giummarra M, Whelan J, Thorn BE, Martin RL, Schatman ME, Gregory MD, Kirz J, Robinson P, Marx JG, Stewart JR, Keck PS, Hadland SE, Murphy JL, Lumley MA, Brown KS, Leong MS, Fillman M, Broatch JW, Perez A, Watford K, Kruska K, Sophia You D, Ogbeide S, Kukucka A, Lawson S, Ray JB, Wade Martin T, Lakehomer JB, Burke A, Cohen RI, Grinspoon P, Rubenstein MS, Sutherland S, Walters K, Lovejoy T. International Stakeholder Community of Pain Experts and Leaders Call for an Urgent Action on Forced Opioid Tapering. Pain Med 2019; 20:429-433. [PMID: 30496540 DOI: 10.1093/pm/pny228] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Beth D Darnall
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Psychiatry and Behavioral Sciences (by courtesy), Palo Alto, California
| | - David Juurlink
- Division of Clinical Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | | | - Sean Mackey
- Division of Pain Medicine, Stanford Systems Neuroscience and Pain Lab, Stanford University School of Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Neurosciences and Neurology (by courtesy), Palo Alto, California
| | - Brent Van Dorsten
- Colorado Center for Behavioral Medicine, Colorado Pain Society, Denver, Colorado
| | | | - Julio A Gonzalez-Sotomayor
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon
| | - Andrea Furlan
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Adam J Gordon
- University of Utah School of Medicine, Salt Lake City, Utah.,Addiction Medicine, Salt Lake City VA Health Care System, Salt Lake City, Utah
| | - Debra B Gordon
- Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Diane E Hoffman
- Law & Health Care Program, University of Maryland Carey School of Law
| | - Joel Katz
- Psychology Department, York University, Toronto, Ontario, Canada
| | - Stefan G Kertesz
- Birmingham VA Medical Center, University of Alabama at Birmingham School of Medicine, Opioid Safety Initiative, Opiate Advice Team, Opioid Risk Mitigation Team, Birmingham, Alabama
| | - Sally Satel
- Yale University School of Medicine, New Haven, Connecticut.,American Enterprise Institute, Washington, DC
| | | | | | - Rosemary C Polomano
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.,University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Heath McAnally
- Northern Anesthesia & Pain Medicine, LLC, Eagle River, Alaska.,Alaska Society of Interventional Pain Physicians
| | | | - Stephan Schug
- University of Western Australia, Perth, Australia.,Royal Perth Hospital, Perth, Australia
| | - Robert Twillman
- Academy of Integrative Pain Management, Sonora, California.,Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Kansas City, Kansas
| | - Terri A Lewis
- Southern Illinois University, Carbondale, Illinois.,National Changhua University of Education, Changhua, Taiwan, Republic of China
| | | | - Kate Lorig
- Stanford School of Medicine, Stanford, California
| | | | | | - Sarah Gray
- Spaulding Rehabilitation Hospital, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Integrative Psychology and Behavioral Medicine, Boston, Massachusetts
| | - Steven R Ariens
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | - Penney Cowan
- American Chronic Pain Association, Rocklin, California
| | - Chad D Kollas
- Palliative & Supportive Care, Orlando Health UF Health Cancer Center, Orlando, Florida
| | - Danial Laird
- Flamingo Pain Specialists, PLLC, Las Vegas, Nevada
| | | | | | - Marian Wilson
- Program of Excellence in Addictions Research (Pain Self-Management/Opioid Use Disorder), Washington State University, Spokane, Washington.,College of Nursing, Washington State University, Spokane, Washington
| | - Kashelle Lockman
- Palliative Care, University of Iowa College of Pharmacy, Iowa City, Iowa
| | - Fiona Hodson
- Hunter Integrated Pain Service, John Hunter Hospital Campus, Newcastle, Australia
| | | | - Roger B Fillingim
- College of Dentistry.,Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Jeffrey Fudin
- Albany College of Pharmacy and Health Sciences, Albany, New York.,Western New England University College of Pharmacy, Springfield, Massachusetts
| | | | - Ajay Manhapra
- Advanced PACT Pain Clinic, Hampton VA Medical Center, Hampton, Virginia.,VA New England Mental Illness, West Haven, Connecticut.,Eastern Virginia Medical School, Norfolk, Virginia.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Steven R Henson
- Veteran of the United States Navy, Air Medical Physician's Association, Medical Missions Outreach
| | - Bruce Singer
- Urban Recovery Center, Silver Hill Hospital, New Canaan, Connecticut.,Chronic Pain and Recovery Center, Silver Hill Hospital, New Canaan, Connecticut
| | - Marie Ljosenvoor
- Critical Access Hospital Specialist in Hospice & Palliative Care, Cook Hospital & Care Center, Cook, Minnesota
| | | | - Jason N Doctor
- Health Policy & Management, University of Southern California, Los Angeles, California
| | | | | | | | | | | | | | | | - Greg Hartley
- Department of Physical Therapy, Academy of Geriatric Physical Therapy, University of Miami Miller School of Medicine
| | - Debbie Nickels Heck
- White River Heath Care, PC, Muncie, Indiana.,School of Medicine, Indiana University, Indianapolis, Indiana.,AIPM.,NEIGlobal.,AAPS
| | | | | | | | | | - Geralyn Datz
- Southern Behavioral Medicine Associates PLLC, Hattiesburg, Mississippi
| | - Justin Dunaway
- Institute of Clinical Excellence, STAND The Haiti Project, Portland, Oregon
| | - Eileen Schonfeld
- End of Life, Psychiatric and Mental Health Nurse, Long Term Care, Education, Alliance for the Treatment of Intractable Pain, Akron, Ohio
| | | | | | - Meredith Craigie
- CALHN Pain Management Unit, Woodville, Adelaide, South Australia, Australia.,Faculty of Pain Medicine, ANZCA
| | - John Sturgeon
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Pamela Flood
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California
| | - Melita Giummarra
- Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | | | - Michael E Schatman
- Department of Public Health & Community Medicine, Boston Pain Care, Tufts University School of Medicine, Boston, Massachusetts
| | | | - Joshua Kirz
- Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California
| | | | | | | | | | - Scott E Hadland
- Division of General Pediatrics, Grayken Center for Addiction, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | | | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan
| | | | | | | | | | | | - Kristine Watford
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Palo Alto, California
| | | | - Dokyoung Sophia You
- Department of Anesthesiology, Perioperative, and Pain Medicine, Palo Alto, California
| | - Stacy Ogbeide
- Clinical Department of Family & Community Medicine, UT Health, San Antonio, San Antonio, Texas.,Division of Behavioral Medicine, Department of Psychiatry, UT Health, San Antonio, San Antonio, Texas
| | | | - Susan Lawson
- Mental Health- Private Practice, Alliance for the Treatment of Intractable Pain, Huntington, West Virginia
| | - James B Ray
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, Iowa
| | - T Wade Martin
- Anesthesiology & Pain Management, Interventional Pain Medicine, Cahaba Pain & Spine Care, Hoover, Alabama
| | | | - Anne Burke
- Central Adelaide Local Health Network, Australian Pain Society
| | - Robert I Cohen
- Massachusetts Pain Initiative Legislative Council Leadership Advisory Group, ABMS ABA Diplomat in Anesthesiology and Pain Medicine, Newton Center, Massachusetts
| | - Peter Grinspoon
- Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marc S Rubenstein
- Academy of Prevention & Health Promotion Therapies, Jersey LiveWell and Jersey Physical Therapy, Princeton, New Jersey
| | | | | | - Travis Lovejoy
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
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Samoborec S, Simpson P, Hassani-Mahmooei B, Ruseckaite R, Giummarra M, Ayton D, Evans S. Impact of comorbidity on health outcome after a transport-related injury. Inj Prev 2019; 26:254-261. [PMID: 31004008 DOI: 10.1136/injuryprev-2019-043195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/26/2019] [Accepted: 03/30/2019] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Understanding the impact of comorbidity on health outcomes is important given that comorbidities can affect survival, morbidity, service delivery costs and healthcare utilisation. However, little is known about the types of comorbidities affecting specific health outcomes after minor to moderate road trauma. METHODS This study involved 1574 participants who claimed injury compensation following transport-related injury. Cross sectional data were collected. Health outcomes were assessed using the EQ-5D-3L specific domains and summary score. Twelve self-reported pre-existing chronic conditions were assessed using a multivariate logistic regression, adjusting for demographic and injury characteristics. RESULTS Out of 1574 participants, only 17 (1%) participants reported no pre-existing comorbidities, 72% reported one, 13% reported two and 14% reported three or more comorbidities. Hypertension (15%), depression (14%) and anxiety (14%) were the most commonly reported comorbidities, followed by arthritis (13%), chronic pain (11%) and asthma (11%). Participants with a history of arthritis (adjusted odds ratio [AOR] 1.90, 95% CI 1.24 to 2.91); chronic back pain (AOR 1.59, 95% CI, 1.04 to 2.43); other chronic pain (AOR 2.73, 95% CI 1.42 to 4.24); depression (AOR 2.55, 95% CI 1.60 to 4.05) and anxiety (AOR 2.08, 95% CI 1.32 to 3.26) were at increased risk of poorer health outcomes, after controlling for age, gender, type of injury and time since injury. CONCLUSION This study found that comorbidities such as arthritis, chronic back pain, other chronic pain, depression and anxiety significantly increase the odds of poorer health postinjury, regardless of the time since injury. Regular screening of comorbid conditions may help identify people likely to have poorer outcomes, thereby enabling the implementation of interventions to optimise health despite the presence of comorbidities.
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Affiliation(s)
- Stella Samoborec
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Pamela Simpson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Melita Giummarra
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Darshini Ayton
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sue Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Sarlos S, Giummarra M, Allan C, Arnold C, Choy K, Doery J, McLachlan R. SUN-228 Opioid Use Is Not Associated with Clinical Hypogonadism in Men with Chronic Non-Cancer Pain. J Endocr Soc 2019. [PMCID: PMC6553223 DOI: 10.1210/js.2019-sun-228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Opioid analgesia is widely used in the management of chronic pain despite lacking a strong evidence base of efficacy and concerns about adverse effects. Opioid use has been associated with hypogonadotrophic hypogonadism in a limited number of small chronic pain studies. Aim: To determine the prevalence and degree of hypogonadism in men with chronic non-malignant pain treated with or without opioid analgesia. Method: A cross-sectional study of community dwelling Australian men over the age of 18yrs with chronic non-cancer pain of at least 6 months duration attending a single multidisciplinary pain clinic between February 2016 to August 2017, and who were managed either with or without opioid therapy for a minimum of 6 weeks. Men with known pituitary or testicular causes of hypogonadism, previous or current testosterone use, and men treated with androgen deprivation therapy were excluded. Men completed questionnaires about sexual function (International Index of Erectile Function-5), pain (Brief Pain Inventory (BPI)) and mood (Depression, Anxiety and Stress Scale (DASS21)). Medications, age and BMI were recorded. Blood was obtained to assess serum total testosterone (TT), FSH, LH and prolactin (mean ± SD) between the two groups. TT levels were measured using gold standard liquid chromatography-tandem mass spectrometry. Results: Participants were 50 men treated with oral or transdermal opioids (oral morphine equivalent daily dose (oMEDD) 100 ± 92mg) and 37 men managed without opioids. Age (48.8 ± 11.5 vs 51 ± 16.3 yrs) and BMI (28.7 ± 5.0 vs 27.8 ± 4.5) were similar. Mean serum TT levels were within the normal range for both groups although were lower in the opioid vs non-opioid group (13.3 ± 6.1 vs 15.9 ± 5.5 nmol/L [383 ± 175.6 vs 457.9 ± 158.4 ng/dL], p=0.04). TT was < 8nmol/L [<230 ng/dL] in 9/50 men from the opioid group and 3/37 men from the non-opioid group. TT was negatively correlated with BMI in both groups. There was no difference in the opioid vs non-opioid treated men in serum FSH (6.6 ± 3.5 vs 6.3 ± 3.2 IU/L, p=0.63), LH (4.0 ± 2.2 vs 4.8 ± 1.9 IU/L, p=0.06) or prolactin (193 ± 97 vs 178 ± 98 mIU/L, p=0.48). TT levels did not correlate with oMEDD across the group nor in the subset of men (n=17) on oMEDD > 100mg per day. Sexual function scores were similar between the groups and did not correlate with TT. Men taking opioids reported higher severity and intensity of pain (BPI), and higher anxiety, depression and stress levels (DASS21). Discussion: There was no clinically significant association between opioid use or dose and TT in this cohort of men with chronic non-cancer pain. Previous smaller studies of men with chronic non-cancer pain documenting lower testosterone levels have utilised significantly higher oMEDD suggesting a possible threshold dose effect. Although opioid use may contribute to hypogonadism in some men, this should not preclude endocrine evaluation to identify other causes.
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Affiliation(s)
- Stella Sarlos
- Hudson Institute of Medical Research; Department of Medicine, Monash University, Clayton VIC, , Australia
| | - Melita Giummarra
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Caulfield VIC; Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Clayton VIC, , Australia
| | - Carolyn Allan
- Hudson Institute of Medical Research; Department of Obstetrics and Gynaecology, Monash University, Clayton VIC, , Australia
| | - Carolyn Arnold
- Caulfield Pain Management & Research Centre, Alfred Health Melbourne, VIC; Department of Anaesthesia & Peri-operative Medicine, Monash University, Clayton VIC, , Australia
| | - Kay Choy
- Department of Pathology, Monash Health, Clayton VIC, , Australia
| | - James Doery
- Department of Pathology, Monash Health; Department of Medicine, Monash University, Clayton VIC, , Australia
| | - Robert McLachlan
- Hudson Institute of Medical Research; Department of Obstetrics and Gynaecology, Monash University; Andrology Australia, Clayton VIC, , Australia
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