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Moyo P, Merlin JS, Gairola R, Girard A, Shireman TI, Trivedi AN, Marshall BDL. Association of Opioid Use Disorder Diagnosis with Management of Acute Low Back Pain: A Medicare Retrospective Cohort Analysis. J Gen Intern Med 2024:10.1007/s11606-024-08799-3. [PMID: 38829451 DOI: 10.1007/s11606-024-08799-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/06/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Practice guidelines recommend nonpharmacologic and nonopioid therapies as first-line pain treatment for acute pain. However, little is known about their utilization generally and among individuals with opioid use disorder (OUD) for whom opioid and other pharmacologic therapies carry greater risk of harm. OBJECTIVE To determine the association between a pre-existing OUD diagnosis and treatment of acute low back pain (aLBP). DESIGN Retrospective cohort study using 2016-2019 Medicare data. PARTICIPANTS Fee-for-service Medicare beneficiaries with a new episode of aLBP. MAIN MEASURES The main independent variable was OUD diagnosis measured prior to the first LBP claim (i.e., index date). Using multivariable logistic regressions, we assessed the following outcomes measured within 30 days of the index date: (1) nonpharmacologic therapies (physical therapy and/or chiropractic care), and (2) prescription opioids. Among opioid recipients, we further assessed opioid dose and co-prescription of gabapentin. Analyses were conducted overall and stratified by receipt of physical therapy, chiropractic care, opioid fills, or gabapentin fills during the 6 months before the index date. KEY RESULTS We identified 1,263,188 beneficiaries with aLBP, of whom 3.0% had OUD. Two-thirds (65.8%) did not receive pain treatments of interest at baseline. Overall, nonpharmacologic therapy receipt was less prevalent and opioid and nonopioid pharmacologic therapies were more common among beneficiaries with OUD than those without OUD. Beneficiaries with OUD had lower odds of receiving nonpharmacologic therapies (aOR = 0.62, 99%CI = 0.58-0.65) and higher odds of prescription opioid receipt (aOR = 2.24, 99%CI = 2.17-2.32). OUD also was significantly associated with increased odds of opioid doses ≥ 90 morphine milligram equivalents/day (aOR = 2.43, 99%CI = 2.30-2.56) and co-prescription of gabapentin (aOR = 1.15, 99%CI = 1.09-1.22). Similar associations were observed in stratified groups though magnitudes differed. CONCLUSIONS Medicare beneficiaries with aLBP and OUD underutilized nonpharmacologic pain therapies and commonly received opioids at high doses and with gabapentin. Complementing the promulgation of practice guidelines with implementation science could improve the uptake of evidence-based nonpharmacologic therapies for aLBP.
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Affiliation(s)
- Patience Moyo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
| | - Jessica S Merlin
- Division of General Internal Medicine, Challenges in Managing and Preventing Pain Clinical Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richa Gairola
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Anthony Girard
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Theresa I Shireman
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Amal N Trivedi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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Koller D, Friligkou E, Stiltner B, Pathak GA, Løkhammer S, Levey DF, Zhou H, Hatoum AS, Deak JD, Kember RL, Treur JL, Kranzler HR, Johnson EC, Stein MB, Gelernter J, Polimanti R. Pleiotropy and genetically inferred causality linking multisite chronic pain to substance use disorders. Mol Psychiatry 2024:10.1038/s41380-024-02446-3. [PMID: 38355787 DOI: 10.1038/s41380-024-02446-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
Individuals suffering from chronic pain develop substance use disorders (SUDs) more often than others. Understanding the shared genetic influences underlying the comorbidity between chronic pain and SUDs will lead to a greater understanding of their biology. Genome-wide association statistics were obtained from the UK Biobank for multisite chronic pain (MCP, Neffective = 387,649) and from the Million Veteran Program and the Psychiatric Genomics Consortium meta-analyses for alcohol use disorder (AUD, Neffective = 296,974), cannabis use disorder (CanUD, Neffective = 161,053), opioid use disorder (OUD, Neffective = 57,120), and problematic tobacco use (PTU, Neffective = 270,120). SNP-based heritability was estimated for each of the traits and genetic correlation (rg) analyses were performed to assess MCP-SUD pleiotropy. Bidirectional Mendelian Randomization analyses evaluated possible causal relationships. Finally, to identify and characterize individual loci, we performed a genome-wide pleiotropy analysis and a brain-wide analysis using imaging phenotypes available from the UK Biobank. MCP was positively genetically correlated with AUD (rg = 0.26, p = 7.55 × 10-18), CanUD (rg = 0.37, p = 8.21 × 10-37), OUD (rg = 0.20, p = 1.50 × 10-3), and PTU (rg = 0.29, p = 8.53 × 10-12). Although the MR analyses supported bi-directional relationships, MCP had larger effects on AUD (pain-exposure: beta = 0.18, p = 8.21 × 10-4; pain-outcome: beta = 0.07, p = 0.018), CanUD (pain-exposure: beta = 0.58, p = 2.70 × 10-6; pain-outcome: beta = 0.05, p = 0.014) and PTU (pain-exposure: beta = 0.43, p = 4.16 × 10-8; pain-outcome: beta = 0.09, p = 3.05 × 10-6) than the reverse. The genome-wide analysis identified two SNPs pleiotropic between MCP and all SUD investigated: IHO1 rs7652746 (ppleiotropy = 2.69 × 10-8), and CADM2 rs1248857 (ppleiotropy = 1.98 × 10-5). In the brain-wide analysis, rs7652746 was associated with multiple cerebellum and amygdala imaging phenotypes. When analyzing MCP pleiotropy with each SUD separately, we found 25, 22, and 4 pleiotropic variants for AUD, CanUD, and OUD, respectively. To our knowledge, this is the first large-scale study to provide evidence of potential causal relationships and shared genetic mechanisms underlying MCP-SUD comorbidity.
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Affiliation(s)
- Dora Koller
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA.
- Department of Genetics, Microbiology, and Statistics, Faculty of Biology, University of Barcelona, Catalonia, Spain.
| | - Eleni Friligkou
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Brendan Stiltner
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Gita A Pathak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Solveig Løkhammer
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
- Dr. Einar Martens Research Group for Biological Psychiatry, Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
| | - Daniel F Levey
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Hang Zhou
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Alexander S Hatoum
- Department of Psychological and Brain Sciences, Washington University in Saint Louis, St. Louis, MO, USA
| | - Joseph D Deak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
| | - Rachel L Kember
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Jorien L Treur
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henry R Kranzler
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Emma C Johnson
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA
- Department of Genetics, Yale School of Medicine, New Haven, CT, USA
- Department of Neuroscience, Yale School of Medicine, New Haven, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
- Veterans Affairs Connecticut Healthcare Center, West Haven, CT, USA.
- Wu Tsai Institute, Yale University, New Haven, CT, USA.
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Dehghan M, Mirza HK, Alaeifar S, Jazinizadeh M, Iranmanesh MH, Mohammadiakbarabadi F, Salehi M, Ghonchehpour A, Zakeri MA. Quality of Life and Use of Complementary and Alternative Medicines among Narcotics Anonymous Patients: A Cross-Sectional Study in Southeast Iran. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2023; 2023:3003247. [PMID: 37727769 PMCID: PMC10506870 DOI: 10.1155/2023/3003247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 08/11/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
Background Addiction, a chronic and recurrent disorder, is associated with lasting changes in the brain and can significantly affect the quality of life of people. Complementary and alternative medicine (CAM) along with modern medical treatments can improve the quality of life of individuals. This study aimed to investigate the relationship between the use of complementary and alternative medicines (CAMs) and quality of life in narcotics anonymous patients. Methods This cross-sectional study was performed on 189 narcotics anonymous patients in southeastern Iran. Using questionnaires such as the demographic information, the World Health Organization Quality of Life-BREF (WHOQOL-BREF), CAM, and satisfaction with the use of CAM, the researcher was able to compile a comprehensive picture of the population. Results The mean score of overall quality of life and general health was 64.02 ± 23.32. Overall, 66.1 percent (n = 125) of the participants reported using at least one type of CAM in the previous year. Last year, 25.9% of participants used at least one kind of CAM, 22.8% used two types of CAM, 7.9% used three types of CAM, and 4.8% used four to five types of CAM. Thirty-nine point seven percent of them reported using prayer, 36.5% reported using medicinal herbs, 15.3% of participants reported using massage, 14.3% of participants reported using dietary supplements, 12.2% reported using wet cupping, and 8.5% reported using meditation. There were no significant differences in physical, psychological, environmental, and overall quality of life between CAM users and non-CAM users. The prayer users had significantly higher scores in terms of social relationships, environment, and overall quality of life than nonprayer users. Employed participants and opium users had significantly higher overall quality of life than others. Conclusion Although there was no difference in quality of life between CAM and non-CAM users, the present study showed that prayer and medicinal herbs were the most commonly used methods among narcotics anonymous patients. However, prayer and religious beliefs were successful in improving the quality of life of these individuals. Physicians and other healthcare providers must advise patients with addiction to use different CAMs in order to improve their quality of life and quit narcotics. Future in-depth studies could help these patients use CAMs and improve their quality of life.
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Affiliation(s)
- Mahlagha Dehghan
- Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Sobhan Alaeifar
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | | | - Mina Salehi
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Asma Ghonchehpour
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Ali Zakeri
- Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Hargett J, Criswell A, Palokas M. Nonpharmacological interventions for acute pain management in patients with opioid abuse or opioid tolerance: a scoping review. JBI Evid Synth 2022; 20:2697-2720. [PMID: 36065876 DOI: 10.11124/jbies-21-00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this scoping review was to identify and map the evidence on nonpharmacological interventions for acute pain management in patients with opioid tolerance or opioid abuse. INTRODUCTION Opioid therapy is the mainstay of pain management for adults experiencing moderate-to-severe acute pain. However, considering the known risks of opioid use and the growing number of patients with opioid tolerance or opioid abuse, nonpharmacological pain management interventions are of increasing interest to health care providers. Nonpharmacological techniques have shown potential in reducing postoperative pain, opioid consumption, stress, and anxiety. INCLUSION CRITERIA Eligible studies included participants in either inpatient or outpatient health care settings who were experiencing acute pain and a tolerance to opioid medications or opioid abuse. Studies that examined nonpharmacological interventions for treating acute pain in these patients were considered. Nonpharmacological interventions included, but were not limited to, acupuncture, electroacupuncture, massage, mindfulness, electroanalgesia, low-level light therapy, meditation, biofeedback, hypnosis, and relaxation techniques. METHODS MEDLINE, CINAHL, Scopus, Embase, Europe PubMed Central, PsycINFO, Cochrane Central Register of Controlled Trials, and the US National Library of Medicine ( https://ClinicalTrials.gov/ ) were searched, as were sources of unpublished studies on December 30, 2020. Only studies published in English were included, and there was no limit on date of publication. After screening the titles and abstracts of identified citations, 2 independent reviewers retrieved potentially relevant full-text studies and extracted data. Data are presented in diagrammatic format, and accompany the narrative synthesis. RESULTS Fourteen articles were included in the study, including 10 expert opinion papers or chapters, 3 case reports, and 1 implementation report. The most common setting was the perioperative setting, specifically orthopedic surgery. Nonpharmacological pain interventions identified in the literature included physical interventions such as acupuncture, physical therapy, therapeutic exercise, yoga, bracing, heat, cold, elevation, compression, chiropractic interventions, massage, manual therapy, transcutaneous electrical nerve stimulation, and pulsed electromagnetic field therapy. Behavioral and psychological modalities included positive affirmations, cognitive behavioral therapy, acceptance and commitment therapy, mindfulness, distraction, guided imagery, meditation, biofeedback, relaxation, hypnosis, breathing exercises, and energy healing. Many expert opinions included only brief mentions or recommendations for nonpharmacological interventions without full explanations, evidence from the literature, or discussion of the level of support for the recommendation. CONCLUSIONS The findings of this review indicate that nonpharmacological interventions for patients with opioid tolerance or dependence include physical, psychological, and multimodal approaches. Nonpharmacological interventions in this scoping review were often presented as combined with opioid or non-opioid medications for a pain management regimen that is opioid-sparing, opioid-free, or drug-free. More primary research is needed on the nonpharmacological acute pain management of patients with opioid dependence or opioid tolerance.
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Affiliation(s)
- Jennifer Hargett
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA.,Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence, Jackson, MS, USA
| | - Amanda Criswell
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA.,Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence, Jackson, MS, USA
| | - Michelle Palokas
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA.,Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence, Jackson, MS, USA
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Bulls HW, Chu E, Goodin BR, Liebschutz JM, Wozniak A, Schenker Y, Merlin JS. Framework for opioid stigma in cancer pain. Pain 2022; 163:e182-e189. [PMID: 34010940 PMCID: PMC8589872 DOI: 10.1097/j.pain.0000000000002343] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
ABSTRACT Millions of patients with cancer pain are treated with prescription opioids each year. However, efforts to mitigate the ongoing opioid crisis result in unintended consequences with opioid pain management, including opioid stigma. Emerging research indicates that opioid stigma is problematic in patients with cancer, but few studies have examined contributors to and impacts of opioid stigma in this population. To guide future research in this area, we propose a conceptual framework-the opioid stigma framework (OSF)-with which to understand and improve opioid stigma in patients with cancer pain. Development of the OSF was guided by a literature review of stigma in health-related conditions, adaptation of the existing Health Stigma and Discrimination Framework, a topical review of challenges related to opioid cancer pain management, and author expertise in cancer, pain, and opioid prescribing. The proposed OSF highlights 5 domains: (1) contributors to opioid stigma, or factors that increase the likelihood that a patient will experience opioid stigma; (2) intersecting stigmas, or the convergence of multiple stigmatized identities within a patient; (3) stigma manifestations, or the ways opioid stigma is manifested in patients, clinicians, and the community; (4) proximal outcomes, or the immediate consequences of opioid stigma in patients; and (5) long-term impacts in patients. The OSF provides 2 main avenues to facilitate future research: (1) providing a framework to explore the mechanisms that underlie opioid stigma and its impact on cancer pain management and (2) supporting the development of targeted, tailored interventions to eliminate opioid stigma.
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Affiliation(s)
- Hailey W. Bulls
- Section of Palliative Care and Medical Ethics and
Palliative Research Center (PaRC), Division of General Internal Medicine, Department
of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Edward Chu
- Department of Medicine & Molecular Pharmacology, Albert
Einsten Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - Jane M. Liebschutz
- Division of General Internal Medicine, Center for Research
on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
| | - Antoinette Wozniak
- Division of Hematology/Oncology, Department of Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics and
Palliative Research Center (PaRC), Division of General Internal Medicine, Department
of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica S. Merlin
- Section of Palliative Care and Medical Ethics and
Palliative Research Center (PaRC), Division of General Internal Medicine, Department
of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Chua IS, Fratt E, Ho JJ, Roldan CS, Gundersen DA, Childers J. Primary Addiction Medicine Skills for Hospice and Palliative Medicine Physicians: A Modified Delphi Study. J Pain Symptom Manage 2021; 62:720-729. [PMID: 33677071 DOI: 10.1016/j.jpainsymman.2021.02.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 01/22/2023]
Abstract
CONTEXT Hospice and palliative medicine (HPM) physicians frequently care for patients with substance use disorders (SUDs), but there is no consensus on which primary addiction medicine (AM) skills are essential. OBJECTIVES Identify key primary AM skills that physicians should acquire during an ACGME-accredited HPM fellowship program. METHODS A modified Delphi study consisting of 18 experts on SUD in HPM and medical education. A literature review and expert input identified initial AM skills. In three Delphi rounds, participants rated each skill on a nine-point scale from "not at all important to include" to "crucial to include." We calculated medians (IQRs), analyzed panelists' comments, and grouped skills using the RAND / UCLA appropriateness method. RESULTS Among 62 proposed AM skills, 53 skills were rated as appropriate to include (38 of which achieved agreement), and nine skills were rated as uncertain. AM skills most relevant to HPM included 1) defining chemical coping, median 8.5 (IQR 2); 2) balancing life expectancy with risks of opioid use for patients with SUD, 9 (IQR 0); 3) explaining best practices to dispose unused opioids postmortem, 8 (IQR 2); 4) managing pain for hospice patients with SUD, 9 (IQR 0.75); and 5) partnering with hospice to manage patients on methadone and buprenorphine, 9 (IQR 2). Experts did not achieve consensus on whether HPM physicians should be encouraged to learn to prescribe buprenorphine for patients with opioid use disorder, 6 (IQR 3). CONCLUSION HPM fellowships should consider incorporating the primary AM skills identified in this study in their curricula.
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Affiliation(s)
- Isaac S Chua
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Ellie Fratt
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - J Janet Ho
- Division of Palliative Medicine, University of California San Francisco, San Francisco, California, USA
| | - Claudia S Roldan
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Daniel A Gundersen
- Division of Population Health Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Julie Childers
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Massachusetts, USA; Section for Treatment, Research, and Education in Addiction Medicine, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Massachusetts, USA
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7
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Canseco JA, Chang M, Karamian BA, Mao JZ, Reyes AA, Mangan J, Divi SN, Goyal DKC, Salmons HI, Dohse N, Levy N, Detweiler M, Anderson DG, Rihn JA, Kurd MF, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Predictors of Prolonged Opioid Use After Lumbar Fusion and the Effects of Opioid Use on Patient-Reported Outcome Measures. Global Spine J 2021; 13:21925682211041968. [PMID: 34488470 PMCID: PMC10448099 DOI: 10.1177/21925682211041968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE To determine risk factors associated with prolonged opioid use after lumbar fusion and to elucidate the effect of opioid use on patient-reported outcome measures (PROMs) after surgery. METHODS Patients who underwent 1-3 level lumbar decompression and fusion with at least one-year follow-up were identified. Opioid data were collected through the Pennsylvania Prescription Drug Monitoring Program. Preoperative "chronic use" was defined as consumption of >90 days in the one-year before surgery. Postoperative "prolonged use" was defined as a filled prescription 90-days after surgery. PROMs included the following: Short Form-12 Health Survey PCS-12 and MCS-12, ODI, and VAS-Back and Leg scores. Logistic regression was performed to determine independent predictors for prolonged opioid use. RESULTS The final analysis included 260 patients. BMI >35 (OR: .44 [.20, .90], P = .03) and current smoking status (OR: 2.73 [1.14, 6.96], P = .03) significantly predicted postoperative opioid usage. Chronic opioid use before surgery was associated with greater improvements in MCS-12 (β= 5.26 [1.01, 9.56], P = .02). Patients with prolonged opioid use self-reported worse VAS-Back (3.4 vs 2.1, P = .003) and VAS-Leg (2.6 vs 1.2, P = .03) scores after surgery. Prolonged opioid use was associated with decreased improvement in VAS-Leg over time (β = .14 [.15, 1.85], P = .02). CONCLUSIONS Current smoking status and lower BMI were significantly predictive of prolonged opioid use. Excess opioid use before and after surgery significantly affected PROMs after lumbar fusion.
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Affiliation(s)
- Jose A Canseco
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Chang
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian A Karamian
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Jennifer Z Mao
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Ariana A Reyes
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - John Mangan
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Srikanth N Divi
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Dhruv KC Goyal
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Harold I Salmons
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicolas Dohse
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Noah Levy
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Maxwell Detweiler
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - D Greg Anderson
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeffrey A Rihn
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark F Kurd
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S Hilibrand
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K Kepler
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D Schroeder
- Rothman Orthopaedic Institute, Spine Service, at institution-id-type="Ringgold" />Thomas Jefferson University, Philadelphia, PA, USA
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Lee JB, Ghanem G, Saadat S, Yanuck J, Yeung B, Chakravarthy B, Nelson A, Shah S. Positive Toxicology Results Are Not Associated with Emergency Physicians' Opioid Prescribing Behavior. West J Emerg Med 2021; 22:1067-1075. [PMID: 34546882 PMCID: PMC8463062 DOI: 10.5811/westjem.2021.5.52378] [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: 03/08/2021] [Accepted: 05/21/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction Given the general lack of literature on opioid and naloxone prescribing guidelines for patients with substance use disorder, we aimed to explore how a physician’s behavior and prescribing habits are altered by knowledge of the patient’s concomitant use of psychotropic compounds as evident on urine and serum toxicology screens. Methods We conducted a retrospective chart review study at a tertiary, academic, Level I trauma center between November 2017–October 2018 that included 358 patients who were discharged from the emergency department (ED) with a diagnosis of fracture, dislocation, or amputation and received an opioid prescription upon discharge. We extracted urine and serum toxicology results, number and amount of prescription opioids upon discharge, and the presence of a naloxone script. Results The study population was divided into five subgroups that included the following: negative urine and serum toxicology screen; depressants; stimulants; mixed; and no toxicology screens. When comparing the 103 patients in which toxicology screens were obtained to the 255 patients without toxicology screens, we found no statistically significant differences in the total prescribed morphine milligram equivalent (75.0 and 75.0, respectively) or in the number of pills prescribed (15.0 and 13.5, respectively). Notably, none of the 103 patients who had toxicology screens were prescribed naloxone upon discharge. Conclusion Our study found no association between positive urine toxicology results for psychotropically active substances and the rates of opioid prescribing within a single-center, academic ED. Notably, none of the 103 patients who had toxicology screens were prescribed naloxone upon discharge. More research on the associations between illicit drug use, opioids, and naloxone prescriptions is necessary to help establish guidelines for high-risk patients.
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Affiliation(s)
- Jonathan B Lee
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Ghadi Ghanem
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Soheil Saadat
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Justin Yanuck
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Brent Yeung
- University of California, Irvine, Department of Anesthesiology & Perioperative Care, Orange, California
| | - Bharath Chakravarthy
- University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Ariana Nelson
- University of California, Irvine, Department of Anesthesiology & Perioperative Care, Orange, California
| | - Shalini Shah
- University of California, Irvine, Department of Anesthesiology & Perioperative Care, Orange, California
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Perviz A, Bole U, Bregar B. Odnos medicinskih sester do pacienta, odvisnega od prepovedanih drog. OBZORNIK ZDRAVSTVENE NEGE 2021. [DOI: 10.14528/snr.2021.55.2.2961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Odnos medicinskih sester do pacientov, odvisnih od prepovedanih drog, je dejavnik, ki vpliva tako na izid zdravljenja kot na rehabilitacijo pacientov, odvisnih od prepovedanih drog. Namen raziskave je bil raziskati odnos medicinskih sester do zdravstvene obravnave pacientov, odvisnih od prepovedanih drog.Metode: Uporabili smo analizo in sintezo pregleda dokazov iz zbirk podatkov CINAHL, ProQuest Dissertations & Theses Global, SpringerLink, WILEY in PubMed. Omejitvena kriterija iskanja sta bila: objava članka med letoma 2008 in 2018 ter dostopnost celotnega besedila članka v angleščini. Oblikovan je bil konceptualni model PICOT s ključnimi besedami: »nurses«, »substance use disorders«, »attitudes«. Ocena kakovosti dokazov je prikazana v hierarhiji dokazov. Podatki so bili obdelani s tematsko analizo.Rezultati: V končni pregled je bilo vključenih 18 izbranih ustreznih člankov, identificiranih je bilo 68 kod, ki so združene v pet vsebinskih kategorij: (1) dejavniki vpliva na negativen medosebni odnos; (2) dejavniki vpliva na pozitivnejši medosebni odnos; (3) psihopatološki, vedenjski in drugi dejavniki tveganja na strani pacienta, ki imajo pomen za kakovost medosebnega odnosa; (4) posledice neustreznega odnosa medicinskih sester za zdravstveno obravnavo pacientov; (5) ukrepi za preprečevanje predsodkov in stigmatizacije pacientov, odvisnih od prepovedanih drog.Diskusija in zaključek: Raziskava potrjuje negativni odnos medicinskih sester do pacientov, odvisnih od prepovedanih drog. Določeni dejavniki so povezani tako z negativnim kot s pozitivnim odnosom medicinskih sester do teh pacientov. Njihovo proučevanje in posledice za zdravstveno oskrbo pacientov, odvisnih od prepovedanih drog, pa zahtevajo dodatne raziskave.
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Spangler JG, Shull CN, Hildebrandt CA, Jones KB, Brewer AL, Knudson MP, Marion GS, Kirk JK. Opioid Use Disorder and Assessment of Patient Interactions Among Family Medicine Residents, Medical Students, and Physician Assistant Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11012. [PMID: 33204836 PMCID: PMC7666834 DOI: 10.15766/mep_2374-8265.11012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 06/26/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION In light of the opioid overdose epidemic in the US and the necessity of developing training to conduct difficult conversations around opioid dependence, three case-based videos were created to demonstrate providers using motivational interviewing (MI) with patients who have opioid use disorder (OUD). These vignettes displayed a primary care provider interacting with a patient seeking opioids. METHODS Learners-including third-year medical and physician assistant (PA) students, and family medicine residents-viewed three videos set in a family medicine clinic and assessed clinician use of MI when interacting with patients with OUD. The patients were at different levels of acknowledging their need to change their opioid use behaviors and/or pursue treatment. Learners rated each video with an MI rating scale, and a facilitator debriefed strengths, weaknesses, and omissions regarding MI. RESULTS Medical and PA students, and resident family physicians provided 572 ratings. Analysis of variance of mean percent incorrect was lower in residents than in all groups combined, but failed to reach statistical significance (47% + 12.0 vs 53% + 15.0, p = .43). DISCUSSION These case-based videos with MI ratings afforded students and residents the opportunity to assess clinician use of MI techniques with patients with OUD. The MI rating scale had clinical significance (residents scored +5 points and had more training) despite lacking statistical significance. These scenarios allowed learners to recognize how to use MI when having a difficult conversation with patients who misuse opioids. We envision individual use or use for group discussion.
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Affiliation(s)
- John G. Spangler
- Professor, Wake Forest School of Medicine, Department of Family & Community Medicine
| | - Catherine N. Shull
- Assistant Professor, Wake Forest School of Medicine, Departments of PA Studies, Family & Community Medicine
| | - Carol A. Hildebrandt
- Academic Curriculum Coordinator, Wake Forest School of Medicine, Department of PA Studies
| | - Keli Beck Jones
- Assistant Professor, Wake Forest School of Medicine, Department of Family & Community Medicine
| | - Andrew L. Brewer
- Instructional Technologist, Northwest Area Health Education Center
| | - Mark P. Knudson
- Professor, Wake Forest School of Medicine, Department of Family & Community Medicine
| | - Gail S. Marion
- Professor, Wake Forest School of Medicine, Department of Family & Community Medicine
| | - Julienne K. Kirk
- Professor, Wake Forest School of Medicine, Department of Family & Community Medicine
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Teckchandani S, Barad M. Treatment Strategies for the Opioid-Dependent Patient. Curr Pain Headache Rep 2017; 21:45. [DOI: 10.1007/s11916-017-0644-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Compton P, Chang YP. Substance Abuse and Addiction: Implications for Pain Management in Patients With Cancer. Clin J Oncol Nurs 2017; 21:203-209. [DOI: 10.1188/17.cjon.203-209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lovejoy TI, Dobscha SK, Turk DC, Weimer MB, Morasco BJ. Correlates of prescription opioid therapy in Veterans with chronic pain and history of substance use disorder. ACTA ACUST UNITED AC 2016; 53:25-36. [PMID: 27005461 DOI: 10.1682/jrrd.2014.10.0230] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 04/02/2015] [Indexed: 11/05/2022]
Abstract
Patients with a history of substance use disorder (SUD) are more likely to be prescribed opioid medications for chronic pain than patients without an SUD history; however, little is known about prescription opioid therapy in populations composed exclusively of patients with SUD. This study examined correlates of prescription opioid therapy in 214 Veterans with chronic noncancer pain and an SUD history. Participants completed psychosocial questionnaires and participated in a structured mental health diagnostic interview, and medical diagnoses and opioid pharmacy data were abstracted from their Department of Veterans Affairs electronic medical records. Participants were categorized into three groups based on opioid prescriptions in the past 90 d: no opioid therapy (n = 134), short-term (<90 d) opioid therapy (n = 31), or long-term (>/= 90 d) opioid therapy (n = 49). Relative to participants prescribed no or short-term opioid therapy, participants who were prescribed long-term opioid therapy had a greater number of pain diagnoses; reported higher levels of pain severity, interference, and catastrophizing; and endorsed lower chronic pain self-efficacy. In a multivariate model, number of pain diagnoses and pain interference were associated with a greater likelihood of being prescribed long-term opioid therapy after controlling for demographic and clinical characteristics. Findings highlight the poor pain-related functioning in patients with SUD histories who are prescribed long-term opioid therapy.
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Affiliation(s)
- Travis I Lovejoy
- Mental Health and Clinical Neurosciences Division and Center to Improve Veteran Involvement in Care, Department of Veterans Affairs Portland Health Care System, Portland, OR; and Department of Psychiatry, Oregon Health and Science University, Portland, OR
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Chaudhary S, Compton P. Use of risk mitigation practices by family nurse practitioners prescribing opioids for the management of chronic nonmalignant pain. Subst Abus 2016; 38:95-104. [DOI: 10.1080/08897077.2016.1265038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Sahil Chaudhary
- Department of Health Systems Administration, Georgetown University, Washington, DC, USA
| | - Peggy Compton
- Department of Advanced Nursing Practice, Georgetown University, Washington, DC, USA
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Galanter M, Seppala M, Klein A. Medication-assisted treatment for opioid dependence in Twelve Step–oriented residential rehabilitation settings. Subst Abus 2016; 37:381-383. [DOI: 10.1080/08897077.2016.1187241] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Marc Galanter
- Department of Psychiatry, New York University School of Medicine, New York, New York, USA
| | - Marvin Seppala
- Hazelden/Betty Ford Foundation, Center City, Minnesota, USA
| | - Audrey Klein
- Hazelden/Betty Ford Foundation, Center City, Minnesota, USA
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