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Rosenfield MN, Beaudoin FL, Gaither R, Hallowell BD, Daly MM, Marshall BDL, Chambers LC. Association between comorbid chronic pain or prior hospitalization for mental illness and substance use treatment among a cohort at high risk of opioid overdose. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 159:209273. [PMID: 38113996 DOI: 10.1016/j.josat.2023.209273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/25/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Chronic pain and serious mental illness increase risk of opioid use, and opioid use can exacerbate both conditions. Substance use disorder (SUD) treatment can be lifesaving, but chronic pain and serious mental illness may make recovery challenging. We evaluated the association between current chronic pain and prior hospitalization for mental illness and 90-day SUD treatment engagement, among emergency department (ED) patients at high risk of opioid overdose. METHODS We conducted a cohort analysis of 648 ED patients enrolled in a randomized controlled trial in Rhode Island. We linked baseline study data on chronic pain and prior hospitalization for mental illness to statewide administrative data on state-licensed treatment programs (including methadone) and buprenorphine treatment via prescription. We defined treatment engagement as initiation of a state-licensed treatment program, transfer between state-licensed programs/providers, or a buprenorphine prescription (re-)fill. We used modified Poisson models to estimate the association between each baseline comorbidity and treatment engagement within 90 days following the ED visit, adjusted for a priori potential confounders. In an exploratory analysis, models were stratified by baseline treatment status. RESULTS The mean age of participants was 37 years; 439 (68 %) were male, and 446 (69 %) had been recently unhoused. Overall, 278 participants (43 %) engaged in treatment within 90 days of the ED visit. Participants with prior hospitalization for mental illness were more likely to engage in treatment than those without (adjusted risk ratio [ARR] = 1.24, 95 % confidence interval [CI] = 1.01-1.53), although this association was only among those already accessing treatment at baseline (ARR = 1.58, 95 % CI = 1.10-2.27). Chronic pain was not associated with 90-day treatment engagement overall (ARR = 1.12, 95 % CI = 0.91-1.38) or within baseline treatment subgroups. CONCLUSIONS Among ED patients at high risk of opioid overdose and accessing treatment at baseline, those with prior hospitalization for mental illness (but not chronic pain) were more likely to engage in treatment following the ED visit, which may reflect disproportionate initiation of additional treatment programs, transfer between programs/providers, or ongoing buprenorphine treatment. Touchpoints within the medical system should be leveraged to ensure that everyone, including those with serious mental illness, can access high-quality SUD treatment at the desired intensity level.
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Affiliation(s)
- Maayan N Rosenfield
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Rachel Gaither
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | | | - Mackenzie M Daly
- Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, Providence, RI, United States
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Laura C Chambers
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States.
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Hampton J, Mugambi P, Caggiano E, Eugene R, Valente A, Taylor M, Carreiro S. Closing the Digital Divide in Interventions for Substance Use Disorder. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2024; 9:e240002. [PMID: 38726224 PMCID: PMC11081399 DOI: 10.20900/jpbs.20240002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Digital health interventions are exploding in today's medical practice and have tremendous potential to support the treatment of substance use disorders (SUD). Developers and healthcare providers alike must be cognizant of the potential for digital interventions to exacerbate existing inequities in SUD treatment, particularly as they relate to Social Determinants of Health (SDoH). To explore this evolving area of study, this manuscript will review the existing concepts of the digital divide and digital inequities, and the role SDoH play as drivers of digital inequities. We will then explore how the data used and modeling strategies can create bias in digital health tools for SUD. Finally, we will discuss potential solutions and future directions to bridge these gaps including smartphone ownership, Wi-Fi access, digital literacy, and mitigation of historical, algorithmic, and measurement bias. Thoughtful design of digital interventions is quintessential to reduce the risk of bias, decrease the digital divide, and create equitable health outcomes for individuals with SUD.
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Affiliation(s)
- Jazmin Hampton
- Division of Toxicology, Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
- Washington University of Health and Science, San Pedro, Belize, Central America
- Division of Public Health, Walden University, Minneapolis, MN 55401, USA
| | - Purity Mugambi
- Manning College of Information and Computer Sciences, University of Massachusetts-Amherst, Amherst, MA 01003, USA
| | - Emily Caggiano
- Division of Toxicology, Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Reynalde Eugene
- Division of Toxicology, Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Alycia Valente
- Division of Toxicology, Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Melissa Taylor
- Division of Toxicology, Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Stephanie Carreiro
- Division of Toxicology, Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
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Tseng TY, Mitchell MM, Chander G, Latkin C, Kennedy C, Knowlton AR. Patient-centered Engagement as a Mediator in the Associations of Healthcare Discrimination, Pain Care Denial, and Later Substance Use Among a Sample of Predominately African Americans Living with HIV. AIDS Behav 2024; 28:429-438. [PMID: 38060111 DOI: 10.1007/s10461-023-04235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
Chronic pain is prevalent and often under-addressed among people with HIV and people who use drugs, likely compounding the stress of discrimination in healthcare, and self-medicating along with its associated overdose risk or other problematic coping. Due to challenges in treating pain and HIV in the context of substance use, collaborative, patient-centered patient-provider engagement (PCE) may be particularly important for mitigating the impact of pain on illicit drug use and promoting sustained recovery. We examined whether PCE with primary care provider (PCE-PCP) mediated the effects of pain, discrimination, and denial of prescription pain medication on later substance use for pain among a sample of 331 predominately African Americans with HIV and a drug use history in Baltimore, Maryland, USA. Baseline pain level was directly associated with a higher chance of substance use for pain at 12 months (Standardized Coefficient = 0.26, p < .01). Indirect paths were observed from baseline healthcare discrimination (Standardized Coefficient = 0.05, 95% CI=[0.01, 0.13]) and pain medication denial (Standardized Coefficient = 0.06, 95% CI=[0.01, 0.14]) to a higher chance of substance use for pain at 12 months. Effects of prior discrimination and pain medication denial on later self-medication were mediated through worse PCE-PCP at 6 months. Results underscore the importance of PCE interpersonal skills and integrative care models in addressing mistreatment in healthcare and substance use in this population. An integrated approach for treating pain and substance use disorders concurrently with HIV and other comorbidities is much needed. Interventions should target individuals at multiple risks of discriminations and healthcare professionals to promote PCE.
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Affiliation(s)
- Tuo-Yen Tseng
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Norton LS, Dibb B. "I'm Not the Same Person Anymore": Thematic Analysis Exploring Experiences of Dependence to Prescribed Analgesics in Patients with Chronic Pain in the UK. Pain Ther 2023; 12:1427-1438. [PMID: 37751058 PMCID: PMC10616007 DOI: 10.1007/s40122-023-00553-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/29/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION The rising issue of dependence to prescribed pain medication for patients with chronic pain has been highlighted in the literature; however, there is a dearth of research exploring the patient perspective of this dependence in the United Kingdom (UK). This exploratory qualitative study aimed to investigate experiences of prescribed analgesic dependence in patients with chronic pain in the UK. METHODS Semi-structured interviews were conducted with nine UK-based participants (eight females, one male) with a mean age of 44, who experienced chronic pain and identified as dependent to their prescribed pain medication. The interviews were recorded and transcribed verbatim and the data analysed using thematic analysis. RESULTS Three main themes emerged, including perceptions of dependence, interactions with others, and interactions with medical professionals. The findings revealed how the experiences focused on the participants' own perception of their dependence, such as its perceived impact on their life and how the dependence began, and the relation of the dependence to their social environment, for example, doctor-patient relations. CONCLUSIONS These findings suggest practical implications for the management of dependence such as, raising awareness of the risks of dependence with these medications in the UK, and stricter observation of those taking the medications to identify dependence issues early.
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Affiliation(s)
- Louise S Norton
- University of Surrey, Guildford, Surrey, GU2 7XH, United Kingdom.
| | - Bridget Dibb
- University of Surrey, Guildford, Surrey, GU2 7XH, United Kingdom.
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DeBruin H, St Marie BJ. Health disparities in ethnic and racial minority populations with pain and opioid use disorder. J Opioid Manag 2023; 19:23-36. [PMID: 37879657 DOI: 10.5055/jom.2023.0796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Healthcare providers are not prepared to address health disparities among ethnic and racial minority populations with either persistent and chronic pain or substance use disorder (SUD). Recognizing biases from policies to provide pain management and treatment for SUD in our healthcare systems, from our individual state laws and federal guidelines, is necessary. Biases are embedded in the screening and treatment of patients with chronic pain through the use of screening tools, opioid treatment agreements, and prescription drug monitoring programs. Additionally, the punitive treatment of people of ethnic and racial minority populations who experience persistent and chronic pain, opioid use disorders, or other SUDs needs to be redirected to facilitate solutions rooted in equity.
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Affiliation(s)
| | - Barbara J St Marie
- University of Iowa, College of Nursing, Iowa City, Iowa. ORCID: https://orcid.org/0000-0003-0231-9464
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Winiker AK, Heidari O, Pollock S, Sodder S, Tobin K. Barriers to Assessing and Treating Trauma in Primary Care and Opportunities for Improvement: Perspectives from Prescribers of Medications for Opioid Use Disorder. Subst Use Misuse 2023; 58:1651-1659. [PMID: 37495397 PMCID: PMC10758239 DOI: 10.1080/10826084.2023.2238301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background: Medication for Opioid Use Disorder (MOUD) is a best practice for treating individuals with opioid use disorder (OUD), and primary care-based MOUD management can reduce treatment barriers among OUD patients. Individuals with OUD experience disproportionately high rates of trauma and violence, highlighting the importance of addressing trauma, mental health, and substance use concurrently. However, clear guidelines for trauma-informed treatment in a primary care setting remain poorly established. Methods: A qualitative approach was engaged to explore primary care providers' perceptions of barriers and facilitators to assessing and treating trauma among MOUD patients. Twenty in-depth interviews were conducted in 2021 with Baltimore-based MOUD prescribers, including primary care physicians and nurse practitioners. Interview questions assessed experiences with identifying and treating trauma among MOUD patients, including challenges and opportunities. Results: Providers reported extensive histories of trauma experienced by MOUD patients. Barriers to addressing trauma include a lack of standardized protocols/procedures for identifying trauma, insufficient training/time to assess and treat trauma, and the limited availability of external mental health providers and specialty services. Opportunities included building strong, mutually respectful patient-provider relationships, providing individualized, person-centered care, and establishing connections to coordinated multidisciplinary treatment networks. Conclusions: MOUD treatment within primary care is an important way to increase OUD treatment access, but clearer standards are needed for the treatment of trauma within this patient population. These findings demonstrate opportunities to improve standards and systems such that primary care providers are better equipped to assess and treat the complex histories of trauma experienced by individuals with OUD.
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Affiliation(s)
- Abigail K. Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Omeid Heidari
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Sarah Pollock
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Shereen Sodder
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Karin Tobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
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"It Just Depends on Their Stability": A Qualitative Examination of Patient Factors Influencing Providers' Contraceptive Counseling Approaches for Persons With Substance Use Disorders. J Addict Med 2023; 17:89-94. [PMID: 35916431 DOI: 10.1097/adm.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This qualitative study examined how patient-related factors influence providers' contraceptive counseling for persons with substance use disorders (SUDs). Specifically, we explored individual behavior and social factors that contribute to providers modifying their contraceptive counseling approaches and described how providers alter their counseling recommendations and communication strategies in the presence of such factors. METHODS In 2019, we purposively recruited a national sample of contraceptive providers (N = 24) and conducted semistructured phone interviews to inquire about their contraceptive counseling practices for women with SUDs. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis with inductive codes. RESULTS Participants included 10 medical doctors, 8 nurse practitioners, and 6 certified nurse-midwives. We found that providers modify their contraceptive counseling provision when their patients are actively using substances or have unstable living conditions, such as intimate partner violence or homelessness. With patients experiencing these instabilities, providers reported postponing contraceptive discussions until patients are stabilized in treatment, recommending long-active reversible contraceptive methods, and varying communication styles according to their own perceptions of patients' communication needs. Providers perceived that individuals in long-term recovery have increased stability and fewer barriers to contraceptive access and adherence and therefore reported increased willingness to provide greater autonomy during contraceptive decision making and shift the counseling focus to short-acting contraceptive methods. CONCLUSIONS This study highlights that substance use and social "stability" of patients contributes to how providers approach their contraceptive counseling and make methods recommendations for their patients with SUDs. More research is needed to understand strategies that individuals with SUDs use to overcome barriers to contraceptive access and adherence in the context of active substance use and social instability.
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Ferari CS, Katsevman GA, Dekeseredy P, Sedney CL. Elective surgery for acute pain in patients with substance use disorder: lessons learned at a rural neurosurgical center. Patient series. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21656. [PMID: 36273856 PMCID: PMC9379765 DOI: 10.3171/case21656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The incidence of pain-generating degenerative spinal problems in patients who are currently using or have previously used drugs has increased as substance use disorder (SUD) becomes a chronic, lifelong condition. Health system–level data in recent years indicate a significant increase in patients with coexisting SUD and degenerative disc disease, representing an emerging population. A retrospective electronic medical record review identified seven patients with SUD who underwent elective spine surgery by orthopedic or neurosurgical staff from 2012 to 2021. The authors present two of these illustrative cases and a framework that can be used in the treatment of similar patients. OBSERVATIONS Substances used included opioids, benzodiazepines, barbiturates, cocaine, methamphetamines, hallucinogens, lysergic acid diethylamide, phencyclidine, and cannabis. All were abstaining from drug use preoperatively, with four patients in a formal treatment program. Five patients were discharged with an opioid prescription, and two patients deferred opioids. Three experienced a relapse of substance use within 1 year. All patients presented for follow-up, although two required additional contact for follow-up compliance. LESSONS Perioperative protocols focusing on patient-led care plans, pain control, communication with medication for opioid use disorder providers, family and social support, and specific indicators of possible poor results can contribute to better outcomes for care challenges associated with these diagnoses.
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Affiliation(s)
| | | | | | - Cara L. Sedney
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia
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Delorme J, Pennel L, Brousse G, Daulouède JP, Delile JM, Lack P, Gérard A, Dematteis M, Kabore JL, Authier N, Chenaf C. Prevalence and Characteristics of Chronic Pain in Buprenorphine and Methadone-Maintained Patients. Front Psychiatry 2021; 12:641430. [PMID: 33981257 PMCID: PMC8107279 DOI: 10.3389/fpsyt.2021.641430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic pain and substance use disorders frequently co-occur. Indeed, chronic pain is highly prevalent, affecting 23-68% of patients receiving opioid agonist treatments (OAT) worldwide. The majority of available estimates come from American studies, but data are still lacking in Europe. We aim to provide European estimates of the prevalence of chronic pain in patients receiving OAT using French data, since France is the first European country in terms of number of patients with OAT. The secondary objectives were to characterize the features and management of chronic pain, as well identify associated risk factors. We conducted a multicenter, cross-sectional study, recruiting patients treated either with buprenorphine or methadone in 19 French addiction centers, from May to July 2016. All participants had to complete a semi-directed questionnaire that collected sociodemographic and medical data, pain characteristics, and licit or illicit drug consumption. In total, 509 patients were included. The prevalence of chronic pain was estimated at 33.2% (95% CI: 29.1-37.3). Compared to non-chronic pain patients, chronic pain patients were older (38.4 vs. 36.1 years, p = 0.006), were more unemployed (66 vs. 52%, p = 0.003), had more psychiatric comorbidities (50 vs. 39%, p = 0.02), and split their OAT for pain management more frequently (24 vs. 7%, p = 0.009). Pain intensity was moderate or severe in 75% of chronic pain patients. Among patients with chronic pain, 15.4% were not prescribed, and did not self-medicate with, any analgesic drugs, 52.1% were prescribed analgesics (non-opioid analgesics, 76.3%; codeine, tramadol, opium, 27.2%; and morphine, fentanyl, oxycodone, 11.8%), and 32.5% exclusively self-medicated with analgesics. Moreover, 20.1% of patients with chronic pain also used illicit drugs for pain relief. On multivariate analysis, variables that remained significantly associated with chronic pain were age [OR = 1.03 (95% CI: 1.00-1.05], p = 0.02], anxiety [OR = 1.52 (1.15-2.02), p = 0.003], and depression [OR = 1.25 (1.00-1.55), p = 0.05]. Chronic pain is a highly prevalent condition in patients receiving OAT, and its appropriate management remains uncertain, since insufficient relief and frequent additional self-medications with analgesics or illicit drugs were reported by these patients. Increased awareness among caregivers is urgently needed regarding a systematic and careful assessment, along with an adequate management of chronic pain in patients receiving OAT.
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Affiliation(s)
- Jessica Delorme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Service Psychiatrie-Addictologie, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Lucie Pennel
- Service d'Addictologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Georges Brousse
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Service Psychiatrie-Addictologie, Clermont-Ferrand, France
| | - Jean-Pierre Daulouède
- Centre de Soins et d'Accompagnement et de Prévention en Addictologie (CSAPA), BIZIA, Médecins du Monde, Centre Hospitalier de la côte Basque, Bayonne, France
| | - Jean-Michel Delile
- Centre de Soins et d'Accompagnement et de Prévention en Addictologie (CSAPA) "Maurice Serisé", Comité d'Etude et d'Information sur la Drogue (CEID), Bordeaux, France
| | - Philippe Lack
- Centre de Soins et d'Accompagnement et de Prévention en Addictologie (CSAPA), Centre Hospitalier de la Croix Rousse, Lyon, France
| | - Antoine Gérard
- Centre de Soins et d'Accompagnement et de Prévention en Addictologie (CSAPA), Centre Hospitalier Emile Roux, Le Puy-en-Velay, France
| | - Maurice Dematteis
- Service d'Addictologie, CHU Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Jean-Luc Kabore
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Service Psychiatrie-Addictologie, Clermont-Ferrand, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Service Psychiatrie-Addictologie, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France.,Institut Analgesia, Faculté de Médecine, BP38, Clermont-Ferrand, France
| | - Chouki Chenaf
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Service Psychiatrie-Addictologie, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques (OFMA) / French monitoring centre for analgesic drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
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Charron E, Mayo RM, Heavner-Sullivan SF, Eichelberger KY, Dickes L, Truong KD, Rennert L. “It’s a very nuanced discussion with every woman”: Health care providers’ communication practices during contraceptive counseling for patients with substance use disorders. Contraception 2020; 102:349-355. [DOI: 10.1016/j.contraception.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 09/01/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
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St Marie B. Assessing Patients' Risk for Opioid Use Disorder. AACN Adv Crit Care 2020; 30:343-352. [PMID: 31951657 DOI: 10.4037/aacnacc2019931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Opioid use disorder and opioid misuse continue to increase rapidly in prevalence in North America. Nurses play a critical role in managing pain in patients who are at risk for opioid use disorder. The interplay of pain and opioid use disorder provides nurses with an opportunity to address urgent needs while treating patients across the continuum of care. This article reviews strategies for assessing risk for opioid use disorder while treating patients with pain. Implementing these approaches into daily nursing practice may improve patient care and help reduce the incidence of opioid use disorder.
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Affiliation(s)
- Barbara St Marie
- Barbara St. Marie is Assistant Professor, College of Nursing, University of Iowa, 50 Newton Road, Iowa City, IA
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Painful lives: Chronic pain experience among people who use illicit drugs in Montreal (Canada). Soc Sci Med 2020; 246:112734. [DOI: 10.1016/j.socscimed.2019.112734] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/05/2019] [Accepted: 12/12/2019] [Indexed: 01/03/2023]
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Dassieu L, Kaboré JL, Choinière M, Arruda N, Roy É. Understanding the link between substance use and chronic pain: A qualitative study among people who use illicit drugs in Montreal, Canada. Drug Alcohol Depend 2019; 202:50-55. [PMID: 31301552 DOI: 10.1016/j.drugalcdep.2019.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/26/2019] [Accepted: 07/02/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Lise Dassieu
- Université de Sherbrooke, Addiction Research and Study Program, Faculty of Medicine and Health Sciences, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada; Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Saint-Antoine Building, 850 Saint-Denis St, Montreal, Quebec, H2X 0A9, Canada.
| | - Jean-Luc Kaboré
- Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Saint-Antoine Building, 850 Saint-Denis St, Montreal, Quebec, H2X 0A9, Canada; Université de Montréal, Faculty of Medicine, Department of Pharmacology and Physiology, Pavillon Roger-Gaudry, C.P. 6128, succursale Centre-ville, Montreal, Quebec, H3C 3J7, Canada
| | - Manon Choinière
- Research Center of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Saint-Antoine Building, 850 Saint-Denis St, Montreal, Quebec, H2X 0A9, Canada; Université de Montréal, Faculty of Medicine, Department of Anesthesiology and Pain Medicine, Pavillon Roger-Gaudry, C.P. 6128, succursale Centre-ville, Montreal, Québec, H3C 3J7, Canada
| | - Nelson Arruda
- Université de Sherbrooke, Addiction Research and Study Program, Faculty of Medicine and Health Sciences, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada
| | - Élise Roy
- Université de Sherbrooke, Addiction Research and Study Program, Faculty of Medicine and Health Sciences, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada; Institut National de Santé Publique du Québec, 190 Crémazie Blvd. East, Montreal, Quebec, H2P 1E2, Canada
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Smallwood RF, Price LR, Campbell JL, Garrett AS, Atalla SW, Monroe TB, Aytur SA, Potter JS, Robin DA. Network Alterations in Comorbid Chronic Pain and Opioid Addiction: An Exploratory Approach. Front Hum Neurosci 2019; 13:174. [PMID: 31191279 PMCID: PMC6548857 DOI: 10.3389/fnhum.2019.00174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/13/2019] [Indexed: 12/17/2022] Open
Abstract
The comorbidity of chronic pain and opioid addiction is a serious problem that has been growing with the practice of prescribing opioids for chronic pain. Neuroimaging research has shown that chronic pain and opioid dependence both affect brain structure and function, but this is the first study to evaluate the neurophysiological alterations in patients with comorbid chronic pain and addiction. Eighteen participants with chronic low back pain and opioid addiction were compared with eighteen age- and sex-matched healthy individuals in a pain-induction fMRI task. Unified structural equation modeling (SEM) with Lagrange multiplier (LM) testing yielded a network model of pain processing for patient and control groups based on 19 a priori defined regions. Tests of differences between groups on specific regression parameters were determined on a path-by-path basis using z-tests corrected for the number of comparisons. Patients with the chronic pain and addiction comorbidity had increased connection strengths; many of these connections were interhemispheric and spanned regions involved in sensory, affective, and cognitive processes. The affected regions included those that are commonly altered in chronic pain or addiction alone, indicating that this comorbidity manifests with neurological symptoms of both disorders. Understanding the neural mechanisms involved in the comorbidity is crucial to finding a comprehensive treatment, rather than treating the symptoms individually.
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Affiliation(s)
- Rachel F Smallwood
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Larry R Price
- Metholology, Measurement and Statistical Analysis, Texas State University, San Marcos, TX, United States
| | - Jenna L Campbell
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States
| | - Amy S Garrett
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Sebastian W Atalla
- College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Todd B Monroe
- College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Semra A Aytur
- Department of Health Management and Policy, University of New Hampshire, Durham, NH, United States
| | - Jennifer S Potter
- Department of Psychiatry, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Donald A Robin
- Department of Communication Sciences and Disorders, University of New Hampshire, Durham, NH, United States.,Interdisciplinary Program in Neuroscience and Behavior, University of New Hampshire, Durham, NH, United States
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15
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Witry MJ, St Marie BJ, Viyyuri BR, Windschitl PD. Factors Influencing Judgments to Consult Prescription Monitoring Programs: A Factorial Survey Experiment. Pain Manag Nurs 2019; 21:48-56. [PMID: 31133408 DOI: 10.1016/j.pmn.2019.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/05/2019] [Accepted: 04/01/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Prescription monitoring programs (PMPs) can provide health care professionals with valuable information. However, few studies have explored providers' decision making for accessing PMPs. AIMS This study aimed to identify provider characteristics and situational factors most influencing perceived importance of consulting the PMP for patients in a simulated context. DESIGN The study used a cross-sectional factorial survey. SETTINGS The survey was administered electronically. PARTICIPANTS/SUBJECTS Community pharmacists, advanced practice registered nurses (APRNs), and physicians in Iowa. METHODS Participants were recruited by mail which included a link to the online survey. The survey consisted of demographic questions, eight randomly generated vignettes, and one ranked item. The vignettes described a hypothetical prescription using eight experimental variables whose levels were randomly varied. Respondents evaluated each vignette for importance to access the PMP. Analyses used linear mixed-effects models in R (Version 3.5.0). RESULTS A total of 138 responses were available for multilevel analysis. Women, physicians, and APRNs rated it more important to consult the PMP for a given prescription compared with men and pharmacists. Accessing a PMP was perceived as more important with cash payments, quantity dispensed, suspicion for misuse, hydromorphone and oxycodone prescriptions, and headache. Advancing age, postoperative pain, and anxiety or sleep indications were associated with less importance. CONCLUSIONS Age, indication for prescribing, misuse, and payment mode each independently had greater importance to providers in accessing the PMP. This was the first study to isolate the influence of different controlled substances on how important it was to consult the PMP.
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Affiliation(s)
- Matthew J Witry
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, Iowa.
| | | | | | - Paul D Windschitl
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
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16
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Bapat AC, Bojarski EF. Transference and Countertransference in Palliative Care #371. J Palliat Med 2019; 22:452-453. [PMID: 30933569 DOI: 10.1089/jpm.2019.0042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Cockroft JD, Adams SM, Bonnet K, Matlock D, McMillan J, Schlundt D. “A scarlet letter”: Stigma and other factors affecting trust in the health care system for women seeking substance abuse treatment in a community setting. Subst Abus 2019; 40:170-177. [DOI: 10.1080/08897077.2018.1544184] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Susie M. Adams
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Jessica McMillan
- Vanderbilt University School of Nursing, Nashville, Tennessee, USA
| | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
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18
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Ditre JW, Zale EL, LaRowe LR. A Reciprocal Model of Pain and Substance Use: Transdiagnostic Considerations, Clinical Implications, and Future Directions. Annu Rev Clin Psychol 2018; 15:503-528. [PMID: 30566371 DOI: 10.1146/annurev-clinpsy-050718-095440] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pain and substance use are highly prevalent and co-occurring conditions that continue to garner increasing clinical and empirical interest. Although nicotine and tobacco, alcohol, and cannabis each confer acute analgesic effects, frequent or heavy use may contribute to the development and progression of chronic pain, and pain may be heightened during abstinence. Additionally, pain can be a potent motivator of substance self-administration, and it may contribute to escalating use and poorer substance-related treatment outcomes. We integrated converging lines of evidence to propose a reciprocal model in which pain and substance use are hypothesized to interact in the manner of a positive feedback loop, resulting in the exacerbation and maintenance of both conditions over time. Theoretical mechanisms in bidirectional pain-substance use relations are reviewed, including negative reinforcement, social cognitive processes, and allostatic load in overlapping neural circuitry. Finally, candidate transdiagnostic factors are identified, and we conclude with a discussion of clinical implications and future research directions.
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Affiliation(s)
- Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, New York 13244, USA; ,
| | - Emily L Zale
- Department of Psychology, Binghamton University, Binghamton, New York 13902, USA;
| | - Lisa R LaRowe
- Department of Psychology, Syracuse University, Syracuse, New York 13244, USA; ,
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19
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Isenberg SR, Maragh-Bass AC, Ridgeway K, Beach MC, Knowlton AR. A qualitative exploration of chronic pain and opioid treatment among HIV patients with drug use disorders. J Opioid Manag 2018; 13:5-16. [PMID: 28345742 PMCID: PMC5560049 DOI: 10.5055/jom.2017.0363] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The study explored high-risk participants' experiences with pain management regarding clinical access to and use of prescription opioids. DESIGN Qualitative semistructured interviews and focus groups. SETTING Data were collected August 2014 to May 2015 at an urban community-based research facility in Baltimore City, MD. PARTICIPANTS HIV participants with chronic pain and a history of illicit drug use. METHODS Qualitative coding and analysis used an iterative, inductive, and thematic approach and coders achieved inter-coder consistency. RESULTS The authors identified two major themes. First, participants had positive and negative interactions with healthcare providers regarding chronic pain treatment. Participants perceived that providers lacked empathy for their pain and/or were not adequately managing their pain. These interactions resulted in participants seeking new providers or mistrusting the medical system. Further, providers' surveillance of participants' pain treatment regimen contributed to distress surrounding pain management. The second theme centered on participants' pain management experiences with prescribed opioid analgesics. Participants felt they were receiving dosages and classes of analgesics that did not sufficiently address their pain, and consequently modified their dosages or rationed prescription opioids. Other participants were reluctant to take analgesics due to their history of illicit drug use. Some participants relapsed to illicit drug use when they felt their prescription opioids did not adequately address their pain needs. CONCLUSIONS Participant struggles with receiving and managing prescribed opioid analgesics suggest a need for: therapies beyond these medications; guidelines for providers specific to this population; and harm reduction trainings for providers.
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Affiliation(s)
- Sarina R Isenberg
- Doctoral Candidate, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allysha C Maragh-Bass
- Doctoral Candidate, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kathleen Ridgeway
- Graduate of the MSPH program, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary C Beach
- Professor of Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Amy R Knowlton
- Associate Professor, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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20
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Delorme J, Chenaf C, Bertin C, Riquelme M, Eschalier A, Ardid D, Authier N. Chronic Pain Opioid-Maintained Patients Receive Less Analgesic Opioid Prescriptions. Front Psychiatry 2018; 9:335. [PMID: 30083113 PMCID: PMC6065119 DOI: 10.3389/fpsyt.2018.00335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/02/2018] [Indexed: 12/29/2022] Open
Abstract
Treating pain and opioid use disorder represents a clinical challenge. While most studies that have assessed opioid analgesic use in opioid substitution treatment (OST) patients primarily address opioid analgesic misuse (1, 2), only few studies focused on OST patients assessed the prescription of analgesic opioids for chronic pain. We sought to compare the prevalence of analgesic opioid prescription (AOP) in two groups of chronic non-cancer pain (CNCP) patients: OST patients vs. the general population. This was a population-based cross-sectional study based on the French national healthcare claims database SNIIRAM (Système National d'Informations Inter-Régimes de l'Assurance Maladie) covering over 66 million people (98.8% of the French population). Overall, 67,173 participants ≥15 years old undergoing continuous OST in 2015 ("OST patients" group) were included and age- and gender-matched by means of a 1:1 ratio with 67,173 patients without OST ("control" group). In each group, patients with cancer conditions were excluded and those having received opioid and non-opioid analgesics for at least 3 months were identified (CNCP patients). Compared to control patients, CNCP OST patients received less AOP (47.8 vs. 68.0%, p < 0.0001) and more often non-opioid prescription (52.2 vs. 32.0%, p < 0.0001). In multivariate analysis, CNCP OST patients were 2.7 times less likely to be prescribed analgesic opioids (adjusted odds ratio [OR] = 2.7 [2.42-3.01], p < 0.0001) than control patients. AOP correlated in CNCP OST patients with: age ≤ 40 years old, female gender, low-income status, methadone-maintained treatment, mental health disorder, hepatitis C virus (HCV) infection, and alcohol abuse disorder. Opioid analgesics were less often prescribed in CNCP OST patients. AOP prevalence was 2.7-fold lower than in the general population. Chronic pain management in OST patients needs to be reinforced through additional physician training and a multidisciplinary approach.
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Affiliation(s)
- Jessica Delorme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Chouki Chenaf
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Celian Bertin
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie Riquelme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Alain Eschalier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Faculté de Médecine, Institut Analgesia, Clermont-Ferrand, France
| | - Denis Ardid
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Faculté de Médecine, Institut Analgesia, Clermont-Ferrand, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France.,Observatoire Français des Médicaments Antalgiques/French Monitoring Centre for Analgesic Drugs, Université Clermont Auvergne - CHU Clermont-Ferrand, Clermont-Ferrand, France.,Faculté de Médecine, Institut Analgesia, Clermont-Ferrand, France
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21
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Sacco P, Cagle JG, Moreland ML, Camlin EA. Screening and Assessment of Substance Use in Hospice Care: Examining Content from a National Sample of Psychosocial Assessments. J Palliat Med 2017; 20:850-856. [DOI: 10.1089/jpm.2016.0538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Paul Sacco
- School of Social Work, University of Maryland-Baltimore, Baltimore, Maryland
| | - John G. Cagle
- School of Social Work, University of Maryland-Baltimore, Baltimore, Maryland
| | - Melissa L. Moreland
- School of Social Work, University of Maryland-Baltimore, Baltimore, Maryland
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22
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Bernhofer EI, St Marie B, Bena JF. A New Clinical Pain Knowledge Test for Nurses: Development and Psychometric Evaluation. Pain Manag Nurs 2017. [PMID: 28629891 DOI: 10.1016/j.pmn.2017.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
All nurses care for patients with pain, and pain management knowledge and attitude surveys for nurses have been around since 1987. However, no validated knowledge test exists to measure postlicensure clinicians' knowledge of the core competencies of pain management in current complex patient populations. To develop and test the psychometric properties of an instrument designed to measure pain management knowledge of postlicensure nurses. Psychometric instrument validation. Four large Midwestern U.S. hospitals. Registered nurses employed full time and part time August 2015 to April 2016, aged M = 43.25 years; time as RN, M = 16.13 years. Prospective survey design using e-mail to invite nurses to take an electronic multiple choice pain knowledge test. Content validity of initial 36-item test "very good" (95.1% agreement). Completed tests that met analysis criteria, N = 747. Mean initial test score, 69.4% correct (range 27.8-97.2). After revision/removal of 13 unacceptable questions, mean test score was 50.4% correct (range 8.7-82.6). Initial test item percent difficulty range was 15.2%-98.1%; discrimination values range, 0.03-0.50; final test item percent difficulty range, 17.6%-91.1%, discrimination values range, -0.04 to 1.04. Split-half reliability final test was 0.66. A high decision consistency reliability was identified, with test cut-score of 75%. The final 23-item Clinical Pain Knowledge Test has acceptable discrimination, difficulty, decision consistency, reliability, and validity in the general clinical inpatient nurse population. This instrument will be useful in assessing pain management knowledge of clinical nurses to determine gaps in education, evaluate knowledge after pain management education, and measure research outcomes.
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Affiliation(s)
- Esther I Bernhofer
- Cleveland Clinic, Office of Nursing Research and Innovation, Cleveland, Ohio.
| | | | - James F Bena
- Cleveland Clinic, Quantitative Health Sciences, Cleveland, Ohio
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23
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Nordmann S, Vilotitch A, Lions C, Michel L, Mora M, Spire B, Maradan G, Bendiane MK, Morel A, Roux P, Carrieri P. Pain in methadone patients: Time to address undertreatment and suicide risk (ANRS-Methaville trial). PLoS One 2017; 12:e0176288. [PMID: 28520735 PMCID: PMC5435132 DOI: 10.1371/journal.pone.0176288] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 04/07/2017] [Indexed: 12/21/2022] Open
Abstract
Background Pain in opioid-dependent patients is common but data measuring the course of pain (and its correlates) using validated scales in patients initiating methadone treatment are sparse. We aimed to assess pain and its interference in daily life, associated correlates, and undertreatment before and during methadone treatment. Methods This is a secondary analysis using longitudinal data of a randomized trial comparing two methadone initiation models. We assessed the effect of methadone initiation and other correlates on pain intensity and interference (using the Brief Pain Inventory) at months 0, 6 and 12 using a mixed multinomial logistic regression model. Results The study group comprised 168 patients who had data for either pain intensity or interference for at least one visit. Moderate to severe pain was reported in 12.9% of patients at M0, 5.4% at M6 and 7.3% at M12. Substantial interference with daily functioning was reported in 36.0% at M0, 14.5% at M6 and 17.1% at M12. Of the 98 visits where patients reported moderate to severe pain or substantial interference, 55.1% reported no treatment for pain relief, non-opioid analgesics were reported by 34.7%, opioid analgesics by 3.1% and both opioid and non-opioid analgesics by 7.1%. Methadone was associated with decreased pain intensity at 6 months (OR = 0.29, p = 0.04) and 12 months (OR = 0.30, p = 0.05) of follow-up and tended to be associated with substantial pain interference. Suicide risk was associated with both pain intensity and pain interference. Conclusions Methadone in opioid-dependent patients can reduce pain. However, undertreatment of pain in methadone patients remains a major clinical concern. Patients with pain are at higher risk of suicide. Adequate screening and management of pain in this population is a priority and needs to be integrated into routine comprehensive care.
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Affiliation(s)
- Sandra Nordmann
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Antoine Vilotitch
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Caroline Lions
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Laurent Michel
- INSERM, UMR-S 669, Paris, France
- Université Paris-Sud and Université Paris Descartes, UMR-S 669, Paris, France
- Centre Pierre Nicole, Paris, France
| | - Marion Mora
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Bruno Spire
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Gwenaelle Maradan
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | - Perrine Roux
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Patrizia Carrieri
- Aix Marseille Université, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
- * E-mail:
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24
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Cooper LA. Ethics of Narcotic Pain Management in Substance Use Disorder Recovery. J Nurse Pract 2016. [DOI: 10.1016/j.nurpra.2016.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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St Marie B. Primary care experiences of people who live with chronic pain and receive opioids to manage pain: A qualitative methodology. J Am Assoc Nurse Pract 2016; 28:429-35. [PMID: 26799819 DOI: 10.1002/2327-6924.12342] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 12/14/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The prevalence of chronic pain continues to rise and the majority of patients with chronic pain are managed in primary care. The purpose of this research was to provide the perspectives of patients who live with chronic pain and receive opioids to help manage their pain from primary care. METHODS In this qualitative study, 12 participants from a Midwest primary care clinic described their primary care experiences with receiving opioids for chronic pain. Thematic and interpretive analyses were used to understand the issues. CONCLUSIONS Participants receiving opioids for pain management through primary care feared losing access to opioids, wanted to protect sobriety when they had histories of substance use disorder, experienced stress at their jobs with frequent appointments, identified inconsistencies in health care prolonging their suffering and increasing substance misuse, and identified improvement in coping with pain when they had confidence in healthcare providers. IMPLICATIONS FOR PRACTICE Providing patient-centered care while managing patients with pain and unknown risk for prescription opioid misuse is possible. Understanding influences that create prescription opioid risk for misuse can help nurse practitioners improve their delivery of care by providing consistent and convenient healthcare encounters, and help patients protect themselves from risk of prescription opioid misuse.
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Dunn KE, Finan PH, Tompkins DA, Fingerhood M, Strain EC. Characterizing pain and associated coping strategies in methadone and buprenorphine-maintained patients. Drug Alcohol Depend 2015; 157:143-9. [PMID: 26518253 PMCID: PMC4663104 DOI: 10.1016/j.drugalcdep.2015.10.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 10/13/2015] [Accepted: 10/13/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chronic pain is common among patients receiving opioid maintenance treatment (OMT) for opioid use disorder. To aid development of treatment recommendations for coexisting pain and opioid use disorder, it is necessary to characterize pain treatment needs and assess whether needs differ as a function of OMT medication. METHODS A point-prevalence survey assessing pain and engagement in coping strategies was administered to 179 methadone and buprenorphine-maintained patients. RESULTS Forty-two percent of participants were categorized as having chronic pain. Methadone patients had greater severity of pain relative to buprenorphine patients, though both groups reported high levels of interference with daily activities, and participants with pain attended the emergency room more frequently relative to participants without pain. Only 2 coping strategies were being utilized by more than 50% of participants (over-the-counter medication, prayer). CONCLUSIONS Results indicate that pain among OMT patients is common, severe, and of significant impairment. Methadone patients reported greater severity pain, particularly worse pain in the past 24h, though interference from pain in daily activities did not vary as a function of OMT. Most participants with pain were utilizing few evidenced-based pain coping strategies. Increasing OMT patient access to additional pain treatment strategies is an opportunity for immediate intervention, and similarities across OMT type suggest interventions do not need to be customized to methadone vs. buprenorphine patients.
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Affiliation(s)
- Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - D Andrew Tompkins
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael Fingerhood
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Willens JS. Josh Gordon suspended by the NFL "for at least one year" for substance abuse. Pain Manag Nurs 2015; 16:77. [PMID: 25814045 DOI: 10.1016/j.pmn.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Joyce S Willens
- College of Nursing, Villanova University, Villanova, Pennsylvania
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