Sex-Differences in Pain and Opioid Use Disorder Management: A Cross-Sectional Real-World Study

Impact of State Policies on Opioid Prescribing Among Surgery and Injury Patients: Controlled Interrupted Time-Series Study, North Carolina, 2014-2019

PURPOSE

Impact of policies limiting opioid prescribing for acute and post-surgical pain among racially minoritized populations is not well understood. We evaluated the impact of two North Carolina (NC) policies on outpatient opioid prescribing among injury and surgical patients by race, ethnicity, age, and sex.

METHODS

We conducted controlled and single series interrupted time series using electronic health data from two integrated healthcare systems in NC, among > 11 years-old patients having acute injuries and surgery between April 2014 and December 2019. The policy interventions were safe opioid prescribing investigative initiative (SOPI, May 2016) and NC law limiting opioid days' supply (STOP Act, January 2018). Outcomes included, proportion of patients receiving index opioid prescription after surgery or injury event, receipt of subsequent opioid prescriptions, days' supply, and milligrams of morphine equivalents (MME).

RESULTS

Of the 621 997 surgical and 864 061 injury patients, 69.4% and 19.7%, respectively, received an index opioid analgesic prescription. There were sustained declines in index opioid prescription among post-surgical patients after SOPI [-2.7% per year (-4.6, -0.9)] and STOP act [-4.1% (-5.9, -2.2)], but no change among injury patients. Policy-related opioid prescribing declines were larger among black, native American, and Hispanic post-surgical patients than whites and Asians. Index and subsequent opioid days' supply showed sustained declines after SOPI and STOP Act among post-surgical patients. There was no policy impact on MME.

CONCLUSIONS

Policies were associated with reductions in opioid prescribing, particularly in post-surgical patients; however, racialized inequities likely reflect implicit and explicit racialized biases in pain management practices.

Gender Medicine and Pharmacology

Gender-specific medicine consists of a transversal methodological approach that aims to study the influence of sex and gender on diseases [...].

The effect of morphine on rat microglial phagocytic activity: An in vitro study of brain region-, plating density-, sex-, morphine concentration-, and receptor-dependency

Opioids have long been used for clinical pain management, but also have addictive properties that have contributed to the ongoing opioid epidemic. While opioid activation of opioid receptors is well known to contribute to reward and reinforcement, data now also suggest that opioid activation of immune signaling via toll-like receptor 4 (TLR4) may also play a role in addiction-like processes. TLR4 expression is enriched in immune cells, and in the nervous system is primarily expressed in microglia. Microglial phagocytosis is important for developmental, homeostatic, and pathological processes. To examine how morphine impacts microglial phagocytosis, we isolated microglia from adult male and female rat cortex and striatum and plated them in vitro at 10,000 (10K) or 50,000 cells/well densities. Microglia were incubated with neutral fluorescent microbeads to stimulate phagocytosis in the presence of one of four morphine concentrations. We found that the brain region from which microglia are isolated and plating density, but not morphine concentration, impacts cell survival in vitro. We found that 10-12 M morphine, but not higher concentrations, increases phagocytosis in striatal microglia in vitro independent of sex and plating density, while 10-12 M morphine increased phagocytosis in cortical microglia in vitro independent of sex, but contingent on a plating density. Finally, we demonstrate that the effect of 10-12 M morphine in striatal microglia plated at 10 K density is mediated via TLR4, and not μORs. Overall, our data suggest that in rats, a morphine-TLR4 signaling pathway increases phagocytic activity in microglia independent of sex. This may is useful information for better understanding the possible neural outcomes associated with morphine exposures.

Pain and anxiety in patients with breast cancer treated with morphine versus tramal with virtual reality

The treatment of pain and anxiety in cancer patients includes both pharmaceutical and non-pharmacological approaches. The researchers of this study aimed to compare the effectiveness of morphine versus Tramal with virtual reality therapy (VR) in reducing pain and anxiety in female patients with breast cancer. The sample was composed of 80 women with breast cancer who where treated at a specialized cancer center in Jordan. A quasi-experimental design was used in the study intervention. When used with VR, the tramal analgesics did not differe significactly from the effect of morphine in reducing the pain and anxiety. However, both groups had a significant drop in the level of pain and anxiety. When combined with VR, the use of weak opioids such as Tramal will have nearly the same effect as strong opioids such as Morphine in reducing pain and anxiety in breast cancer patients.