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Ezell JM, Pho MT, Ajayi BP, Simek E, Shetty N, Goddard-Eckrich DA, Bluthenthal RN. Opioid use, prescribing and fatal overdose patterns among racial/ethnic minorities in the United States: A scoping review and conceptual risk environment model. Drug Alcohol Rev 2024. [PMID: 38646735 DOI: 10.1111/dar.13832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 02/11/2024] [Accepted: 02/19/2024] [Indexed: 04/23/2024]
Abstract
ISSUES To date, there has been no synthesis of research addressing the scale and nuances of the opioid epidemic in racial/ethnic minority populations in the United States that considers the independent and joint impacts of dynamics such as structural disadvantage, provider bias, health literacy, cultural norms and various other risk factors. APPROACH Using the "risk environment" framework, we conducted a scoping review on PubMed, Embase and Google Scholar of peer-reviewed literature and governmental reports published between January 2000 and February 2024 on the nature and scale of opioid use, opioid prescribing patterns, and fatal overdoses among racial/ethnic minorities in the United States, while also examining macro, meso and individual-level risk factors. KEY FINDINGS Results from this review illuminate a growing, but fragmented, literature lacking standardisation in racial/ethnic classification and case reporting, specifically in regards to Indigenous and Asian subpopulations. This literature broadly illustrates racial/ethnic minorities' increasing nonmedical use of opioids, heightened burdens of fatal overdoses, specifically in relation to polydrug use and synthetic opioids, with notable elevations among Black/Latino subgroups, in addition uneven opioid prescribing patterns. Moreover, the literature implicates a variety of unique risk environments corresponding to dynamics such as residential segregation, provider bias, overpolicing, acculturative stress, patient distrust, and limited access to mental health care services and drug treatment resources, including medications for opioid use disorder. IMPLICATIONS There has been a lack of rigorous, targeted study on racial/ethnic minorities who use opioids, but evidence highlights burgeoning increases in usage, especially polydrug/synthetic opioid use, and disparities in prescriptions and fatal overdose risk-phenomena tied to multi-level forms of entrenched disenfranchisement. CONCLUSION There is a need for further research on the complex, overlapping risk environments of racial/ethnic minorities who use opioids, including deeper inclusion of Indigenous and Asian individuals, and efforts to generate greater methodological synergies in population classification and reporting guidelines.
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Affiliation(s)
- Jerel M Ezell
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, USA
| | - Mai T Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, USA
| | - Babatunde P Ajayi
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
| | - Elinor Simek
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, USA
- Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, USA
| | - Netra Shetty
- University of California Berkeley, Berkeley, USA
| | | | - Ricky N Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, USA
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Mackeen AD, Sullivan MV, Berghella V. Evidence-based Cesarean Delivery: Preoperative Management (Part 7). Am J Obstet Gynecol MFM 2024:101362. [PMID: 38574855 DOI: 10.1016/j.ajogmf.2024.101362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/18/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
The preoperative preparation for cesarean delivery is a multistep approach for which protocols should exist at each hospital system. These protocols should be guided by the findings of this review. The interventions reviewed and recommendations made for this review have a common goal of decreasing maternal and neonatal morbidity and mortality related to cesarean delivery (CD). The preoperative time period starts prior to the patient's arrival to the hospital and ends immediately prior to skin incision. Skin cleansing in addition to CDC recommendations of showering with either soap or an antiseptic solution at least the night prior to a procedure has not been shown to further decrease rates of infection. Hair removal at the cesarean skin incision is not necessary, however if preferred by the surgical team then clipping or depilatory creams should be used rather than shaving. Preoperative enema is not recommended. A clear liquid diet may be ingested up to 2 hours prior and a light meal up to 6 hours prior to CD. Consider giving a preoperative carbohydrate drink to non-diabetic patients up to 2 hours prior to planned CD. Weight-based intravenous (IV) cefazolin is recommended 60 minutes prior to skin incision: 1-2g IV for patients without obesity and 2g for patients with obesity or weight ≥ 80kg. Adjunctive azithromycin 500mg IV is recommended for patients with labor or rupture of membranes. Preoperative gabapentin can be considered as may decrease pain scores with movement in the postoperative period. Tranexamic acid (1g in 10-20mL of saline or 10mg/kg IV) is recommended prophylactically for patients at high-risk of postpartum hemorrhage, and can be considered in all patients. Routine use of mechanical venous thromboembolism prophylaxis is recommended preoperatively and is to be continued until the patient is ambulatory. Music, active warming of the patient, and adequate operating room temperature improves outcomes for the patient and neonate, respectively. Noise levels should allow clear communication between teams, however a specific decibel level has not been defined in the data. Patient positioning with left lateral tilt decreases hypotensive episodes compared to right lateral tilt, which is not recommended. Manual displacers result in fewer hypotensive episodes than left lateral tilt. Both vaginal and skin preparation should be performed with either chlorhexidine (preferred) or povidone-iodine. Placement of an indwelling urinary catheter is not necessary. Non-adhesive drapes are recommended. Cell salvage, while effective for high-risk patients, is not recommended for routine use. Maternal supplemental oxygen does not improve outcomes. A surgical safety checklist (including a timeout) is recommended for all CDs.
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Affiliation(s)
- A Dhanya Mackeen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Geisinger, Danville, PA.
| | - Maranda V Sullivan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Geisinger, Danville, PA
| | - Vincenzo Berghella
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA
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Thakker PU, Temple DM, Minnick C, Ponzi D, Badlani G, Hemal A, Doares W, Webb C, McCracken E, Orlando G, Jay C, Farney A, Stratta RJ. Continuous flow local anesthetic wound infusion for post-operative analgesia following kidney transplantation. Clin Transplant 2024; 38:e15305. [PMID: 38567895 DOI: 10.1111/ctr.15305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/27/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Some patients with end stage renal disease are or will become narcotic-dependent. Chronic narcotic use is associated with increased graft loss and mortality following kidney transplantation. We aimed to compare the efficacy of continuous flow local anesthetic wound infusion pumps (CFLAP) with patient controlled analgesia pumps (PCA) in reducing inpatient narcotic consumption in patients undergoing kidney transplantation. MATERIALS AND METHODS In this single-center, retrospective analysis of patients undergoing kidney transplantation, we collected demographic and operative data, peri-operative outcomes, complications, and inpatient oral morphine milligram equivalent (OME) consumption. RESULTS Four hundred and ninety-eight patients underwent kidney transplantation from 2020 to 2022. 296 (59%) historical control patients received a PCA for postoperative pain control and the next 202 (41%) patients received a CFLAP. Median age [53.5 vs. 56.0 years, p = .08] and BMI [29.5 vs. 28.9 kg/m2, p = .17] were similar. Total OME requirement was lower in the CFLAP group [2.5 vs. 34 mg, p < .001]. Wound-related complications were higher in the CFLAP group [5.9% vs. 2.7%, p = .03]. Two (.9%) patients in the CFLAP group experienced cardiac arrhythmia due to local anesthetic toxicity and required lipid infusion. CONCLUSIONS Compared to PCA, CFLAP provided a 93% reduction in OME consumption with a small increase in the wound-related complication rate. The utility of local anesthetic pumps may also be applicable to patients undergoing any unilateral abdominal or pelvic incision.
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Affiliation(s)
- Parth U Thakker
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Davis M Temple
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Caroline Minnick
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Dominick Ponzi
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Gopal Badlani
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Ashok Hemal
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - William Doares
- Department of Pharmacy, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Christopher Webb
- Section of Transplantation, Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Emily McCracken
- Section of Transplantation, Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Giuseppe Orlando
- Section of Transplantation, Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Colleen Jay
- Section of Transplantation, Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Alan Farney
- Section of Transplantation, Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Robert J Stratta
- Section of Transplantation, Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
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Erdem S, Damlakhy A, Konja K, Bashar S. Altered Mental Status in an Octogenarian: How Frequently Should Serotonin Syndrome Be Considered? Cureus 2024; 16:e57403. [PMID: 38694682 PMCID: PMC11062574 DOI: 10.7759/cureus.57403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 05/04/2024] Open
Abstract
Serotonin toxicity, an adverse consequence of elevated serotonin levels in the brain, poses a considerable threat to life. Antidepressants, frequently prescribed for various conditions in older adults, such as depression, anxiety, and sleep disturbances, significantly contribute to this risk. The elderly are particularly vulnerable due to multiple comorbidities, cognitive decline, medication interactions, polypharmacy, and chronic kidney disease. This case underscores the critical importance of considering serotonin syndrome as a potential diagnosis in patients using serotonin and norepinephrine reuptake inhibitors, especially within vulnerable populations. Here, we present the case of an 89-year-old female who presented with altered mental status and a hypertensive emergency. Following a thorough examination and exclusion of alternative causes of acute encephalopathy, serotonin syndrome induced by the use of venlafaxine and oxycodone was diagnosed.
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Affiliation(s)
- Saliha Erdem
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Ahmad Damlakhy
- Internal Medicine, Detroit Medical Center, Sinai Grace Hospital, Wayne State University, Detroit, USA
| | - Kristin Konja
- Internal Medicine, Detroit Medical Center, Michigan State University, Detroit, USA
| | - Sifullah Bashar
- Internal Medicine, Detroit Medical Center, Sinai Grace Hospital, Wayne State University, Detroit, USA
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Wagoner SF, Lawrence AS, Alapati R, Renslo B, Hamill CS, Bon Nieves A, Baumanis M, Bur AM, Kakarala K, Sykes KJ, Shnayder Y. Six-week postoperative opioid use and pain following a randomized controlled trial evaluating multimodal analgesia for head and neck free flap patients. Laryngoscope Investig Otolaryngol 2024; 9:e1235. [PMID: 38525114 PMCID: PMC10958932 DOI: 10.1002/lio2.1235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/25/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Head and neck malignancy treatment often involves invasive surgeries, necessitating effective postoperative pain control. However, chronic reliance on opioid medications remains a challenge for many patients after surgery. Multimodal analgesia (MMA) within enhanced recovery after surgery protocols has shown success in limiting narcotic pain medications for other cancer types. In a prior study, MMA comprising acetaminophen, ketorolac, gabapentin, and a neurogenic block reduced opioid use in the 7-day postoperative period for major head and neck reconstructive surgery. This study investigates the impact of multimodal analgesia on opioid prescription and pain during the 6-week postoperative period for patients undergoing major head and neck oncologic surgeries, aiming to understand the longer-term effects of narcotic use. Methods The study retrospectively examined participants in a [hybrid type 1 effectiveness-implementation pragmatic trial to assess multimodal analgesia's long-term effectiveness in head and neck free flap surgery. Arm A received scheduled acetaminophen and as-needed opioids, while Arm B received scheduled gabapentin, ketorolac, a regional nerve block at the donor site, scheduled acetaminophen, and as-needed opioids. Retrospective data collection included opioid prescription use and pain scores up to 6 weeks after surgery, gathered from the Kansas prescription drug monitoring program, K-TRACS. Results Thirty patients participated, 14 in Arm A and 16 in Arm B. The average morphine milligram equivalents per day of filled prescriptions were not significantly different between Arm A and Arm B (7.23 vs. 7.88, p = .845). Additionally, average pain scores at 6 weeks showed no significant difference between the two groups (1.4 vs. 1.9, p = .612). Conclusion Patients with head and neck cancer treated with multimodal analgesia during the perioperative period did not exhibit significant differences in opioid use and pain within 6 weeks after discharge. To confirm these findings, a re-examination with strict measures of opioid use and scheduled pain assessments in a prospective manner is warranted. Level of Evidence 4.
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Affiliation(s)
- Sarah F. Wagoner
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Amelia S. Lawrence
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Rahul Alapati
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Bryan Renslo
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Chelsea S. Hamill
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Antonio Bon Nieves
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Maraya Baumanis
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Andrés M. Bur
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Kiran Kakarala
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Kevin J. Sykes
- Health and Wellness CenterBaylor Scott and White HealthDallasTexasUSA
| | - Yelizaveta Shnayder
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Kansas Medical CenterKansas CityKansasUSA
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Tieppo Francio V, Leavitt L, Alm J, Mok D, Yoon BJV, Nazir N, Lam CM, Latif U, Sowder T, Braun E, Sack A, Khan TW, Sayed D. Healthcare Utilization (HCU) Reduction with High-Frequency (10 kHz) Spinal Cord Stimulation (SCS) Therapy. Healthcare (Basel) 2024; 12:745. [PMID: 38610166 PMCID: PMC11012032 DOI: 10.3390/healthcare12070745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Spinal cord stimulation (SCS) is a well-established treatment for patients with chronic pain. With increasing healthcare costs, it is important to determine the benefits of SCS in healthcare utilization (HCU). This retrospective, single-center observational study involved 160 subjects who underwent implantation of a high-frequency (10 kHz) SCS device. We focused on assessing trends in HCU by measuring opioid consumption in morphine milligram equivalents (MME), as well as monitoring emergency department (ED) and office visits for interventional pain procedures during the 12-month period preceding and following the SCS implant. Our results revealed a statistically significant reduction in HCU in all domains assessed. The mean MME was 51.05 and 26.52 pre- and post-implant, respectively. There was a 24.53 MME overall decrease and a mean of 78.2% statistically significant dose reduction (p < 0.0001). Of these, 91.5% reached a minimally clinically important difference (MCID) in opioid reduction. Similarly, we found a statistically significant (p < 0.01) decrease in ED visits, with a mean of 0.12 pre- and 0.03 post-implant, and a decrease in office visits for interventional pain procedures from a 1.39 pre- to 0.28 post-10 kHz SCS implant, representing a 1.11 statistically significant (p < 0.0001) mean reduction. Our study reports the largest cohort of real-world data published to date analyzing HCU trends with 10 kHz SCS for multiple pain etiologies. Furthermore, this is the first and only study evaluating HCU trends with 10 kHz SCS by assessing opioid use, ED visits, and outpatient visits for interventional pain procedures collectively. Preceding studies have individually investigated these outcomes, consistently yielding positive results comparable to our findings.
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Affiliation(s)
- Vinicius Tieppo Francio
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, USA
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Logan Leavitt
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - John Alm
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Daniel Mok
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Byung-jo Victor Yoon
- Department of Physical Medicine and Rehabilitation, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Niaman Nazir
- Department of Population Health, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Christopher M. Lam
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Usman Latif
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Timothy Sowder
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Edward Braun
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Andrew Sack
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Talal W. Khan
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, USA
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Villa NAE, Shum K, Atkinson A, Ong A, Muller A, Espiridion E. Opioid Use in Pelvic Fractures: The Impact of Opioid Prescribing Laws in Pennsylvania. Am Surg 2024:31348241241644. [PMID: 38516756 DOI: 10.1177/00031348241241644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Pennsylvania's Prescription Drug Monitoring Program (PDMP) was established in 2016, but its impact on opioid use for pelvic fractures is understudied. We compared opioid use in 277 pelvic fracture cases between two periods: 2015-2017 (T1) and 2018-2020 (T2). Outcomes included daily inpatient morphine milligram equivalents (MME), long-term opioid use (LOU) 60-90 days post-discharge, and intermediate-term opioid use (IOU) 30-60 days post-discharge. T1 and T2 had comparable baseline characteristics. T2 was associated with a decrease in average daily inpatient MME (58.6 vs 78.5, P = .02), particularly in younger patients. Regression analyses showed age and Injury Severity Score (ISS) were significant predictors for daily inpatient MME, while time period was not. Geriatric patients in T2 had significantly decreased IOU (30% vs 9%, P = .05). Pelvic fracture type and daily MME predicted IOU, while pelvic fracture type predicted LOU. This study suggests a modest impact of these laws, but further study is needed.
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Affiliation(s)
- Nicole Ann E Villa
- Drexel University College of Medicine at Tower Health, Wyomissing, PA, USA
| | - Kristina Shum
- Drexel University College of Medicine at Tower Health, Wyomissing, PA, USA
| | - Allison Atkinson
- Drexel University College of Medicine at Tower Health, Wyomissing, PA, USA
| | - Adrian Ong
- Department of Surgery, Tower Health Systems, Reading Hospital, West Reading, PA, USA
| | - Alison Muller
- Department of Surgery, Tower Health Systems, Reading Hospital, West Reading, PA, USA
| | - Eduardo Espiridion
- Drexel University College of Medicine at Tower Health, Wyomissing, PA, USA
- Department of Psychiatry, Tower Health Systems, Reading Hospital, West Reading, PA, USA
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Shah VS, Dornbos D, Hoang NA, Cua S, Rodgers B, Pezzutti D, Duenas H, Eaton R, Kreatsoulas D, Elder JB, Prevedello DM, Lonser RR, Nimjee SM. Preoperative prescription opioid use as an independent predictor of 90-day mortality and adverse events in craniotomy and craniectomy patients. J Neurosurg 2024:1-6. [PMID: 38457788 DOI: 10.3171/2024.1.jns23615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/04/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE A growing body of literature suggests that preoperative opioid exposure is an independent predictor of poor outcomes in surgical patients. No outcomes data exist on preoperative opioid use and craniotomies/craniectomies. The objective of this study was to determine the impact of preoperative opioid use on 90-day adverse events after craniotomy or craniectomy. METHODS A single-center retrospective cohort study of 2445 patients undergoing a craniotomy/craniectomy between January 1, 2013, and October 1, 2018, was conducted. Baseline demographics, pre- and postoperative opioid use (morphine milligram equivalents [MMEs]), and surgical metrics were recorded. Patients were categorized based on whether they took prescription opioids preoperatively, defined as within 1 month of surgery, or were opioid naive. The outcomes were mortality and adverse events 90 days after craniotomy/craniectomy. RESULTS Overall, 26.6% of patients composed the preoperative opioid group. The median daily MME intake among this group was 34.6 (IQR 14.1-90) MMEs. Lower employment rates (p < 0.001), uninsured status (p = 0.016), and intravenous drug use (p = 0.006) were associated with preoperative opioid use. Preoperative opioid use was associated with increased venous thromboembolism (p = 0.001), acute kidney injury (p = 0.002), acute respiratory failure (p < 0.001), myocardial infarction (p = 0.002), delirium (p < 0.001), and infection (p < 0.001). Preoperative opioid use was an independent predictor of overall 90-day adverse events (OR 1.643, 95% CI 1.289-2.095; p < 0.001) and 90-day mortality (OR 1.690, 95% CI 1.254-2.277; p < 0.001). CONCLUSIONS Preoperative opioid use was independently associated with 90-day postoperative adverse events and mortality. Opioid use increases vulnerability in craniotomy/craniectomy patients and necessitates close monitoring to improve outcomes.
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Affiliation(s)
- Varun S Shah
- 1College of Medicine, The Ohio State University, Columbus, Ohio
- 2Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - David Dornbos
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
- 4Department of Neurological Surgery, University of Tennessee Health Science Center and Semmes Murphey Clinic, Memphis, Tennessee
| | - Nguyen Alex Hoang
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Santino Cua
- 1College of Medicine, The Ohio State University, Columbus, Ohio
| | - Brandon Rodgers
- 1College of Medicine, The Ohio State University, Columbus, Ohio
| | - Dante Pezzutti
- 1College of Medicine, The Ohio State University, Columbus, Ohio
| | - Helen Duenas
- 1College of Medicine, The Ohio State University, Columbus, Ohio
| | - Ryan Eaton
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Daniel Kreatsoulas
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - J Bradley Elder
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Daniel M Prevedello
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Russell R Lonser
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Shahid M Nimjee
- 3Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
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9
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Rizvi RF, Schoephoerster JA, Desphande SS, Usher M, Oien AE, Peters MM, Loth MS, Bahr MW, Ventz S, Koopmeiners JS, Melton GB. Decreasing Opioid Addiction and Diversion Using Behavioral Economics Applied Through a Digital Engagement Solution: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e52882. [PMID: 38457203 PMCID: PMC10960208 DOI: 10.2196/52882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Despite strong and growing interest in ending the ongoing opioid health crisis, there has been limited success in reducing the prevalence of opioid addiction and the number of deaths associated with opioid overdoses. Further, 1 explanation for this is that existing interventions target those who are opiate-dependent but do not prevent opioid-naïve patients from becoming addicted. OBJECTIVE Leveraging behavioral economics at the patient level could help patients successfully use, discontinue, and dispose of their opioid medications in an acute pain setting. The primary goal of this project is to evaluate the effect of the 3 versions of the Opioid Management for You (OPY) tool on measures of opioid use relative to the standard of care by leveraging a pragmatic randomized controlled trial (RCT). METHODS A team of researchers from the Center for Learning Health System Sciences (CLHSS) at the University of Minnesota partnered with M Health Fairview to design, build, and test the 3 versions of the OPY tool: social influence, precommitment, and testimonial version. The tool is being built using the Epic Care Companion (Epic Inc) platform and interacts with the patient through their existing MyChart (Epic Systems Corporation) personal health record account, and Epic patient portal, accessed through a phone app or the MyChart website. We have demonstrated feasibility with pilot data of the social influence version of the OPY app by targeting our pilot to a specific cohort of patients undergoing upper-extremity procedures. This study will use a group sequential RCT design to test the impact of this important health system initiative. Patients who meet OPY inclusion criteria will be stratified into low, intermediate, and high risk of opiate use based on their type of surgery. RESULTS This study is being funded and supported by the CLHSS Rapid Prospective Evaluation and Digital Technology Innovation Programs, and M Health Fairview. Support and coordination provided by CLHSS include the structure of engagement, survey development, data collection, statistical analysis, and dissemination. The project was initially started in August 2022. The pilot was launched in February 2023 and is still running, with the data last counted in August 2023. The actual RCT is planned to start by early 2024. CONCLUSIONS Through this RCT, we will test our hypothesis that patient opioid use and diverted prescription opioid availability can both be improved by information delivery applied through a behavioral economics lens via sending nudges directly to the opioid users through their personal health record. TRIAL REGISTRATION ClinicalTrials.gov NCT06124079; https://clinicaltrials.gov/study/NCT06124079. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52882.
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Affiliation(s)
- Rubina Fatima Rizvi
- Division of Computational Health Sciences, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN, United States
- University of Minnesota Medical School, Minneapolis, MN, United States
| | | | - Sagar Satish Desphande
- University of Minnesota Medical School, Minneapolis, MN, United States
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Michael Usher
- University of Minnesota Medical School, Minneapolis, MN, United States
- M Health Fairview Systems, Minneapolis, MN, United States
| | - Andy Elaine Oien
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Maya Marie Peters
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Matthew Scott Loth
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN, United States
| | | | - Steffen Ventz
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Joseph Stephen Koopmeiners
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN, United States
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Genevieve B Melton
- Division of Computational Health Sciences, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
- Center for Learning Health System Sciences, University of Minnesota, Minneapolis, MN, United States
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
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10
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Wedoff M, Brinton DL, Maldonado L, Andrews AL, Simpson AN, Basco WT. Persistent Opioid Use Following Pediatric Nonfatal Firearm Injury. Acad Pediatr 2024:S1876-2859(24)00059-7. [PMID: 38437979 DOI: 10.1016/j.acap.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE Firearms are a major cause of pediatric injury. An analysis of opioid use following pediatric firearm injury has not previously been reported. Our objective was to determine the prevalence and factors associated with persistent opioid use among pediatric nonfatal firearm injury victims. METHODS We performed a retrospective cohort study using 2015-18 claims data from the Merative MarketScan Multi-State Medicaid and Commercial Databases, utilizing International Classification of Diseases, Tenth Revision codes for firearm injury and National Drug Codes for opioids. Dispensed opioid claims were used as a proxy for opioid use. Opioid exposure was defined both dichotomously and continuously (by the total number of opioid days prescribed) in the 30 days following discharge from firearm injury index encounter. Persistent opioid use was defined as ≥1 opioid claim(s) in the 90 to 270 days following index encounter. Multivariable logistic regression analysis was performed to determine whether covariates of interest were associated with greater odds of persistent opioid use. RESULTS Our cohort consisted of 2110 children who experienced nonfatal firearm injury (mean age 13.5, 80.9% male, 79.5% Medicaid) with 608 children (28.8%) exposed to opioids. Of patients exposed to opioids, 10.4% developed persistent opioid use. In adjusted analyses, each opioid day dispensed during the exposure period represented 5% greater odds of experiencing persistent opioid use. CONCLUSIONS Clinicians caring for children injured by firearms should be aware of the risk of developing persistent opioid use and balance that risk with the need to sufficiently control pain.
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Affiliation(s)
- Michael Wedoff
- Department of Pediatrics (M Wedoff and WT Basco), College of Medicine, Medical University of South Carolina, Charleston.
| | - Daniel L Brinton
- Department of Healthcare Leadership and Management (DL Brinton and L Maldonado), College of Health Professions, Medical University of South Carolina, Charleston.
| | - Lizmarie Maldonado
- Department of Healthcare Leadership and Management (DL Brinton and L Maldonado), College of Health Professions, Medical University of South Carolina, Charleston.
| | - Annie L Andrews
- Department of Pediatrics (A Andrews), The George Washington School of Medicine, DC.
| | - Annie N Simpson
- Real World Evidence (A Simpson), PrecisionHEOR, Boston, Mass.
| | - William T Basco
- Department of Pediatrics (M Wedoff and WT Basco), College of Medicine, Medical University of South Carolina, Charleston.
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11
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Lay S, Nguyen LL, Sangani A. Catatonia and Opioid Withdrawal: A Case Report. Cureus 2024; 16:e56396. [PMID: 38633950 PMCID: PMC11021997 DOI: 10.7759/cureus.56396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
In this case report, we present an 82-year-old female who was diagnosed with catatonia after she exhibited immobility, mutism, withdrawal, and stereotypy during a hospitalization for altered mental status. Fentanyl was found in her urine toxicology, and it was later discovered that she had been taking non-prescription pills from Mexico that were likely the source of the fentanyl. Her catatonia quickly remitted with benzodiazepine treatment. This case underscores previously unknown risks of substance use, which has grown especially important to psychiatric care considering how rampant the opioid epidemic has become. More so, these risks extend beyond opioid use disorders since other non-prescription drugs are commonly laced with fentanyl. Not only does this education need to be given to providers and patients alike, but further research should be conducted to establish and quantify the risk of catatonia with opioid withdrawal.
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Affiliation(s)
- Synthia Lay
- Psychiatry, Kaweah Delta Health Care District, Visalia, USA
| | - Long L Nguyen
- Psychiatry, Kaweah Delta Health Care District, Visalia, USA
| | - Arul Sangani
- Psychiatry, Kaweah Delta Health Care District, Visalia, USA
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12
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Shankar DS, Kim J, Bienstock DM, Gao M, Lee Y, Zubizarreta NJ, Poeran J, Lin JD, Chaudhary SB, Hecht AC. Postoperative Opioid Use and Prescribing Patterns among Patients Undergoing Cervical Laminectomy with Instrumented Fusion versus Cervical Laminoplasty with Reconstruction. Global Spine J 2024; 14:561-567. [PMID: 35861211 PMCID: PMC10802526 DOI: 10.1177/21925682221116825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To compare patterns in opioid usage and prescriptions between patients who undergo cervical laminectomy with instrumented fusion (LF) vs cervical laminoplasty with reconstruction (LP) within single surgeon and national database cohorts. METHODS We identified patients with cervical myelopathy undergoing primary LF or LP in both a single-surgeon series cohort (2004-2018) and a nationally representative cohort drawn from the IBM® Marketscan® database (2014-2016). We recorded opioid usage within 6 months of surgery and identified differences in unadjusted opioid use rates between LF and LP patients. Multivariable logistic regression was used to evaluate the association between procedure type and postoperative opioid use. RESULTS Without adjusting for covariates, LF patients had a higher rate of 6-month opioid use in the single-surgeon cohort (15.7% vs 5.1%, P = .02). After adjusting for covariates, LF patients had higher odds of 6-month postoperative opioid use (OR 2.8 [95% CI 1.0-7.7], P = .04). In the national cohort, without adjusting for covariates, there was no significant difference in 6-month opioid use between LF and LP patients. Even after adjusting for covariates, we found no significant difference in odds. CONCLUSIONS Findings from a single-surgeon cohort reveal that LF is associated with a higher rate of 6-month opioid use than LP. This is at odds with findings from a national database cohort, which suggested that LP and LF patients have similar rates of opioid usage at 6-months postoperatively. To prevent overuse of narcotics, surgeons must consider the distinct pain requirements associated with different procedures even in treatment of the same condition.
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Affiliation(s)
- Dhruv S. Shankar
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jinseong Kim
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dennis M. Bienstock
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Gao
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yunsoo Lee
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole J. Zubizarreta
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jashvant Poeran
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James D. Lin
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Saad B. Chaudhary
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew C. Hecht
- Leni & Peter May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Maya S, Mirzazadeh A, Kahn JG. Effect of wildfire on the prevalence of opioid misuse through anxiety among young adults in the United States: A modeling study. Res Sq 2024:rs.3.rs-3940689. [PMID: 38464027 PMCID: PMC10925450 DOI: 10.21203/rs.3.rs-3940689/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background Exposure to climate change events like wildfires can lead to health and mental health problems. While conceptual frameworks have been hypothesized describing the potential relationship between disaster exposure and substance use, the association remains under-researched and unquantified. Methods We constructed a quantitative portrayal of one proposed conceptual framework that focuses on the intermediary role of anxiety. We used the Monte Carlo simulation to estimate the impact of wildfire exposure on opioid misuse outcomes through increased anxiety. We searched for and extracted prior empirical evidence on the associations between wildfire anxiety and anxiety-opioid misuse. A base case scenario (S1) was devised in which the impact of wildfire on opioid misuse was limited to increasing anxiety incidence. Two exploratory scenarios investigated the additive roles of altered anxiety phenotype (S2) and increased severity of pre-existing anxiety (S3) due to wildfire exposure. Results Models show that the prevalence of opioid misuse post-wildfire may rise to 6.0%-7.2%. In S1 (base case), the opioid misuse prevalence ratio was 1.12 (95% uncertainty interval [UI]: 1.00 - 1.27). The two exploratory scenarios, with less stringent assumptions, yielded prevalence ratios of 1.23 (95% UI: 1.00 - 1.51) and 1.34 (95% UI: 1.11 - 1.63). Conclusions Our modeling study suggests that exposure to wildfires may elevate opioid misuse through increasing anxiety incidence and severity. This may lead to substantial health burdens that may persist long after the initial wildfire event, which may offset recent gains in opioid misuse prevention.
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Miller-Matero LR, Yaldo M, Chohan S, Zabel C, Patel S, Chrusciel T, Salas J, Wilson L, Sullivan MD, Ahmedani BK, Lustman PJ, Scherrer JF. Factors Associated With Interest in Engaging in Psychological Interventions for Pain Management. Clin J Pain 2024; 40:67-71. [PMID: 37819213 PMCID: PMC10842945 DOI: 10.1097/ajp.0000000000001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE Engagement in evidence-based psychological interventions for pain management is low. Identifying characteristics associated with interest in interventions can inform approaches to increase uptake and engagement. The purpose of this study was to examine factors associated with interest in psychological interventions among persons with chronic noncancer pain receiving prescription opioids. METHODS Participants with chronic noncancer pain and a new 30 to 90 day opioid prescription were recruited from 2 health systems. Participants (N=845) completed measures regarding pain, opioid use, psychiatric symptoms, emotional support, and interest in psychological interventions for pain management. RESULTS There were 245 (29.0%) participants who reported a high interest in psychological interventions for pain management. In bivariate analyses, variables associated with interest included younger age, female sex, greater pain severity, greater pain interference, greater number of pain sites, lower emotional support, depression, anxiety, and post-traumatic stress disorder ( P <0.05). In a multivariate model, greater pain severity (odds ratio [OR]=1.17; CI: 1.04-1.32), depression (OR=2.10; CI: 1.39-3.16), post-traumatic stress disorder (OR=1.85; CI: 1.19-2.95), and lower emotional support (OR=0.69; CI: 0.5-0.97) remained statistically significant. DISCUSSION The rate of interest in psychological interventions for pain management was low, which may indicate that patients initiating opioid treatment of chronic noncancer pain have low interest in psychological interventions. Greater pain severity and psychiatric distress were related to interest, and patients with these characteristics may especially benefit from psychological interventions. Providers may want to refer to psychological interventions before or when opioids are initiated. Additional work is needed to determine whether this would reduce long-term opioid use.
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Affiliation(s)
- Lisa R. Miller-Matero
- Henry Ford Health, Behavioral Health Services
- Henry Ford Health, Center for Health Policy and Health Services Research
| | - Marissa Yaldo
- Henry Ford Health, Center for Health Policy and Health Services Research
| | | | - Celeste Zabel
- Henry Ford Health, Center for Health Policy and Health Services Research
| | | | - Timothy Chrusciel
- Department of Family and Community Medicine, Saint Louis University School of Medicine
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine
| | - Lauren Wilson
- Department of Family and Community Medicine, Saint Louis University School of Medicine
| | - Mark D. Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine
| | - Brian K. Ahmedani
- Henry Ford Health, Behavioral Health Services
- Henry Ford Health, Center for Health Policy and Health Services Research
| | | | - Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine
- Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine
- Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine
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15
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Rim F, Liu SS, Kelly M, Kim D, Sideris A, Langford DJ. Preoperative pain screening and optimisation by a perioperative pain service to support complex surgical patients: no patient left behind. Br J Anaesth 2024; 132:437-439. [PMID: 38087742 DOI: 10.1016/j.bja.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 01/21/2024] Open
Affiliation(s)
- Faye Rim
- Department of Anesthesiology, Critical Care & Pain Management, Pain Prevention Research Center at Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Spencer S Liu
- Department of Anesthesiology, Critical Care & Pain Management, Pain Prevention Research Center at Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Mary Kelly
- Department of Anesthesiology, Critical Care & Pain Management, Pain Prevention Research Center at Hospital for Special Surgery, New York, NY, USA
| | - Dae Kim
- Department of Anesthesiology, Critical Care & Pain Management, Pain Prevention Research Center at Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Alexandra Sideris
- Department of Anesthesiology, Critical Care & Pain Management, Pain Prevention Research Center at Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Dale J Langford
- Department of Anesthesiology, Critical Care & Pain Management, Pain Prevention Research Center at Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Department of Anesthesiology & Perioperative Medicine, University of Rochester, Rochester, NY, USA; Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA.
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16
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Werthman AM, Jolley BD, Rivera A, Rusli MA. Emergency Department Management of Low Back Pain: A Comparative Review of Guidelines and Practices. Cureus 2024; 16:e53712. [PMID: 38455774 PMCID: PMC10919314 DOI: 10.7759/cureus.53712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
This narrative review examines the current best practices and guidelines for integrating pharmacologic interventions, imaging, and physiotherapy in the management of low back pain. The review also explores how patient factors such as age, sex, comorbidities, and prevalent pathologies/diagnoses influence the choice and effectiveness of these treatment approaches.
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Affiliation(s)
- Alec M Werthman
- Internal Medicine, Lakeland Regional Health Medical Center, Lakeland, USA
| | - Brayden D Jolley
- Internal Medicine, Lakeland Regional Health Medical Center, Lakeland, USA
| | - Andrew Rivera
- Internal Medicine, Lakeland Regional Health Medical Center, Lakeland, USA
| | - Melissa A Rusli
- Internal Medicine, Lakeland Regional Health Medical Center, Lakeland, USA
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17
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Silverman B, Shofer F, Bonner K, Hampton S. The Effect of Kyphoplasty on Opioid Use in Patients With Vertebral Compression Fractures. Cureus 2024; 16:e54084. [PMID: 38487151 PMCID: PMC10937115 DOI: 10.7759/cureus.54084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/17/2024] Open
Abstract
Objective The primary objective of this study was to assess opioid use in the 90 days following kyphoplasty (KP) compared to the period between compression fracture and KP. Methods All patients aged 50-85 who underwent KP following a newly diagnosed vertebral compression fracture (VCF) at a large, urban academic medical center between January 1st, 2015, and January 1st, 2023, were screened for inclusion. Patients were excluded if they had an opioid prescription in the month prior to the compression fracture, had a history of malignancy, or underwent concomitant or other surgical procedures in the 90 days following KP. Opioid measures, including the prescribed amount of morphine milliequivalents (MME) per day, number of opioid days, and total MME (MME per day x number of opioid days), in addition to numerical rating scale (NRS) pain scores, were analyzed pre- and post-KP. Results A total of 27 patients met the eligibility criteria, with a mean age of 69.7 and 59.2% being female. Sixteen patients (59%) had received an opioid prescription between compression fracture and KP (opioid group). The median differences pre- and post-KP in prescribed MMEs per day, number of opioid days, and total MMEs were 17.7 (p=.0009), 11.0 (p=.0004), and 232.5 (p<.0001), respectively. There was a significant difference in NRS pain scores in both the opioid group (6.25, p<.0001) and the non-opioid group (4.36, p<.0001) pre- and post-KP. Conclusion Our findings suggest that KP may be associated with a reduction in both opioid use and pain scores in opioid-naïve patients with VCFs. Larger studies that directly compare KP to conservative management are needed to fully assess the impact of KP on opioid and pain outcome measures.
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Affiliation(s)
- Ben Silverman
- Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Frances Shofer
- Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Kirk Bonner
- Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Stephen Hampton
- Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia, USA
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18
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Do J. The Role of Epigenetics and Contributing Impact of Stress, Multigenerational, and Developmental Factors in Opiate Addiction. Cureus 2024; 16:e53788. [PMID: 38465047 PMCID: PMC10923639 DOI: 10.7759/cureus.53788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
Drug addiction is characterized by maladaptive neural plasticity, particularly in vulnerable individuals exposed to drugs of abuse. Epigenetic factors include environmental influences, events during development, and stress adaptations, which seem to play an important role in the neuropathogenesis of drug addiction. This critical review hypothesizes that epigenetic modulation increases an individual's susceptibility to opiate addiction in three key areas of epigenetic study: developmental, stress-related, and transgenerational effects. The widespread use of opioids for clinical and recreational purposes raises significant societal and scientific concerns. Despite the increasing prevalence of opioid abuse, there is limited comprehensive knowledge about the impact of epigenetic factors on opiate addiction manifestation. This review hypothesizes that epigenetic modulation increases susceptibility to opiate addiction, exploring three key areas of epigenetic study: developmental, stress-related, and transgenerational effects. Current literature reveals a correlation between epigenetic influences and vulnerability to drug addiction, specifically in the context of opioid use. Epigenetics, the modulation of genetic expression beyond genotypic predisposition, plays a crucial role in an individual's susceptibility to drug addiction. Studies suggest that epigenetic mechanisms, once considered static in the adult brain, continue to influence synaptic plasticity and long-term memory, particularly in the endogenous opioid system. This review examines the effects of opioids and stress on epigenetic modifications, providing evidence of increased vulnerability to opiate addiction. Animal studies demonstrate how developmental adversities and adolescent exposure to substances can induce persistent epigenetic changes, predisposing individuals to opiate addiction in adulthood. Moreover, the review explores the transgenerational effects of opioid exposure during adolescence, suggesting that functional epigenetic neuroadaptations within the nucleus accumbens can persist for multiple generations. The examination of DNA methylation patterns in opioid addicts reveals potential markers for identifying susceptibility to opiate vulnerability. A critical analysis of research reports supports the hypothesis that developmental, transgenerational, and stress-related epigenetic mechanisms have a profound role in increasing the risk of opioid addiction susceptibility. Each study confirmed that developmental, stress-related, or transgenerational epigenetic regulations have a correlation to increased opiate sensitization and vulnerability. Unfortunately, every study reviewed was unable to elucidate an epigenetic mechanism to explain a specific neuropathogenesis of opiate drug addiction vulnerability, emphasizing our lack of knowledge in the complex pathology of epigenetics.
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Affiliation(s)
- Jason Do
- Physical Medicine and Rehabilitation, State University of New York Downstate Health Sciences University, Brooklyn, USA
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19
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Thorpe S, Orphé P, Pitcher G, McCleod K, Malone N, Stevens-Watkins D. Correlates of Transactional Sex Among Black Men and Women Who Misuse Opioids. Health Educ Behav 2024:10901981231225440. [PMID: 38281101 DOI: 10.1177/10901981231225440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
The rise in opioid misuse coincides with increased sexually transmitted infection (STI) and HIV incidence. Transactional sex is an under-researched phenomenon among Black Americans who misuse opioids, and may increase their risk of STI or HIV transmission. Given the disproportionate impact of the opioid epidemic on Black Americans and the risks associated with opioid misuse, the current study aims to investigate sociostructural factors, history of violence, and sexual risk factors associated with transactional sex among Black men and women. A sample of n = 375 Black adult Kentuckians reporting opioid misuse completed a survey including transactional sex, sociostructural, violence history, and sexual risk measures. Results of chi-squares and independent samples t-tests revealed that compared to men who did not report engaging in transactional sex, men who engaged in transactional sex were less educated, reported being sexually assaulted or having an unwanted sexual experience in their lifetime, and were more likely to use opioids or cocaine before or during sex in the last year. Women who engaged in transactional sex had a history of violence, more structural barriers, higher psychological distress, and engaged in more sexual risk behaviors compared to women who did not engage in transactional sex. Implications for future research and interventions with this population are discussed.
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20
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Antoine D, Chupikova I, Jalodia R, Singh PK, Roy S. Chronic Morphine Treatment and Antiretroviral Therapy Exacerbate HIV-Distal Sensory Peripheral Neuropathy and Induce Distinct Microbial Alterations in the HIV Tg26 Mouse Model. Int J Mol Sci 2024; 25:1569. [PMID: 38338849 PMCID: PMC10855564 DOI: 10.3390/ijms25031569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/12/2024] Open
Abstract
Distal Sensory Peripheral Neuropathy (DSP) is a common complication in HIV-infected individuals, leading to chronic pain and reduced quality of life. Even with antiretroviral therapy (ART), DSP persists, often prompting the use of opioid analgesics, which can paradoxically worsen symptoms through opioid-induced microbial dysbiosis. This study employs the HIV Tg26 mouse model to investigate HIV-DSP development and assess gut microbiome changes in response to chronic morphine treatment and ART using 16S rRNA sequencing. Our results reveal that chronic morphine and ART exacerbate HIV-DSP in Tg26 mice, primarily through mechanical pain pathways. As the gut microbiome may be involved in chronic pain persistence, microbiome analysis indicated distinct bacterial community changes between WT and Tg26 mice as well as morphine- and ART-induced microbial changes in the Tg26 mice. This study reveals the Tg26 mouse model to be a relevant system that can help elucidate the pathogenic mechanisms of the opioid- and ART-induced exacerbation of HIV-associated pain. Our results shed light on the intricate interplay between HIV infection, ART, opioid use, and the gut microbiome in chronic pain development. They hold implications for understanding the mechanisms underlying HIV-associated pain and microbial dysbiosis, with potential for future research focused on prevention and treatment strategies.
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Affiliation(s)
- Danielle Antoine
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Department of Neuroscience, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Irina Chupikova
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Richa Jalodia
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Praveen Kumar Singh
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Sabita Roy
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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Radhakrishna U, Sadhasivam S, Radhakrishnan R, Forray A, Muvvala SB, Metpally RP, Patel S, Rawal RM, Vishweswaraiah S, Bahado-Singh RO, Nath SK. Placental cytochrome P450 methylomes in infants exposed to prenatal opioids: exploring the effects of neonatal opioid withdrawal syndrome on health horizons. Front Genet 2024; 14:1292148. [PMID: 38264209 PMCID: PMC10805101 DOI: 10.3389/fgene.2023.1292148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/24/2023] [Indexed: 01/25/2024] Open
Abstract
Background: Neonatal opioid withdrawal syndrome (NOWS), arises due to increased opioid use during pregnancy. Cytochrome P450 (CYP) enzymes play a pivotal role in metabolizing a wide range of substances in the human body, including opioids, other drugs, toxins, and endogenous compounds. The association between CYP gene methylation and opioid effects is unexplored and it could offer promising insights. Objective: To investigate the impact of prenatal opioid exposure on disrupted CYPs in infants and their anticipated long-term clinical implications. Study Design: DNA methylation levels of CYP genes were analyzed in a cohort of 96 placental tissues using Illumina Infinium MethylationEPIC (850 k) BeadChips. This involved three groups of placental tissues: 32 from mothers with infants exposed to opioids prenatally requiring pharmacologic treatment for NOWS, 32 from mothers with prenatally opioid-exposed infants not needing NOWS treatment, and 32 from unexposed control mothers. Results: The study identified 20 significantly differentially methylated CpG sites associated with 17 distinct CYP genes, with 14 CpGs showing reduced methylation across 14 genes (CYP19A1, CYP1A2, CYP4V2, CYP1B1, CYP24A1, CYP26B1, CYP26C1, CYP2C18, CYP2C9, CYP2U1, CYP39A1, CYP2R1, CYP4Z1, CYP2D7P1 and), while 8 exhibited hypermethylation (CYP51A1, CYP26B1, CYP2R1, CYP2U1, CYP4X1, CYP1A2, CYP2W1, and CYP4V2). Genes such as CYP1A2, CYP26B1, CYP2R1, CYP2U1, and CYP4V2 exhibited both increased and decreased methylation. These genes are crucial for metabolizing eicosanoids, fatty acids, drugs, and diverse substances. Conclusion: The study identified profound methylation changes in multiple CYP genes in the placental tissues relevant to NOWS. This suggests that disruption of DNA methylation patterns in CYP transcripts might play a role in NOWS and may serve as valuable biomarkers, suggesting a future pathway for personalized treatment. Further research is needed to confirm these findings and explore their potential for diagnosis and treatment.
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Affiliation(s)
- Uppala Radhakrishna
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Obstetrics and Gynecology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States
| | - Senthilkumar Sadhasivam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rupa Radhakrishnan
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Srinivas B. Muvvala
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Raghu P. Metpally
- Department of Molecular and Functional Genomics, Geisinger, Danville, PA, United States
| | - Saumya Patel
- Department of Botany, Bioinformatics and Climate Change Impacts Management, School of Science, Gujarat University, Ahmedabad, India
| | - Rakesh M. Rawal
- Department of Life Sciences, School of Sciences, Gujarat University, Ahmedabad, India
| | - Sangeetha Vishweswaraiah
- Department of Obstetrics and Gynecology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States
| | - Ray O. Bahado-Singh
- Department of Obstetrics and Gynecology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States
| | - Swapan K. Nath
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, United States
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Osterhage KP, Hser YI, Mooney LJ, Sherman S, Saxon AJ, Ledgerwood M, Holtzer CC, Gehring MA, Clingan SE, Curtis ME, Baldwin LM. Identifying patients with opioid use disorder using International Classification of Diseases (ICD) codes: Challenges and opportunities. Addiction 2024; 119:160-168. [PMID: 37715369 PMCID: PMC10846664 DOI: 10.1111/add.16338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/27/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND AND AIMS International Classification of Diseases (ICD) diagnosis codes are often used in research to identify patients with opioid use disorder (OUD), but their accuracy for this purpose is not fully evaluated. This study describes application of ICD-10 diagnosis codes for opioid use, dependence and abuse from an electronic health record (EHR) data extraction using data from the clinics' OUD patient registries and clinician/staff EHR entries. DESIGN Cross-sectional observational study. SETTING Four rural primary care clinics in Washington and Idaho, USA. PARTICIPANTS 307 patients. MEASUREMENTS This study used three data sources from each clinic: (1) a limited dataset extracted from the EHR, (2) a clinic-based registry of patients with OUD and (3) the clinician/staff interface of the EHR (e.g. progress notes, problem list). Data source one included records with six commonly applied ICD-10 codes for opioid use, dependence and abuse: F11.10 (opioid abuse, uncomplicated), F11.20 (opioid dependence, uncomplicated), F11.21 (opioid dependence, in remission), F11.23 (opioid dependence with withdrawal), F11.90 (opioid use, unspecified, uncomplicated) and F11.99 (opioid use, unspecified with unspecified opioid-induced disorder). Care coordinators used data sources two and three to categorize each patient identified in data source one: (1) confirmed OUD diagnosis, (2) may have OUD but no confirmed OUD diagnosis, (3) chronic pain with no evidence of OUD and (4) no evidence for OUD or chronic pain. FINDINGS F11.10, F11.21 and F11.99 were applied most frequently to patients who had clinical diagnoses of OUD (64%, 89% and 79%, respectively). F11.20, F11.23 and F11.90 were applied to patients who had a diagnostic mix of OUD and chronic pain without OUD. The four clinics applied codes inconsistently. CONCLUSIONS Lack of uniform application of ICD diagnosis codes make it challenging to use diagnosis code data from EHR to identify a research population of persons with opioid use disorder.
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Affiliation(s)
- Katie P Osterhage
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Yih-Ing Hser
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Larissa J Mooney
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Andrew J Saxon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
- Center of Excellence in Substance Addiction Treatment and Education, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Maja Ledgerwood
- Rural Social Service Solutions, LLC, New Meadows, Idaho, USA
| | - Caleb C Holtzer
- Providence Northeast Washington Medical Group, Colville, Washington, USA
| | | | - Sarah E Clingan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
| | - Megan E Curtis
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA
- Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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23
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Campbell AG, Naz S, Gharbi S, Chambers J, Denne S, Litzelman DK, Wiehe SE. The Concordance of Electronic Health Record Diagnoses and Substance use Self-Reports Among Reproductive Aged Women Enrolled in a Community-Based Addiction Reduction Program. Inquiry 2024; 61:469580241237051. [PMID: 38528783 DOI: 10.1177/00469580241237051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Substance use disorders among reproductive aged women are a major public health issue. There is little work investigating the validity and reliability of electronic health record (EHR) data for measuring substance use in this population. This study examined the concordance of self-reported substance use with clinical diagnoses of substance use, substance abuse and substance use disorder in EHR data. Reproductive age women enrolled in the Community-Based Addiction Reduction (CARE) program were interviewed by peer recovery coaches (PRC) at enrollment. That survey data was linked with EHR data (n = 102). Concordance between self-reported substance use and clinical diagnoses in the EHR was examined for opioids, cannabis/THC, and cocaine. Cohen's kappa, sensitivity, and specificity were calculated. The survey captured a higher number of women who use substances compared to the EHR. The concordance of self-report with EHR diagnosis varied by substance and was higher for opioids (17.6%) relative to cannabis/THC (8.8%), and cocaine (3.0%). Additionally, opioids had higher sensitivity (46.2%) and lower specificity (76.2%) relative to cannabis/THC and cocaine. Survey data collected by PRCs captured more substance use than EHRs, suggesting that EHRs underestimate substance use prevalence. The higher sensitivity and lower specificity of opioids was due to a larger number of women who had a diagnosis of opioid use in the EHR who did not self-report opioid use in the self-report survey relative to cannabis/THC and cocaine. Opioid self-report and diagnosis may be influenced by research setting, question wording, or receipt of medication for opioid use disorder.
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Affiliation(s)
| | - Saman Naz
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sami Gharbi
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joanna Chambers
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Clinical Translational Sciences Institute, Indianapolis, IN, USA
| | - Scott Denne
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Clinical Translational Sciences Institute, Indianapolis, IN, USA
| | - Debra K Litzelman
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Clinical Translational Sciences Institute, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Sarah E Wiehe
- Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana Clinical Translational Sciences Institute, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
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24
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Driscoll Powers L, Cook PF, Weber M, Techau A, Sorrell T. Comorbidity of Lifetime History of Abuse and Trauma With Opioid Use Disorder: Implications for Nursing Assessment and Care. J Am Psychiatr Nurses Assoc 2024; 30:149-159. [PMID: 35403485 DOI: 10.1177/10783903221083260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Opioid use disorder (OUD) is a public health crisis and is challenging to treat. Previous research has shown correlations between OUD, abuse/trauma, and chronic pain. AIMS The purpose of this study was to investigate history of lifetime sexual, physical, and/or emotional abuse among participants in a medication-assisted treatment (MAT) program for OUD, and to investigate associations between abuse history and chronic pain. METHODS This is a secondary analysis of intake data from a 2-year, nonexperimental cohort treatment program of patients with OUD in rural Colorado. De-identified data were provided by 476 adult MAT patients using the Adult Addiction Severity Index (ASI-6). The ASI-6 includes three yes/no questions about history of abuse (emotional, physical, and sexual), with separate scoring for "past 30 days" and "lifetime" abuse. RESULTS Lifetime history among MAT program for OUD patients was 23% for sexual abuse, 43% for physical abuse, and 58% for emotional abuse. History of physical abuse was significantly associated with having a chronic pain diagnosis, χ2 = 4.49, p = .03, and also with higher reported pain levels, t(460) = 2.71, p = .007. CONCLUSION Lifetime history of physical abuse was associated with OUD and chronic pain, yet standard pain assessments do not assess these factors. In health care settings, the implementation of standardized trauma-informed screening tools, prompt recognition of abuse/trauma history, and adjunct psychological interventions may reduce stigma, reduce opioid use escalation, and help patients overcome OUD.
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Affiliation(s)
| | - Paul F Cook
- Paul F. Cook, PhD, University of Colorado, Aurora, CO, USA
| | - Mary Weber
- Mary Weber, PhD, PMHNP-BC, FAANP, FAAN, University of Colorado, Aurora, CO, USA
| | - Aimee Techau
- Aimee Techau, MSN, PMHNP-BC, University of Colorado, Aurora, CO, USA
| | - Tanya Sorrell
- Tanya Sorrell, PhD, PMHNP-BC, Rush University, Chicago, IL, USA
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25
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Moon AS, LeRoy TE, Yacoubian V, Gedman M, Aidlen JP, Rogerson A. Cannabis Use Is Associated With Increased Use of Prescription Opioids Following Posterior Lumbar Spinal Fusion Surgery. Global Spine J 2024; 14:204-210. [PMID: 35536563 PMCID: PMC10676165 DOI: 10.1177/21925682221099857] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective review. OBJECTIVES Cannabis is an antinociceptive which has been evaluated as a possible adjunct or substitute for opioid use in the treatment of acute pain. The aim of this study was to evaluate the association between preoperative cannabis usage and consumption of opioids for postoperative analgesia. METHODS Patients who underwent one- or two-level posterior lumbar fusion surgery were categorized as cannabis users or non-cannabis users based on preoperative diagnoses of cannabis use. Total morphine equivalent dose was calculated for both in-house opioid consumption and postoperative prescription opioid usage. Age, ASA, BMI, depression, tobacco use, estimated blood loss, OR time, LOS, disposition to rehab, 30-day readmission, in-house opioid consumption and postoperative prescription opioid usage were compared between groups using t-tests. RESULTS Of the 220 opioid naïve patients, 29 (13%) patients were identified as cannabis users while 191 (87%) were non-cannabis users. There were no significant associations between opioid naïve cannabis usage and ASA, BMI, tobacco use, EBL, OR time, LOS, disposition to rehab, or readmission. Opioid naïve cannabis users had greater association with depression (31.3% vs 13.7%, P=.017) and younger age (56.37 years vs 65.37 years, P<.001). Interestingly, cannabis use was associated with a lower Charlson Comorbidity Index (CCI), with 1.38 vs 2.49 (P=.002). Cannabis users were found to have increased postoperative prescription opioid usage (2545.41 POST-MED vs 1379.72 POST-MED, P=.019). CONCLUSIONS Cannabis usage is associated with increased usage of opioids postoperatively, both while in-patient and post-discharge, after posterior lumbar spinal fusion surgery.
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Affiliation(s)
- Andrew S. Moon
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
| | - Taryn E. LeRoy
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
| | | | | | - Jessica P. Aidlen
- Department of Orthopaedic Surgery, Newton Wellesley Hospital, Newton, MA, USA
| | - Ashley Rogerson
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA
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26
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Nichols M, Kesaria A, Spencer HJ, Williams HR, Samanta S, Lewis GD. Opioid Use in Patients With Cervical Cancer at a Tertiary Academic Medical Center. Anticancer Res 2024; 44:151-155. [PMID: 38160002 DOI: 10.21873/anticanres.16797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND/AIM Opioids are a common treatment for cancer-related pain and information is limited on the rates of opioid use for cervical cancer patients. This study aimed to analyze outpatient opioid use and various predictors among patients with cervical cancer at a tertiary academic medical center. PATIENTS AND METHODS Data from patients with cervical cancer receiving treatment at a single institution, from August 2019 to July 2022, were retrospectively collected. Women with unrelated chronic opioid use or opioid use associated with acute inpatient stays were excluded. Charts were reviewed for patient demographics, disease characteristics, treatment characteristics, disease outcomes, and opioid prescriptions. The primary endpoint was duration of opioid use ≥6 months. Pearson's chi-squared testing, Welch's two-sample t-testing and Fisher's exact testing were used to determine predictors of opioid use ≥6 months. RESULTS In total, 108 patients with cervical cancer (76.1%) of the 142 that received treatment were prescribed opioids. In women who were prescribed outpatient opioids, the median duration of opioid use was 69 days (interquartile range=5-359 days). In total, 40 (37.0%) had prescriptions for ≥180 days and 27 (25.0%) had prescriptions ≥365 days. On bivariate analysis, lower stage and receipt of surgery were associated with opioid use duration <6 months. Age, race, histology, substance/tobacco/alcohol use, depression/anxiety, and the receipt of brachytherapy/radiation were not associated with length of opioid prescriptions. CONCLUSION This study demonstrated that 37% of patients with cervical cancer were using opioids for cancer-related pain longer than 6 months. Higher stage was associated with opioid use duration ≥6 months.
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Affiliation(s)
- Madison Nichols
- Department of Radiation Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A
| | - Anam Kesaria
- Department of Radiation Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A
| | - Horace J Spencer
- Department of Biostatistics, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A
| | - Heather R Williams
- Division of Gynecologic Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A
| | - Santanu Samanta
- Department of Radiation Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A
| | - Gary D Lewis
- Department of Radiation Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, U.S.A.
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Kraimer K, Scott B, Farrell N, Geltzeiler M, Smith T, Detwiller K. Postoperative Pain Following Coblation of Sinonasal Hereditary Hemorrhagic Telangiectasias. Ann Otol Rhinol Laryngol 2024; 133:58-62. [PMID: 37377016 DOI: 10.1177/00034894231182212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND Hereditary hemorrhagic telangiectasia (HHT) is a rare, autosomal dominant disease and epistaxis is the most common symptom. This can be treated conservatively but severe cases may require operative interventions. Endoscopic endonasal coblation of HHT lesions has been used successfully but postoperative pain management has not been well described. OBJECTIVES This study aimed to assess levels of postoperative pain and opioid use among patients with HHT who underwent coblation of sinonasal lesions. METHODS This is a longitudinal, prospective cohort study of adult patients undergoing endoscopic endonasal coblation for treatment of HHT lesions with or without bevacizumab injection between November 2019 and March 2020 at a single academic university hospital. Patients were given preoperative questionnaires and contacted via telephone 48 hours after surgery. If they reported using opioids for pain control, they were called every 2 days until they no longer used these medications. RESULTS Fourteen cases, including 13 unique patients, were included in this study. Opioids were ordered on discharge in 4 cases and the average morphine milligram equivalent prescribed on discharge was 41. The median pain score on postoperative day (POD) 2 was 4 of 10. Twelve patients reported using acetaminophen and 4 were using opioid pain medications. Of those using opioid pain medications, only 1 patient was using opioid pain medication by POD 4 and denied any use after POD 10. CONCLUSION This study is the first to analyze postoperative pain management and opioid prescribing patterns in HHT patients undergoing endonasal coblation of telangiectasias. Postoperative pain was mild to moderate and most patients stopped using opioid medications by POD 4, although the majority of patients solely used acetaminophen. Future studies with increased sample size will be useful to further identify predictors of need for analgesics postoperatively and other non-opioid adjuncts for pain control.
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Affiliation(s)
- Kristen Kraimer
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Brian Scott
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Nyssa Farrell
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St Louis, MI, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Timothy Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Kara Detwiller
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
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28
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Guilcher SJT, Cimino SR, Tadrous M, McCarthy LM, Riad J, Tricco AC, Hagens S, Lien J, Tharmalingam S, Gomes T. Experiences and Outcomes of Using e-Prescribing for Opioids: Rapid Scoping Review. J Med Internet Res 2023; 25:e49173. [PMID: 38153776 PMCID: PMC10784986 DOI: 10.2196/49173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/31/2023] [Accepted: 11/01/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND e-Prescribing is designed to assist in facilitating safe and appropriate prescriptions for patients. Currently, it is unknown to what extent e-prescribing for opioids influences experiences and outcomes. To address this gap, a rapid scoping review was conducted. OBJECTIVE This rapid scoping review aims to (1) explore how e-prescribing has been used clinically; (2) examine the effects of e-prescribing on clinical outcomes, the patient or clinician experience, service delivery, and policy; and (3) identify current gaps in the present literature to inform future studies and recommendations. METHODS A rapid scoping review was conducted following the guidance of the JBI 2020 scoping review methodology and the World Health Organization guide to rapid reviews. A comprehensive literature search was completed by an expert librarian from inception until November 16, 2022. Three databases were electronically searched: MEDLINE (Ovid), Embase (Ovid), and Scopus (Elsevier). The search criteria were as follows: (1) e-prescribing programs targeted to the use or misuse of opioids, including those that were complemented or accompanied by clinically focused initiatives, and (2) a primary research study of experimental, quasi-experimental, observational, qualitative, or mixed methods design. An additional criterion of an ambulatory component of e-prescribing (eg, e-prescribing occurred upon discharge from acute care) was added at the full-text stage. No language limitations or filters were applied. All articles were double screened by trained reviewers. Gray literature was manually searched by a single reviewer. Data were synthesized using a descriptive approach. RESULTS Upon completing screening, 34 articles met the inclusion criteria: 32 (94%) peer-reviewed studies and 2 (6%) gray literature documents (1 thesis study and 1 report). All 33 studies had a quantitative component, with most highlighting e-prescribing from acute care settings to community settings (n=12, 36%). Only 1 (3%) of the 34 articles provided evidence on e-prescribing in a primary care setting. Minimal prescriber, pharmacist, and clinical population characteristics were reported. The main outcomes identified were related to opioid prescribing rates, alerts (eg, adverse drug events and drug-drug interactions), the quantity and duration of opioid prescriptions, the adoption of e-prescribing technology, attitudes toward e-prescribing, and potential challenges with the implementation of e-prescribing into clinical practice. e-Prescribing, including key features such as alerts and dose order sets, may reduce prescribing errors. CONCLUSIONS This rapid scoping review highlights initial promising results with e-prescribing and opioid therapy management. It is important that future work explores the experience of prescribers, pharmacists, and patients using e-prescribing for opioid therapy management with an emphasis on prescribers in the community and primary care. Developing a common set of quality indicators for e-prescribing of opioids will help build a stronger evidence base. Understanding implementation considerations will be of importance as the technology is integrated into clinical practice and health systems.
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Affiliation(s)
- Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie R Cimino
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Lisa M McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Jessica Riad
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Andrea C Tricco
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health, Toronto, ON, Canada
| | | | | | | | - Tara Gomes
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health, Toronto, ON, Canada
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29
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Driesman AS, Montgomery WC, Kleeman-Forsthuber LT, Johnson RM, Dennis DA, Jennings JM. Perioperative Sleep Quality Disturbances in Total Joint Arthroplasty is Multifactorial. J Arthroplasty 2023:S0883-5403(23)01201-9. [PMID: 38072098 DOI: 10.1016/j.arth.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Sleep quality following arthroplasty procedures is important for patient recovery and satisfaction, but remains poorly understood. The purpose of this study was to report risk factors for sleep disturbances in the perioperative period in patients undergoing primary total joint arthroplasty procedures. METHODS Sleep surveys were prospectively collected on 751 consecutive patients undergoing total joint arthroplasty at our institution between June 2019 and February 2021 at their preoperative and postoperative visits (2 and 6 weeks). Data were collected on patient demographics, opioid use (preoperatively and postoperatively) as well as tobacco and alcohol use, and specific medical diagnosis that may influence sleep patterns (ie, depression). Statistical analyses were performed using the Student's t-tests and 1-way analysis of variances. RESULTS For both total hip and total knee patients, worse sleep patterns preoperatively were found in patients who used opioids prior to surgery (P < .001), were current smokers (P < .001), and were aged less than 65 years (P < .001). Postoperative persistent opioid use (more than 3 months) was seen in patients who had worse reported sleep quality preoperatively (P < .001). In comparison to total hip arthroplasty, patients who underwent total knee arthroplasty were more likely to report less sleep in the postoperative period. Patients who were current smokers (compared to nonsmokers or previous smokers) (P = .014) had worse sleep quality at all time points that persisted at 6 weeks, although these differences were seen more in total hip patients than in total knee patients (P = .006 versus P = .059). CONCLUSIONS Sleep quality disturbances around the time of surgery appear to be multifactorial. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
| | | | | | | | - Douglas A Dennis
- Colorado Joint Replacement, Denver, Colorado; Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado; Department of Orthopaedics, University of Colorado School of Medicine, Aurora, Colorado; Department of Biomedical Engineering, University of Tennessee, Knoxville, Tennessee
| | - Jason M Jennings
- Colorado Joint Replacement, Denver, Colorado; Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado
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Yang Y, Pan Z, Kang J, Brummett C, Li Y. Simultaneous selection and inference for varying coefficients with zero regions: a soft-thresholding approach. Biometrics 2023; 79:3388-3401. [PMID: 37459178 PMCID: PMC10792111 DOI: 10.1111/biom.13900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/05/2023] [Indexed: 08/02/2023]
Abstract
Varying coefficient models have been used to explore dynamic effects in many scientific areas, such as in medicine, finance, and epidemiology. As most existing models ignore the existence of zero regions, we propose a new soft-thresholded varying coefficient model, where the coefficient functions are piecewise smooth with zero regions. Our new modeling approach enables us to perform variable selection, detect the zero regions of selected variables, obtain point estimates of the varying coefficients with zero regions, and construct a new type of sparse confidence intervals that accommodate zero regions. We prove the asymptotic properties of the estimator, based on which we draw statistical inference. Our simulation study reveals that the proposed sparse confidence intervals achieve the desired coverage probability. We apply the proposed method to analyze a large-scale preoperative opioid study.
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Affiliation(s)
| | - Ziyang Pan
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, U.S.A
| | - Jian Kang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, U.S.A
| | - Chad Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, U.S.A
| | - Yi Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, U.S.A
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Okano H, Kataoka Y, Sakuraya M, Aoki Y, Okamoto H, Imai E, Yamazaki T. Efficacy of Remifentanil in Patients Undergoing Cardiac Surgery: A Systematic Review and Network Meta-Analysis. Cureus 2023; 15:e51278. [PMID: 38161541 PMCID: PMC10756075 DOI: 10.7759/cureus.51278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/03/2024] Open
Abstract
Remifentanil, characterized by its ultra-short action duration and nonorgan-dependent metabolism, is applied in postcardiac surgery settings worldwide. While previous studies have compared its efficacy with that of other opioids, it has never been compared to a single specific opioid. Here, we evaluated whether remifentanil shortens mechanical ventilation (MV) times in patients after cardiac surgery. We identified randomized controlled trials that compared various opioids in adults (≥18 years) admitted to the intensive care unit after cardiac surgery. The primary outcome was the duration of MV, expressed as the mean difference (MD) in minutes, with a 95% confidence interval (CI). A 60-min reduction was considered significant based on prior research. Data were sourced from MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, the World Health Organization International Clinical Trials Platforms Search Portal, and ClinicalTrials.gov, and a frequentist network meta-analysis was conducted. The eight identified studies indicate no differences in the duration of MV between remifentanil and fentanyl (MD 0.09 min; 95%CI -36.89-37.08), morphine (MD -19 min; 95%CI -55.86-16.21), or sufentanil (MD -2.44 min; 95%CI -67.52-62.55). Our study revealed that remifentanil did not reduce MV times in patients after cardiac surgery. The study protocol was registered with the Open Science Forum (https://osf.io/) (DOI 10.17605/OSF.IO/YAHW2).
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Affiliation(s)
- Hiromu Okano
- Department of Critical Care Medicine, St. Luke's International Hospital, Tokyo, JPN
- Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, Tokyo, JPN
| | - Yuki Kataoka
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, JPN
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, JPN
- Department of Systematic Reviewers, Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, JPN
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, JPN
| | - Masaaki Sakuraya
- Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hiroshima, JPN
| | - Yoshitaka Aoki
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Hiroshi Okamoto
- Department of Critical Care Medicine, St. Luke's International Hospital, Tokyo, JPN
| | - Eriya Imai
- Division of Anesthesiology, Mitsui Memorial Hospital, Tokyo, JPN
| | - Tsutomu Yamazaki
- Department of Social Medical Sciences, Graduate School of Medicine, International University of Health and Welfare, Tokyo, JPN
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Leopold T, Gerschutz M, Rao S. Trends of Opioid Usage in Surgical Patients in a Small Community Hospital: Analysis of Patient Data Between 2017 and 2021. Hosp Pharm 2023; 58:614-620. [PMID: 38560545 PMCID: PMC10977068 DOI: 10.1177/00185787231172389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Purpose: The purpose of our study was to quantify and analyze the annual opioid usage in surgical patients at Wood County Hospital (WCH) between 2017 and 2021. Methods: In this retrospective study, patient data between 2017 and 2021 was analyzed to determine the oral morphine milligram equivalent (MME) of opioids used in surgical patients at WCH. Annual MME prescribed per admission was compared each year using one-way ANOVA followed by Tukey post hoc test. Similarly, the annual use of intravenous (IV) acetaminophen for surgical patients per admission was also calculated and analyzed using the one-way ANOVA followed by Tukey post hoc test. Results: Compared to the year 2017 (42.0 ± 3.6), a statistically significant decrease in opioid usage per surgical admission (mean±SEM of MME) was observed during the years 2018 (32.6 ± 1.4; P = .04), 2019 (30.4 ± 1.2; P = .01), and 2021 (30.8 ± 1.9; P = .01). An analysis of individual opioid use revealed a trend toward lower fentanyl and hydromorphone usage each year since 2017. A significant decrease in the annual morphine usage (mean±SEM of MME) for surgical patients was observed during both 2020 (14.4 ± 0.9; P = .05) and 2021 (14.0 ± 0.7; P = .05) compared to the year 2017 (22.1 ± 2.4). Finally, compared to the year 2017, a statistically significant decrease (P < .05) in the annual use of oxycodone (MME) and IV acetaminophen (mg) for pain management in surgical patients was observed from 2018 to 2021. Conclusion: Our analysis reveals a significant decrease in opioid usage per surgical admission at WCH over 2017 to 2021 indicating a positive impact of the various opioid stewardship measures implemented at the hospital.
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Affiliation(s)
| | | | - Shantanu Rao
- Wood County Hospital, Bowling Green, OH, USA
- The University of Findlay, Findlay, OH, USA
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de Dios C, Suchting R, Green C, Klugh JM, Harvin JA, Webber HE, Schmitz JM, Lane SD, Yoon JH, Heads A, Motley K, Stotts A. An opioid-minimizing multimodal pain regimen reduces opioid exposure and pain in trauma-injured patients at high risk for opioid misuse: Secondary analysis from the mast trial. Surgery 2023; 174:1463-1470. [PMID: 37839970 PMCID: PMC10836717 DOI: 10.1016/j.surg.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/06/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Screening to identify patients at risk for opioid misuse after trauma is recommended but not commonly used to guide perioperative opioid management interventions. The Multimodal Analgesic Strategies for Trauma trial demonstrated that an opioid-minimizing multimodal pain regimen reduced opioid exposure in a heterogeneous trauma patient population. Here, we assess the efficacy of the Multimodal Analgesic Strategies for Trauma multimodal pain regimen in a critical patient subgroup who screened at high risk for opioid misuse. METHODS The Multimodal Analgesic Strategies for Trauma trial compared an opioid-minimizing multimodal pain regimen (oral acetaminophen, naproxen, gabapentin, lidocaine patch, as-needed opioid) against an original multimodal pain regimen (intravenous followed by oral acetaminophen, 48-hour celecoxib and pregabalin, followed by naproxen and gabapentin, scheduled tramadol, as-needed opioid), in a randomized trial conducted from April 2018 to March 2019. A total of 631 enrolled patients were classified either as low- or high-risk via the Opioid Risk Tool. Bayesian analyses evaluated the moderating influence of Opioid Risk Tool risk (high/low) on the effect of Multimodal Analgesic Strategies for Trauma multimodal pain regimen (versus original) on opioid exposure (morphine milligram equivalents/day), opioids prescribed at discharge, and pain scores. RESULTS Multimodal Analgesic Strategies for Trauma multimodal pain regimen effectively reduced morphine milligram equivalents/day in low- and high-Opioid Risk Tool risk groups. Moderation was observed for opioids at discharge and pain scores; Multimodal Analgesic Strategies for Trauma multimodal pain regimen was effective in the high-risk group only (opioids at discharge: 63% vs 77%, relative risk = 0.86, 95% Bayesian credible interval [0.66-1.08], posterior probability (relative risk <1) = 90%; pain scores: b = 3.8, 95% Bayesian credible interval [3.2-4.4] vs b = 4.0, 95% Bayesian credible interval [3.4-4.6], posterior probability (b <0) = 87%). CONCLUSION This study is the first to show the moderating influence of opioid misuse risk on the effectiveness of an opioid-minimizing multimodal pain regimen. The Opioid Risk Tool was useful in identifying high-risk patients for whom the Multimodal Analgesic Strategies for Trauma multimodal pain regimen is recommended for perioperative pain management.
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Affiliation(s)
- Constanza de Dios
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, TX.
| | - Robert Suchting
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, TX
| | - Charles Green
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, TX; Department of Pediatrics, Center for Clinical Research and Evidence-Based Medicine, UTHealth McGovern Medical School, University of Texas Health Science Center at Houston, TX
| | - James M Klugh
- Center for Translational Injury Research, Department of Surgery, University of Texas Health Science Center at Houston, TX
| | - John A Harvin
- Center for Translational Injury Research, Department of Surgery, University of Texas Health Science Center at Houston, TX
| | - Heather E Webber
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, TX
| | - Joy M Schmitz
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, TX
| | - Scott D Lane
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, TX
| | - Jin H Yoon
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, TX
| | - Angela Heads
- Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, TX
| | - Kandice Motley
- Center for Translational Injury Research, Department of Surgery, University of Texas Health Science Center at Houston, TX
| | - Angela Stotts
- Department of Family and Community Medicine, UTHealth McGovern Medical School, University of Texas Health Science Center at Houston, TX
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Abed V, Lemaster NG, Hawk GS, Thompson KL, Conley CEW, Mair SD, Jacobs CA. Patients With Depression and/or Anxiety Having Arthroscopic Rotator Cuff Repair Show Decreased Number of Prescriptions and Number of Psychotherapy Sessions in the Year After Surgery. Arthroscopy 2023; 39:2438-2442.e9. [PMID: 37355188 PMCID: PMC10741251 DOI: 10.1016/j.arthro.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To determine whether the utilization of psychological treatments changes after arthroscopic rotator cuff repair (RCR) for patients with preoperative depression and/or anxiety. METHODS The Truven Healthcare Marketscan database was used to identify patients who underwent arthroscopic RCR between January 2009 and December 2016. We included all patients with diagnosis codes associated with either depression or anxiety before RCR. Patients were excluded if they did not have complete insurance coverage for 1 year before or after surgery, or if they had arthroscopic RCR in the year before the index surgical procedure. We compared the proportion of patients with preoperative depression or anxiety who filled a prescription and had psychotherapy procedural codes in the year before and the year after arthroscopic RCR. RESULTS A total of 170,406 patients who underwent RCR were identified, of which depression and/or anxiety was found in 46,737 patients (43.7% male). Of the 46,737 patients, 19.6% filled a prescription for a depression/anxiety medication at least once in the year before surgery. Of this subset of patients, 41.5% did not fill a prescription for depression or anxiety medication after surgery, whereas 32.6% continued medication use but demonstrated a median 30-day reduction in the number of days' worth of medication. Similarly, 13.1% of patients were attending psychotherapy sessions preoperatively, but 76.6% of those patients either stopped or reduced the amount of psychotherapy sessions in the year following RCR. CONCLUSIONS The number of prescriptions and psychotherapy sessions decreased in the year after RCR for patients with preoperative diagnoses of depression and/or anxiety. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Varag Abed
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Nicole G Lemaster
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Gregory S Hawk
- Department of Statistics, University of Kentucky, Lexington, Kentucky, U.S.A
| | | | - Caitlin E W Conley
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Scott D Mair
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Cale A Jacobs
- Mass General Brigham Sports Medicine, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A..
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Regmi S, Kedia SK, Ahuja NA, Lee G, Entwistle C, Dillon PJ. Association Between Adverse Childhood Experiences and Opioid Use-Related Behaviors: A Systematic Review. Trauma Violence Abuse 2023:15248380231205821. [PMID: 37920999 DOI: 10.1177/15248380231205821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
As opioid use-related behaviors continue at epidemic proportions, identifying the root causes of these behaviors is critical. Adverse childhood experiences (ACEs) are shown to be an important predictor of opioid initiation, opioid dependence, and lifetime opioid overdose. The purpose of this systematic review is to examine the association between ACEs and opioid use-related behaviors later in life and to discuss implications for policy, practice, and research regarding ACEs and opioids. Five databases (PubMed, PsycINFO, CINAHL, Medline, and Scopus) were used to identify studies investigating the association between ACEs and opioid use-related behaviors. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 20 studies out of the initial 428 met the inclusion criteria for this review. Among the included 20 studies, 15 focused on the relationship between ACEs and lifetime opioid use-related behaviors, and five focused on current opioid use-related behaviors. All studies found statistical associations between ACEs and lifetime or current opioid use-related behaviors. Five studies found a significant gradient effect; that is, as the number of ACEs increased, the risk of opioid use-related behaviors also increased. A significant dose-response relationship exists between ACEs and opioid use-related behaviors. Hence, it is essential for clinicians to screen for ACEs before prescribing opioid medications, for opioid treatment to incorporate trauma-informed methods, and for messaging around opioid use interventions to include information about ACEs. The current review points to a critical need to implement standardized ACE screening instruments in clinical and research settings.
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Hayaki J, Cinq-Mars H, Christopher PP, Anderson BJ, Stewart C, Stein MD. Gender Differences in Civil Commitment Hearing Experience for Persons Who Use Opioids. J Addict Med 2023; 17:e355-e360. [PMID: 37934523 PMCID: PMC10759199 DOI: 10.1097/adm.0000000000001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
OBJECTIVES Civil commitment has increasingly served as a court-based legal intervention for severe opioid use, but little research has examined the civil commitment (CC) hearing process from the perspective of the person who is committed. Despite documented gender differences in opioid use and experiences within the legal system, past research has also not investigated gender differences in perceptions of the CC process for persons who use opioids. METHODS Participants were 121 persons (43% female) with opioid use who were interviewed upon arrival at the CC facility about their experience of the CC hearing process in Massachusetts. RESULTS Two thirds of participants were taken to the commitment hearing by police, and 59.5% shared a cell with others while waiting. Overall, the commitment intake process at the courthouse took over 5 hours. Participants spent, on average, less than 15 minutes with their lawyer before the hearing, and a majority of CC hearings lasted less than 15 minutes. Once transferred to a CC facility, opioid withdrawal management began within 4 hours. Compared with women, men reported longer wait times between the hearing and transfer, as well as longer wait times for withdrawal management at the facility ( P < 0.05). Women perceived worse interactions with the judge and greater dissatisfaction with the commitment process compared with men ( P < 0.05). CONCLUSIONS There were few gender differences in the experience of CC. However, overall, participants reported a lengthy court process and low levels of perceived procedural justice.
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Affiliation(s)
- Jumi Hayaki
- Department of Psychology, College of the Holy Cross, Worcester, MA, USA
| | - Haley Cinq-Mars
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, USA
- Present address: Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Paul P. Christopher
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Bradley J. Anderson
- Behavioral Medicine and Addiction Research Unit, Butler Hospital, Providence, RI, USA
| | - Catherine Stewart
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, USA
| | - Michael D. Stein
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, USA
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Lesko CR, Falade-Nwulia OO, Pytell JD, Hutton HE, Fojo AT, Keruly JC, Moore RD, Chander G. Joint effects of substance use disorders and recent substance use on HIV viral non-suppression among people engaged in HIV care in an urban clinic, 2014-2019. Addiction 2023; 118:2193-2202. [PMID: 37491566 PMCID: PMC10592031 DOI: 10.1111/add.16301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/19/2023] [Indexed: 07/27/2023]
Abstract
AIMS To estimate the joint effects of substance use disorder (SUD) and recent substance use on human immunodeficiency virus (HIV) non-suppression. DESIGN Retrospective clinical cohort study with repeated observations within individuals. SETTING Baltimore, Maryland, United States. PARTICIPANTS 1881 patients contributed 10 794 observations. MEASUREMENTS The primary independent variable was the combination of history of SUD and recent substance use. History of SUD was defined as any prior International Classification of Diseases 9/10 code for cocaine or opioid disorder. Recent substance use was defined as the self-report of cocaine or non-prescribed opioid use on the National Institute of Drug Abuse-modified Alcohol, Smoking and Substance Involvement Screening Test or clinician-documented cocaine or opioid use abstracted from the medical record. The outcome was viral non-suppression, defined as HIV RNA >200 copies/mL on the first viral load measurement within 1 year subsequent to each observation of substance use. We adjusted for birth sex, Black race, age, HIV acquisition risk factors, years in care and CD4 cell count. In secondary analyses, we also adjusted for depressive, anxiety and panic symptoms, cannabis use and cannabis use disorder. FINDINGS On their first observation, 31% of patients had a history of an SUD and 18% had recent substance use. Relative to no history of SUD and no recent substance use, the 1-year fully adjusted risk difference (RD) for viral non-suppression associated with cocaine and opioid use disorder and recent substance use was 7.7% (95% CI = 5.3%-10.0%), the RD was 5.5% (95% CI = 1.2%-9.7%) for history of cocaine use disorder without recent substance use, and the RD was 4.6% (95% CI = 2.7%-6.5%) for recent substance use without a SUD. CONCLUSIONS Substance use and substance use disorders appear to be highly prevalent among, and independently associated with, viral non-suppression among people with HIV.
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Affiliation(s)
- Catherine R Lesko
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Jarratt D Pytell
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Heidi E Hutton
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Anthony T Fojo
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Seybold D, Simmons K, Taylor LA, Roslonski AR, Rozycki B, Calhoun B. Opioid Use Following Cesarean Delivery: A Pilot Study on Patterns of Use, Storage, and Disposal. Cureus 2023; 15:e49474. [PMID: 38152813 PMCID: PMC10751732 DOI: 10.7759/cureus.49474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
Objective The aim of this study was to describe various aspects related to opioid use and storage in the setting of at-home pain management after cesarean deliveries among an Appalachian population. Methods Women who underwent cesarean delivery (January-June 2019) at an Appalachian institution were prospectively enrolled and administered a telephone survey seven (± 3) days post-discharge. Results Of the 87 women enrolled, 40 (46%) completed the survey; 92.5% were prescribed an opioid medication, most commonly oxycodone/acetaminophen 5/325 mg. A Kruskal-Wallis H test revealed a significant association between the severity of pain that interfered with normal daily activities and the number of pills consumed [χ2(2)=6.75, p=0.034]. More than 70% of the participants (28/40) had not safely stored or disposed of their unused opioid medications. Conclusion Our findings highlight the need for interventions to educate patients on how to appropriately use, store, and dispose of unused opioids.
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Affiliation(s)
- Dara Seybold
- Obstetrics and Gynecology, Institute for Academic Medicine, Charleston Area Medical Center, Charleston, USA
| | - Kelly Simmons
- Obstetrics and Gynecology, West Virginia University, Charleston Division, Charleston Area Medical Center, Charleston, USA
| | - Lesli A Taylor
- Charleston Area Medical Center, Institute for Academic Medicine, Charleston, USA
| | - Annie R Roslonski
- Obstetrics and Gynecology, West Virginia University, Charleston Division, Charleston Area Medical Center, Charleston, USA
| | - Blake Rozycki
- Obstetrics and Gynecology, West Virginia University, Charleston Division, Charleston Area Medical Center, Charleston, USA
| | - Byron Calhoun
- Maternal-Fetal Medicine, West Virginia University, Charleston Division, Charleston, USA
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Puylaert M, Nijs L, Buyse K, Vissers K, Vanelderen P, Nagels M, Daenekindt T, Weyns F, Mesotten D, Van Zundert J, Van Boxem K. Long-Term Outcome in Patients With Spinal Cord Stimulation for Failed Back Surgery Syndrome: A 20-Year Audit of a Single Center. Neuromodulation 2023; 26:1433-1440. [PMID: 35577695 DOI: 10.1016/j.neurom.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 11/24/2022]
Abstract
STUDY DESIGN This is a retrospective, observational study. INTRODUCTION Spinal cord stimulation (SCS) has found its application in chronic pain treatment, with failed back surgery syndrome (FBSS) as one of the most important indications. However, to date, little is known about the long-term effectiveness of the treatment. The aim of this study is to analyze retrospectively the long-term outcomes of SCS treatment in a single multidisciplinary pain center on predominant radicular pain, using devices of a single manufacturer. MATERIALS AND METHODS Patient data on overall patient satisfaction, pain intensity, and adverse events were retrospectively collected in our clinical practice between January 1998 and January 2018, for 191 patients who received a permanent SCS implant. Secondary health measures included the influence of opioid and nicotine use on pain reduction after therapy. RESULTS The trial-to-implant ratio was 93.6%. At a mean follow-up of 10.6 years, 78.5% of the patients were satisfied with the treatment outcome, with a significant pain reduction of an average three points on a Numeric Rating Scale. Opioid and nicotine usage did not have a significant link with the pain reduction one year after the treatment. Furthermore, devices had an average battery lifespan of 8.4 years. A total of 248 revisions were recorded. A total of 24 patients (11.7%) acquired an infection; 7 of 204 patients had an infection during the trial period, 2 of 191 patients had an infection in the first postoperative year, and 15 of 191 patients had an infection after the first year. The average time to infection, if not in the first year, was 10.1 years. CONCLUSIONS A successful long-term outcome regarding pain relief in patients with predominant radicular pain due to FBSS is established with SCS therapy.
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Affiliation(s)
- Martine Puylaert
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands
| | - Lynn Nijs
- KU Leuven, Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, Leuven, Belgium
| | - Klaas Buyse
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pascal Vanelderen
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium; Hasselt University and Limburg Clinical Research Center, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Margot Nagels
- Department of Medicine, Hasselt University, Hasselt, Belgium
| | | | - Frank Weyns
- Hasselt University and Limburg Clinical Research Center, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium; Department of Neurosurgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Dieter Mesotten
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium; Hasselt University and Limburg Clinical Research Center, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Jan Van Zundert
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands
| | - Koen Van Boxem
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium; Department of Anesthesiology and Pain Management, University Medical Centre Maastricht, Maastricht, The Netherlands.
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Newton W, Hoch C, Chen C, Scott DJ, Gross CE. Preoperative Opioid Use Predicts Poorer Outcomes of Total Ankle Arthroplasty and Hindfoot Fusions. Foot Ankle Spec 2023; 16:497-505. [PMID: 37119178 DOI: 10.1177/19386400231164677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative opioid use on outcomes of patients undergoing ankle or hindfoot arthrodesis, or total ankle arthroplasty (TAA). METHODS We conducted a retrospective review of 190 patients undergoing an ankle or hindfoot arthrodesis (n=122) or TAA (n=68) between December 2015 and September 2020 with a single fellowship-trained orthopaedic foot and ankle surgeon at an academic medical center. Data collected included demographics, medical comorbidities, treatment history, complications and reoperation rates, patient-reported outcome measures (PROMs) (eg, Foot and Ankle Outcome Score [FAOS]), and opioid use. RESULTS Patients with preoperative opioid use were more likely to continue usage at 90 (r = 0.931, P < .001) and 180 (r = 0.940, P < .001) days postoperatively. For the entire cohort, complication and reoperation rates were 48.9% and 13.2%, respectively. While preoperative opioid use groups did not differ in the overall complication rate, users had significantly more infections (user = 12.5%, nonuser = 3.3%; P = .036) and reoperations (user = 22.5%, nonuser = 10.7%; P = .049). When analyzing postoperative opioid prescriptions, there were many significant correlations with preoperative PROMs, mainly FAOS, such that increased postoperative opioid use was associated with worse subjective outcomes. CONCLUSION Preoperative opioid users are more likely to continue postoperative opioid use, experience infections, and undergo reoperations. LEVEL OF EVIDENCE Level III: Retrospective cohort study.
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Affiliation(s)
- William Newton
- Department of Orthopaedics & Physical Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Caroline Hoch
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Caroline Chen
- Department of Orthopaedics & Physical Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel J Scott
- Department of Orthopaedics & Physical Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Christopher E Gross
- Department of Orthopaedics & Physical Medicine, Medical University of South Carolina, Charleston, South Carolina
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Chalmers BP, Puri S, Chiu YF, Lebowitz J, Sideris A, Westrich GH, Jerabek SA, Gonzalez Della Valle A. Patients Undergoing Primary, Cementless TKA had Similar Pain, Opioid Utilization, and Functional Outcomes Compared to Matched Patients With Cemented Fixation. J Arthroplasty 2023; 38:2131-2136. [PMID: 37142071 DOI: 10.1016/j.arth.2023.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/18/2023] [Accepted: 04/22/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Despite renewed interest in cementless fixation of total knee implants, many surgeons have anecdotal concerns about slower recovery and higher early pain scores. We sought to analyze 90-day opioid utilizations, inhospital pain scores, and patient-reported outcome measures (PROMs) in patients undergoing primary cemented versus cementless total knee arthroplasty (TKA). METHODS We retrospectively identified a cohort of opioid naïve patients undergoing primary TKA for osteoarthritis. There were 186 patients who had cementless TKAs matched 1:6 with 1,116 who received a cemented TKAs based on age (±6 years), body mass index (BMI) (±5), and sex. We compared inhospital pain scores, 90-day opioid utilizations in morphine milligram equivalents (MMEs), and early postoperative PROMs. RESULTS The cemented and cementless cohorts had similar lowest (0.09 versus 0.08), highest (7.36 versus 7.34), and average (3.26 versus 3.27) pain scores using numeric rating scale (P > .05). They received similar inhospital (90 versus 102, P = .176), discharge (315 versus 315, P = .483), and total (687 versus 720, P = .547) MMEs. They had similar average inpatient hourly opioid consumption (2.5 versus 2.5 MMEs/hour, P = .965). Average refills 90 days postoperatively were similar in both cohorts (1.5 versus 1.4 refills, P = .893). Also, preoperative, 6-week, 3-month, delta 6-week, and delta 3-month PROMs scores were similar between cemented and cementless cohorts (P > .05) CONCLUSION: This matched study demonstrated similar in-hospital pain scores and opioid utilization, total MMEs prescribed within 90 days, and PROMs at 6 weeks and 3 months postoperatively between cemented and cementless TKAs. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Simarjeet Puri
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Yu-Fen Chiu
- Biostatistics Core, Research Administration, Hospital for Special Surgery, New York, New York
| | - Juliana Lebowitz
- Operational Excellence, Hospital for Special Surgery, New York, New York
| | - Alexandra Sideris
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Seth A Jerabek
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Alejandro Gonzalez Della Valle
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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Hoerster V, Tang D, Milkis M, Litzenberger S, Stoltzfus J, Stankewicz H. Opioid Use and Disposal Patterns of Emergency Department Patients. J Emerg Trauma Shock 2023; 16:177-181. [PMID: 38292287 PMCID: PMC10824224 DOI: 10.4103/jets.jets_55_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 10/24/2021] [Accepted: 01/20/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction To date, there is limited literature to guide emergency providers (EPs) on the proper dosing of prescription opioids. Our study aims to assess the self-reported opioid use, storage, and disposal practices of patients presenting to the emergency department (ED) with acute pain. Methods This prospective cohort study employed a validated, cross-sectional survey of subjects identified using electronic medical records. The survey link was e-mailed to a continuous sample of eligible participants 3-4 weeks following ED discharge. Nonrespondents were surveyed through telephone after 1 week. We used descriptive and nonparametric statistics to report survey results. Results Of 500 eligible subjects, 97 completed the questionnaire. Only 28% of respondents reported that they took all of the prescribed pills. Of the remaining responses, 20% stated that they did not take any pills, 33% took about one-fourth, 7.2% took about half, and 12.4% took about three-fourths of the pills. Among those who did not take any pills, 42% filled the prescription. Most (71.2%) reported storing their leftover pills; among those who stored their pills, less than one-fourth (23.8%) used a locked storage location. Conclusions Our findings suggest that less than one-third of patients who receive prescriptions in the ED for acute pain use all of their prescribed pills, suggesting that many patients are unnecessarily prescribed opioids for acute conditions. The findings of this study also suggest that many patients with unused prescription opioids do not practice safe storage or proper disposal of leftover pills. This represents a potential opportunity for EPs to improve medication safety by educating patients on proper storage and disposal practices. Limitations include low response rate and the use of self-reporting.
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Affiliation(s)
- Valerie Hoerster
- Department of Emergency Medicine, Sibley Memorial Hospital, Washington, DC, USA
| | - Derek Tang
- Department of Internal Medicine, GME Data Measurement and Outcomes Assessment, St. Luke’s University Health Network, Bethlehem, USA
| | - Marlee Milkis
- Department of Family Medicine, UPMC St. Margaret, Pittsburgh, PA, USA
| | | | - Jill Stoltzfus
- Department of St. Luke's University Health Network, GME Data Measurement and Outcomes Assessment, St. Luke’s University Health Network, Bethlehem, USA
| | - Holly Stankewicz
- Department of Emergency Medicine, St. Luke’s University Health Network, Bethlehem, USA
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Abstract
BACKGROUND The incidence of ankle fractures is increasing, and risk factors for prolonged opioid use after ankle fracture fixation are unknown. Accordingly, the purpose of this study was to investigate risk factors that lead to prolonged opioid use after surgery. METHODS The Truven MarketScan database was used to identify patients who underwent ankle fracture surgery from January 2009 to December 2018 based on CPT codes. Patient characteristics were collected, and patients separated into 3 cohorts based on postoperative opioid use (no refills, refills within 6 months postoperative, and refills within 1 year postoperatively). The χ2 test and multivariate analysis were performed to assess the association between risk factors and prolonged use. RESULTS In total, 34 691 patients were analyzed. Comorbidities most highly associated with prolonged opioid use include 2+ preoperative opioid prescriptions (odds ratio [OR] = 11.92; P < .001), tobacco use (OR = 2.03; P < .001), low back pain (OR = 1.81; P < .001), depression (OR = 1.48; P < .001), diabetes (OR = 1.34; P < .001), and alcohol abuse (OR = 1.32; P < .001). CONCLUSION Opioid use after ankle fracture surgery is common and may be necessary; however, prolonged opioid use and development of dependence carries significant risk. Identifying those patients at an increased risk for prolonged opioid use can aid providers in tailoring their postoperative pain regimen. LEVELS OF EVIDENCE Prognostic, Level III.
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Affiliation(s)
| | | | - Corey Spenser
- Department of Orthopaedics, Emory University, Atlanta, Georgia
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Trenchfield D, Lee Y, Brush P, McCurdy M, Lambrechts M, Narayanan R, Christianson A, Deez A, Wiafe B, Kaye ID, Canseco J, Hilibrand AS, Vaccaro AR, Kepler C, Schroeder G. Effect of Preoperative Marijuana on Patient Outcomes and Opioid Use after Lumbar Decompression. Global Spine J 2023:21925682231203650. [PMID: 37728558 DOI: 10.1177/21925682231203650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES Our study aims to analyze the effect of preoperative marijuana use on outcomes and postoperative opioid use in patients who have undergone lumbar decompression without fusion. METHODS All patients >18 years of age who underwent lumbar decompression from 2017-2022 with documented preoperative marijuana use at our academic institution were retrospectively identified. A 3:1 propensity match incorporating demographics, procedure type, and levels decompressed was performed to compare preoperative marijuana users and non-users. 1-year preoperative and postoperative opioid consumption in milligrams of morphine equivalents and postoperative outcomes including readmissions, reoperations, and complications, were obtained. A multivariate regression model was performed to measure the effect of marijuana use on the likelihood of a spine reoperation. RESULTS Of the 340 included patients, 85 were preoperative marijuana users. There were no significant differences in medical complications, 90-day readmissions, or opioid consumption preoperatively or postoperatively (P > .05). We identified a trend towards patients who used marijuana having more reoperations for any cause (20.0% vs 11.37%, P = .067). Multivariate logistic regression analysis suggested that preoperative marijuana use was a significant predictor of all-spine reoperations (OR = 2.06, P = .036). CONCLUSIONS In lumbar decompression patients, preoperative marijuana use does not impact opioid consumption, readmissions, or medical complications, but is a significant predictor of future postoperative reoperations. Additional research is necessary to further explore the role of marijuana use in spine surgery.
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Affiliation(s)
- Delano Trenchfield
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Parker Brush
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Michael McCurdy
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mark Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
- Department of Orthopaedic Surgery, Washington University Hospital, St. Louis, MO, USA
| | - Rajkishen Narayanan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alex Christianson
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Azra Deez
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Bright Wiafe
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jose Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Christopher Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Gregory Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Collinsworth AW, Kouznetsova M, Hall L, Robinson C, Ogola GO, Turner A, Priest EL, Hart C, Böing EA, Wan GJ, Peters WR, Masica AL. Impact of an enhanced recovery after surgery program with a multimodal analgesia care pathway on opioid prescribing and clinical outcomes for patients undergoing colorectal surgery. Proc AMIA Symp 2023; 36:706-715. [PMID: 37829209 PMCID: PMC10566428 DOI: 10.1080/08998280.2023.2254185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/07/2023] [Indexed: 10/14/2023] Open
Abstract
Background Opioids are a mainstay for acute pain management, but their side effects can adversely impact patient recovery. Multimodal analgesia (MMA) is recommended for treatment of postoperative pain and has been incorporated in enhanced recovery after surgery (ERAS) protocols. The objective of this quality improvement study was to implement an MMA care pathway as part of an ERAS program for colorectal surgery and to measure the effect of this intervention on patient outcomes and costs. Methods This pre-post study included 856 adult inpatients who underwent an elective colorectal surgery at three hospitals within an integrated healthcare system. The impact of ERAS program implementation on opioid prescribing practices, outcomes, and costs was examined after adjusting for clinical and demographic confounders. Results Improvements were seen in MMA compliance (34.0% vs 65.5%, P < 0.0001) and ERAS compliance (50.4% vs 57.6%, P < 0.0001). Reductions in mean days on opioids (4.2 vs 3.2), daily (51.6 vs 33.4 mg) and total (228.8 vs 112.7 mg) morphine milligram equivalents given during hospitalization, and risk-adjusted length of stay (4.3 vs 3.6 days, P < 0.05) were also observed. Conclusions Implementing ERAS programs that include MMA care pathways as standard of care may result in more judicious use of opioids and reduce patient recovery time.
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Affiliation(s)
- Ashley W. Collinsworth
- Baylor Scott & White Health, Dallas, Texas, USA
- Medical Solutions Division, 3M, St Paul, Minnesota, USA
| | - Maria Kouznetsova
- Baylor Scott & White Health, Dallas, Texas, USA
- Analytics Division, Simulstat Incorporated, Solana Beach, California, USA
| | - Lauren Hall
- Baylor Scott & White Health, Dallas, Texas, USA
| | - Chessie Robinson
- Baylor Scott & White Health, Dallas, Texas, USA
- Employers Health Network, Dallas, Texas, USA
| | | | | | | | | | - Elaine A. Böing
- Health Economics and Outcomes Research Department, Mallinckrodt Pharmaceuticals, Bedminster, New Jersey, USA
- Ipsen, Cambridge, Massachusetts, USA
| | - George J. Wan
- Health Economics and Outcomes Research Department, Mallinckrodt Pharmaceuticals, Bedminster, New Jersey, USA
| | | | - Andrew L. Masica
- Baylor Scott & White Health, Dallas, Texas, USA
- Reliable Health, Texas Health Resources, Arlington, Texas, USA
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Maylott SE, Conradt E, McGrath M, Knapp EA, Li X, Musci R, Aschner J, Avalos LA, Croen LA, Deoni S, Derefinko K, Elliott A, Hofheimer JA, Leve LD, Madan JC, Mansolf M, Murrison LB, Neiderhiser JM, Ozonoff S, Posner J, Salisbury A, Sathyanarayana S, Schweitzer JB, Seashore C, Stabler ME, Young LW, Ondersma SJ, Lester B. Latent Class Analysis of Prenatal Substance Exposure and Child Behavioral Outcomes. J Pediatr 2023; 260:113468. [PMID: 37182662 PMCID: PMC10524438 DOI: 10.1016/j.jpeds.2023.113468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 03/30/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVES To predict behavioral disruptions in middle childhood, we identified latent classes of prenatal substance use. STUDY DESIGN As part of the Environmental influences on Child Health Outcomes Program, we harmonized prenatal substance use data and child behavior outcomes from 2195 women and their 6- to 11-year-old children across 10 cohorts in the US and used latent class-adjusted regression models to predict parent-rated child behavior. RESULTS Three latent classes fit the data: low use (90.5%; n = 1986), primarily using no substances; licit use (6.6%; n = 145), mainly using nicotine with a moderate likelihood of using alcohol and marijuana; and illicit use (2.9%; n = 64), predominantly using illicit substances along with a moderate likelihood of using licit substances. Children exposed to primarily licit substances in utero had greater levels of externalizing behavior than children exposed to low or no substances (P = .001, d = .64). Children exposed to illicit substances in utero showed small but significant elevations in internalizing behavior than children exposed to low or no substances (P < .001, d = .16). CONCLUSIONS The differences in prenatal polysubstance use may increase risk for specific childhood problem behaviors; however, child outcomes appeared comparably adverse for both licit and illicit polysubstance exposure. We highlight the need for similar multicohort, large-scale studies to examine childhood outcomes based on prenatal substance use profiles.
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Affiliation(s)
- Sarah E Maylott
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC; Department of Psychology, University of Utah, Salt Lake City, UT.
| | - Elisabeth Conradt
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC; Department of Psychology, University of Utah, Salt Lake City, UT
| | - Monica McGrath
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Emily A Knapp
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Xiuhong Li
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Rashelle Musci
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD
| | - Judy Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Albert Einstein College of Medicine, Bronx, NY
| | - Lyndsay A Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Sean Deoni
- Department of Pediatrics and Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI
| | - Karen Derefinko
- Department of Preventive Medicine and Department of Pharmacology, Addiction Science, and Toxicology, The University of Tennessee Health Science Center, Memphis, TN
| | - Amy Elliott
- Avera Research Institute and Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD
| | - Julie A Hofheimer
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Leslie D Leve
- Prevention Science Institute, University of Oregon, Eugene, OR
| | - Juliette C Madan
- Department of Pediatrics, Psychiatry and Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Maxwell Mansolf
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Liza B Murrison
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Sally Ozonoff
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA
| | - Jonathan Posner
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC
| | - Amy Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, VA
| | - Sheela Sathyanarayana
- Departments of Pediatrics, Environmental and Occupational Health Sciences, and Epidemiology, University of Washington, Seattle, WA; Seattle Children's Research Institute, Seattle, WA
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences and the MIND Institute, University of California, Davis, School of Medicine, Sacramento, CA
| | - Carl Seashore
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Meagan E Stabler
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, NH
| | - Leslie W Young
- Department of Pediatrics, University of Vermont Medical Center, Burlington, VT
| | - Steven J Ondersma
- Division of Public Health and Department of Obstetrics, Gynecology, & Reproductive Biology, Michigan State University, East Lansing, MI
| | - Barry Lester
- Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI
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Vermeijden HD, Holuba K, Yang XA, O’Brien R, van der List JP, DiFelice GS. Prospective Comparison of Postoperative Pain and Opioid Consumption Between Primary Repair and Reconstruction of the Anterior Cruciate Ligament. Orthop J Sports Med 2023; 11:23259671231187442. [PMID: 37786478 PMCID: PMC10541769 DOI: 10.1177/23259671231187442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 10/04/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) reconstruction (ACLR) is associated with postoperative pain and necessitates using perioperative nerve blocks and multimodal analgesic plans. Purpose To assess postoperative pain and daily opioid use after ACL repair versus ACLR and to assess whether ACL repair could be performed successfully without using long-acting nerve blocks. Study Design Cohort study; Level of evidence, 2. Methods All eligible patients who underwent ACL surgery between 2019 and 2022 were prospectively enrolled. Patients were treated with primary repair if proximal tears with sufficient tissue quality were present; otherwise, they underwent single-bundle ACLR with either hamstring tendon or quadriceps tendon autograft. The patients were divided into 3 groups: ACLR with adductor canal nerve block (up to 20 mL of 0.25% bupivacaine with 2 mg dexamethasone), primary repair with nerve block, and primary repair without nerve block. Pain visual analog scale and number of opioids used were recorded during the first 14 postoperative days (PODs). Furthermore, patients completed the Quality of Recovery-15 (QoR-15) survey, and range of motion was assessed. Group differences were compared using Mann-Whitney U test and chi-square test. Results Seventy-eight patients were included: 30 (39%) underwent ACLR, 19 (24%) ACL repair with nerve block, and 29 (37%) ACL repair without nerve block. Overall, the ACL repair group used significantly fewer opioids than the ACLR group on POD 1 (1 vs 3, P = .027) and POD 2 (1 vs 3, P = .014) while also using fewer opioids in total (3 vs 8, P = .038). This difference was even more marked when only analyzing those patients who received postoperative nerve blocks (1 vs 8, P = .029). Repair patients had significantly higher QoR-15 scores throughout the first postoperative week, and they had greater range of motion (all P < .05). There were no significant differences in pain scores, opioid usage, or QoR-15 scores between patients who underwent repair with versus without nerve block. Conclusion The ACL repair group experienced less postoperative pain during the first 2 weeks after surgery and used significantly fewer opioids than the ACLR group. Furthermore, they had improved knee function and higher recovery quality than patients who underwent ACLR during the initial postoperative period. Postoperative nerve blocks may not be necessary after ACL repair.
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Affiliation(s)
- Harmen D. Vermeijden
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, the Netherlands
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, the Netherlands
| | - Kurt Holuba
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, the Netherlands
| | - Xiuyi A. Yang
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, the Netherlands
| | - Robert O’Brien
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, the Netherlands
| | - Jelle P. van der List
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, the Netherlands
- Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, the Netherlands
| | - Gregory S. DiFelice
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Toska E, Mayrovitz HN. Opioid Impacts on Cardiovascular Health. Cureus 2023; 15:e46224. [PMID: 37905258 PMCID: PMC10613512 DOI: 10.7759/cureus.46224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
The prevalence of opioid use in the current opioid epidemic era has led to a public health emergency due to the ties to mortality and morbidity. Studies have investigated opioids' impacts on different aspects of cardiovascular health, although there seems to be a lack of a current concise review. Therefore, the aim of this literature review is to provide a summary of the most recent studies from the past decade that postulate a connection between opioids and their impact on cardiovascular health while highlighting conflicting areas among published research. For this literature review, three databases, PubMed (NLM), EMBASE, and Web of Science (Core Collection), were searched for full peer-reviewed articles written in English about human subjects and published between 2013 and 2023 inclusive. The following initial approach was to search for terms in the title of articles: "opioid AND ("vascular" OR "artery" OR "vein" OR "heart rate" OR "infarct" OR "stroke" OR "aortic" OR "cardiovascular disease"). After assessing for duplicate articles from the three databases, the remaining articles were assessed for inclusion eligibility. In the present review, a brief description of the overall role of opioid receptors is provided followed by the literature findings. These findings indicate potentially important negative impacts of opioid use on cardiovascular health in a number of areas. These include opioid-associated increases in the following: (1) vascular aging based on demonstrated increases in arterial stiffness, (2) opioid-related reductions in heart rate variability (HRV) and its implications on morbidity and mortality, (3) opioid's impacts on coronary artery and coronary heart disease (CHD), (4) opioids as a risk factor for atrial fibrillation (AF) and (5) opioid use as a risk factor for vascular occlusion processes. In addition to these broad cardiovascular effects, other aspects of concern are related to the potential impacts of withdrawal from opioid use, which, when done rapidly, are associated with increases in blood pressure and a decrease in HRV.
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Affiliation(s)
- Erjola Toska
- Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
| | - Harvey N Mayrovitz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
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Patel NP, Bates CM, Patel A. Developmental Approaches to Chronic Pain: A Narrative Review. Cureus 2023; 15:e45238. [PMID: 37842431 PMCID: PMC10576536 DOI: 10.7759/cureus.45238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Chronic pain, which can potentially develop from acute pain, subacute pain, or breakthrough pain, is generally defined as pain persisting for greater than three months with minimal relief. Chronic pain can be associated with a myriad of medical conditions. It is also one of the most common causes of disability, physical suffering, depression, and reduced quality of life. Treatment can vary depending on the underlying pathophysiology and can involve physical therapy, non-pharmaceutical approaches, pharmaceutical drugs, and invasive procedures. Currently available pharmaceutical agents have been effective for short-term management of chronic pain conditions, but few options address chronic pain with long-term efficacy. First-line pharmaceutical agents can potentially include over-the-counter (OTC) or prescription-strength non-steroidal anti-inflammatory drugs (NSAIDs), which have been linked to numerous side effects. If chronic pain persists, steroids are frequently used to provide longer relief. For more progressive or resistant chronic pain and/or in conjunction with invasive procedures, opioids have been utilized for acute treatment and for long-term maintenance. While these agents have proven to be effective for both acute and long-term use due to their modulation at various peripheral and central opioid receptors, they can be associated with numerous side effects and tied to the risk of addiction. As such, an unmet need exists to identify treatment modalities that provide opioid-like pain relief without opioid-induced adverse effects and the potential for addiction. This narrative review will provide an overview of the currently available treatment modalities for chronic pain and their adverse event profiles, as well as a review of therapies that are currently in development and/or preclinical trials for the management and treatment of chronic pain.
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Affiliation(s)
- Nikita P Patel
- College of Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Chad M Bates
- College of Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Aakash Patel
- Anesthesiology, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, USA
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Heidari O, O’Conor KJ, Meyer D, Cargill V, Lowensen K, Farley JE. High Primary COVID-19 Vaccine Series Completion by People Who Inject Drugs When Colocating Services at a Syringe Services Van. J Addict Med 2023; 17:e287-e289. [PMID: 37788618 PMCID: PMC10492892 DOI: 10.1097/adm.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVE The aim of the study is to describe the impact of colocating COVID-19 vaccinations with local syringe service programs on vaccine completion among people who inject drugs. METHODS Data were derived from 6 community-based clinics. People who inject drugs who received at least one COVID-19 vaccine from a colocated clinic partnering with a local syringe service program were included in the study. Vaccine completion was abstracted from electronic medical records; additional vaccinations were abstracted using health information exchanges embedded within the electronic medical records. RESULTS Overall, 142 individuals with a mean age of 51 years, predominantly male (72%) and Black, non-Hispanic (79%) received COVID-19 vaccines. More than half elected to receive a 2-dose mRNA vaccine (51.4%). Eighty-five percent completed a primary series, and 71% of those who received a mRNA vaccine completed the 2-dose series. Booster uptake was 34% in those completing a primary series. CONCLUSIONS Colocated clinics are an effective means of reaching vulnerable populations. As the COVID-19 pandemic continues and need for annual booster vaccines arises, it is important to bolster public support and funding to continue low-barrier preventive clinics colocated with harm reduction services for this population.
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Affiliation(s)
- Omeid Heidari
- Department of Child, Family, and Population Health Nursing, University of Washington, School of Nursing
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing
| | - Katie J. O’Conor
- Departments of Anesthesiology, Critical Care Medicine and Emergency Medicine, Johns Hopkins University School of Medicine
| | - Diane Meyer
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing
- Center for Health Security, Johns Hopkins University, Bloomberg School of Public Health
| | | | - Kelly Lowensen
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing
| | - Jason E. Farley
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, School of Nursing
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