Wide Variation in Opioid Prescribing for Pain Relief Following Knee Arthroscopy

PainRelief.com Interview with:
Benjamin Ukert PhD
Assistant Professor
Department of Health Policy and Management
Texas A&M

Mucio Kit Delgado, MD, MS
Department of Emergency Medicine
Perelman School of Medicine
University of Pennsylvania

PainRelief.com:  What is the background for this study?

Response: The opioid epidemic has received a lot of attention and many state policies have been passed to address excessive opioid prescribing and highlight the dangers of opioid use initiation for those who have never been exposed to opioids. We also now know that most patients prescribed opioids for post-operative pain have significant quantities of pills leftover. One study showed that after knee arthroscopy, 50% of patients took no opioids, and 90% took less than 5 pills (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190545/).

We thought to investigate whether overprescribing is still common, and asked the question whether we now observe low levels of prescribing following knee arthroscopy and whether there are differences in prescribing practices across states.

Study Finds Chronic Pain Patients Used More Opioids For Pain Relief When COVID-19 Cancelled Elective Procedures

PainRelief.com Interview with:

Dr. Shantha Ganesan MD
 Pain Medicine Specialist
Kings County Hospital Center

David Kim, MD, PGY-2
SUNY Downstate Department of Anesthesiology 

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: The opioid epidemic is a serious national crisis that has detrimental impacts on both public health, and social and economic welfare. Therefore, any efforts to combat the opioid epidemic, including minimizing or weaning opioid prescriptions, and using other modes of analgesia when possible are undeniably necessary in this day and age. With the onset of Covid-19 pandemic, healthcare providers abruptly changed their care delivery. In-person clinic visits were changed to telemedicine, and elective cases were cancelled.

Due to a growing concern that chronic pain patients may have limited resources from this unprecedented time of social and economic shutdown, organizations such as American Medical Association and Drug Enforcement Administration have supported implementing measures to ensure these patients achieve adequate pain control by increasing access to pain medications, but at the cost of reducing barriers and restrictions to controlled substances. Given the cancellation of elective interventional pain management procedures and relaxed regulations on controlled substances during the Covid-19 pandemic, it is reasonable to suspect a dramatic increase in opioid prescription during this time.

Continue reading

Factors Affecting Adults’ Choice of Opioids for Pain Relief

PainRelief.com Interview with:
Didem Bernard, Ph.D.
Senior Economist
Agency for Healthcare Research and Quality

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: There had not been any studies on whether patient attitudes about health affect opioid use. A self-reliant health attitude is agreement with the following statements: “I do not need health insurance,” and “I can overcome illness without help from a medically trained person.”

We find that health-related attitudes affect both adults with and without chronic pain treatment similarly. Adults with self-reliant health attitudes are less likely to start and more likely to discontinue opioid use. Exercise is also associated with a higher probability of choosing no analgesic treatments over using opioids. Similarly, among adults who are using opioids for pain treatment, exercise is associated with a higher probability of discontinuing opioid use in the year following opioid initiation.

Cesarean Section: TAP Block with EXPAREL Provides Long-Acting Pain Relief and Reduces Opioid Use

PainRelief.com Interview with:

Dr. Ashraf Habib, MB BCh
Chief of the Division of Women’s Anesthesia
Professor of Anesthesiology
Duke University, Durham, NC

PainRelief.com:  What is the background for this study?

Response:  Cesarean sections (C-sections) occur every day in the United States, with more than 1.2 million procedures in the US each year according to the CDC. Since postsurgical pain after C-sections can range from moderate to severe discomfort, it is important that this pain is managed effectively and safely. The amount of pain experienced and the way pain is treated can have an impact on a new mother’s postsurgical recovery. While opioids were once considered the standard treatment to manage pain after surgery, postsurgical opioid consumption can have a negative impact on a new mother’s recovery experience, causing unwanted side effects such as drowsiness, itching, nausea, vomiting, constipation and the risk of persistent use or dependence. In fact, research shows nearly nine in 10 mothers and mothers-to-be have concerns about taking opioids during and after childbirth, yet 51% of all C-section patients are still prescribed an opioid to manage postsurgical pain.

We recently published results from a Phase 4 study in Anesthesia and Analgesia that revealed the long-acting local anesthetic EXPAREL (bupivacaine liposome injectable suspension), when administered with bupivacaine as part of transversus abdominis plane (TAP) field block, provided a significant reduction in opioid consumption and a greater percentage of opioid-spared patients, with optimized pain control through 72 hours. This was a multicenter, randomized, double-blind study across 13 clinical sites in the United States, in patients undergoing elective C-section and receiving spinal anesthesia and a multimodal analgesic regimen. Patients were randomized to receive EXPAREL 266 mg plus bupivacaine HCl 50 mg or bupivacaine HCl 50 mg alone administered via TAP field block after delivery.

Continue reading

Deprescribing Opioids Used For Chronic Non-Cancer Pain Relief

PainRelief.com Interview with:
Dr Stephanie Mathieson PhD
NHMRC Health Professional Research Early Career Fellow
The University of SydneyFaculty of Medicine and Health, Sydney School of Public Health
Australia

Dr Stephanie Mathieson is a Research Fellow at the Institute for Musculoskeletal Health, The University of Sydney. Her National Health and Medical Research Council (NHMRC) Health Professional Research Early Career Fellow is focused around reducing the opioid epidemic in Australia.

Dr. MATHIESON

PainRelief.com:  What is the background for this study?

Response: This study aimed to review the current evidence of the efficacy of interventions designed to reduce/cease the prescription of, or the use of, opioid analgesics in patients with chronic non-cancer pain.

As clinical practice guidelines now discourage the initial prescription of opioid analgesics for chronic non-cancer pain, clinicians need to know which opioid dose reduction methods are most effective and safe for deprescribing opioid analgesics in their patients.

PainRelief.com:?  What are the main findings?

Response: Our systematic review extended the previous body of literature by incorporating five new randomised trials; however, clinical and statistical heterogeneity prevented meta-analysis. There were ten patient-focused interventions (i.e. aimed at reducing a patient’s opioid dose), and two clinician focused interventions (i.e. aimed at changing the clinician’s behaviour). Overall, our review was unable to recommend any one opioid analgesic deprescribing strategy in patients with chronic pain due to the small number of trials and heterogeneity.

Continue reading

Joint Replacement: Have Opioid Prescription Patterns for Pain Relief Changed?

PainRelief.com Interview with:
Rahul Shah
Medical Student
The University of Texas Medical Branch

PainRelief.com:  What is the background for this study?

Response: The United States has a unique overreliance on opioids for managing both acute and chronic pain, compared to many other developed nations. Opioid misuse and addiction frequently start with large doses of opioids prescribed after surgical interventions. This overprescribing contributes to the high rates of opioid use disorder and overdose deaths in the United States. There have been myriad interventions to curb opioid overprescribing, ranging from the DEA’s hydrocodone rescheduling law to opioid prescribing guidelines issued by the CDC, states and orthopedics specialty organizations. 

Continue reading

Opioids Frequently Prescribed For Headache Pain Relief

PainRelief.com Interview with:
Richard B. Lipton, M.D.
Professor, The Saul R. Korey Department of Neurology
Professor, Department of Psychiatry and Behavioral Sciences
Professor, Department of Epidemiology & Population Health
Edwin S. Lowe Chair in Neurology
Vice Chair The Saul R. Korey Department of Neurology
Director, Montefiore Headache Center
Albert Einstein College of Medicine

PainRelief.com:  What is the background for this study

Response: Almost everyone with migraine takes acute treatments at the time of attacks to relieve pain and restore function.  Acute treatments include over-the-counter medications. prescription drugs and devices.  The most widely used prescription drugs for migraine are triptans (such as sumatriptan and rizatriptan) and NSAIDs (such as ibuprofen and naproxen). 

Richard B. Lipton, M.D. Professor, The Saul R. Korey Department of Neurology Professor, Department of Psychiatry and Behavioral Sciences Professor, Department of Epidemiology & Population Health Edwin S. Lowe Chair in Neurology Vice Chair The Saul R. Korey Department of Neurology Director, Montefiore Headache Center Albert Einstein College of Medicine
Dr. Lipton

Opioids are not recommended in treatment guidelines as acute treatments for migraine.  Longitudinal studies show that in people with migraine treatment with opioids is associated with dose dependent acceleration of headache frequency and the development of chronic migraine in people with episodic migraine.  The purpose of this study was to determine the relative frequency of opioid use and the characteristics of those who use opioids to treat migraine. The hope is to use this information to develop programs which will encourage guideline compliant treatment.

Targeting Specific Inflammatory Cells May Offer Enhanced Pain Relief

PainRelief.com Interview with:
Prof. Dr. Halina Machelska
Department of Experimental Anesthesiology
Charité-Universitätsmedizin Berlin
Berlin, Germany

Prof. Dr. Halina Machelska
Department of Experimental Anesthesiology
Charité-Universitätsmedizin Berlin
Berlin, Germany

PainRelief.com:  What is the background for this study?

Response: Pathological pain such as pain resulting from nerve injury is often accompanied by inflammation. This is manifested by accumulation of immune cells, including macrophages, in the damaged tissue. Current research mostly emphasizes the role of these cells in the enhancement of pain. One of the suggested strategies in the basic research is to deplete immune cells from the affected tissue. However, several previous preclinical studies, including our own, have shown that this approach did not sufficiently decrease pain. We think that one of the reasons is that not all immune cells invading damaged tissue are detrimental and in fact, some are needed there to counteract pain.

Macrophages are very heterogeneous and they comprise at least two subpopulations, pro-inflammatory M1 and anti-inflammatory M2 macrophages. Our idea in this study was to promote the analgesic properties of macrophages. We took advantage of the cytokine interleukin-4 (IL-4) to switch macrophages from the M1 to the M2 state.

Continue reading

Safety And Efficacy Of The Unique Opioid Buprenorphine For Chronic Pain Relief

PainRelief.com Interview with:
Joseph V. Pergolizzi, Jr., M.D.

Co-Founder and Chief Operating OfficerNEMA Research Inc.

Joseph V. Pergolizzi, Jr., M.D.
 Co-Founder and Chief Operating OfficerNEMA Research Inc.

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Chronic low back pain (CLBP) is a leading cause of disability.

  • Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line analgesic options or mild CLBP; however, when certain patients with moderate to severe CLBP do not achieve adequate pain relief, opioids are considered as an add-on therapy. Unfortunately, most opioid analgesics have the potential for adverse effects, abuse, and diversion.
  • Buprenorphine buccal film (Belbuca®) is an opioid analgesic classified as a Schedule III controlled substance in the United States and is a partial μ-opioid receptor agonist.
  • Buprenorphine buccal film is a unique analgesic that is approved by the US Food and Drug Administration for use in patients with chronic pain severe enough to require daily, around-the-clock, long-term opioid treatment for whom alternative treatment options are inadequate.
  • Two pivotal phase 3 clinical trials (Study 307, Clinical Trial ID NCT01675167, and Study 308, Clinical Trial ID NCT01633944) established the efficacy and safety profiles of buprenorphine buccal film.
Continue reading

Older Adults More Likely to Misuse Opioids for Pain Relief

PainRelief.com Interview with:

Ty S. Schepis, PhD
Department of Psychology
Texas State University
San Marcos, TX

Ty S. Schepis, PhD
 Department of Psychology
 Texas State University
 San Marcos, TX
Dr. Schepis

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Prescription opioid misuse motives have been studied in adolescents, young adults, and across the population. One study across the population suggested that older adults differed from younger adults, but this was not fully clear.

We wanted to examine motives across age groups and to investigate the correlates of opioid motive groups in older adults (50 and older). We found that motives changed with aging, with increasing endorsement of pain relief motives, particularly pain relief without other motives.

In contrast, more recreational opioid misuse motives (e.g., to experiment, to get high) peaked in adolescents or young adults. Finally, non-pain relief motives in older adults (50 and older) were associated with higher rates of any past year substance use disorder and past year suicidal ideation.

Continue reading