Persistent Opioid Use for Pain Relief After Dental Procedures Higher Than Previously Reported

PainRelief.com Interview with:
Kao-Ping Chua, M.D., Ph.D.
Assistant Professor, Department of Pediatrics
Susan B. Meister Child Health Evaluation and Research Center
University of Michigan

Dr. Kao-Ping Chua,

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

Response: Persistent opioid use occurs when opioid-naïve patients prescribed opioids after procedures continue to fill opioid prescriptions well past the time that acute post-procedural pain typically resolves. Studies have shown that privately insured adolescents and young adults undergoing wisdom tooth removal are more likely to develop persistent opioid use if they fill opioid prescriptions after the procedure than if they do not. However, it is unknown whether these findings generalize to a broader variety of dental procedures or to publicly insured patients covered by Medicaid.

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COVID-19: Lack of Access to Buprenorphine May Have Contributed to Opioid Overdoses During Pandemic

PainRelief.com Interview with:
Janet Currie, PhD
Henry Putnam Professor of Economics and Policy Affairs
Co-Director, Center for Health and Wellbeing
Princeton University, Princeton NJ 08544

Janet Currie, PhD

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

Response: There has been a great deal of discussion and media reports of disrupted access to care because of the pandemic, as well as reports (including the most recent numbers from the CDC which were just released) about increases in drug overdoses linked to opioids. 

We wondered how this might be related to changes in patterns of opioid prescribing and also the prescribing of buprenorphine for opioid-use disorder.

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Does Medical Marijuana Prevents Opioid Overdoses?

PainRelief.com Interview with:

Daniel Kaufman, MS Geisinger Commonwealth School of Medicine
Daniel Kaufman

Daniel Kaufman, MS
Geisinger Commonwealth School of Medicine

Brian J. Piper, PhD, MS
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, PA 18510

Dr. Piper










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

Response: The opioid epidemic has stricken the United States and caused thousands of deaths nationally. Researchers continue to search for a solution to the ongoing escalation in opioid related deaths, with some states turning to medical cannabis as a potential alternative treatment for chronic pain. The objectives of this study were to:

  1. To determine if medical cannabis program implementation had any effect on opioid overdoses at a state-wide level
  2. To contribute to the discussion of researchers searching for a solution to the opioid epidemic facing the United States
  3. Begin the discussion on the standardization of autopsy procedures, including death/overdose determination
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Opioids Not Only Option for Pain Relief After Cesarean Delivery

PainRelief.com Interview with:
Cristina Wood, MD
Obstetric and Fetal Anesthesiologist
Children’s Hospital Colorado

Dr. Wood

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

Response: ​We all know that opiate abuse is a national crisis, but also is one of the top causes of maternal mortality in the state of Colorado. At the Colorado Fetal Care Center at Children’s Hospital Colorado, we wanted to see what we could do to reduce the need for opiate medications after cesarean delivery. We started by using wound soakers to reduce the opiate requirement and demonstrated an almost 30% reduction in postoperative opiate use. Then, when the Society of Obstetric Anesthesia and Perinatology (SOAP) published guidelines for Early Recovery

After Cesarean (ERAC), we incorporated these into our practice to determine if these interventions would decrease the opiate requirements further. We were so pleased to see that we could further reduce the opiate need for our moms postoperatively. In fact, we reduced it by approximately 80%, with 1/3 of our patients never taking a single narcotic medication after cesarean delivery. 

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No Decrease in Pain Relief With Less Opioids After Surgery

PainRelief.com Interview with:
Ryan Howard, MD
Academic Development Time Year 1
Resident, General Surgery
University of Michigan

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

Response: Opioids are commonly prescribed to control pain after surgery, but they also carry significant risks such as overdose, long-term dependence, and diversion into the community. While some have advocated for decreasing or eliminating opioids from postoperative pain control regimens, others are concerned that this would lead to uncontrolled pain and dissatisfied patients. To study whether that’s true, we compared two groups of patients undergoing the same surgical procedures. One group received “opioid-sparing” prescriptions after surgery and the other group received “normal-sized” prescriptions.

Conditioned Open-Label Placebos Provide Pain Relief in Some Post-Surgical Patients

PainRelief.com Interview with:
Kristin Schreiber, MD, PhD
Neuroscientist and Clinical Regional Anesthesiologist
Brigham and Women’s Hospital
Assistant Professor of Anesthesia
Harvard Medical School

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

Response: Traditionally, the placebo effect has involved deceiving patients, where they think they may be taking a real medication. “Open-label placebos” are when placebos are given to patients, and patient are told that they are in fact a placebo. Recent research has suggested that these open-label placebos may actually reduce a number of symptoms in patients, including chronic low back pain. We were interested whether this strategy could be used to help reduce pain and opioid use around the time of surgery. We decided to combine the use of OLP with a conditioning approach, so that anytime a patient took an opioid analgesic, they would take the open-label placebo, so that the OLP pills would be associated with pain relief. That way when patients took them on their own, it would serve to trigger an expectation of pain relief, which is thought to at least partially explain the placebo effect.  

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Study Discusses Overlap of Opioid Therapy for Physical and Social Pain Relief

PainRelief.com Interview with:
Mark Sullivan, MD, PhD
Professor, Psychiatry and Behavioral Sciences
Adjunct Professor, Anesthesiology and Pain Medicine, Bioethics and Humanities
Medical Co-Director, UW Telepain

Dr. Sullivan

University of Washington
Seattle, WA 98195

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

Response: This is a review paper than synthesizes neuroscience, pharmacological and epidemiological research on the opioid epidemic. It has been known since at least the 1970s that opioids treat not only pain due to physical damage, but also separation distress.

Functional neuroimaging (fMRI) studies have shown that physical pain (tissue injury) and social pain (social rejection) activate the same limbic brain centers (insula, cingulate cortex). Both chronic pain and depression are associated with dysfunction of the endogenous opioid system in the human brain. Studies of opioid prescribing have shown that patients with chronic pain, who also have anxiety and depressive disorders are more likely to be prescribed long-term opioid therapy at high doses and with concurrent sedatives.

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Opioid Analgesic Use For Pain Relief in Chronic Noncancer Pain

PainRelief.com Interview with:
Dr Stephanie Mathieson
NHMRC Health Professional Research Early Career Fellow
The University of Sydney
Faculty of Medicine and Health, Sydney School of Public Health
Institute for Musculoskeletal Health
Royal Prince Alfred Hospital Australia

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

Response: Chronic non-cancer pain, such as chronic non-specific low back pain has a substantial impact on society by costing billions of dollars each year in health care costs and lost productivity.

Current clinical practice guidelines for the management of chronic non-cancer pain, such as those from the Centers for Disease Control and Prevention, now recommend avoiding the initial use of opioid analgesics, as the risk of harms, such as overdose and death.

We wanted to establish the extent to which opioid analgesics are used by people with chronic noncancer pain. This is important, as many studies report how many opioids are prescribed, but this may not represent the actual use of opioid analgesics.

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New Model Helps Clinicians Predict Which Patients Require Highest Doses of Opioids for Pain Relief

PainRelief.com Interview with:
DrMieke Soens, MD
Anesthesiology Specialist 
Brigham and Women’s Hospital

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

Response: Opioid use worldwide has doubled in the last two decades and several countries, including the US, are struggling with a real opioid epidemic. Higher opioid doses after surgery are associated with prolonged opioid use and misuse. For example, in a study of more than 30,000 patients undergoing minor surgery such as appendectomy or gallbladder surgery, the risk to become a chronic opioid user was around 6% compared to 0.4% in the non-surgical population.

Many of our colleagues have previously identified predictors associated with more severe pain and opioid use after surgery, however, to assess those predictors, they had to use lengthy questionnaires. This approach is very time-consuming and impractical for use in daily clinical practice. The machine learning models that we have developed can work quickly and in real-time prior to surgery to mine data from patient’s electronic medical records and without the need for cumbersome questionnaires, in order to selectively identify those patients who will need high doses of opioids after surgery.

This can help reduce postoperative opioid use, by allowing the care team to maximize non-opioid analgesic strategies in these patients. Examples of non-opioid strategies include nerve blocks and epidurals and different types of non-opioid medications. We know that these alternatives can be very costly and sometimes risky. Therefore, being able to target the right treatment to the right patient is important to not only to reduce opioid use, but also to ensure that patients receive the treatment that is right for them.

Opioid Epidemic for Pain Relief Has Waned But is Not Over

PainRelief.com Interview with:
Mario Moric M.S.
Department of Anesthesiology
Rush University Medical
Center Department of Anesthesiology

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

  • Prescription Pain Medicine (PPM) abuse has become a national problem and is now consider an epidemic. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication; enough for every American adult to have a bottle of opioids. 
  • With the recent public information campaign about the epidemic and the possible addictive nature of opioid prescription pain medications, the abuse rates have declined.  We examined data from the National Survey on Drug Use and Health (NSDUH) public data derived from a national survey. 
  • We have raw data (actual reported rates of PPM abuse, see attached image) and weighted data (corrected for the sampling design).  Looking at the raw data you can see that abuse rates for lifetime use (highest line), past year use (middle red line) and past month use (bottom green line) are all more or less stable until 1998 after which we saw huge increase. From 1998 to 2004 the lifetime use increased 186%, the past year use increased 193% and the past month use increased 183%.  Then the decrease, from 2009 to 2018 the lifetime use decreased 72%, the past year use decreased 90% and the past month use decreased 185%.
  • Using the weighted data, the past year use decreases 26% and was statistically significant, indicating a real world decrease in prescription pain medication abuse.
Prescription Pain Medicine