PainRelief.com Interview with: Maaz Siddiqui, BS Department of Medical Education Geisinger Commonwealth School of Medicine Scranton, Pennsylvania
Maaz Siddiqui
PainRelief.com: What is the background for this study?
Response: Over the last twenty years, the rise of deaths due to drug overdoses have been mainly and rightfully attributed to opioids. However, many investigations identify non-opioid drugs and drug classes that additionally contribute to deaths due to polysubstance overdoses. Through the Maine Diversion Alert Program (DAP) data, we examined drugs that often escape the attention of healthcare providers and directly or indirectly contribute to substance misuse, arrests, addiction, and deaths due to overdose.
The goal of this study was to utilize a novel dataset to uncover and identify the noncontrolled drugs that have shown potential to be misused.
PainRelief.com Interview with: Peggy Compton, RN, PhD, FAAN Professor and van Ameringen Endowed Chair Program Director, Hillman Scholars in Nursing Innovation Department of Family and Community Health University of Pennsylvania School of Nursing Philadelphia, PA 19104
Dr. Compton
PainRelief.com: What is the background for this study?
Response: Patients with substance use disorders are highly likely to leave the hospital against medical advice (AMA) or self-discharge, putting them at risk for poorer health outcomes including progressing illness, readmissions, and even death. Inadequate pain management is identified as a potential motivator of self-discharge in this patient population. The objective of these secondary analyses was to describe the association between acute and chronic pain and AMA discharges among persons with opioid-related conditions.
PainRelief.com: What are the main findings?
Response: The main findings were that 16% of the 7,972 admissions involving opioid-related conditions culminated in an AMA discharge, which was more than five times higher than in the general population. Self-directed discharge rates were positively associated with polysubstance use, nicotine dependence, depression, and homelessness. Among the 955 patients with at least one self-directed discharge, 15.4% had up to 16 additional self-directed discharges during the 12-month observation period. Those admitted with an acutely painful diagnosis were almost twice as likely to have an AMA discharge, and for patients with multiple admissions, rates of acutely painful diagnoses increased with each admission coinciding with a cascading pattern of worsening infectious morbidity over time. Chronic pain diagnoses were inconsistent for those patients with multiple admissions, appearing, for the same patient, in one admission but not others; those with inconsistent documentation of chronic pain were substantially more likely to self-discharge.
PainRelief.com: What should readers take away from your report?
Response: These findings underscore the importance of aggressive and effective pain care in disrupting a process of self-directed discharge, intensifying harm, and preventable financial cost and suffering. Each admission represents a potential opportunity to provide harm reduction and treatment interventions addressing both substance use and pain.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: Future research should be aimed at evaluating approaches for effective pain management in patients with opioid related disorders. These patients may present with high levels of opioid analgesic tolerance and opioid-induced hyperalgesia, suggesting that non-opioid analgesic approaches may be warranted to effectively manage their pain. Regardless of the specific pain management approach employed, patients with opioid-related disorders should believe that their complaints of pain are taken seriously and managed aggressively to maximize duration of hospital stay.
Citation:
Compton, P., Aronowitz, S.V., Klusaritz, H. et al. Acute pain and self-directed discharge among hospitalized patients with opioid-related diagnoses: a cohort study. Harm Reduct J 18, 131 (2021). https://doi.org/10.1186/s12954-021-00581-6
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The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.
PainRelief.com Interview with: Maryann Mason, PhD Department of Emergency Medicine Northwestern University Feinberg School of Medicine Buehler Center for Health Policy and Economics, Northwestern University, Chicago, Illinois
PainRelief.com: What is the background for this study?
Response: This study came about because we were looking at data for Cook County, Illinois and saw an increase in older adult opioid overdose deaths. That made us wonder if there was a national trend or the observation was limited to our local area. We undertook the research to determine that and found that it is indeed a national phenomenon.
PainRelief.com Interview with: Dr Deanne Jenkin PhD UNSW Australia, now Research Fellow at The Daffodil Centre Sydney, Australia
Dr Jenkin
PainRelief.com: What is the background for this study? What are the main findings?
Response: At the time, long-term opioid use for chronic non-cancer pain was increasing and there were signs that their benefit was overestimated whilst the harms were underestimated. Our randomized trial found that after going home from fracture surgery, strong opioids were not better for pain relief compared to a milder, potentially safer opioid alternative.
PainRelief.com Interview with: Deepak Kumar, PT, PhD Assistant Professor, Physical Therapy Assistant Professor, BU School of Medicine Director, Movement & Applied Imaging Lab
Dr. Kumar
PainRelief.com: What is the background for this study? What are the main findings?
Response: We investigated the association of physical therapy interventions with long-term opioid use in people who undergo total knee replacement surgery. For people with advanced osteoarthritis, total knee replacement is the only option. The number of total knee replacement surgeries has been increasing and is expected to rise exponentially over the next few years with an aging population and rising rates of obesity. However, up to a third of patients continue to experience knee pain after this surgery. Also, a significant proportion of people become long-term opioid users after total knee replacement. Reliance on opioids may reflect a failure of pain management in these patients. Given that physical therapy interventions are known to be effective at managing pain due to knee osteoarthritis, we wanted to study whether physical therapy before or after surgery may reduce the likelihood of long-term opioid use.
We used real-world data from insurance claims for this study. In our cohort of about 67,000 patients who underwent knee replacement between 2001-2016, we observed that, receiving physical therapy within 90 days before surgery or outpatient physical therapy within 90 days after surgery were both related to lower likelihood of long-term opioid use later. We also observed that initiating outpatient physical therapy within 30 days and 6 or more sessions of physical therapy were associated with reduced likelihood of long-term opioid use compared to later initiation or fewer PT sessions, respectively. However, we did not see an association between type of physical therapy. i.e., active (e.g., exercsise) vs. passive (e.g., TENS) and long-term opioid use.
Importantly, most of our findings were consistent for people who had or had not used opioids previously. We also were able to account of a larger number of potential factors that could confound these associations because of the large sample size. However, there are limitations to our work. Since we only had access to insurance claims data but not to health records, we are unable to make any inferences about association of physical therapy with pain or quality of life, etc.
PainRelief.com Interview with: Adriane Fugh-Berman MD Professor, Dept. of Pharmacology and Physiology Georgetown University Medical Center
PainRelief.com: What is the background for this study? What are the main findings?
Response: The first exposure of adolescents and young people to opioids is through dentists, who frequently prescribe opioids after dental procedures. Dentists are the highest prescribers of opioids to patients under 18. We conducted a national survey of dentists and received 269 responses from 30 states and 2 territories.
Four of five dentists knew that that nonsteroidal anti-inflammatory drug (NSAID)-acetaminophen combinations are equally as effective or more effective than opioids, but 43% still regularly prescribed opioids. There was more caution about prescribing opioids to adolescents aged 11 through 18 years, but only half ( 48%) reported they were less likely to prescribe opioids to young adults 19 -25 years (compared to adults over 25). This is concerning because adolescents and young adults under 25 are more likely to develop opioid use disorder than adults over 25.
One-half of those who reported prescribing opioids reported prescribing more opioids than needed, which would result in leftover pills. Leftover pills pose a risk for later misuse.
PainRelief.com Interview with: Carlen Reyes PhD Médico de familia Gestora de proyectos de investigación IDIAP Jordi Gol
PainRelief.com: What is the background for this study? What are the main findings?
Response: Tramadol and codeine are two “weak” opioids frequently prescribed for different non-cancer pain indications, however, few are the studies that compare the adverse outcomes between them using large routinely collected primary care data. We aimed to fulfil this gap by analysing the risk of adverse events with the tramadol and codeine dispensations in a large primary care health care data (SIDIAP database) from Spain.
We found that the dispensations of tramadol were associated with a greater risk of cardiovascular events, mortality and fractures compared to the dispensations of codeine.
PainRelief.com Interview with: Carsten Hjorthøj, senior Researcher Copenhagen Research Center for Mental Health – CORE, Mental Health Center Copenhagen, Copenhagen University Hospital University of Copenhagen, Department of Public Health Section of Epidemiology, Copenhagen, Denmark.
PainRelief.com: What is the background for this study? What are the main findings?
Response:Denmark introduced a pilot program of medical cannabis in 2018. Medical cannabis, and cannabis-based medicine, has gained a lot of both attention and controversy as a possible way to treat pain disorders, but the evidence base is still sparse. The Danish nationwide unselected registers allow us to perform a high quality pharmacoepidemiologic study with propensity score matched controls.
The main findings are that medical cannabis and cannabis-based medicine did not reduce the use of opioids in pain patients, and might actually lead to an increase in use of opioids. However, patients with neuropathic pain disorders appeared to reduce their use of gabapentin, their use of overall medication (but not opioids!), and the number of days spent in hospital, compared with controls.
Sarah A. Eidbo, MS MD Candidate Geisinger Commonwealth School of Medicine Class of 2023 Scranton, Pennsylvania
Sarah A. Eidbo
MedicalResearch.com: What is the background for this study?
Response: The United States is still witnessing the fallout from years of a devastating, multifaceted opioid crisis. However, in the wake of this situation, healthcare providers and systems across the nation have implemented many strategies to curb the damage where they can. This study1 used reports from the Drug Enforcement Administration (DEA)2 to quantify the changes and trends in prescription opioid distribution to hospitals in the U.S .over the past two decades.
PainRelief.com Interview with: Victoria D. Powell, MD, FACP Clinical Lecturer – Geriatric and Palliative Medicine University of Michigan Staff Physician, Palliative Care LTC Charles S. Kettles VA Medical Center Ann Arbor, MI
Dr. Powell
PainRelief.com: What is the background for this study? What are the main findings?
Response: People with chronic pain who use long-term opioids face a number of health risks, and often do not have optimally controlled pain.
Buprenorphine acts on the opioid receptor with a different effect than drugs like morphine or oxycodone, and as a result is less associated with the risks of long-term opioid use, such as accidental overdose. While buprenorphine has been successfully used in patients with opioid use disorder for several years, certain experts have proposed using buprenorphine for pain management in people with chronic pain. We found low quality evidence supporting pain control that may be superior to traditional opioids, but much more research is needed to confirm.
The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, endorese, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website. None of the content on PainRelief.com is warranted by the editors or owners of PainRelief.com or Eminent Domains Inc.
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