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.
PainRelief.com Interview with: Dan P. Ly M.D., M.P.P., Ph.D. Division of General Internal Medicine and Health Services Research David Geffen School of Medicine University of California, Los Angeles
PainRelief.com: What is the background for this study? What are the main findings?
Response: We know that minority patients were less likely to receive opioids than white patients, but this could have been due to minority patients seeing lower opioid-prescribing physicians. As far as I could tell, nobody had been able to examine whether the same physician prescribed opioids differently to their minority patients.
I find that this is the case: the same physician was less likely to prescribe opioids to their minority patients with new low back pain, and instead was more likely to prescribe NSAIDs to their minority patients. And unfortunately, this differential prescribing may have had the consequence of leading to more chronic opioid use in white patients.
PainRelief.com Interview with: Kao-Ping Chua, MD, PhD Department of Pediatrics Susan B. Meister Child Health Evaluation and Research Center, Department of Health Management and Policy, School of Public Health, University of Michigan Ann Arbor
Dr. Kao-Ping Chua
PainRelief.com: What is the background for this study? What are the main findings?
Response: Having overlapping opioid and benzodiazepine prescriptions is a strong risk factor for opioid overdose even if these prescriptions are written by the same prescriber.
In this study of privately insured and Medicare Advantage patients, we show that the risk of overdose is even greater when the prescriptions are written by multiple prescribers. Specifically, the unadjusted risk of overdose on a day of overlap was 1.8 times higher when the prescriptions were written by multiple prescribers. After controlling for patient demographic characteristics, clinical co-morbidities, and prescribing patterns, the adjusted odds of overdose was 1.2 times higher, corresponding roughly to a 20% higher adjusted risk.
PainRelief.com Interview with: Julie Donohue, Ph.D., Chair and Professor University of Pittsburgh Graduate School of Public Health Department of Health Policy and Management. Lead, Medicaid Outcomes Distributed Research Network
Dr. Donohue
PainRelief.com: What is the background for this study?
Response: Medicaid plays an incredibly important role in our health system, and the population it serves overlaps with those most likely to have opioid use disorder. But Medicaid is 50-plus separate programs that can’t easily share data, so it can be difficult to draw evidence-based conclusions about the impact of interventions to prevent and treat opioid use disorder in this population.
PainRelief.com: What are the main findings?
Response: For the first time, we’ve pooled a large part of that data, enabling us to draw powerful conclusions that could better enable our country to address the opioid epidemic, which has only grown more intense during the COVID-19 pandemic. We found that the prevalence of opioid use disorder increased from 3.3% of enrollees in 2014 to 5% in 2018. Notably, the share of enrollees with opioid use disorder enrolled in Medicaid due to the ACA expansion grew from 27.3% to 50.7% in the same time period.
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