Jason E. Goldstick, PhD Injury Prevention Center Department of Emergency Medicine University of Michigan, Ann Arbor
PainRelief.com: What is the background for this study? What are the main findings?
Response: In 2016, the CDC released the Guideline for Prescribing Opioids for Chronic Pain. A primary goal of this voluntary guideline is that individuals should receive pain management care that provides the greatest overall benefit. Among other things, this may entail beginning opioid treatment only when the clinician determines that the expected benefits outweigh the risks.
Other research has shown reductions in opioid prescribing as reduced since the guideline release; this report examines whether there were changes in nonopioid pain medication prescribing.
Our overall findings were that nonopioid prescribing increased nationally following the guideline release, above and beyond what would’ve been predicted based on the pre-guideline trends, and this finding was generally consistent across patient subpopulations (e.g., those with vs. without prior opioid exposure).
PainRelief.com Interview with: Lauren R. Gorfinkel MPH New York State Psychiatric Institute New York, NY Department of Medicine, University of British Columbia Vancouver, Canada
PainRelief.com: What is the background for this study?
Response: The opioid crisis has led to clear declines in opioid prescribing across North America, however, chronic pain remains an extremely common health problem with limited treatment options. This study was therefore interested in using nationally-representative data to find out whether alternative pain medications are growing more popular as opioid prescriptions decline.
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: 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: 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: 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.
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.
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.
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.
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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