Alternative Pain Management Strategies Research Articles

Prescription time trends in patients with high-impact chronic pain: A National Patient Registry Study.

High-impact chronic pain (HICP), defined as chronic pain with a significant impact on daily function, affects approximately 8% of the Western population. In Denmark, HICP still remains to be described at the population level. Some patients with HICP are referred to the Danish pain centres, where they are registered with a procedural code. We conducted a nationwide registry-based study of all Danish patients registered with a visit to a pain centre from January 2005 to March 2022, to explore time trends in the prescription of analgesics and sedatives in this HICP subpopulation. Furthermore, data on socioeconomics and hospital diagnoses are reported. We used data from the Central Person Registry, the Danish National Patient Registry, the Danish National Prescription Registry, combined with data on socioeconomic information from Statistics Denmark. Data was collected on prescriptions 3 months before the first visit to a pain centre. Prescriptions were stratified into five calendar periods: before 2011, 2011-2013, 2014-2016, 2017-2019, and 2020-2022. We identified 66,577 patients referred to a pain centre. Over 15 years, prescriptions before referral declined for opioids (from 53.2% to 31.7%), NSAIDs (from 28.3% to 23.5%), antidepressants (from 20.5% to 16.8%), anxiolytics (from 12.3% to 3.2%), and sleep medication (from 15.8% to 7.6%). In contrast, prescriptions increased for paracetamol (from 31.1% to 48.9%) and gabapentinoids (from 19.2% to 27.7%). In patients with HICP visiting Danish pain centres, prescriptions before referral decreased for opioids over 15 years, with a simultaneously increased prescription of gabapentinoids (gabapentin and pregabalin). This nationwide study of 66,577 Danish patients with high-impact chronic pain reveals a significant decrease in filled opioid prescriptions over the past 15 years, with a simultaneous rise in gabapentinoid use before referral to pain centres. These findings suggest a shift in clinical practice towards alternative pain management strategies. The study underscores the need for continued research into the long-term effects of these changes and their impact on patient outcomes.

Efficacy of Epidural Steroid in Controlling Pain After Unilateral Biportal Endoscopic Discectomy for Single-Level Lumbar Disc Herniation: A Randomized, Double-Blind, Placebo-Controlled Trial.

The effects of epidural steroid (ES) administration following open or minimally invasive surgery lumbar discectomy have been extensively studied. However, no research has investigated the impact of steroids following the unilateral biportal technique endoscopic lumbar discectomy (UBE-D) for lumbar disc herniation. This study aims to evaluate the efficacy of ES administration in controlling postoperative pain and disability scores following UBE-D for single-level lumbar disc herniation. This double-blind, randomized, placebo-controlled trial was conducted between June 2021 and June 2023. Eighty-two patients were assessed, and 60 were eligible and randomized to receive either ES (n = 30) or saline (placebo; n = 30) after UBE-D. The Outcome measures included visual analog scale scores for pain, Oswestry Disability Index scores, morphine consumption over 24 hours, serum C-reactive protein levels, and the occurrence of complications over a 6-month follow-up period. The baseline characteristics were comparable between the 2 groups, with no significant differences observed. Analysis of visual analog scale scores for back and leg pain, as well as Oswestry Disability Index scores, at various postoperative time points (6 hours, 12 hours, 24 hours, 2 weeks, 6 weeks, 3 months, and 6 months), showed no statistically significant differences between the ES and placebo groups (P values ranged from 0.47-0.94). Additionally, no significant differences were found in morphine consumption within the first 24 hours postoperatively (P = 0.85), length of hospital stay (P = 0.36), or C-reactive protein levels at 24 hours and 3 weeks postoperatively (P values ranged from 0.54-0.79) between the 2 groups. Importantly, no postoperative or steroid-related complications were reported in either group within the 6-month follow-up period. ES administration after UBE-D did not significantly reduce postoperative pain, disability scores, or morphine consumption compared with placebo. The findings suggest that routine use of ESs in this context may not provide additional benefits. Clinicians should reconsider the use of epidural steroids as part of standard postoperative management after UBE-D, as the lack of significant improvement in patient outcomes indicates that alternative pain management strategies may be more effective.

Opioid use and adverse health effects in breast cancer survivors.

Little information exists on adverse effects related to opioid use in breast cancer survivors following active cancer treatment, and no studies included an age-matched comparison group. Thus, we examined opioid use and risk of falls, fractures, lung problems, and cardiovascular events in breast cancer survivors in the years following active cancer treatment along with a comparison group. We conducted a longitudinal cohort study 33989 breast cancer survivors and 157609 age-matched women without cancer. Rates of adverse events, and multivariable hazards ratios for association between opioid use and the adverse health effects were calculated. Women with breast cancer had greater opioid use (60% vs 48%); longer median opioid duration (18 vs 16 days); and were prescribed stronger opioids than the matched cohort over 5.6 median years of follow-up. In multivariable models, the risk of falls was 12% higher (HR, 95% CI, 1.12 [1.07-1.17]), and fracture risk was 56% (HR = 1.56 [1.48-1.65]) greater in women with breast cancer who used opioids vs the matched cohort unexposed to opioids. In an analysis restricted to women with breast cancer, opioid use was strongly associated with the risk of falls (HR = 1.74 [1.63-1.85]); fractures (HR = 2.10 [1.95-2.27]); lung problems (HR = 1.53 [1.43-1.64]); and cardiovascular events (HR = 1.70 [1.39-2.08]) than opioid non-use. After active cancer treatment, opioid use and high dosage use were common in breast cancer survivors, and were associated with increased risk for falls, lung problems, fractures, and cardiovascular events. Findings underscore the need for careful monitoring of opioid use in these survivors and the exploration of alternative pain management strategies.

OXYCODONE FOR ENDOMETRIOSIS PAIN MANAGEMENT: A COMPREHENSIVE NARRATIVE REVIEW

Endometriosis is a chronic gynecological condition characterized by the presence of endometrial-like tissue outside the uterus, leading to severe pelvic pain, infertility, and diminished quality of life. Pain management in endometriosis is multifaceted, often requiring a combination of pharmacological and non-pharmacological approaches. Oxycodone, a potent opioid analgesic, is frequently considered for managing severe pain when conservative treatments fail. This narrative review explores the efficacy, benefits, and challenges associated with oxycodone use in endometriosis pain management. Additionally, it examines alternative pain management strategies and provides clinical recommendations to optimize patient outcomes while mitigating potential risks.

Mitigating the Opioid Epidemic: The Role of Cannabinoids in Chronic Pain Management-A Systematic Review and Meta-Analysis of Clinical Evidence and Mechanisms

Background and Objectives: As the medical community seeks alternative pain management strategies, cannabinoids have emerged as a potential option. This review discusses the role of cannabinoids in chronic pain management and their potential as an alternative treatment in pain medicine, focusing on efficacy, safety, and possible opioid reduction. The objectives are to evaluate the efficacy and safety of cannabinoids in chronic pain management, explore their potential to reduce opioid use, and identify the mechanisms by which cannabinoids exert their analgesic effects. Additionally, the review seeks to highlight the clinical implications and limitations of using cannabinoids as an alternative to opioids. Methods: A comprehensive literature review and meta-analysis were conducted, focusing on studies from PubMed, MEDLINE, and Cochrane, focusing on various types of studies. Data were extracted and analyzed to assess the efficacy, safety, and potential opioid-sparing effects of cannabinoids. Mechanistic insights were also explored to understand how cannabinoids modulate pain. Results: Cannabinoids have shown efficacy in managing chronic pain, with evidence indicating their ability to reduce pain and improve quality of life. Studies suggest that cannabinoids can provide significant analgesic effects, although there is variability in efficacy across trials. Findings also show that Cannabinoids modulate pain through the endocannabinoid system, which plays a crucial role in pain perception and inflammation. Limitations: The variability in efficacy across studies suggests a need for standardized formulations and dosing regimens. Long-term effects of cannabinoid use are not fully understood, necessitating further research. More highquality trials are needed to confirm findings and address potential biases. Conclusion: Cannabinoids offer a promising alternative for chronic pain management, with the potential to mitigate the opioid epidemic. Integrating cannabinoids into clinical practice, guided by evidence-based protocols, can provide a safer and effective approach to chronic pain management

Opioid alternatives in spine surgeries.

The escalating opioid crisis has intensified the need to explore alternative pain management strategies for patients undergoing spine surgery. This review is timely and relevant as it synthesizes recent research on opioid alternatives for perioperative management, assessing their efficacy, side effects, and postoperative outcomes. A systematic search was conducted to capture articles from the past 18 months that examined opioid-sparing strategies. Findings indicate that multimodal analgesia, incorporating nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, lidocaine, gabapentinoids, N-methyl-D-aspartate (NMDA) antagonists, dexmedetomidine, and emerging regional block techniques like the erector spinae block and TLIF (thoraco lumbar interfascial block), can significantly reduce opioid consumption without compromising pain relief. Additionally, these approaches reduce opioid-related side effects such as postoperative nausea, vomiting, and prolonged hospital stays. The use of multimodal analgesia aligns with current pain management guidelines and addresses public health concerns related to opioid misuse. While effective, these alternatives are not without side effects, and the ultimate outcome depends on balancing benefits and risks. Future research should focus on the long-term outcomes of opioid alternatives, their effectiveness across diverse populations, and further validation and optimization of these strategies.

A Systematic Literature Review on the Predictors of Drug Abuse, Substance Use, and Opioid Misuse among Adolescents

Opioid misuse and dependence on prescribed opioids have strong link with drug addiction prevalence among adolescents. To gather evidence on the predictors of substance use, opioid abuse, and misuse of prescribed opioids, a systematic literature review was conducted covering articles published between 2016-2022. Of the 31 included articles, descriptively, substance use was considered as the dependent outcome in most of the studies (n = 15), compared to opioid misuse (n = 11), and prescription opioid misuse (n = 5). Resultantly, the common factors for substance use, opioid abuse, and misuse of prescribed opioids were broadly categorised into family-related factors, pain intensity and interference, comorbidity and psychopathology, demographic factors, substance use disorders and other drug addictive behaviours, and peer influence. Apart from the need to provide alternative pain management strategies, these factors should be considered by clinicians in identifying adolescents who are currently engaged in substance use or opioid abuse, and those likely to misuse prescribed opioids in the future.

Exploring the Role of Community Pharmacists in Pain Management: Enablers and Challenges.

Pain is a common complaint, and the consumption of analgesics is prevalent. Community pharmacists, as primary contact points for patients, can play a crucial role in guiding patients toward rational pharmacotherapy or alternative pain management strategies. However, there are no specific educational curricula or standard guidelines to support this role, and the perception of this potential role is not well known. We conducted an anonymous online questionnaire among community pharmacists in Norway to assess their knowledge, perspectives, and willingness to engage in pain care. The survey also explored potential facilitators and barriers, and the use of any current guidelines. Seventy-one community pharmacists participated from various regions in Norway. Findings revealed that community pharmacists felt knowledgeable and willing to engage in pain management but anticipated barriers such as time constraints and a lack of standard guidelines. Participants also highlighted the need for better collaboration with other healthcare professionals and continuous professional development to enhance their role. To optimize the role of community pharmacists in pain management, therefore, integrating them into multidisciplinary healthcare teams, minimizing barriers, and providing continuous education and standard guidelines seem essential. This approach can empower community pharmacists and improve pain management outcomes.

Understanding Fentanyl A Synthetic Piperidine Opioid Drug: Deciphering the Pain-Relieving Double-Edged Sword

Fentanyl is a synthetic opioid analgesic that has revolutionized pain management in various medical contexts. It has remarkable potency and effectiveness in managing severe pain, owing to its unique mechanisms of action on opioid receptors and modulation of pain perception. Fentanyl can be administered through various routes, such as transdermal patches, intravenous injections, lozenges, and nasal sprays. It is commonly utilized for post-operative pain management, cancer-related pain, and palliative care. However, fentanyl also poses significant risks of addiction, abuse, and overdose. The alarming increase in fentanyl-related fatalities underscores the importance of understanding proper dosage, monitoring patients closely, and implementing harm reduction strategies. Furthermore, the responsible use of fentanyl requires comprehensive patient assessment, individualized treatment plans, and the active involvement of healthcare providers in educating patients and obtaining informed consent. The article also discusses ongoing research efforts to improve fentanyl’s safety profile while maintaining its efficacy. These include emerging technologies, potential formulations, and alternative pain management strategies that could help reduce the dependence on fentanyl and prevent its adverse effects. The article provides a balanced perspective on fentanyl, emphasizing the balance between its pain-relieving benefits and the potential risks it poses. It also reinforces the significance of responsible prescribing, vigilant monitoring, and patient education to ensure optimal pain relief and patient safety.

Effectiveness of the Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) for Postoperative Pain Management in Patients Undergoing Major Surgical Operations at Manokwari Hospital

Postoperative pain is a common complication in patients undergoing major surgical operations, interfering with comfort and recovery and increasing the risk of further complications. This study aimed to evaluate the effectiveness of NSAIDs in managing postoperative pain at Manokwari Regional Hospital. Utilizing qualitative research methods, data was collected through observation and literature study and analyzed via data reduction, data presentation, and conclusion drawing. The findings indicate that NSAIDs effectively alleviate postoperative pain by inhibiting cyclooxygenase (COX) enzymes responsible for prostaglandin production. However, their use is limited by potential systemic side effects, including gastrointestinal disorders, kidney impairment, increased blood pressure, heart attack, and heart failure. Consequently, topical NSAID formulations are recommended to mitigate these risks. The study suggests that while NSAIDs are effective, clinicians should consider their side effects and prefer topical alternatives. Future research should explore the efficacy and safety of topical NSAIDs and alternative pain management strategies to enhance clinical practice.

New perspectives on migraine treatment: a review of the mechanisms and effects of complementary and alternative therapies.

Migraine is a prevalent and disabling neurovascular disorder, with women being more susceptible, characterized by unilateral throbbing headache, often accompanied by nausea and vomiting, and often associated with various comorbidities such as brain and cardiovascular diseases, which can have a serious impact on quality of life. Although nonsteroidal anti-inflammatory drugs (NSAIDs) are the main first-line medications for the treatment of pain, long-term use often leads to side effects and drug addiction, which emphasizes the need to investigate alternative pain management strategies with fewer adverse effects. Complementary and alternative medicine is a viable pain intervention often used in conjunction with traditional medications, including acupuncture, herbs, moxibustion, transcutaneous electrical stimulation, bio-supplements, and acupressure, which offer non-pharmacological alternatives that are now viable pain management options. This review focuses on the mechanistic doctrine of migraine generation and the role and potential mechanisms of Complementary and Alternative Therapies (CAT) in the treatment of migraine, summarizes the research evidences for CAT as an adjunct or alternative to conventional therapies for migraine, and focuses on the potential of novel migraine therapies (calcitonin gene-related peptide (CGRP) antagonists and pituitary adenylyl cyclase-activating peptide (PACAP) antagonists) with the aim of evaluating CAT therapies as adjunctive or alternative therapies to conventional migraine treatment, thereby providing a broader perspective on migraine management and the design of treatment programs for more effective pain management.

Trends in Opioid Use during Hospitalization following Revision Total Hip Arthroplasty from 2016 to 2021

AbstractThough opioids can be very effective for postoperative pain management after revision total hip arthroplasty (rTHA), many physicians have made an effort to decrease usage of these medications by focusing on alternative pain management strategies to reduce opioid dependence and unwanted side effects. This study sought to investigate trends in opioid consumption during hospitalization following rTHA from 2016 to 2021. We retrospectively reviewed all patients who received rTHA from January 2016 to April 2021. Baseline demographic variables including age, gender, race, body mass index, and American Society of Anesthesiologists classification were recorded. Additional information including patient-reported outcome measures (PROMs), postoperative outcomes, dosage, and type of opioid medication prescribed postoperatively were also collected. Opioid dosage and type were converted to milligram morphine equivalents (MMEs) per day of hospitalization and compared across the 6 years studied. Linear regression as well as t-tests were utilized to determine significant trends in MME consumption over time. In total, 1,096 patients met inclusion and exclusion criteria. The greatest daily average opioid consumption per patient was in 2017 (61.6 ± 155.4 MME per day) and the lowest was in 2021 (31.8 ± 105.8 MME per day). Linear regression analysis detected a downward trend of 4.97 MME per day each year, though these results were not statistically significant (R 2: 0.444, p = 0.089). t-Test analysis, however, did reveal a significant decrease in opioid consumption in the postprotocol cohort (38.41 ± 90.5 vs. 52.18 ± 120.2; p = 0.034). There was a significant increase in preoperative Hip Disability and Osteoarthritis Outcome Score, Joint Replacement scores (p = 0.007) over time as well as a significant decrease in preoperative visual analog scale pain scores (p = 0.012). The results of this study show that opioid consumption in 2021 was lower than in 2016 and 2017. This result emphasizes the effectiveness of protocols limiting opioid usage during hospitalization following rTHA. Moreover, the relatively consistent patient-reported outcome scores over time demonstrate that this decrease in opioid consumption per year does not impact patient-reported outcomes and satisfaction.

Attitudes and Practices Surrounding Opioid Prescriptions following Open Reduction Internal Fixation of Distal Radius and Ankle Fractures: A Survey of the Canadian Orthopaedic Association Membership.

The past two decades have seen a significant increase in consequences associated with nonmedical misuse of prescription opioids, such as addiction and unintentional overdose deaths. This study aimed to use an electronic survey to assess attitudes and opioid-prescribing practices of Canadian orthopaedic surgeons and trainees following open reduction internal fixation (ORIF) of distal radius and ankle fractures. This study was the first to assess these factors following ORIF of distal radius and ankle fractures using a survey design. A 40-item survey was developed focusing on four themes: respondent demographics, opioid-prescribing practice, patients with substance use disorders, and drug diversion. The survey was distributed among members of the Canadian Orthopaedic Association. Descriptive statistics were used to summarize respondent demographics and outcomes of interest. A Chi-square test was used to determine if proportion of opioid prescriptions between attending surgeons and surgeons in training was equal. 191 surveys were completed. Most respondents prescribed 10-40 tabs of immediate-release opioids, though this number varied considerably. While most respondents believed patients consumed only 40-80% of the prescribed opioids (73.6%), only 28.7% of respondents counselled patients on safe storage/disposal of leftover opioids. 30.5% of respondents felt confident in their knowledge of opioid use and mechanisms of addiction. Most respondents desired further education on topics such as procedure-based opioid-prescribing protocols (74.2%), alternative pain management strategies (69.7%), and mechanisms of opioid addiction (49.0%). The principle finding of this study is the lack of a standardized approach to postoperative prescribing in distal radius and ankle fractures, illustrated by the wide range in number of opioids prescribed by Canadian orthopaedic surgeons. Our data suggest a trend towards overprescription among respondents following distal radius and ankle ORIF. Future studies should aim to rationalize interventions targeted at reducing postoperative opioid prescribing for common orthopaedic trauma procedures.

Experiences of pain and pain management in advanced disease and serious illness for people from South Asian communities in Leeds and Bradford: a qualitative interview study

BackgroundPain is a significant problem for many people with advanced disease or a serious illness. Culture and ethnicity can affect the experience and management of pain. However, there is limited research in South Asian communities in the UK on their experiences of pain. The aim of this study is to explore the experiences and attitudes of patients and family carers from South Asian communities about pain and its management within advanced disease or serious illness.MethodsQualitative thematic analysis based on descriptive phenomenology (Sundler et al. 2019). Qualitative semi-structured interviews with patients or family carers from South Asian communities (N = 15). Interviews were recorded, transcribed and analysed using an inductive approach. Public and Patient Involvement representatives from British South Asian communities were consulted for guidance.ResultsThere were five key themes from the interviews: The importance of communication about pain with healthcare professionals; Concerns about taking pain medication; Personal resilience, privacy and self-management; Gender, culture and pain; Home pain management as struggle and frustration.ConclusionTo improve pain management for people from South Asian communities with advanced disease or a serious illness, there are a number of important issues for healthcare professionals from palliative and primary care services to address. These include: greater awareness around people’s fears and concerns about pain medication; their potential use of alternative pain management strategies; and cultural issues such as resilience, privacy, dignity and gender roles. Effective communication between doctors, patients and family members could be improved by using a ‘cultural humility’ model; providing clear and accessible pain medication information; understanding and taking account of people with both low, and medium levels, of English language proficiency; and improving patient trust. Additionally, improvements to out of hours services could improve pain management for all patients managing their pain at home.

Multimodal Analgesia and Patient Education Reduce Postoperative Opioid Consumption in Otology.

This study sought to validate alternative pain management strategies that can reduce reliance on opioids for postoperative pain management in otology. Prospective cohort study. Single tertiary-care facility. Adult patients who underwent outpatient otologic surgery from September 2021 to July 2022 were randomized into treatment cohorts. The opioid monotherapy cohort received a standard opioid prescription. The multimodal analgesia cohort received the same opioid prescription, prescriptions for acetaminophen and naproxen, and additional pain management education with a flyer on discharge. All patients completed a questionnaire 1 week after surgery to evaluate opioid usage and pain scores. Eighty-six patients completed the study. The opioid monotherapy cohort (n = 42) and multimodal analgesia cohort (n = 44) were prescribed an average of 42.1 ± 20.4 morphine milligram equivalents (MME) and 38.4 ± 5.7 MME, respectively (p = 0.373). Four patients (9.52%) in the opioid monotherapy cohort required opioid refills compared to 1 patient (2.27%) in the multimodal analgesia cohort (p = 0.156). Multivariate analysis demonstrated that the multimodal analgesia cohort consumed significantly fewer opioids on average than the opioid monotherapy cohort (11.9 ± 15.9 MME vs 22.8 ± 28.0 MME, respectively). There were no significant differences in postoperative rehospitalizations (p = 0.317) or Emergency Department visits (p = 0.150). Pain scores on the day of surgery, postoperative day (POD) 1, POD3, and POD7 were not significantly different between cohorts (p = 0.395, 0.896, 0.844, 0.765, respectively). The addition of patient education, acetaminophen, and naproxen to postoperative opioid prescriptions significantly reduced opioid consumption without affecting pain scores, refill rates, or complication rates after otologic surgery.

Prevention and Management of Sickle Cell Pain Crises: Lessons Learned from Older Adults with Sickle Cell Disease

Background Innovations in medicine over the last fifty years have extended the median lifespan of people living with sickle cell disease (SCD) from 14 years to as long as 61 years in cohorts from academic centers. There is a paucity of information on the experiences preventing and managing vaso-occlusive pain crises by older adults with SCD. Older adults with SCD have decades of experience navigating pain and other complications of SCD. They have a wealth of knowledge about how to care for themselves, which can be shared with a younger generation of those with SCD. The purpose of this study was to describe strategies used by older adults (≥50 years) to prevent and manage pain crises. Methods We enrolled 19 men and women at least 50 years old from a single comprehensive sickle cell center in the Southeastern United States. We conducted semi-structured qualitative interviews by phone or in person. A single interviewer asked open-ended questions about the participant's experiences living with SCD and strategies they feel helped them live a long life. Participants described strategies they have adopted to cope with and prevent pain crises. A commercial service transcribed audio-recordings of the interviews verbatim. We used conventional content analysis to code the transcripts. Results The mean age of participants was 58 years (range 50-71). Over half (53%) had HbSS genotype, 37% had HbSC, and 11% had HbSβ+-thalassemia. Almost half (45%) were hospitalized and 63% had an emergency room visit in the last year. Most participants (84%) were on short-acting and 37% were on long-acting opiates. The majority (58%) reported current use of hydroxyurea. During the interview participants discussed strategies used to prevent and manage their pain crises. There were two major themes. (Figure 1) Theme 1 was "Strategies for Pain Prevention", which centered on methods they adopted throughout their lives to help prevent pain crises. Participants described that when they were younger pain medicine was not readily available, causing them to focus on strategies to prevent pain crises. They often relied on their parents to set limits on their activity levels to avoid having a crisis. When they reached adulthood, they learned to advocate for themselves by communicating their limitations. Having a good support system to encourage them to rest also helped. Most participants emphasized the importance of moving at their own pace and slowing down when they needed to. They discussed how knowing their triggers helped avoid a pain crisis or manage it better on their own. Sometimes simply sleeping once they felt a pain crisis coming on could help avert a crisis. Avoiding stressful situations, emotional triggers, temperature extremes, being underdressed, sitting long periods, and dehydration helped to prevent pain crises. Most participants described how a healthy diet and exercise were key in the prevention of pain crises. Eating fruits and vegetables, avoiding sugary drinks, excessive alcohol, and processed foods helped reduce pain episodes. They described low impact exercises they engaged in such as walking, yard work, and cycling. Theme 2 was "Strategies for Managing Pain” which included using pharmacological and non-pharmacological methods. One of the most important strategies participants mentioned was to rest as soon as a pain crisis started. For some, physical activity helped relieve pain, while for others, it was a trigger for a crisis. The strategies adopted also included hydration, heating pads, resting, distraction techniques, and avoiding stress as much as possible. Alternative pain management strategies that were reported included acupuncture, massage, and aquatic therapy. While pain medication was useful, many participants stated that they did not like being prescribed pain medicine without other therapies. Conclusion The growing population of older adults with SCD have a wealth of knowledge that can benefit younger adults with SCD to prevent and manage pain crises. Strategies they have learned through a lifetime of experience living with SCD have given them a unique insight into how to best cope with pain crises. In future research we will evaluate how best to share approaches developed by people with SCD for preventing and managing SCD complications. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Emergency Department Experience and the Use of Non-Pharmacologic Treatment for Acute Pain Among Patients with Sickle Disease

Background: Appropriate management for patients presenting to the Emergency Department (ED) with acute pain from vaso-occlusive episodes (VOE) primarily includes treatment with parenteral opioid and non-opioid analgesia and fluids if the episode is uncomplicated. Non-pharmacological strategies that significantly affect non-physical aspects of behavioral, social, and cultural life, have been studied for pain treatment in sickle cell patients; however, the data on the effectiveness of these methods are limited. Objectives: This work aims to assess the overall ED experience among patients seeking care for acute VOE. We also aim to assess any effective alternative pain management strategies used by patients to treat their acute pain symptoms. Methods: We conducted ED follow up assessments for patients who sought care in the ED for acute pain from vaso-occlusive episodes from January 1, 2022- July 15, 2022. These were brief individual phone interviews. The semi-structured interview guide was created using a hospital specific patient experience questionnaire in addition to questions pertaining to pain management in the acute and day-to-day settings, demographic data including, age, sex, emergency department visit characteristics (length of stay (LOS), emergency severity index assignment (ESI), time to first opioid). The interviews were analyzed using a framework matrix analysis. This qualitative data reduction technique was used to review, summarize, and classify the interview data. NVivo 20 qualitative data analysis software includes a framework matrix tool used to manage data and facilitate this analysis in which participant comments about key content were aggregated and entered for review. Results: Overview: Among the 21 patients who met study criteria, eight participants are included in this analysis. Six participants identified as male, and two participants identified as female. ED Experience: Patients rated their ED care from a 3/10 to a 10/10 (avg 6.4, +/- 2.6). Common themes included prolonged wait times for pain management (6/8 participants). Five of the eight patients interviewed expressed gratitude for the care provided though noted some room for improvement. One participant noted "they could have been nicer to me. It's like they don't talk to each other" (2/8 participants). Patients also expressed frustration when intravenous access issues arise and compounding delays in treatment. Pain management: Three of the eight patients interviewed reported using scheduled opioids (oxycodone-5 patients, and methadone-2 patients) at home every 3-8 hours. One patient declined to answer questions about home opioid use. All patients received hydromorphone for acute management in the ED. Two of the eight patients expressed knowledge of their care coordination pain management plan. Alternative pain management: Five of the eight patients used heat or hot packs as their primary alternative pain management and specifically referenced this as an intervention that they would find helpful in the ED. Two patients prioritized distractions such as video games or other screen time. One patient relied on family support, massages, and meditation. Conclusions: Patients experiencing acute pain from VOE rely on the ED for care. Optimizing that care will not only improve patient's health, but also their well-being. Considering complementary alternatives for acute pain management including heat therapy (packs, blankets) as well as massage (heated chair) or distractions (video games, reading or movies) may provide additional benefits while patients seek care for acute pain crises.

Laparoscopic transversus abdominis plane block reduces postoperative opioid requirements after laparoscopic cholecystectomy

BackgroundSurgeons directly contribute to the over-prescription of opioids. Alternative postoperative pain management strategies are necessary to reduce opioid dispensation and combat the opioid epidemic. We set out to examine the effectiveness of a laparoscopic transversus abdominis plane block on reducing opioid requirements after laparoscopic cholecystectomy. MethodsIn a retrospective cohort analysis, we compared opioid naïve patients who underwent an elective, outpatient laparoscopic cholecystectomy with a transversus abdominis plane block with patients who underwent a laparoscopic cholecystectomy alone between January 2018 and June 2021 at a single institution. Patient characteristics, perioperative pain scores, and postoperative analgesic requirements were compared between cohorts. ResultsThere were 200 patients included in the study (laparoscopic cholecystectomy with a transversus abdominis plane block, n = 100; laparoscopic cholecystectomy alone, n = 100). The average postoperative pain scores in the postanesthesia care unit were equivalent between the groups (laparoscopic cholecystectomy with a transversus abdominis plane block = 3.39 versus laparoscopic cholecystectomy alone = 4.17, P = .12), with the mean postanesthesia care unit opioid requirements significantly lower in patients receiving laparoscopic cholecystectomy with a transversus abdominis plane block (12.1 vs 20.4 oral morphine equivalents, P < .001). Patients receiving laparoscopic cholecystectomy with a transversus abdominis plane block were prescribed fewer opioids on discharge (mean 77.5 vs 92.9 oral morphine equivalents, P < .05) and reported using a lower proportion of their opioid prescription at follow-up (83.2% vs 100%, P < .001). Of the patients receiving laparoscopic cholecystectomy with a transversus abdominis plane block, 65% reported using over-the-counter pain medications compared with 82% of patients receiving laparoscopic cholecystectomy alone (P < .001). ConclusionPerforming a laparoscopic transversus abdominis plane block during elective laparoscopic cholecystectomy is a safe and effective strategy to reduce postoperative opioid requirements for the treatment of acute postoperative pain.

Management of Chronic Pain in Long-Term Care: A Systematic Review and Meta-Analysis.

Pain, a complex subjective experience, is common in care home residents. Despite advances in pain management, optimal pain control remains a challenge. In this updated systematic review, we examined effectiveness of interventions for treating chronic pain in care home residents. A Cochrane-style systematic review and meta-analysis using PRISMA guidelines. Randomized and nonrandomized controlled trials and intervention studies included care home residents aged ≥60years receiving interventions to reduce chronic pain. Six databases were searched to identify relevant studies. After duplicate removal, articles were screened by title and abstract. Full-text articles were reviewed and included if they implemented a pain management intervention and measured pain with a standardized quantitative pain scale. Meta-analyses calculated standardized mean differences (SMDs) using random-effect models. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool 2.0. We included 42 trials in the meta-analysis and described 13 more studies narratively. Studies included 26 nondrug alternative treatments, 8 education interventions, 7 system modifications, 3 nonanalgesic drug treatments, 2 analgesic treatments, and 9 combined interventions. Pooled results at trial completion revealed that, except for nonanalgesic drugs and health system modification interventions, all interventions were at least moderately effective in reducing pain. Analgesic treatments (SMD-0.80; 95% CI-1.47 to-0.12; P= .02) showed the greatest treatment effect, followed by nondrug alternative treatments (SMD-0.70; 95% CI-0.95 to-0.45; P < .001), combined interventions (SMD-0.37; 95% CI-0.60 to-0.13; P= .002), and education interventions (SMD-0.31; 95% CI-0.48 to-0.15; P < .001). Our findings suggest that analgesic drugs and nondrug alternative pain management strategies are the most effective in reducing pain among care home residents. Clinicians should also consider implementing nondrug alternative therapies in care homes, rather than relying solely on analgesic drug options.

Cancer pain and alcohol self-medication.

Cancer survivors are at increased risk of pain due to their either cancer and/or treatments. Substances like alcohol may be used to self-medicate cancer pain; however, these substances pose their own health risks that may be more pronounced for cancer survivors. We used cross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS) 2012-2019 to quantify the association between cancer pain and alcohol use. We used negative binomial regression, with interaction terms added to examine variations across age, sex, and race. We also examined whether alcohol use relates to cancer pain control status. Cancer survivors with cancer pain were more likely to be younger, female, Black, and to have been diagnosed with breast cancer. Cancer pain was associated with lower alcohol consumption (incidence rate ratio (IRR): 0.88, confidence interval (CI): 0.77, 0.99). This association was primarily among people 65 and older, women, and white and Hispanic people. Cancer pain control status was not related to alcohol use. Lower alcohol use among cancer survivors with pain has many possible explanations, including several alternative pain management strategies or a decrease in social engagement. Our findings of racial and gender disparities in cancer pain are consistent with the broader evidence on disparities in pain. Cancer pain management for marginalized groups should be improved. Healthcare providers should screen cancer survivors for both pain and substance use, to prevent unhealthy self-medication behaviors.