Prescription Of Analgesic Drugs Research Articles

A decade of water monitoring in a Mediterranean region: Pharmaceutical prioritisation for an upgraded analytical methodology

In order to evaluate the performance of wastewater treatment strategies and to foster water reclamation it is necessary to evaluate the removal of water pollutants such as pharmaceutical active compounds (PhACs). Therefore, the development and application of appropriate analytical methods for the monitoring of the most relevant ones is crucial. In this work, the occurrence data of 157 PhACs in different water bodies and wastewaters in Catalonia (Spain) in the last 10 years, as reported in circa 30 publications, was gathered and reviewed to select the 50 most relevant compounds, including 12 transformation products and metabolites. Historical data confirmed the high consumption and prescription of analgesic and anti-inflammatory drugs, together with psychiatric drugs and antibiotics. An analytical protocol based on solid-phase extraction preconcentration and further measurement by UHPLC-MS/MS was upgraded for the selected 50 compounds and applied to the characterisation of water samples from Catalonia and the Greek Islands, both areas suffering from water scarcity. Results showed similar PhAC concentration profiles in both countries except in the case of some compounds such as iopromide, venlafaxine, and gemfibrozil.

Prevalence and persistent prescription of analgesic drugs in persons admitted with dementia to a nursing home - A longitudinal study.

The overall aim was to explore the prevalence and persistent regular prescription of opioids and paracetamol among nursing home (NH) residents with dementia at admission and over time. A total of 996 residents with dementia, mean (SD) age 84.5 (7.6) years and (36.1% men), were included at admission (A1). Yearly assessments were performed for two years (A2 and A3) or until death. Pain was assessed using the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) Pain Scale. Information regarding prescription of analgesics, general physical health, personal activities of daily living, severity of dementia, neuropsychiatric symptoms, and prescription of psychotropic drugs was collected. A generalized linear mixed model was used to explore whether pain severity was associated with persistent and persistent prescription of opioids and/or paracetamol across timepoints. At A1, 495 of 996 (49.7%) NH residents were prescribed analgesics and prevalence increased at the follow-ups (A2: n = 630, 65.1%; A3: n = 382, 71.2%). Paracetamol was the most frequently prescribed analgesic at all assessments (A1: 45.5%; A2: 59.5%; A3: 67.1%). Opioid prescriptions were quite prevalent (A1: 18.1%; A2: 25.1%; A3: 28.3%), with odds approximately 13 times (OR = 13.3, 95% CI 6.8-26.0) and 9 times (OR = 8.6, 95% CI 3.7-20.3) higher for prescription at follow-up A2 and A3, respectively, relative to prescription at A1. In adjusted analyses, higher pain intensity and poor physical health were associated with prescription and persistent prescription of opioids and paracetamol. In conclusion, prevalence and persistent prescription of analgesics were high in NH residents with dementia. The odds for the prescription of opioids at follow-up were high if prescribed at baseline. Interdisciplinary collaboration, routine assessment of pain at admission and regularly thereafter, and systematic drug reviews are essential to adequately assess and treat pain in NH residents with dementia.

ANGINA BULLOSA HEMORRHAGICA: A RARE OR UNDIAGNOSED CONDITION?

Angina Bullosa Hemorrhagica (ABH) is a recurrent disorder characterized by the appearance of oral mucosal blisters filled with blood, mainly in the soft palate and tongue of middle-aged or older adults. We report a case of a 68-year-old White female patient with no relevant medical history complaining of a blood blister on the lateral surface of the tongue lasting 2 days. No possible triggering factors were identified. Based on clinical features and exclusion of hematologic disorders, the diagnosis was ABH. The treatment was an incision of the blister and prescription of analgesic drugs. At 15 days of follow-up, the oral mucosa was normal. ABH can easily be confused with autoimmune or hematologic disorders. Therefore, recognition of the lesion is essential to dentists to avoid misdiagnosis. The clinical management of ABH is often focused only on the relief of symptoms.

Continuous Erector Spinae Plane Block as Postoperative Analgesic Technique for Robotic-Assisted Thoracic Surgery: A Case Series.

IntroductionThe erector spinae plane block (ESPB) is a recently implemented analgesic technique initially reported for thoracic analgesia and subsequently adopted for both intra- and postoperative pain management. Thoracic surgery is among the most painful surgical procedures, even when conducted with minimally invasive approach. Robotic-assisted thoracic surgery (RATS) challenges the traditional analgesic regimens as one of its aims is to decrease the patient’s length of stay (LOS) whilst achieving optimal postoperative pain management. Furthermore, there is lots of growing evidence on the impact of poorly controlled postoperative pain (PP) on the development of chronic post-surgical pain (CPSP). In these case series, we aim to describe our preliminary experience of postoperative pain management with continuous ESPB in the field of RATS.Case Series PresentationIn eight consecutive patients undergoing elective RATS procedure, we performed the ESPB after surgery with an initial bolus of local anesthetic followed by catheter insertion for continuous infusion. The infusion of local anesthetic lasted for the first two postoperative days. The effectiveness of the ESPB was evaluated through serial pain assessment with numeric rate scale (NRS) score, both at rest and during movement every 6 hours. Any analgesic rescue drug prescription was reported. We noted that the ESPB strongly reduced the prescription of opioids and of rescue analgesic. In our series, only one patient needed opioids during the first two postoperative days, and no rescue analgesic administration was noted in the remaining cases.ConclusionWe report a small but promising experience regarding postoperative pain management with continuous ESPB performed after RATS. We implemented the ESPB before surgery. Larger studies on postoperative pain management with continuous regional blocks in thoracic surgery are warranted.

How, Why and Where it Hurts—Breaking Down Pain Syndrome Among Nursing Home Patients With Dementia: A Cross-Sectional Analysis of the COSMOS Trial

BackgroundBetween 40%-60% of nursing home patients with dementia suffer from chronic and acute pain despite increasing their analgesic drug prescription. AimsDetermine the locations and intensity of pain and the association between quality of life (QoL) and four stratified pain–analgesic groups: (1) pain—analgesics treatment; (2) pain—no analgesics; (3) no pain—analgesics treatment; and (4) no pain—no analgesics. DesignMulticenter, multicomponent cluster randomized controlled Communication, Systematic assessment and treatment of pain, Medication review, Occupational therapy, and Safety - an effectiveness (COSMOS) trial. ParticipantsAt baseline, 723 nursing home patients were enrolled; 463 were completely evaluated for the presence of pain and included in the cross-sectional analyses. MethodsData were collected using the following tests: Cognitive function (Mini-Mental-State Evaluation [MMSE]); Quality of Life in Late stage of Dementia (QUALID); Dementia-Specific QoL (QUALIDEM); Mobilization–Observation–Behavior–Intensity–Dementia Pain Scale (MOBID-2); and number of analgesic drug prescriptions. Analysis of covariance (ANCOVA) was used to compare pain and QoL across pain–analgesics groups. ResultsThe majority of participants (78%) had moderate-to-severe dementia, were female (74%), and a mean age of 86.7 years. Almost 44% reported clinically significant pain, whereas 69% had ≥2 pain locations, especially in the musculoskeletal system. Some 33.5% of participants had pain receiving analgesics, 10% had pain with no analgesics, and 27% had no pain receiving analgesics. Patients evaluated with clinically significant pain intensity scores had lower QoL (<.001) compared with assessments relying on different pain locations. ConclusionUntreated musculoskeletal and multi-located pain is still common in nursing home patients with dementia. A significant share without pain receive analgesics. Proper pain assessment and regular re-assessment are prerequisites for the prescribing and deprescribing of analgesics. Pain intensity scores are more significantly connected to QoL. This must be stressed when evaluating pain and QoL.

Angina bullosa hemorrhagica: a rare or undiagnosed condition?

Angina Bullosa Hemorrhagica (ABH) is a recurrent disorder characterized by the appearance of a blood-filled blister in the oral mucosa, mainly in the soft palate and tongue of middle-aged or older adults. The purpose of the present study is to report an additional case of ABH in conjunction with a comprehensive literature review describing this entity’s clinical and therapeutic characteristics. A 68-year-old Caucasian woman with no relevant medical history sought an oral medicine service presenting a blood blister on the lateral surface of the tongue lasting two days. No possible triggering factors were identified. Based on clinical features and exclusion of hematological disorders, the diagnosis was ABH. The treatment was an incision of the blister and a prescription of analgesic drugs. At 15 days of follow-up, the oral mucosa was normal. ABH can be confused with autoimmune and hematological diseases. Therefore, clinicians must recognize ABH to avoid misdiagnosis. The clinical management of ABH is often focused only on the relief of symptoms.

Impact of hysterectomy on analgesic, psychoactive and neuroactive drug use in women with endometriosis: nationwide cohort study.

ObjectiveTo evaluate how hysterectomy affects the prescription of analgesic, psychotropic and neuroactive drugs in women with endometriosis using population‐based nationwide registers.DesignNationwide cohort study.SettingSwedish national registers, from 1 January 2009 to 31 December 2018.PopulationWomen with benign disease undergoing a total hysterectomy during the 4‐year period of 2012–2015. Women with endometriosis (n = 1074) were identified and compared with women who did not have endometriosis (n = 10 890).MethodsProspectively collected data from two population‐based registers were linked: the Swedish National Quality Register of Gynaecological Surgery and the Swedish National Drug Register. Multivariate logistic regression was used as the main statistical method.Main outcome measuresChanges in drug prescription over time for 3 years prior to and 3 years after hysterectomy.ResultsThe frequency of prescription of analgesics was higher in women with endometriosis compared with women without endometriosis (OR 2.2, 95% CI 1.7–2.9). Among women with endometriosis, the prescription of analgesics (OR 1.0, 95% CI 0.8–1.2) did not decrease 3 years after hysterectomy compared with the 3 years prior to surgery. There was also a significantly higher rate of prescription of psychoactive (OR 1.6, 95% CI 1.4–2.0) and neuroactive drugs (OR 1.9, 95% CI 1.3–2.7) in the long term postoperatively.ConclusionsIn women undergoing hysterectomy, endometriosis was associated with a higher prescription rate of analgesics. In the endometriosis group the prescription of analgesic, psychoactive and neuroactive drugs did not decrease when comparing prescription rates for the 3 years prior to and the 3 years after surgery.Tweetable abstractIn women with endometriosis, the long‐term prescription of analgesics did not decrease after hysterectomy.

Pain Management in Nursing Home Residents: Results from the INCUR Study.

Pain is very common among older persons living in nursing home, affecting 45% to 80% of residents, interfering with daily activities and quality of life. Aims of the study are: 1) to measure the analgesics non-prescription in nursing home residents who present pain symptoms; 2) to identify the main determinants of analgesics non-prescription. Retrospective cross-sectional analysis. Data from an observational study ('Incidence of pNeumonia and related ConseqUences in nursing home Residents' [INCUR] study). 800 older persons living in 13 French nursing homes. Measurments: Pain symptoms were definied by one of the following criteria: i) Presence of pain affecting the individual's function in the Activities of Daily Living; ii) Presence of daily pain, and/or; iii) Severe pain measured with a visual analogue scale. Among the patients originally included in the study, 288 (36%) reported pain symptomatology (mean age 86.9 [SD 7.2] years, 220 (76%) participants women). Amongst these, 138 (47.9%) were treated with non-opioid analgesic drugs, 52 (18.1%) with opioids, and 98 (34%) did not receive any analgesic prescription. An adjusted logistic regression analysis found that the strongest determinant of analgesics non-prescription was the number of concomitantly prescribed drugs (p<0.001). Age, education, and frailty were not associated with prescription of analgesic drugs. Pain undertreatment is very common among older persons living in nursing homes. The number of prescribed medications represents the most relevant risk factor for the analgesics non-prescription. Our findings document the importance of reviewing prescriptions in nursing home residents.

Network Analysis and Visualisation of Opioid Prescribing Data.

In many countries around the world (including Australia), the prescribing of opioid analgesic drugs is an increasing trend associated with significant increases in drug-related patient harm such as abuse, overdose, and death. In Australia, the Medicines Regulation and Quality Unit within Queensland Health maintains a database recording opioid analgesic drug prescriptions dispensed across the State (population 4.703 million). In this work, we propose the use of network visualisation and analysis as a toolfor improved understanding of these data. Prescribing data for Fentanyl patches, a strong opioid with high potential for misuse and subsequent harm, across Queensland, Australia from 2011 to 2018 is analysed as an example of using network analysis, where prescribing patterns are viewed as a dynamic, bipartite graph of the interactions between patients and prescribers over time. The technique provides a global view of a large state-wide prescribing dataset, including the distribution of subgraph structures present. Local analysis is also carried out to demonstrate the clinical utility of the technique, including the dynamics of the graph structure over time. A variety of network statistics that measure network structural and dynamic properties are presented to reveal the characteristics and trends of drug seeking and prescribing behaviours. This approach has been recognised by healthcare professionals at Queensland Health as leading to new and useful insights on the relationship between patients and prescribers and supporting their advisory role to reduce patient harm from inappropriate use of prescription drugs.

The Economic Burden of Selected Analgesic Drugs Prescription by Dentists in Slovakia

Objective: To analyse economic burden of selected analgesic drugs prescription by dentists in Slovakia over a 24-month period. Material and Methods: In this economic burden study, the data were provided from the largest public health insurance company in Slovakia. It was analysed 23,256 prescriptions of selected analgesic drugs (Acetylsalicylic Acid, Diclofenac, Nimesulide, Tramadol and Metamizole Sodium) by dentists in Slovakia. Results: The highest analgesics prescription by dentists was found in Diclofenac in 2016 with 11.2% prescription increase in 2017. The significant decrease of analgesic drug prescription by dentists in 2017 was observed in Tramadol (-29.9%). The economic burden of selected analgesic drugs by patients were €33,926 in 2017 with 21.3% significant decrease of average percentage differences (APD) in Tramadol and 84.6% significant increase of APD in Metamizole sodium in 2017. Patients participated 65.5% share in payment of selected analgesic drugs and Health Insurance Company participated only 34.5% share in payment of selected analgesic drugs in 2017. It was found increase of percentage analgesic drugs prescription in Diclofenac and Nimesulide and decrease of percentage drug prescription in Metamizole sodium from 1/2016 to 12/2017. Conclusion: Economic burden on analgesic drugs prescribed by dentist was low per Slovak inhabitant in calculated. Diclofenac was most frequent prescribed analgesic drug with the highest economic burden. We recommend prescribing cheaper analgesic drugs with a lower economic burden and with the same effect.

Association of joint replacement surgery with incident dementia diagnosis in German claims data.

We determined incidence rates of dementia diagnosis following endoprosthetic joint replacement surgery (upper and lower extremities). The observation period covered up to 28 quarters using German claims data comprising 154,604 cases 65 years and older. Effects were controlled for cerebrovascular and vascular risk factors, age, sex, the presence of a diagnosis of delirium, and regular prescription of sedative or analgesic drugs (SAD). The rate of incident dementia diagnoses in people without joint replacement surgery was 21.34 per 1,000 person years, compared with 80.76 incident cases when joint replacement surgery was conducted during the quarter of the incident dementia diagnosis; rates declined to 21.77 incident cases 7 and more quarters after joint replacement surgery had taken place. This pattern was maintained when controlling for delirium diagnosis and regular prescription of SAD. Among 10,563 patients with at least one joint replacement surgery, patients with a diagnosis of delirium in the quarter of the surgery were at increased risk of a dementia diagnosis compared to patients without such a diagnosis (HR=2.00, p < 0.001). In people surviving the high-risk phase for dementia immediately after surgery, long-term risk of dementia may reach the level of those without surgery. These findings encourage consequent perioperative management to reduce the risk of dementia as well as prospective studies of potentially beneficial effects of joint replacement surgery on mid- to long-term recovery of mobility and cognition in geriatric patients.

Orientare l'organizzazione dei Servizi verso un modello efficace e sicuro di trattamento del dolore con farmaci oppiacei: l'esperienza della Casa di Reclusione di Padova

In carcere il dolore assume una grandezza sproporzionata e di solito non viene adeguatamente trattato. Le ragioni sono spesso dovute alla paura di prescrivere ai detenuti sostanze analgesiche oppioidi con il rischio di un uso improprio o alternativo. Lo scopo di questo studio osservazionale, condotto con 598 detenuti della Casa di Reclusione di Padova, &amp;egrave; stato quello di identificare gli ostacoli e le barriere all'uso di farmaci analgesici oppioidi per il trattamento del dolore e trovare modalit&amp;agrave; utili per un uso razionale delle sostanze.

Analgesic Drug Prescription After Carpal Tunnel Surgery

Carpal tunnel syndrome is a frequent cause of neuropathic pain of the upper limb. Surgery is often proposed in second-line treatment, leading to an expected decrease in analgesic drug consumption. The main objective of this study was to investigate the variations in analgesic drug prescriptions, with a special focus on constant or increasing prescription patterns, before and after surgery for carpal tunnel syndrome. We designed a retrospective cohort study of French beneficiaries from the health insurance system in Midi-Pyrénées area. All patients undergoing carpel tunnel surgery during a specified period were identified and included. Definition of increased or constant prescription of analgesics was based on the comparison of the accumulated defined daily doses received by months and a difference between early preoperative (2 months before) and late postoperative period (2-12 months after surgery) superior to a -3.5 margin. We performed 4 multivariate logistic regression models to identify factors associated with increased or constant analgesic drug prescription patterns (for all analgesics, opioid, antineuropathic, nonopioid drugs). Among the 3665 patients included, 3255 (89%) received at least 1 analgesic drug during the late postoperative period (39% [n = 1426] for opioids and 15% [n = 563] for antineuropathic drugs). Prescription of analgesic, opioid, or antineuropathic drugs was maintained or increased in the late postoperative period in 11%, 5%, and 3% of the population, respectively. High levels of preoperative pain and female sex were associated with an increase in opioid use, whereas inpatient surgery (vs ambulatory surgery), high levels of preoperative pain, and psychiatric disorders were found to be associated with an increase in antineuropathic drug use. This study revealed that approximately 3% to 5% of patients undergoing carpal tunnel surgery had persistent and even increased use of opioid or antineuropathic drugs more than 2 months after surgery, in relation with possible chronic postoperative pain. Considering the incidence of carpal tunnel syndrome, the risks associated with persistent opioid use in this population should be further monitored.

Temporal Trends in Analgesic Use in Long-Term Care Facilities: A Systematic Review of International Prescribing.

ObjectivesTo explore global changes in the prescription of analgesic drugs over time in the international long‐term care (LTC) population.DesignSystematic review.SettingWe included original research articles in English, published and unpublished, that included number of participants, country and year(s) of data collection, and prescription of analgesics (analgesics not otherwise specified, opioids, acetaminophen; scheduled only, or scheduled plus as needed (PRN)).Participants LTC residents.MeasurementsWe searched PubMed, EMBASE, CINAHL, International Pharmaceutical s, PsycINFO, Cochrane, Web of Science, Google Scholar, using keywords for LTC facilities and analgesic medication; hand‐searched references of eligible papers; correspondence. Studies were quality rated using an adapted Newcastle‐Ottawa scale. Pearson correlation coefficients were generated between percentage of residents prescribed an analgesic and year of data collection. If available, we investigated changes in acetaminophen and opioid prescriptions.ResultsForty studies met inclusion criteria. A moderate correlation (0.59) suggested that scheduled prescription rates for analgesics have increased over time. Similar findings were reflected in scheduled prescriptions for acetaminophen and opioids. No increase was seen when analyzing scheduled plus PRN analgesics. Use of opioids (scheduled plus PRN) appears to have increased over time.ConclusionWorldwide, use of opioids and acetaminophen has increased in LTC residents. Research is needed to explore whether this reflects appropriate pain management for LTC residents and if PRN medication is used effectively.

Postoperative analgesia following elective abdominal surgery: a prospective observational study

Background: Laparotomy forms an important subset of general surgical operations. This study aimed at collecting the baseline information on postoperative analgesia, to detect deficiencies in current management of postoperative pain and to aid as a reference for future endeavours aimed at improving pain management following abdominal surgeries.Methods: It was conducted as a prospective descriptive study in patients undergoing elective laparotomies in the Department of General Surgery of a tertiary care institute, for two years. The patterns of prescription and administration of analgesic drugs for postoperative pain after abdominal surgery, incidence and severity of postoperative pain, adverse effects of drugs and patient satisfaction were assessed.Results: A total of 289 elective laparotomies were performed. Combinations of Non-steroidal anti-inflammatory drugs (NSAID) with opioids, epidural analgesia (EA) with supplemental intramuscular ketorolac and PCEA (Patient controlled EA) provided effective pain relief with high satisfaction score (3/4) and were associated with low sedation (1/3) and the least side effects. Patients receiving NSAIDs had higher pain score with lesser satisfaction score and lower sedation score. IV-PCA with morphine provided effective pain relief with high satisfaction score (3/4), with least side effects, but patients had high sedation score (2/3). Around 55 (55/289; 19.03%) patients experienced postoperative nausea and vomiting, which responded to antiemetic treatment.Conclusions: A combination of NSAIDs with opioids provided effective pain relief, high satisfaction with less sedation and least side effects. Epidural analgesia with supplemental intramuscular ketorolac and PCEA also provided effective pain relief with high satisfaction and less sedation with least side effects.

Analgesic Drug Prescription Patterns on Five International Paediatric Wards.

Analgesic and anti-inflammatory drugs are frequently prescribed in paediatrics. Prescribing and dosing patterns in hospitalised children are not well known. This study explores analgesic drug utilisation on five paediatric wards and discusses its findings in comparison with World Health Organization (WHO) guidelines. A sub-analysis of a prospective, multicentre, observational cohort study was undertaken. Prescription data of children aged up to≤18years were collected between October 2008 and December 2009 on paediatric general medical wards in five hospitals in Australia, Germany, the United Kingdom (UK), Hong Kong (HK) and Malaysia. Analgesic drug prescriptions were analysed for prescribing patterns in terms of dosing, frequency and route of administration. Dosing data were compared with local recommendations and WHO guidelines for children. In the study cohort, 56.8% (726/1278) of paediatric patients received at least one analgesic drug prescription (1227 prescriptions). The median age of patients with analgesics was 2.2years [interquartile range (IQR) 0.8-7.3], and the median number of prescriptions per patient was one (IQR 1-2). The most commonly prescribed drugs were oral paracetamol (45.9%, 563/1227) and oral ibuprofen (19.9%, 244/1227). Daily doses of paracetamol ranged from 30mg/kg/day in Germany to 67-68mg/kg/day in the UK and HK (p<0.05). For ibuprofen, single doses ranged from 5-6mg/kg in HK and the UK to 10mg/kg in Germany and Australia (p<0.001). Opioid use prevalence was statistically different between the centres and ranged from 0 to 17.6% (p<0.001). This study provides a comprehensive overview of analgesic drug use of hospitalised children. Similar to primary care data, paracetamol is the most commonly used analgesic. As recommended by WHO guidelines, oral medication was favoured and opioids used in addition to paracetamol and ibuprofen. Overall drug utilisation was in line with local recommendations and WHO guidelines. Differences in use of paracetamol and ibuprofen among countries were seen, indicating that safety concerns are perceived differently. More large-scale safety studies are needed.

Prescription Pattern of Analgesic Drugs for Patients Receiving Palliative Care in a Teaching Hospital in India.

Background:Drugs used in the palliative care unit for managing symptoms are major contributors toward the expenditure occurring in palliative care. This study was conducted to understand the prescription pattern of analgesic drugs in the patients who are receiving palliative care in a teaching hospital in India by a retrospective study of case records.Methods:Case record based, retrospective, descriptive study was conducted at the Pain and Palliative Care Department of St. John's Medical College Hospital, Bengaluru. Case record files of all patients referred to Pain and Palliative Care Department for the treatment of pain in the year of 2012 were studied. Patients’ age, gender, diagnoses, numerical pain rating scale (0–10), drugs prescribed, dosage, frequency, route of administration were recorded. The difference in drug utilization between the genders was done using Chi-square test. Data were collected from 502 patients of which 280 (56%) were males and 222 (44%) were females. Twelve percent of patients had mild pain (1–3), 34% had moderate pain (4–6), and 54% had severe pain (7–10). The most commonly used analgesic drugs were opioids (47%), followed by nonsteroidal anti-inflammatory drugs (36%). The opioids used were tramadol (56%), and morphine (38%). Ninety percent of patients with numerical pain scale more than 6 received morphine. There was no difference in analgesic drug utilization with regards to gender. Prescription pattern differed depending on the severity of pain. Opioids were the most commonly used drugs for pain management.Conclusion:The study shows that prescription pattern in palliative care unit of this hospital was in accordance with WHO pain management guidelines. The study showed the current trend in prescription of analgesic drugs in the teaching hospital where the study was conducted.

Effectiveness of the CardioPain initiative in reducing inappropriate NSAID prescriptions in pain therapy among high cardiovascular risk patients: an informative Italian survey.

Non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors (COXIBs) may be associated with increased cardiovascular (CV) risk and mortality in CV patients. After the release of Note 66 by Agenzia Italiana del Farmaco (AIFA) to reduce inappropriate prescribing of NSAIDs and COXIBs, the CARDIOPAIN initiative was started in Italy to include such recommendations into the hospital discharge letter of patients with high CV risk. We evaluated the effect of the CARDIOPAIN initiative on the prescription of analgesic drugs by general practitioners (GPs). An online interview was proposed to 414 Italian GPs. A descriptive statistic was reported. Three groups of GPs were identified: those who found the Note 66 recommendations in most hospital discharge letters (the "MOST" group), those who found them in only few cases (the "FEW" group) and those who never found the recommendations (the "NO" group). In patients with high CV risk, the percentage of GPs prescribing NSAIDs as first choice in pain management was lower in the MOST group compared with the "FEW" or "NO" groups. GPs belonging to the "MOST" group prescribed NSAIDs in 28% of cases, compared with 50% of cases observed for GPs belonging to the "NO" group. The more severe the pathology the fewer the NSAID prescriptions, in favor of opioid agents administration. Our results suggest that the inclusion of the AIFA Note 66 in the discharge documents of high CV risk patients may have contributed to lower inappropriate NSAID prescriptions in Italian GPs. Presumably, a wider diffusion of the CARDIOPAIN initiative might improve the prescription appropriateness of analgesic drugs.

A survey of analgesic and anti-inflammatory drug prescription for oral implant surgery

Aim: This study was conducted to determine the preferred analgesic and anti-inflammatory drugs prescribed by oral implantologists in India. Methods: A structured questionnaire was distributed to 332 dentists to gather information regarding their prescription habits for analgesics and anti-inflammatory drugs. Frequency distributions were computed by type of drug being prescribed and the protocol followed. Results: Analysis of data showed that majority of dentists (85.8%, n = 285) prescribed conventional non-steroidal anti-inflammatory drugs (NSAIDs) for implant surgery. The most common prescription was ibuprofen with paracetamol combination (32.2%, n = 107) followed by diclofenac (20.2%, n = 67). Most dentists reported prescribing different NSAIDs for the same procedure in different patients (64.7%, n = 215). Only, 35.5% ( n = 118) followed the peri-operative protocol. Adjunctive prescription of steroids was done by only 33.7% ( n = 112). Conclusion: Our study illustrates that the general trend of analgesic and anti-inflammatory drug prescription for dental implant surgery among Indian dentists is mostly in accordance with the guidelines for pain management worldwide. However, it is noteworthy that a few dentists do prescribe drugs not primarily indicated for dental pain management and use widely varying protocols for the same. Therefore, in order to avoid potential complications, it is essential to raise awareness of among the dental practitioners of the appropriate indications and dosage regimen of specific drugs.

Diagnoses indicating pain and analgesic drug prescription in patients with dementia: a comparison to age- and sex-matched controls

BackgroundThe evidence of undertreatment of pain in patients with dementia is inconsistent. This may largely be due to methodological differences and shortcomings of studies. In a large cohort of patients with incident dementia and age- and sex-matched controls we examined (1) how often they receive diagnoses indicating pain, (2) how often they receive analgesics and (3) in which agents and formulations.MethodsUsing health insurance claims data we identified 1,848 patients with a first diagnosis of dementia aged ≥ 65 years and 7,385 age- and sex-matched controls. We analysed differences in diagnoses indicating pain and analgesic drugs prescribed between these two groups within the incidence year. We further fitted logistic regression models and stepwise adjusted for several covariates to study the relation between dementia and analgesics.ResultsOn average, patients were 78.7 years old (48% female). The proportions receiving at least one diagnosis indicating pain were similar between the dementia and control group (74.4% vs. 72.5%; p = 0.11). The proportion who received analgesics was higher in patients with dementia in the crude analysis (47.5% vs. 44.7%; OR: 1.12; 95% CI: 1.01-1.24), but was significantly lower when adjusted for socio-demographic variables, care dependency, comorbidities and diagnoses indicating pain (OR: 0.78; 95% CI: 0.68-0.88). Analgesics in liquid form such as metamizole and tramadol were more often used in dementia.ConclusionsOur findings show a comparable documentation of diagnoses indicating pain in persons with incident dementia compared to those without. However, there still seems to be an undertreatment of pain in patients with dementia. Irrespective of dementia, analgesics seem to be more often prescribed to sicker patients and to control pain in the context of mobility.