Analgesic Prescription Research Articles

Perioperative Analgesics and Anesthesia as Risk Factors for Postoperative Chronic Opioid Use in Patients Undergoing Total Knee Arthroplasty: A Retrospective Cohort Study Using Japanese Hospital Claims Data.

Patients with chronic postsurgical pain are commonly prescribed opioids chronically because of refractory pain although chronic opioid use can cause various severe problems. We aimed to investigate postoperative chronic opioid use and its association with perioperative pain management in patients who underwent a total knee arthroplasty in a Japanese real-world clinical setting. We conducted a retrospective cohort study using an administrative claims database. We used a multivariate logistic regression analysis to examine the association between perioperative analgesic and anesthesia prescriptions and postoperative chronic opioid use. We calculated all-cause medication and medical costs for each patient. Of the 23,537,431 patient records, 14,325 patients met the criteria and were included in the analyses. There were 5.4% of patients with postoperative chronic opioid use. Perioperative prescriptions of weak opioids, strong and weak opioids, and the α2δ ligand were significantly associated with postoperative chronic opioid use (adjusted odds ratio [95% confidence interval], 7.22 [3.89, 13.41], 7.97 [5.07, 12.50], and 1.45 [1.13, 1.88], respectively). Perioperative combined prescriptions of general and local anesthesia were also significantly associated with postoperative chronic opioid use (3.37 [2.23, 5.08]). These medications and local anesthesia were more commonly prescribed on the day following surgery, after routinely used medications and general anesthesia were prescribed. The median total direct costs were approximately 1.3-fold higher among patients with postoperative chronic opioid use than those without postoperative chronic opioid use. Patients who require supplementary prescription of analgesics for acute postsurgical pain are at high risk of postoperative chronic opioid use and these prescriptions should be given careful consideration to mitigate the patient burden.

Assessment of the conformity of analgesics prescribed in postoperative patients: a cross-sectional audit

Introduction: Post-operative pain management is crucial and patients can experience moderate to severe pain after surgery. The aims of this study were to assess the conformity to guidelines of analgesic prescription after major surgeries and evaluate the different predictors of non-conformity. Methods: A cross-sectional study was conducted on 497 hospitalized patients undergoing major surgeries between November 2018 and June 2019 using the data from their medical charts. Results: In total, 227 patients had a previous medical history. A significant relationship was noted between conformity, age, and length of stay where patients older than 65 had a higher degree of non-conformity compared to younger patients. Almost 90% of the analgesic were conforming in terms of dosage, treatment duration, choice and contraindication. Conclusion: This study highlights the importance of adequate pain management and its influence on the quality of life of patients, as well as the importance of age, comorbidities and pain intensity as predictors to reach a higher level of conformity.

Are There Differences in Opioid Prescriptions to Urban and Rural Patients by Oral and Maxillofacial Surgeons in Massachusetts From 2011 to 2021?

Oral-maxillofacial surgeons (OMSs) are frequent prescribers of opioid analgesics. It remains unclear if prescription patterns differ for urban versus rural patients, given potential differences in access to and delivery of care. This study aimed to characterize urban-rural differences in opioid analgesic prescriptions to patients in Massachusetts by OMSs from 2011 to2021. This retrospective cohort study used the Massachusetts Prescription Monitoring Program database to identify Schedule II and III opioid prescriptions by providers with specialty of oral and maxillofacial surgery from 2011 to 2021. The primary predictor variable was patient geography (urban/rural) and secondary predictor was year (2011-2021). The primary outcome variable was milligram morphine equivalent (MME) per prescription. Secondary outcome variables were days' supply per prescription and number of prescriptions received per patient. Descriptive and linear regression statistics were performed to analyze differences in prescriptions to urban and rural patients each year and throughout the study period. The study data, which includes OMS opioid prescriptions (n=1,057,412) in Massachusetts from 2011 to 2021, ranged annually between 63,678 and 116,000 prescriptions to between 58,000 and 100,000 unique patients. The cohorts each year ranged between 48 and 56% female with mean ages between 37 and 44years. There were no differences in the mean number of patients per provider in urban and rural populations in any year. The study sample had a large majority of urban patients (>98%). MME per prescription, days' supply per prescription, and prescriptions received per patient were all generally similar between urban and rural patients each year, with the largest MME per prescription difference in 2019 (87.3 for rural to 73.9 for urban patients, P<.01). From 2011 to 2021, all patients had a steady decrease in MME per prescription (β=-6.64, 95% confidence interval: -6.81, -6.48; R2=0.39) and day's supply per prescription (β=-0.1, 95% confidence interval: -0.1, -0.09; R2=0.37). In Massachusetts, there were similar opioid prescribing patterns by oral and maxillofacial surgeons to urban and rural patients from 2011 to 2021. There has also been a steady decrease in the duration and total dosage of opioid prescriptions to all patients. These results are consistent with multiple statewide policies over the last several years aimed at curbing opioid overprescribing.

Recent trends in the prescription of opioids in the emergency department in patients with urolithiasis.

Pain management is central in the treatment of urolithiasis. We aimed to estimate the impact of the 2017 Department of Health and Human Services declaration of an opioid crisis on prescribing patterns of opioids and NSAIDs in emergency department visits for urolithiasis. The National Health Ambulatory Medical Care Survey (NHAMCS) was queried for emergency department visits of adults with a diagnosis of urolithiasis. The association between urolithiasis and narcotic and NSAIDs prescription patterns was evaluated and compared at pre-declaration (2014-2016) to post-declaration (2017-2018) periods. Opioids were prescribed in about 211 million (41.1%) out of 513 million emergency department visits, over a 5-year period. Diagnosis of urolithiasis accounted for 1.9% of the visits (6.0 million). The use of opioids was higher in urolithiasis (82.7%) compared to non-urolithiasis diagnosis (40.3%), as well as the use of multiple opioids per visit (p < 0.01 for all). There was an overall decrease in opioid prescriptions in the post-declaration period, -4.3% for urolithiasis (p = 0.254) and -5.6% for non-urolithiasis visits (p < 0.05). A decrease in the use of hydromorphone (-47.5%. p < 0.001), an increase in the use of morphine (+ 59.7% p = 0.006), and an increase of 'other' opioids (+ 98.8%, p < 0.041), were observed. Opioids combined with NSAIDs comprised 72.6% of the opioid prescriptions and 62.3% of all analgesic prescriptions in visits with urolithiasis diagnosis. The use of opioids when managing urolithiasis decreased 4.3% after the crisis declaration; however, statistically are not different from pre-declaration numbers. Most often, opioids were prescribed with NSAIDs in urolithiasis patients.

Analgesic Patterns and Opioid Administration in Children Hospitalized With Acute Pancreatitis.

Pain is the most common symptom of acute pancreatitis (AP), and opioids have been utilized as the cornerstone of treatment. Despite the adverse effects of opioids, data on effective analgesia in children with AP is lacking. We aimed to evaluate analgesia prescribing patterns in pediatric AP, identify factors associated with opioid administration, and test the associations between opioid administration and hospital length of stay (LOS). This is a retrospective cohort study of pediatric AP hospitalizations in a single institution from 2010 to 2020. Opioid administration was calculated for the first 48 hours of admission (morphine milligram equivalent; MME48). Data on multimodal analgesia [defined as the administration of acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)] during hospitalization was captured. The sample included 224 patients, mean age 12.0 years (standard deviation = 4.9) and 58.9% female. Median LOS was 4 days (interquartile range 2-9). Most patients (71.4%) were prescribed opioids, 77.7% acetaminophen, 40.2% NSAIDs, and 37.5% multimodal analgesia. Opioid administration decreased over the study period; in contrast, there was an increase in multimodal analgesia administration. Opioid administration did not differ by sex, age, biliary versus non-biliary etiology, or race/ethnicity. In a multivariate regression model, lower albumin values ( P < 0.01) and younger age ( P < 0.05) were significant predictors of increased LOS, while MME48 was not associated with increased LOS. Opioids were commonly administered; only 37.5% of children were administered multimodal analgesia during their hospitalization for AP. Opioid administration was not associated with increased LOS. Prospective studies are needed to determine optimal pain management for pediatric AP.

The impact of radiation caries on morbidity and mortality outcomes of head and neck squamous cell carcinoma patients.

Radiation caries (RC) is a highly prevalent and chronic complication of head and neck radiotherapy (HNRT) and presents a challenge for clinicians and patients. The present study aimed to assess the impact of RC on the morbidity and mortality outcomes of head and neck squamous cell carcinoma (HNSCC) patients. Patients were divided into three groups: (1) RC (n=20), (2) control (n=20), and (3) edentulous (n=20). Information regarding the number of appointments, dental procedures, osteoradionecrosis (ORN), prescriptions, and hospital admissions were collected. Mortality outcomes were assessed through disease-free survival (DFS) and overall survival (OS) rates. RC patients required more dental appointments (p<.001), restorations (p<.001), extractions (p=.001), and antibiotic and analgesic prescriptions (p<.001). Kaplan-Meier subgroup analyses showed a significantly increased risk of ORN in RC compared to edentulous patients (p=.015). RC patients presented lower DFS rates (43.2months) than the control and edentulous groups (55.4 and 56.1months, respectively). RC impacts morbidity outcomes among cancer survivors due to increased demand for medication prescriptions, multiple specialized dental appointments, invasive surgical treatments, increased risk of ORN, and increased need for hospital admissions.

Variations of pain medication use for patients with acute extremity pain in an emergency department: A quality improvement project.

The opioid epidemic continues to take over 50,000 lives annually. At least 75 percent of patients present to an emergency department (ED) for pain. The objective of this study is to describe the characteristic(s) for receiving opioid, non-opioid, and combination analgesics in an ED for acute extremity pain. A single-site, retrospective chart audit was conducted at a community-based teaching hospital. Patients ≥ 18 years old who were discharged from the ED with acute extremity pain and received at least one analgesic were included. Primary goal included determining characteristics associated with the prescribing of analgesics. Secondary goals included amount of pain score reduction, frequency of prescribing, and discharge prescription patterns among each group. Analyses consisted of univariate and multivariate general linear models analyses. There were 878 patients identified as having acute extremity pain between February and April 2019. A total of 335 patients met inclusion criteria and were separated into three groups: nonopioids (n = 200), opioids (n = 97), and combination analgesics (n = 38). The individual characteristics showing statistical differences (p < 0.05) between the groups were (1) an allergy to specific analgesics, (2) diastolic blood pressure > 90 mmHg, (3) heart rate > 100 bpm, (4) opioid use prior to ED admission, (5) prescriber level, and (6) discharge diagnosis. Multivariate analyses showed combination therapy (regardless of which two analgesics were administered) had a significant difference in mean pain score reduction compared to nonopioids (p < 0.05). There are patient, prescriber, and environment-specific characteristics that are associated with analgesic selection in an ED. Combination therapy had the greatest reduction in pain regardless of the two medications received.

Comparison of the Centers for Disease Control (CDC) recommendations and the risk index for overdose or serious opioid-induced respiratory depression (RIOSORD) tool for guiding naloxone coprescribing.

Patients treated with ongoing opioid therapy may be at an increased risk of respiratory depression or death, which may be mitigated through prompt administration of naloxone. The Centers for Disease Control (CDC) guidelines for prescribing opioids in primary care settings recommend patients treated with ongoing opioid analgesic therapy be offered a coprescription of naloxone based on total oral morphine milligram equivalents per day or concurrent benzodiazepine therapy. Opioid overdose risk is dose-dependent, yet other patient-specific factors contribute to this risk. The risk index for overdose or serious opioid-induced respiratory depression (RIOSORD) incorporates additional risk factors to assess the risk of overdose or clinically relevant respiratory depression. This study compared the frequency of meeting CDC, Veterans' Health Administration (VA) RIOSORD, or civilian RIOSORD criteria for naloxone coprescribing. A retrospective chart review of 42 Federally Qualified Health Centers in Illinois was conducted for all CII-CIV opioid analgesic prescriptions. Ongoing opioid therapy was defined as patients who received seven or more CII-CIV opioid analgesic prescriptions during the 1-year study period. Patients aged 18-89, receiving opioids for nonmalignant pain, and meeting the criteria of ongoing opioid therapy were included in the analysis. A total of 41,777 controlled substance analgesic prescriptions were prescribed during the study period. Data from 651 individual patient charts were evaluated. Of those, 606 patients met inclusion criteria. From these data, 57.9 percent of patients (N = 351) met civilian RIOSORD criteria, 36.5 percent (N = 221) met VA RIOSORD criteria, and 22.8 percent (N = 138) met CDC guideline recommendations for naloxone coprescribing. The percentage of patients who met RIOSORD criteria compared to CDC criteria was significantly higher (p < 0.001). Of all patients meeting ongoing opioid therapy criteria, only seven had been coprescribed naloxone. Coprescribing of naloxone is significantly underutilized in patients treated with opioid therapy for nonmalignant chronic pain and should not solely be based on total oral morphine milligram equivalents per day or concurrent benzodiazepine therapy. As risk assessment improves, consideration of other risk-conferring variables, such as gabapentinoids, skeletal muscle relaxants, and sleep hypnotics, should be considered.

Prescriptions For Analgesics For The Treatment Of Osteoarthritis During The Covid-19 Pandemic: A Retrospective Analysis

Prescriptions For Analgesics For The Treatment Of Osteoarthritis During The Covid-19 Pandemic: A Retrospective Analysis

Analgesic utilization in people with knee osteoarthritis: A population-based study using primary care data.

Osteoarthritis (OA) is a chronic painful condition that often affects large joints such as the knee. Treatment guidelines recommend paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids. Antidepressants and anti-epileptic drugs (AEDs) are commonly prescribed for chronic noncancer pain conditions including OA, as an off-label use. This study describes analgesic utilization in patients with knee OA at population level using standard pharmaco-epidemiological methods. This was a cross-sectional study between 2000 and 2014 using data from the U.K. Clinical Practice Research Datalink (CPRD). The use of antidepressants, AEDs, opioids, NSAIDs, and paracetamol was studied in adults with knee OA using the following measures: annual number of prescriptions, defined daily doses (DDD), oral morphine equivalent dose (OMEQ), and days' supply. In total, there were 8,944,381 prescriptions prescribed for 117,637 patients with knee OA during the 15-year period. There was a steady increase in the prescribing of all drug classes, except for NSAIDs, over the study period. Opioids were the most prevalent class prescribed in every study year. Tramadol was the most commonly prescribed opioid, with the number of DDD increasing from 0.11 to 0.71 DDDs per 1000 registrants in 2000 and 2014, respectively. The largest increase in prescribing was for AEDs, where the number of prescriptions increased from 2 to 11 per 1000 CPRD registrants. There was an overall increase in the prescribing of analgesics apart from NSAIDs. Opioids were the most frequently prescribed class; however, the greatest increase in prescribing between 2000 and 2014 was observed in AEDs.

Frequency of typical complications of morphine during its intrathecal and epidural introduction in knee arthroplasty

The objective was to compare the efficacy and safety of morphine in neuraxial blocks during knee arthroplasty.Materials and methods. A retrospective analysis of 60 medical histories of patients who underwent total knee arthroplasty for the period from 2017 to 2019 was performed. All patients were operated under general anesthesia with mechanical ventilation in combination with epidural or spinal analgesia with opiates. Patients of the 1st group (n=20) after catheterization of the epidural space at the level of L1–2 were injected with a morphine solution 1% – 0.3 ml epidurally. Patients of the 2nd group (n=20) were injected with a morphine solution 1% – 0.01 ml intrathecally at the level of L3–4. Patients of the 3rd group (n=20) underwent standard combined anesthesia: general anesthesia with mechanical ventilation and epidural analgesia at the level of L1–2 with a solution of 0.2% ropivacaine in the form of an infusion of 6 ml/hour. All patients received infusion of 0.2% solution of ropivacaine epidurally 6 ml/hour at the level of L1–2 in the postoperative period.The incidence of nausea, vomiting, pruritus, headache and the level of postoperative pain syndrome were assessed on a numerical rating scale 6 hours after the end of the surgery.Results. The level of pain syndrome in patients who received intrathecal and epidural analgesia with morphine was equally low, while in patients who received epidural analgesia with ropivacaine, the level of pain syndrome was statistically significantly higher, which required the additional prescription of non-steroidal anti-inflammatory drugs and/or narcotic analgesics parenterally. The frequency of nausea, vomiting, pruritus and headaches was maximum in the 2nd group, significantly lower in the 1st, while in the 3rd, pruritus did not occur.Conclusion. The use of morphine in neuraxial block in knee arthroplasty has a positive effect on the quality of anesthesia and postoperative pain relief.

Evaluation of Pain and Use of Analgesics during Medical Termination of Pregnancy in Real-Life Settings.

Women frequently report pain associated with medical termination of pregnancy (MToP), and its management can differ largely between centres. This study aimed at evaluating in real-life settings pain related to MToP and its management in France. This was a non-interventional prospective, longitudinal study run in 23 centres between 2015 and 2016 that included 893 pregnant women. Pain was reported by women prior any curative analgesic intake (CAI) through a five-level Likert scale (absence, mild, moderated, severe, extreme). Modalities of analgesic prophylaxis prescription (APP) and intake (API) and CAI were collected. Risk factors were investigated using ordinal logistic regression (for pain) or logistic regression (for CAI) with stepwise selection of variables. APP was prescribed to 657 (73.7%) women irrespective of the gestational age, among whom 386 (73.7%) took the treatment. Out of 740 women who documented their pain symptoms prior to any CAI, few declared no pain (n = 94, 12.7%) or intense pain (n = 88, 11.9%). The majority reported mild or moderate pain (n = 558, 75.4%). On multivariate analysis adjusted on gestational age, increasing initial [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.06-1.47] or total dose (OR 1.15, 95% CI 1.05-1.26) of misoprostol taken were independent factors associated with risk of more pain. When adjusting for gestational age, initial dose of misoprostol (OR 1.69, 95% CI 1.45-2.66) and pain experienced (OR 3.58, 95% CI 2.82-4.55) were significantly associated with higher risk of CAI while API (OR 0.52, 95% CI 0.36; 0.75) was negatively associated. Most of the women received an APP, but not all used it. API and gestational age were not related to different risks of more pain following MToP, whereas history of at least one child showed a negative association. Higher doses of misoprostol were strongly associated with both pain and CAI. API was associated with a decreased risk of CAI.

Do kids with forearm fractures need opioids at discharge from the emergency department? Analgesic prescribing and pain control following closed reduction of pediatric forearm fractures.

The purpose of this 2-part study is to determine opioid prescribing patterns and opioid use and pain control after discharge following closed reduction of pediatric forearm fractures. A retrospective study was conducted from December 2016 to January 2018 at a level 1 trauma center to determine opioid prescribing habits for patients 1-17 years old with forearm fractures treated with closed reduction. A prospective study was then conducted from August 2019 to October 2020 to determine pain control and opioid use after discharge. Data were collected through chart review and with telephone surveys on post-discharge days 1, 3, and 5 to collect pain scores and opioid use. Fifty patients with a median age of 8 (interquartile range [IQR], 5-11) years old and 51 patients with a mean age of 9 (IQR, 6-11) years old were included in the retrospective and prospective cohorts, respectively. From the retrospective study, 21 patients (42%) were prescribed a median of 10 opioid doses (IQR, 8-12) at discharge. From the prospective study, 12 patients (24%) were discharged with a median of 8 opioid doses (IQR, 5.5-10), for a total of 98 total doses. Of those, only 7 doses (7%) were used by 3 patients. Higher weight and initial pain score were associated with increased rates of opioid prescription. Pediatric patients who undergo closed reduction of a forearm fracture under procedural sedation in the emergency department are prescribed approximately 14 times the amount of opioid that is used. We propose that prescribing only non-opioid analgesics to these patients would afford equivalent pain control without the side-effects and abuse potential of opioid use at an early age.

We need to talk: The urgent conversation on chronic pain, mental health, prescribing patterns and the opioid crisis.

The opioid crisis' pathways from first exposure onwards to eventual illnesses and fatalities are multiple, intertwined and difficult to dissect. Here, we offer a multidisciplinary appraisal of the relationships among mental health, chronic pain, prescribing patterns worldwide and the opioid crisis. Because the opioid crisis' toll is especially harsh on young people, emphasis is given on data regarding the younger strata of the population. Because analgesic opioid prescription constitute a recognised entry point towards misuse, opioid use disorder, and ultimately overdose, prescribing patterns across different countries are examined as a modifiable hazard factor along these pathways of risk. Psychiatrists are called to play a more compelling role in this urgent conversation, as they are uniquely placed to provide synthesis and lead action among the different fields of knowledge and care that lie at the crossroads of the opioid crisis. Psychiatrists are also ideally positioned to gauge and disseminate the foundations for diagnosis and clinical management of mental conditions associated with chronic pain, including the identification of hazardous and protective factors. It is our hope to spark more interdisciplinary exchanges and encourage psychiatrists worldwide to become leaders in an urgent conversation with interlocutors from the clinical and basic sciences, policy makers and stakeholders including clients and their families.

ANALYZING ANALGESIC PRESCRIPTION PATTERNS AMONG OUTPATIENTS IN THREE SOUTH-WEST CITIES OF BANGLADESH

This study examines the prescription patterns of analgesics among outpatients in three South-West cities of Bangladesh. A retrospective analysis was conducted on prescription records collected from outpatient departments in selected healthcare facilities over a specified period. The study investigates the types, frequencies, and combinations of analgesics prescribed, along with demographic and clinical characteristics of the patients. Findings reveal trends in analgesic prescription practices, highlighting common medications and potential areas for improvement in pain management strategies among outpatient populations in South-West Bangladesh.

Level of knowledge in undergraduate dental students about the prescription of analgesics, anti-inflammatories, and antibiotics in pediatric dentistry

To determine the level of knowledge about the prescription of analgesics, anti-inflammatories and antibiotics in pediatric dentistry of undergraduate dental students. This study was descriptive, transversal and observational. The sample included 84 students. The instrument was a questionnaire validated by expert judgment which contained 22 questions divided into 2 parts, 11 questions on NSAIDs and 11 questions on antibiotics, indicating whether the level of knowledge was adequate or inadequate. The level of knowledge in the use of analgesics and anti-inflammatories in undergraduate students of cycle XII was insufficient (90.5%), followed by 82.9% in cycle X and finally 82.1% in cycle VIII also insufficient. In relation to antibiotics in cycle VIII there was 85.7% insufficient knowledge, in cycle X it was 68.6%, and finally in cycle XII 61.9%, also was insufficient. The undergraduate students presented mostly insufficient level of knowledge in the use of analgesics, anti-inflammatories and antibiotics.

Association between first-step analgesic use and cancer in patients with diabetes.

This study aimed to determine the effectiveness of analgesics in inhibiting cancer development in patients with diabetes based on a sample cohort supplied by the Korean National Health Insurance Service. Regular users of analgesics included those using prescription analgesics ≥15 days per month at least 6 times over 2 years after the diagnosis of diabetes mellitus (baseline). The effectiveness of analgesics in patients with diabetes was evaluated using metformin adherence and three models: model 1 was adjusted for age and sex; model 2 was further adjusted for body mass index (BMI), exercise, cholesterol, hypertension, and Charlson comorbidity index (CCI); and model 3 was further adjusted for analgesics. Based on stringent extraction criteria, the sample had a cancer incidence of 4.6%. The hazard ratios of models 1 and 2 were 0.830 and 0.865, respectively. The adjusted hazard ratio for all variables, including acetaminophen and nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen, was 0.871 (model 3). Regular use of analgesics by patients with diabetes decreased their risk of subsequent cancer development in this large national cohort. Compared with participants who did not develop cancer, those with cancer were older and more likely to be male, did not exercise, have more comorbidities (as assessed by CCI), and did not use analgesics regularly.

Necrotizing gingivitis – diagnosis and treatment: a narrative review and case report

ChatGPT Introduction: Necrotizing periodontal diseases (NPD) are acute lesions with a rapid onset that may cause considerable periodontal tissue destruction. Among these conditions, necrotizing gingivitis (NG) is caused by microorganisms from the oral biofilm and is associated with predisposing factors such as psychological stress, HIV/AIDS, alcohol and tobacco consumption, malnutrition, inadequate oral hygiene, and other systemic conditions that may compromise the host immune response. Objective: The aim of this narrative literature review was to describe the available evidence on the diagnosis and treatment of NG and present a successfully treated case of NG in a 22-year-old woman. Case report: The patient was a smoker, had poor oral hygiene, and was experiencing psychological stress. Her complaints were abundant gingival bleeding and halitosis during the past two weeks preceding the first appointment. Clinical findings included considerable biofilm accumulation, generalized gingival bleeding, pseudomembrane, and necrotic tissue. Treatment consisted of supragingival scaling, professional prophylaxis, 0.12% chlorhexidine rinsing for two weeks, prescription of analgesics, and oral hygiene instructions. Results: The patient’s response to initial therapy was satisfactory. Successful clinical outcomes were observed at seven days after initial therapy, and the patient has remained stable without signs of disease recurrence for six months. Conclusion: Periodontal health and function were successfully reestablished.

P850 Co-medication before and after onset of inflammatory bowel disease in adults or elderly

Abstract Background The incidence of Inflammatory Bowel Disease (IBD) is increasing. Co-medication is clinically important in addition to the treatment of IBD. However, real-world data on co-medication is sparse. Thus, we aimed to describe whether a diagnosis of IBD affects the prescription pattern of co-medication used to treat other diseases in adult-onset and elderly-onset IBD. Methods This nationwide cohort study utilized data from Danish Health Registers. We included patients with adult-onset of IBD (18-59 years of age) and elderly-onset of IBD (+60 years of age) from 1998-2018 with three years of follow-up after the diagnosis for all patients. We identified patients who had at least two diagnoses of IBD in The National Patient Register. We described redeemed prescriptions of 11 common groups for medication used to treat conditions other than IBD using data from The Danish National Prescription Registry. Results We identified 36,165 incident patients. We created two cohorts; 27,386 (75%) had adult-onset IBD, and 8,779 (25%) patients had elderly-onset IBD, Table 1. The proportion of patients with redeemed prescriptions in both cohorts was statistically significantly increased one and three years after onset of IBD for antidepressants, antipsychotics, sedatives/hypnotics, opioids, non-opioid analgesics, antidiabetics, and proton pump inhibitors, compared to one and three years before diagnosis, Figure 1 &amp; Figure 2. Conclusion The proportion of patients with redeemed prescriptions for antidepressants, antipsychotics, sedatives/hypnotics, opioids, non-opioid analgesics, antidiabetics, and proton pump inhibitors was significantly increased one and three years after a diagnosis of IBD compared to one and three years before diagnosis.

Rapid Adoption of Telemedicine Increases Opioid Prescribing in Orthopedic Surgery.

Background: The COVID-19 pandemic led to health care practitioners utilizing new technologies to deliver health care, including telemedicine. The purpose of this study was to examine the effect of rapidly proliferative use of video visits on opioid prescribing to orthopedic patients at a large academic health system that had existing procedure-specific opioid prescribing guidelines. Methods: This IRB-exempt study examined 651 opioid prescriptions written to patients who had video (visual and audio), telephone (audio only), or in-person encounters at our institution from March 1 to June 1, 2020 and compared them with 963 prescriptions written during the same months in 2019. Prescriptions were converted into daily milligram morphine equivalents (MMEs) to facilitate direct comparison. Chi-square testing was used to compare categorical data, whereas analysis of variance and Mann-Whitney tests were used to compare numerical data between groups. Statistical significance was set at <0.05. Results: Six hundred fifty-one of 1,614 prescriptions analyzed (40.3%) occurred during the pandemic. Patients prescribed opioids during video visits were prescribed 53.3 ± 37 MME, significantly higher than in-person (p = 0.002) or audio visits (p < 0.001) before or during the pandemic. Prepandemic, significantly higher MME were prescribed for in-person versus audio only visits (41.6 ± 89 vs. 30.2 ± 28 MME; p = 0.026); during the pandemic, there was no difference between these groups (p = 0.91). Significantly higher MME were prescribed by Nurse Practitioners and Physician Associates versus MD or DO prescribers for both time periods (51.3 ± 109 vs. 27.9 ± 42 MME; p < 0.001; 42.9 ± 70 vs. 28.2 ± 42 MME; p < 0.001). Conclusion: During crisis and with new technology, we should be vigilant about prescribing of opioid analgesics. Despite well-established protocols, patients received significantly higher MME through video than for other encounter types, including in-person encounters. In addition, significantly higher MME were prescribed by mid-level prescribers compared with DOs or MDs. Institutions should ensure these prescribers are involved during creation of opioid prescribing protocols after orthopedic surgery.