Non-opioid Analgesics Research Articles

Epidemiology and treatment of pain associated with osteoarthritis of the knee in Germany: A retrospective health claims data analysis

ObjectiveOsteoarthritis of the knee (knee OA) is a serious joint disease leading to pain and reduced quality of life. Pharmacological treatments include anti-inflammatories, analgesics, intraarticular hyaluronic acid, and intraarticular corticosteroids while for severe knee OA, knee replacement is an option. This study examined the incidence, prevalence, patient characteristics, and uptake of medical and surgical treatments in knee OA patients in Germany. DesignA non-interventional, retrospective health claims data analysis with anonymized data from the InGef database was performed. Patients ≥18 years were analyzed cross-sectionally for each year 2015–2020. Newly diagnosed patients in 2015 were also longitudinally analyzed until end of 2020. ResultsAnnual knee OA prevalence increased from 7.07 ​% in 2015 to 7.39 ​% in 2020. Annual incidence proportions ranged from 1.71 ​% in 2015 to 1.46 ​% in 2020. Knee replacement was the most common surgery, with rising patient numbers (e.g., 7918 patients in 2015 and 8975 patients in 2019). Approximately 62 ​% of patients newly diagnosed in 2015 received prescription pharmacological pain treatment during follow-up. Most (96.95 ​%) received non-opioid analgesics, followed by weak opioids (8.14 ​%) and strong opioids (3.00 ​%) as first-line treatment (combinations possible). Knee surgery was performed in 16.6 ​% of patients during follow-up. Median time from first diagnosis until surgery was 346 days for any knee surgery and 564 days for knee replacement. ConclusionsThe number of patients with knee OA in Germany is steadily rising, along with an increasing number of surgical interventions, especially knee replacement. Time until first surgery and knee replacement is relatively short, even for newly diagnosed patients.

Analgesic consumption in a large sample of people in musculoskeletal rehabilitation: A descriptive study

BackgroundConsumption of opioids is increasing worldwide in people with chronic non-cancer pain, although their effectiveness is debated. ObjectivesThe aim of the current study was to evaluate analgesic consumption and its association with different variables (demographic variables, pain, anxiety/depression, catastrophism, and kinesiophobia), in the field of musculoskeletal rehabilitation, where no data are available. MethodsThis was a retrospective study over a period of 8 years on people hospitalised for rehabilitation after injury. Participants were classified into 3 categories: no analgesics (NA), non-opioid analgesics (NOA), and opioid analgesics (OPA). ANOVA or chi-squared tests were used to compare the 3 groups. ResultsA total of 4,350 people (84% men; mean [SD] age, 44 [11] years) were included. In total, 20% were taking OPA, 40% NOA and 40% NA. In the OPA group, tramadol was mainly used, and the morphine equivalent median dose was 8.3 mg/day. In the NOA group, paracetamol and ibuprofen were mostly used. Symptoms increased progressively across the 3 groups (NA/NOA/OPA), with increased levels of pain severity/interference, anxiety/depression and catastrophizing, and a higher prevalence of neuropathic pain in the OPA group versus the others. ConclusionsThese results are consistent with those found in groups of people with chronic pain taking larger doses of opioids and following opioid reduction or cessation programs. Opioid prescription did not increase over the 8 years, which was reassuring. These factors are important to emphasise because they can be modified in the rehabilitation setting with interdisciplinary management. RegistrationOur database was registered on Mendeley Data.

Toxicology Screening in Sports-Related Sudden Cardiac Death: A Multinational Observational Study

BackgroundKnowledge of toxicological findings among sports-related sudden cardiac death (SrSCD) is scarce. ObjectivesThis study aimed to describe postmortem toxicology findings in a multinational cohort of young SrSCD. MethodsPatients with sudden cardiac death (SCD) aged 12 to 49 years with a complete post mortem were included from Denmark, Spain, and Australia. Postmortem findings were compared between SrSCD and non-SrSCD, and toxicology findings in SrSCD were assessed. ResultsWe included 3,189 SCD, of which 219 (7%) were sports-related. SrSCD patients were younger (36 years vs 41 years; P < 0.001) and of male predominance (96% vs 75%; P < 0.001), and their death was more often caused by structural cardiac disease (68% vs 61%; P = 0.038). Positive toxicology screenings were significantly less likely among SrSCD than non-SrSCD (12% vs 43%; P < 0.001), corresponding to 82% lower odds of a positive toxicology screening in SrSCD. Patient characteristics were similar between SrSCDs with positive and negative toxicology screenings, but deaths were more often unexplained (59% vs 34%). Nonopioid analgesics were the most common finding (3%), and SCD-associated drugs were detected in 6% of SrSCD. SUD was more prevalent among the SrSCD with positive toxicology (59% vs 34%). ConclusionsSports-related SCD mainly occurred in younger men with structural heart disease. They had a significantly lower prevalence of a positive toxicology screening compared with non-SrSCD, and detection of SCD-associated drugs was rare.

Opioid analgesics for nociceptive cancer pain: Acomprehensive review.

Pain is one of the most burdensome symptoms in people with cancer, and opioid analgesics are considered the mainstay of cancer pain management. For this review, the authors evaluated the efficacy and toxicities of opioid analgesics compared with placebo, other opioids, nonopioid analgesics, and nonpharmacologic treatments for background cancer pain (continuous and relatively constant pain present at rest), and breakthrough cancer pain (transient exacerbation of pain despite stable and adequately controlled background pain). They found a paucity of placebo-controlled trials for background cancer pain, although tapentadol or codeine may be more efficacious than placebo (moderate-certainty to low-certainty evidence). Nonsteroidal anti-inflammatory drugs including aspirin, piroxicam, diclofenac, ketorolac, and the antidepressant medicine imipramine, may be at least as efficacious as opioids for moderate-to-severe background cancer pain. For breakthrough cancer pain, oral transmucosal, buccal, sublingual, or intranasal fentanyl preparations were identified as more efficacious than placebo but were more commonly associated with toxicities, including constipation and nausea. Despite being recommended worldwide for the treatment of cancer pain, morphine was generally not superior to other opioids, nor did it have a more favorable toxicity profile. The interpretation of study results, however, was complicated by the heterogeneity in the study populations evaluated. Given the limited quality and quantity of research, there is a need to reappraise the clinical utility of opioids in people with cancer pain, particularly those who are not at the end of life, and to further explore the effects of opioids on immune system function and quality of life in these individuals.

A Resident-Driven Quality Initiative for Reducing Opioid Prescribing in Patients Undergoing Elective General Surgery Procedures, With Long-Term Follow-Up

Background The opioid epidemic has been declared a public health emergency in the United States—and major news outlets have labeled operating rooms as “unintended gateways.” In response to this emergency, our academic institution sought to decrease our contribution to the potential diversion pool—the opioids surgeons prescribe to patients which go unused. Methods Patients undergoing common surgical procedures between August 2017 and March 2018 were identified. Patients were contacted by phone and consented, and opioid use data was collected. The potential diversion pool was calculated as pills prescribed minus pills consumed for each patient and procedure, and subgroup analysis was performed to correlate the number of opioid pills taken within 24 hours before hospital discharge to the number taken after discharge. Results Surveys were completed for 357 patients. Overall, 6,831 of the 12,061 tablets prescribed were unused (57%). Patients who took 7 or more doses of oral opioids in the last 24 hours before discharge had significantly fewer (30%) pills remaining compared to patients who took 0–6 doses (68% remaining). Ninety-nine of 111 patients (89%) who took 0 tablets 24 hours prior to discharge left with an opioid prescription, creating a diversion pool of 2,419 pills remaining out of 3,353 prescribed (72%). Based on a 95% confidence interval of procedural opioid consumption, prescribing guidelines were created within a toolkit designed to set preoperative expectations, promote use of nonopioid analgesics, and provide opioid disposal information. We have continued to track our data, with low opioid prescribing patterns. Conclusion Surgical departments can develop opioid reduction toolkits aimed at reducing the potential diversion pool of opioids in our communities. Such toolkits have a sustained positive impact.

Implementation of a nonopioid multimodal analgesia protocol significantly reduces opioids prescribed after total shoulder arthroplasty: a retrospective study

BackgroundThe purpose of this study was to evaluate the impact of a nonopioid multimodal pain protocol on the amount of opioids prescribed, pain level, and complications in patients undergoing total shoulder arthroplasty (TSA) compared to a standard opioid regimen. MethodsWe retrospectively reviewed 2 consecutive cohorts who underwent either primary anatomic or reverse TSA by a single surgeon. The opioid cohort included patients from 2016 to 2020 who received an intraoperative periarticular injection (Ropivacaine, Epinephrine, and Ketorolac cocktail) and were prescribed Oxycodone/Acetaminophen 5/325 mg on discharge. The nonopioid cohort included patients from 2020 to 2022, consisting of preoperative oral analgesics (Celecoxib, Pregabalin, and Tramadol); intraoperative intravenous Dexamethasone and Acetaminophen and periarticular injection; and postoperative oral Dexamethasone and oral analgesics (Pregabalin, Tizanidine, Magnesium, Ibuprofen, and Acetaminophen). The nonopioid cohort had the option to ask for an opioid prescription postoperatively if needed. Patient-reported outcomes collected included visual analog scale scores for pain and Patient-Reported Outcome Measurement Information System up to 1 year after surgery. Opioid consumption using Morphine Milligram Equivalents were compared up to 3 months postoperatively. ResultsThere were 232 patients in the opioid and 112 in the nonopioid cohorts, respectively. The nonopioid protocol had lower mean visual analog scale scores at preoperative (6.4 vs. 7.4, P < .05), 10-day (3.5 vs. 4.2, P < .05), and 6-week postoperative time points (2.1 vs. 2.8, P < .05), but no differences between the groups were noted 3 months postoperatively. No differences in Patient-Reported Outcome Measurement Information System–upper extremity, pain interference, or depression were found preoperatively and up to 1 year after surgery. Opioid consumption was lower in the nonopioid cohort at all time periods (P < .01). Patients in the nonopioid cohort had significantly lower Morphine Milligram Equivalents at discharge, 10-day, 6-week, and 90-day time periods (P < .01) when compared to the opioid cohort. When analyzing risk factors for continued opioid prescriptions for the whole cohort, preoperative opioid use within 90 days before surgery (relative risk 4.69 [95% confidence interval 3.18-6.91; P < .01) and current tobacco use (relative risk 2.61 [95% confidence interval 1.50-4.54]; P = .01) were associated with continued refills >30 days. Complications in the perioperative period and 90-day hospital readmissions were not significantly different between the groups. ConclusionA nonopioid postoperative regimen for patients undergoing TSA significantly reduces opioid prescriptions with similar patient-reported outcomes, subjective pain scores, and without increased complication rates compared to an opioid-only regimen.

Sex Differences in Opioid Administration After Cardiac Surgery

ObjectivesAre there sex-based differences in the administration of opioid analgesic drugs among inpatients after cardiac surgery? DesignThis is a retrospective cohort study. SettingA tertiary academic referral centre. ParticipantsAdult patients who underwent cardiac surgery from 2014 to 2019. InterventionsNone Measurements and Main ResultsThe primary outcome was the cumulative oral morphine equivalent dose (OMED) for the post-operative admission. Secondary outcomes were the daily difference in OMED and the administration of non-opioid analgesics. We developed multivariable regression models controlling for known confounders, including weight and length of stay.A total of 3,822 patients (1,032 women and 2,790 men) were included. The mean cumulative OMED was 139 mg for women and 180 mg for men, and this difference remained significant after adjustment for confounders (adjusted mean difference [aMD], -33.21 mg; 95% confidence interval [CI], -47.05 to -19.36 mg; p < 0.001). The cumulative OMED was significantly lower in female patients on postoperative days 1 to 5, with the greatest disparity observed on day 5 (aMD, -89.83 mg; 95% CI, -155.9 to -23.80 mg; p = 0.009). By contrast, women were more likely to receive a gabapentinoid (OR, 1.91; 95% CI, 1.42 to 2.58; p < 0.001). We found no association between patient sex and the administration of other non-opioid analgesics or specific types of opioid analgesics. We found no association between patient sex and pain scores recorded within the first 48 hours following extubation, or the amount of opioid administered in close proximity to pain assessments. ConclusionsFemale sex was associated with significantly lower amounts of opioid administered after cardiac surgery.

Opioid-free versus opioid-sparing anaesthesia in ambulatory total hip arthroplasty: a randomised controlled trial

BackgroundEnhanced recovery after surgery pathways are essential for ambulatory surgery. They usually recommend lower intraoperative opioid use to avoid opioid-related adverse effects. This has led to opioid-sparing anaesthesia (OSA) techniques, with the extreme approach of opioid-free anaesthesia (OFA) mostly with dexmedetomidine. As evidence is lacking in day-case primary total hip arthroplasty, this study was performed to assess the potential benefits in postoperative analgesia of OFA over OSA. MethodsIn this single-centre, prospective, triple blind study, we randomly allocated 80 patients undergoing day-case primary THA under general anaesthesia. Patients received a total intravenous anaesthesia with a laryngeal mask and multimodal analgesic regimen with non-opioid analgesics. The OSA group received low dose of sufentanil, and the OFA group received dexmedetomidine The primary outcome was the opioid consumption in the first 24 h in oral morphine equivalents (OME). ResultsThere was no difference in median cumulative OME consumption at 24 h between the OSA and OFA groups (12 [0–25] mg vs 16 [0–30] mg, respectively; P=0.7). Pain scores were similar and low in both groups with comparable walking recovery time. Adverse events were sparse and equivalent in both groups except for dizziness, which was more frequent in the OSA group (P<0.05). ConclusionsIn day-case total hip arthoplasty under general anaesthesia, opioid-free anaesthesia and opioid-sparing anaesthesia both provide early recovery and effective postoperative pain relief. When compared with opioid-sparing anaesthesia, opioid-free anaesthesia does not decrease opioid consumption in the first 24 h. These findings do not suggest any significant benefit from complete intraoperative avoidance of opioids. Clinical trial registrationNCT0507270.

Abstract B026: Exploring differences in supportive care medication use among racial and ethnic minorities with pancreatic and colorectal cancers

Abstract Background: Pancreatic (PC) and colorectal cancer (CRC) are both cancers of the digestive system, with similar symptom profiles. Neurologic and psychiatric symptoms are commonly seen in multiple types of cancer including PC and CRC. Supportive care medications (SCM) are central to symptom management and improving health-related Quality of Life (HRQoL). Examples of SCM used to manage these symptoms include opioid analgesics, non-opioid analgesics, antidepressants, anxiolytics, and antipsychotics. Racial disparities in clinical outcomes including HRQoL have been reported in PC and CRC, respectively. While racial disparities have been separately described in the use of SCM for PC and CRC, no comparisons of SCM use based on cancer type in racial and ethnic minorities has been performed. The purpose of our study was to explore differences in SCM use among racial and ethnic minorities with PC and CRC, respectively. Methods: We used the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER)- Medicare-linked database to analyze all patients with a PC or CRC diagnosis and a newly initiated outpatient prescription claim for an SCM of interest from 2009-2018. Patients on SCM before cancer diagnosis or were not a member of racial or ethnic group were excluded from the analysis. We assessed five SCM classes, including opioids, non-opioid analgesics, antidepressants, anxiolytics, and antipsychotics. Prescription claims were specific to patients diagnosed with PC or CRC, and compared by cancer type. Our objective was to characterize the relationship between cancer type and receipt of SCM in racial and ethnic minorities. Results: After assessment of our inclusion/exclusion criteria, 45,502 patients were included in the analysis (PC- 44.9%; CRC- 55.1%). Racial demographics were as follows: Black/African American: 51.5%, Hispanic- 23.6%, Asian- 23.5%, American Indian/Alaska Native: 1.3%. When comparing cancer types, patients with PC were more likely to receive multiple classes of SCM including opioids (Odds Ratio [OR] 2.17, 95%CI: 2.09-2.25), non-opioid analgesics (OR 1.29, 95%CI: 1.22-1.37), antidepressants (OR 1.19, 95%CI: 1.14-1.24), and anxiolytics (OR 1.45, 95%CI:1.37- 1.54). PC patients were less likely to receive antipsychotics (OR 0.77, 95%CI: 0.72- 0.83). Differences were similar when disaggregated by specific race and ethnicity. Conclusion: Among racial and ethnic minorities, patients with PC were more likely to be prescribed multiple classes of SCM used to treat neurologic and psychiatric symptoms, including opioids, non-opioid analgesics, antidepressants, and anxiolytics. The observed results suggests a heavier overall symptom burden for PC in this population. Citation Format: John M. Allen, MegCholack Awunti, Yi Guo, Sherise C. Rogers, Lisa Scarton, Chardaé Whitner, Diana J. Wilkie. Exploring differences in supportive care medication use among racial and ethnic minorities with pancreatic and colorectal cancers [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B026.

Impact of Srs-CoV2 Infection on Pain Crises and Acute Chest Syndome in Patients with Sickle Cell Anemia: A Retrospective Multi-Cohort Study Based on USA Data from 2020-2022

Objective: To determine the impact of SARS-CoV-2 infection on vaso-occlusive pain crisis (VOC) and acute chest syndrome (ACS), incidence, and outcomes in sickle cell anemia (SCA) patients. Method: This retrospective study used the TriNetX USA health research network database to identify SCA patients (Hb-SS, Sβ0-thal) ages 1-50 with and without concomitant SARS-CoV-2 infection from May 2020 to May 2022. A total of 6 cohorts were created: pain crisis with/without SARS-CoV-2, ACS with/without SARS-CoV-2, and SARS-CoV-2 without pain crisis/ACS. Patients with SARS-CoV-2 and pain crisis/ACS were compared to 2 cohorts (SARS-CoV-2 without pain crisis/ACS) for demographic characteristics, baseline laboratory parameters, disease-modifying drug use, and influenza/COVID-19 vaccination status by t-tests. Pain crisis/ACS patients with SARS-CoV-2 were then compared to 2 cohorts (pain crisis/ACS without concomitant infection) for demographic characteristics, and relative risk for acute settings of care, pain control, laboratory parameters/outcomes (including hemolytic and inflammatory markers), procedures (blood transfusion) and mortality. Results : The incidence of pain crises and ACS in SCA patients following SARS-CoV-2 infection was 34 and 27 per 100 patients, respectively. The risk of developing ACS was significantly increased by SARS-CoV-2 infection (2.57% vs. 1.17%, RR 2.2), but not the risk of developing a pain crisis (RR 1.04). Pain crisis and ACS patients with concomitant SARS-CoV-2 infection had a greater risk for inpatient services, subsequent hospital visits, opioid and non-opioid analgesia, blood transfusions, and concerning hemolytic and inflammatory markers compared to those without the infection. Patients with SARS-CoV-2 who did not develop pain crises/ACS had higher baseline hemoglobin levels prior to infection compared to patients who developed pain crisis/ACS. There was a higher rate of COVID-19 and influenza vaccination in the cohorts who did not develop pain crisis/ACS and might have improved pain crisis rates (but not ACS) following SARS-CoV-2 infection. Conclusions: COVID-19 illness had an impact on the incidence of both pain crises and ACS, significantly increased the risk of developing ACS, and influenced morbidity outcomes for both pain crises and ACS. Prior vaccination against influenza and COVID-19 may represent a protective factor for developing pain crises.

Pain Management Throughout Pediatric Laparoscopic Appendectomy: A Systematic Review.

Opioid-related fatalities are a leading cause of accidental death in the United States. Appendicitis is a common cause of abdominal pain in children and adolescents. The management of pain throughout the laparoscopic appendectomy (LA) in the pediatric population is a critical concern. This study aimed to evaluate trends in analgesic use and patient satisfaction following LA, with a focus on reducing the reliance on opioids for pain management. From 2003 to 2023, 18258 articles were filtered for all types of analgesic use with LA. The publications were screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 19 studies were included for analysis and review. The study included peer-reviewed experimental and observational studies involving individuals under 18 years. Pain management strategies varied across studies, involving a combination of analgesics, nerve blocks, and wound infiltrations. Analgesics such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids were administered before and after surgery. Some studies implemented patient-controlled analgesia (PCA) pumps. Other studies explored non-pharmacological interventions like magnetic acupuncture. The results showed a reduction in the need for postoperative analgesics in patients treated with LA, particularly when using non-opioid medications and novel analgesic techniques. Pediatric patients who received gabapentin reported lower opioid use, shorter hospital stays, and high satisfaction rates. However, the reliance on opioids remained significant in some cases, particularly among patients with peritonitis who required more morphine. Pain management in pediatric patients is multifaceted, involving preoperative and postoperative analgesics, nerve blocks, and PCA pumps. Efforts to improve pain management following pediatric LA while reducing opioid reliance are essential in the context of the ongoing opioid epidemic. The findings from this study highlight the potential benefits of non-opioid analgesics, nerve blocks, and alternative methods for managing postoperative pain in <18 appendectomy patients. Further research and standardization of pain management protocols are needed to ensure optimal patient outcomes and minimize the risk of opioid-related complications.

Antiplatelet effect of acetylsalicylic acid in patients early after cardiac valve surgery: comparative investigation of the impairment of platelet inhibition by dipyrone versus acetaminophen

Abstract Background Low-dose acetylsalicylic acid (ASA) is recommended in current guidelines for a period of 3 months after surgical implantation of a bioprosthesis in aortic position or after surgical repair of the mitral valve. Dipyrone (D; metamizole) and acetaminophen (A; paracetamol) are frequently used non-opioid analgesics after surgery. The active metabolite of dipyrone (4-methylaminoantipyrine) is a reversible inhibitor of cyclooxygenase-1 and an interaction with the antiplatelet effect of ASA in more than 50 % of patients has been reported. Material and methods We enrolled 162 patients scheduled for cardiac surgery in this prospective investigator-initiated clinical study. Patients were randomized at day 1 after surgery to either 4 x 1g dipyrone iv/day or 4 x 1g acetaminophen iv/day. All patients were on ASA 100 mg daily (200 mg at day 1). The primary endpoint was the proportion of patients with adequate antiplatelet response to ASA assessed via determination of thromboxane B2 in platelet rich plasma after stimulation with arachidonic acid (AA) at day 4/5 after surgery (cutpoint ≤209.8 ng/ml thromboxane B2). Key secondary endpoints comprised platelet reactivity assessed by light transmission aggregometry [LTA] and by multiple electrode impedance aggregometry [MEIA]. Results 15 patients dropped out of the study. Thus, data from 71 patients randomized to dipyrone and 76 patients randomized to acetaminophen were available for data analysis. Patients had a mean age of 66.5±7.6 years and 97 were male and 50 female. Aortic valve was replaced in 92 patients, 54 underwent mitral valve reconstruction and combined surgery was performed in a single patient. The primary endpoint analyzed at day 4/5 after surgery is shown in the Figure. The proportion of non-responders was 12.5% (D) and 3.0% (A), respectively. Platelet reactivity at day 4/5 after surgery was assessed after stimulation with arachidonic acid by LTA or MEIA. No statistically significant difference between the treatment strata was determined in both assays: Maximum aggregation in LTA was 5.0% (median; 95% confidence interval [95% CI]: 4.0 - 8.0%) in D+ASA and 6.0% (95% CI: 5.0 - 11.0%) in A+ASA (p=0.528) and MEIA AUC was 345.5 AU*min (95% CI: 268.0 - 419.0) in D+ASA and 276.5 AU*min (95% CI: 241.0 - 330.0) in A+ASA (p=0.098). Plasma concentrations of MAA in patients treated with dipyrone were higher in patients identified as responders to ASA (86.6 µM; 95% CI: 67.9 - 102.4 µM) compared to non-responders (31.0 µM; 95% CI: 2.9 – 146.7 µM; p=0.0147). Summary and conclusion The proportion of non-responders to ASA is higher in patients treated with dipyrone compared to acetaminophen. The proportion of non-responders in the dipyrone-treated group in our study is substantially lower than reported in previous studies. High plasma concentrations of MAA in responders may contribute to enhanced inhibition of COX-1 in patients treated with dipyrone.

Non-opioid multimodal analgesia in the immediate postoperative period

Objective. To increase the effectiveness of postoperative multimodal analgesia using contact LED exposure with Russian BASI bracelets emitting in blue range 470 ± 10 nm and including magnesium sulfate in the multimodal postoperative analgesia protocol.Material and methods. To achieve the goal set in the work, the effectiveness of contact LED blood irradiation in blue range of 470 ± 10 nm at the microcirculation state was analyzed in patients of the main group (n = 46) in the immediate postoperative period. We studied the percentage of oxygen, as well as the acid-base state of venous blood before and after contact LED exposure. In the comparison group (n = 42), patients did not have contact LED blood irradiation in the immediate postoperative period.To study the effectiveness of contact LED blood irradiation at blood coagulation parameters, a series of coagulograms of blood samples taken from patients of both groups was done: once (before surgery) in the preoperative period and once in the immediate postoperative period up to 6 hours, because after 6 hours, anticoagulant therapy was administered according to the protocol. Coagulological testing was performed using Sysmex CA-560 apparatus (Japan). The acid-base state of venous blood was evaluated using Gem Premier 3000 apparatus manufactured by Instrumentation Laboratory.Research results. Coagulation tests revealed a positive effect of contact LED blood irradiation in patients of the main group. This effect was manifested in the stable trend of shifts towards moderate hypocoagulation in postoperative hemostatic parameters in all studied stages, what indicates the prevention of possible complications like thromboembolism in the postoperative period.Conclusion. Contact LED blood irradiation in blue range 470 ± 10 nm prevents thromboembolism in the postoperative period and allows to achieve pain relief without narcotic analgesics on the first day after the surgery.

Repurposing EGFR Inhibitors for Oral Cancer Pain and Opioid Tolerance.

Oral cancer pain remains a significant public health concern. Despite the development of improved treatments, pain continues to be a debilitating clinical feature of the disease, leading to reduced oral mobility and diminished quality of life. Opioids are the gold standard treatment for moderate-to-severe oral cancer pain; however, chronic opioid administration leads to hyperalgesia, tolerance, and dependence. The aim of this review is to present accumulating evidence that epidermal growth factor receptor (EGFR) signaling, often dysregulated in cancer, is also an emerging signaling pathway critically involved in pain and opioid tolerance. We presented preclinical and clinical data to demonstrate how repurposing EGFR inhibitors typically used for cancer treatment could be an effective pharmacological strategy to treat oral cancer pain and to prevent or delay the development of opioid tolerance. We also propose that EGFR interaction with the µ-opioid receptor and glutamate N-methyl-D-aspartate receptor could be two novel downstream mechanisms contributing to pain and morphine tolerance. Most data presented here support that repurposing EGFR inhibitors as non-opioid analgesics in oral cancer pain is promising and warrants further research.

Medication prescription profile and hospital admission related to medication administration errors in England and Wales: an ecological study

ObjectiveTo explore the correlation between prescribing rate of medications and hospital admissions related to medications administration errors in England and Wales during the time from 1999 to 2020.DesignAn ecological study.SettingA...

Payor-driven denials and delays for cancer-related supportive care medications.

78 Background: Prior authorization (PA) requires providers to obtain payor pre-approval for a prescribed treatment in order for it to be covered financially. While PA can be used to ensure adherence to evidence-based guidelines and to contain payor costs, it often results in delayed or denied care, which is problematic for patients with cancer who are seeking urgent management of symptoms. This analysis sought to describe PA-related denials and delays for supportive care medications among patients with cancer. Methods: All outpatient prescriptions at an urban comprehensive cancer center requiring PA from 2021-2022 were reviewed to characterize PA for supportive care medications. Prescriptions included long-acting opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone, oxymorphone); non-opioid analgesics (duloxetine, pregabalin); and anti-emetics (aprepitant, dronabinol, granisetron, ondansetron, scopolamine). Prescription-level outcomes included decision status (approval vs. denial) and days to insurance decision. Bivariate analyses identified variations in PA denials by drug class and payor type. Among a subset of PA approvals for which data were available, we conducted bivariate analyses to evaluate associations of payor type and drug class with length of delay. Results: In the analysis period, 3304 supportive care medication prescriptions required PA: 2489 (75%) long-acting opioids; 131 (4%) non-opioid analgesics; 684 (21%) anti-emetics. Of these, 246 (8%) prescriptions were denied by the payor. The proportion of denied PAs for non-opioid analgesics (n=17; 13%) was greater than the proportion for opioids (n=182; 7%) and anti-emetics (n=17; 2%: χ2=6.5, df=2, p=.04). The proportion of denials among Medicare beneficiaries was greater than the proportion of denials among patients with private insurance, Medicaid, or Medicare Advantage plans (χ2=12.6, df=3, p=.006). Among denials, length from prescription entry to PA final denial ranged from 0-78 days (median=2.0), with no variation by payor type (F=0.85, p=.47). Among approved prescriptions with available data (n=851), 349 (41%) had same-day approval, with delays ranging from 1-54 days (median=2.0). Medicaid patients faced longer delays than patients from other payors (F=4.98, p=.002), with no difference in length of delay by drug class. Conclusions: The acute burden of cancer-related pain and nausea requires immediate mitigation, often with medication. PA can have a negative impact on the medication management of cancer-related pain and nausea: over one-half of supportive care medications had a ≥1 day delay, and 8% were denied altogether. Denials, or even brief delays, of provider-prescribed medication to ease symptom burden may lead to downstream increases in patient morbidity and payor costs, including symptom-related emergency room visits and hospitalization. Urgent efforts to reform PA are needed.

Comparative Effectiveness of Opioids vs. Non-Opioid Analgesics on the Risk of ESRD and Mortality Among US Veterans with CKD and Chronic Pain

Comparative Effectiveness of Opioids vs. Non-Opioid Analgesics on the Risk of ESRD and Mortality Among US Veterans with CKD and Chronic Pain

Paediatric hospitalisation related to medications administration errors of non-opioid analgesics, antipyretics and antirheumatics in England and Wales: a longitudinal ecological study

ObjectiveThis study aimed to explore paediatric hospitalisation related to medication administration errors (MAEs) of non-opioid analgesics, antipyretics and antirheumatics in England and Wales.DesignAn ecological study.SettingA population-based study on hospitalised patients...

GLIOMA-07 E.R.A.S. IN NEURO-ONCOLOGY

Abstract BACKGROUND We performed a retrospective study assesses the efficacy and safety of a protocol for the enhanced recovery after surgery for supratentorial gliomas and metastasis.The protocol applied to the Ca' Foncello Hospital in Treviso starts from the recommendations on the subject that the medical literature reported up to December 2018.Briefly, three main sections:1) preoperative functional status evaluation, preoperative oral carbohydrate loading; 2) minimally invasive surgery, scalp incision anesthesia, nonopioid analgesia; 3) early urinary-catheter removal, standing and feeding resumption within 3-4 hours from surgery. METHODS We analyzed data on 28 patients operated on ERAS protocol and compared them to a control group (22 patients). The main clinical variables are: age, ASA and Charlson comorbidity index; times urinary-catether removal, adherence ambulation, taking food by mouth; hospital long of stay (LOS). We also collected studies from 2016 to 2020 describing data about ERAS and craniotomy and we pooled these into a meta-analysis. RESULTS Postoperative pain was significantly lower in the ERAS group (2.47 vs. 3.95, p-value=0.0007)) as long as time to removal of urinary catheter (3.1 vs. 25.0 hours, p-value &amp;lt; 0.001), adherence to ambulation (4 vs. 25 hours, p-value &amp;lt; 0.001), and first oral solid food intake (5.3 hours vs. 23.7 hours, p-value &amp;lt; 0.001). The mean LOS was 2.9 days in the ERAS group and 4.8 days in the control group (p-value &amp;lt; 0.001), and no differences in terms of surgical and medical complications, 30 days readmission rate, and time between surgery and RT were found. Our data are in line with those reported in the literature as highlighted by our meta-analysis, where hospital LOS and moderate to severe postoperative pain rates (&amp;gt; 4 points on NPRS) were significantly lower in ERAS patients. CONCLUSIONS Our protocol for ERAS in neuro-oncology appears to have significant benefits over conventional management: it may accelerate functional recovery and decrease length of stay

Pain Management and Opioid Use with Long-Acting Peripheral Nerve Blocks for Hand Surgery: A Descriptive Study.

Peripheral nerve blocks (PNBs) are used in multiple surgical fields to provide a high level of regional pain relief with a favorable adverse effect profile. Peripheral nerve blocks aim to decrease overall perioperative pain and lower systemic analgesic requirements. Short-acting anesthetic agents are commonly given as single-injection PNBs for pain relief, typically lasting less than 24 hours. Liposomal bupivacaine is a newer anesthetic formulation lasting up to 72 hours as a single-injection PNB and may allow patients to recover postoperatively with a lower need for opioid analgesics. This study investigates peri- and postoperative pain and opioid use in patients receiving a long-acting brachial plexus PNB for hand surgery. A retrospective review of patients who underwent a long-acting PNB using liposomal bupivacaine in the brachial plexus for minor hand operations was performed between July 2020 and May 2023 in Florida, USA. Patients were administered a ten-question survey regarding perioperative pain levels, post-operative symptoms, patient satisfaction, postoperative opioid use, and postoperative non-opioid analgesics. One hundred three patients, including 21 males and 82 females with an average age of 68.3 ± 15.8 years, completed a survey (34.2% response rate). Patients reported a considerable reduction in pain from 7.9 ± 2.2 out of ten before the PNB to 1.6 ± 1.8 in the perioperative period, 4.3 ± 2.7 in postoperative days zero to three, and 3.8 ± 2.4 in postoperative days four and five. Nerve block effects lasted a mean of 2.2 ± 2.0 days and patients reported a high level of satisfaction regarding their pain management plan with a score of 9.4 ± 1.4 out of ten. 20.4% of patients were prescribed opioids and 41.7% used NSAIDs postoperatively. Liposomal bupivacaine PNBs effectively reduced peri- and postoperative pain with pain relief lasting 2.2 ± 2.0 days. Patients were highly satisfied with their pain management and there was a low rate of postoperative opioid prescription. Given these results, long-acting PNBs have the potential to significantly improve patient satisfaction, reduce anesthesia use, and reduce postoperative opioid prescription.