Opiate Use Research Articles

Association of socioeconomic deprivation with outcomes in critically ill adult patients: an observational prospective multicenter cohort study.

The influence of socioeconomic deprivation on health inequalities is established, but its effect on critically ill patients remains unclear, due to inconsistent definitions in previous studies. Prospective multicenter cohort study conducted from March to June 2018 in eight ICUs in the Greater Paris area. All admitted patients aged ≥ 18years were enrolled. Socioeconomic phenotypes were identified using hierarchical clustering, based on education, health insurance, income, and housing. Association of phenotypes with 180-day mortality was assessed using Cox proportional hazards models. A total of 1,748 patients were included. Median age was 62.9 [47.4-74.5] years, 654 (37.4%) patients were female, and median SOFA score was 3 [1-6]. Study population was clustered in five phenotypes with increasing socioeconomic deprivation. Patients from phenotype A (n = 958/1,748, 54.8%) were without socioeconomic deprivation, patients from phenotype B (n = 273/1,748, 15.6%) had only lower education levels, phenotype C patients (n = 117/1,748, 6.7%) had a cumulative burden of 1[1-2] deprivations and all had housing deprivation, phenotype D patients had 2 [1-2] deprivations, all of them with income deprivation, and phenotype E patients (n = 93/1,748, 5.3%) included patients with 3 [2-4] deprivations and included all patients with health insurance deprivation. Patients from phenotypes D and E were younger, had fewer comorbidities, more alcohol and opiate use, and were more frequently admitted due to self-harm diagnoses. Patients from phenotype C (predominant housing deprivation), were more frequently admitted with diagnoses related to chronic respiratory diseases and received more non-invasive positive pressure ventilation. Following adjustment for age, sex, alcohol and opiate use, socioeconomic phenotypes were not associated with increased 180-day mortality: phenotype A (reference); phenotype B (hazard ratio [HR], 0.85; 95% confidence interval CI 0.65-1.12); phenotype C (HR, 0.56; 95% CI 0.34-0.93); phenotype D (HR, 1.09; 95% CI 0.78-1.51); phenotype E (HR, 1.20; 95% CI 0.73-1.96). In a universal health care system, the most deprived socioeconomic phenotypes were not associated with increased 180-day mortality. The most disadvantaged populations exhibit distinct characteristics and medical conditions that may be addressed through targeted public health interventions.

The comparison between opiate use disorder patients in the remission state with healthy volunteers regarding behavioral addictions

ABSTRACT Objective The present study aimed to compare the patients with opiate use disorder (OUD) and healthy volunteers with respect to behavioral addictions (gambling, excessive shopping, internet, and exercise). Methods Our study included 100 OUD patients in the remission state for at least one month who had been diagnosed according to DSM-5 diagnostic criteria and completed detoxification therapy and 100 healthy volunteers. Sociodemographic Data Form, South Oaks Gambling Screen (SOGS), Compulsive Online Shopping Scale (COSS), Exercise Addiction Scale (EAS), and Internet Addiction Scale (IAS) were administered to all participants. Results Mean ages were 31.62 ± 6.48 and 31.67 ± 7.8 years in the OUD and healthy volunteer groups, respectively (p = NS). Male participants constituted 90% (n = 90) of both groups. Similar SOGS (p = NS), COSS (p = NS), and EAS (p = NS) scores were detected in both groups. IAS scores of healthy controls were found significantly higher than the OUD group (p < .001). Conclusion According to our study results, we can state that OUD patients in the remission state are similar with general population with respect to exercise, gambling, and shopping addictions whereas their risk for internet addiction is lower than the general population.

375 Cervical Arthroplasty in the Treatment of Myelopathy: Clinical Predictors, Utilization, and Outcomes in a Large Administrative Database

INTRODUCTION: Cervical arthroplasty is a treatment for cervical radiculopathy; however, it may also be safe and effective in patients with mild myelopathy. METHODS: Retrospective data spanning 2016-2020 from the PearlDiver Patient Claims Database was used to select patients. Age, gender, osteoporosis, obesity, smoking, diabetes, Charlson Comorbidity Index (CCI), and 1- or 2-level surgery, re-operation rates, 90-day readmission, medical complications, and morphine milligram equivalents (MME) before/after surgery were collected. Univariate &amp; multivariate analyses were performed to identify differences. Reoperation rates were compared using propensity-matched analysis. RESULTS: We identified n = 2,391 (4.5%) CDA and n = 50,845 ACDF procedures for cervical myelopathy. Predictors favoring CDA included female sex, younger age, lower CCI score, lower incidence of obesity, osteoporosis, diabetes, or smoking (p ≤ 0.001); remaining significant after multivariate analysis except sex (p = 0.06). Single-level surgery was more predictive for undergoing CDA. CDA patients had lower 90-day readmissions, complications, and lower opioid utilization. The overall reoperation rate was 5%. Predictors of reoperation included: male sex, younger age, greater CCI, obesity, osteoporosis, diabetes, smoking, and 2-level surgery, remaining significant after multivariable logistic regression except for diabetes (p = 0.23) and CCI (p = 0.05). The robustness of these factors were evaluated by matching patients (n = 2,391) with no difference in re-operation rates identified (p = 0.47). CONCLUSIONS: CDA patients are generally healthier (lower incidence of obesity, smoking, diabetes, CCI) and represents 4.5% of procedures for 1- or 2-level cervical myelopathy. Readmission rates, medical complications, and opiate use was lower with patients undergoing CDA, despite an overall similar reoperation rate. This study is limited by its retrospective nature and the lack of granular outcomes measurements. However, the data suggests that CDA is a viable option for cervical myelopathy.

Combined Targeted Muscle Reinnervation With Regenerative Peripheral Nerve Interfaces Decreases Long-Term Narcotic Use in Amputees: A Case Control Study.

Combined targeted muscle reinnervation with regenerative peripheral nerve interfaces ("TMRpni") is a recently described nerve management strategy that leverages beneficial elements of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI) techniques. This study aimed to evaluate the effect of TMRpni on long-term opioid consumption after amputation. We hypothesize that TMRpni decreases chronic opioid consumption in amputees. This is a retrospective cohort study of all patients who underwent TMRpni between 2019 and 2021. These patients were age-matched at a 1:1 ratio with a control group of patients who underwent amputation without TMRpni. Statistical analysis was performed using SPSS Version 28.0. Thirty-one age-matched pairs of patients in the TMRpni and control groups were included. At 30 days after surgery, there was no significant difference in number of patients who required an additional refill of their opioid prescriptions (45% vs 55%, P = 0.45) or patients who continued to actively use opioids (36% vs 42%, P = 0.60). However, at 90 days after surgery, there was a significantly lower number of patients from the TMRpni group who reported continued opioid use compared with the control group (10% vs 32%, P = 0.03). This study demonstrates that TMRpni may translate to decreased rates of chronic opiate use. Continued study is indicated to optimize TMRpni techniques and patient selection and to determine its long-term efficacy.

Opiate-reduction protocol for common outpatient spinal procedures: a long-term feasibility study and single-center experience.

The opioid epidemic continues to be at the forefront of public health. As a response to this crisis, many statewide and national medical groups have sought to develop opioid-prescribing guidelines for both acute and chronic pain states. Given the lack of evidence in the neurosurgical landscape, the authors' institution implemented opioid-prescribing guidelines for common outpatient spinal procedures in 2017, subsequently demonstrating a significant reduction in the narcotics prescribed. However, the ability to maintain the results garnered from such guidelines long term has not been described. The objective of this study was to evaluate postoperative opioid utilization at a high-volume quaternary referral center 5 years after the initial implementation of an opioid-reduction protocol for common outpatient spinal procedures. From the electronic medical records, authors collected data on the number of tablets and total morphine equivalent dose (MED) prescribed, acute postoperative readmissions for pain concerns, refill requests, and conversion to long-term opiate use in the 5 years following implementation of an opioid-reduction protocol for common outpatient spinal procedures. These procedures, undertaken in opiate-naive patients, included 1- or 2-level anterior cervical discectomy and fusion, 1- or 2-level cervical disc replacement, and 1- or 2-level laminectomy, laminotomy, or foraminotomy (cervical or lumbar). The total quantity of narcotics was reduced by 37.0 tablets per patient after protocol implementation and over the 5-year period thereafter. Generally, patients were discharged with an average of 23.3 tablets, concurrent with the initial goal of 24 tablets, set forth in 2017. These results confirm an ongoing reduction in opiate quantities prescribed and overall morphine equivalent totals at the time of discharge over the course of 5 years after initial protocol implementation. A standardized discharge protocol for postoperative outpatient spinal procedures can lead to long-term reductions in opioid discharge quantity, without compromising patient safety or increasing the utilization of hospital resources through readmissions, refill requests, or clinic phone calls. This study provides an example of a feasible and effective discharge prescription regimen that may be generalizable to common outpatient neurosurgical procedures with long-term evidence that a small intervention can lead to ongoing reduced quantities of postoperative opioids at the time of discharge.

Missed opportunities for treatment of inflammatory arthritis and factors associated with non-treatment: An observational cohort study in United States Veterans with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis

ObjectiveTo identify factors associated with non-treatment with biologic and non-biologic disease modifying anti-rheumatic drugs (DMARDs) during the 12 months after initial inflammatory arthritis (IA) diagnosis. MethodsWe identified Veterans with incident IA diagnosed in 2007–2019. We assessed time to treatment with Kaplan-Meier curves. We identified associations between non-treatment and factors relating to patients, providers, and the health system with multivariate Generalized Estimation Equation (GEE) log-Poisson. Subgroup analyses included IA subtypes (rheumatoid arthritis [RA], psoriatic arthritis [PsA], and ankylosing spondylitis [AS]) and timeframes of the initial IA diagnosis (2007–11, 2012–15, and 2016–19). ResultsOf 18,318 study patients, 40.7 % did not receive treatment within 12 months after diagnosis. In all patients, factors associated with non-treatment included Black race (hazard ratio, 95 % confidence interval: 1.13, 1.08–1.19), Hispanic ethnicity (1.14, 1.07–1.22), Charlson Comorbidity Index ≥2, (1.15, 1.11–1.20), and opiate use (1.09, 1.05–1.13). Factors associated with higher frequency of DMARD treatment included married status (0.86, 0.81–0.91); erosion in joint imaging report (HR: 0.86, 0.81–0.91); female diagnosing provider (0.90, CI: 0.85–0.96), gender concordance between patient and provider (0.91, CI: 0.86–0.97), and diagnosing provider specialty of rheumatology (0.53, CI: 0.49–0.56). ConclusionA high proportion of Veterans with IA were not treated with a biologic or non-biologic DMARD within one year after their initial diagnosis. A wide range of factors were associated with non-treatment of IA that may represent missed opportunities for improving the quality of care through early initiation of DMARDs.

Decreasing Opioid Addiction and Diversion Using Behavioral Economics Applied Through a Digital Engagement Solution: Protocol for a Randomized Controlled Trial.

Despite strong and growing interest in ending the ongoing opioid health crisis, there has been limited success in reducing the prevalence of opioid addiction and the number of deaths associated with opioid overdoses. Further, 1 explanation for this is that existing interventions target those who are opiate-dependent but do not prevent opioid-naïve patients from becoming addicted. Leveraging behavioral economics at the patient level could help patients successfully use, discontinue, and dispose of their opioid medications in an acute pain setting. The primary goal of this project is to evaluate the effect of the 3 versions of the Opioid Management for You (OPY) tool on measures of opioid use relative to the standard of care by leveraging a pragmatic randomized controlled trial (RCT). A team of researchers from the Center for Learning Health System Sciences (CLHSS) at the University of Minnesota partnered with M Health Fairview to design, build, and test the 3 versions of the OPY tool: social influence, precommitment, and testimonial version. The tool is being built using the Epic Care Companion (Epic Inc) platform and interacts with the patient through their existing MyChart (Epic Systems Corporation) personal health record account, and Epic patient portal, accessed through a phone app or the MyChart website. We have demonstrated feasibility with pilot data of the social influence version of the OPY app by targeting our pilot to a specific cohort of patients undergoing upper-extremity procedures. This study will use a group sequential RCT design to test the impact of this important health system initiative. Patients who meet OPY inclusion criteria will be stratified into low, intermediate, and high risk of opiate use based on their type of surgery. This study is being funded and supported by the CLHSS Rapid Prospective Evaluation and Digital Technology Innovation Programs, and M Health Fairview. Support and coordination provided by CLHSS include the structure of engagement, survey development, data collection, statistical analysis, and dissemination. The project was initially started in August 2022. The pilot was launched in February 2023 and is still running, with the data last counted in August 2023. The actual RCT is planned to start by early 2024. Through this RCT, we will test our hypothesis that patient opioid use and diverted prescription opioid availability can both be improved by information delivery applied through a behavioral economics lens via sending nudges directly to the opioid users through their personal health record. ClinicalTrials.gov NCT06124079; https://clinicaltrials.gov/study/NCT06124079. PRR1-10.2196/52882.

Association between opioids use and risk of multiple cancers: A two-sample Mendelian randomization study

BackgroundPrevious observational studies have investigated the possible link between opiate use and the risk of cancer. Nevertheless, there is still no solid evidence linking opioids to any particular type of cancer. MethodsIn the present study, we performed a two-sample Mendelian randomization (MR) study to elucidate the potential causal effects of opioid use on cancers risk. To find appropriate instrumental single nucleotide polymorphisms (SNPs) linked to the exposure of interest, a stringent quality control procedure was first applied. We evaluated the association between opioids and cancers risk using the inverse-variance weighted (IVW) method,. Additionally, we conducted sensitivity analyses employing the simple mode, weighted mode, MR-Egger, weighted median and MR-PRESSO tests to complement our findings. ResultsBased on the results of IVW analysis, our study indicated a positive causal relationship between opioids and lung cancer (OR=1.001, 95% CI: 1.000–1.003, P = 0.041), and kidney cancer (OR=1.002, 95% CI: 1.001–1.003, P = 0.001). However, no causal relationship was found between opioids and other types of cancer (corrected P > 0.05). ConclusionsThis study sheds light on the potential association between opioid use and the risk of developing lung and kidney cancers. Nonetheless, it’s worth noting that no statistically significant relationship between opioids use and various other types of cancer was identified.

The death of Veronica Nelson: Reconsidering the criminalisation of opiate use

This article considers the preventable death of Veronica Nelson, an Aboriginal woman who had been denied bail and then suffered a terrible death in custody, which was the subject of recent bail reforms and a Coroner's Report that has recommended sweeping reforms to the management of people in custody. This article considers a reform that the Coroner and the Parliament did not, removing the criminal prohibition on opiate use.

Opiate prescription after hip and knee arthroplasty: a retrospective cohort study.

Excessive opiate analgesia in relation to orthopaedic surgery is associated with morbidity and mortality. Pre-operative use of opiates is associated with higher post-operative use. There is little information about opiate prescribing practices in relation to elective total joint arthroplasty (TJA) in New Zealand rural centres. The aims of this study were to describe opiate use before, immediately after and 1 year after TJA, and to compare prescribing practices with local guidelines. A retrospective cohort study of elective primary hip and knee arthroplasties was conducted between January 2018 and April 2019. Opiate use was evaluated from clinical records and from electronic prescribing records and described in morphine milligram equivalents (MME) with a particular focus on pre-operative and post-operative periods, and use after 1 year. In the study period, 199 patients underwent 203 joint arthroplasties. Of these, data from 157 patients were analysed. Patient data were not analysed because of unavailable files (N=20), non-elective procedures (N=11), bilateral arthroplasties (N=4), deaths (N=4) and incomplete information (N=3). Pre-operative opiates were used by 92 (59%) patients, of whom 70 (76%) were not using opiates after 1 year. There were 126 (80%) patients who were discharged with opiate prescriptions and the vast majority, 121 (96%), did not receive discharge prescriptions that conformed to local guidelines. Despite undergoing joint arthroplasty, about one quarter of patients who had been prescribed opiates before the operation were still receiving opiates after 1 year. There was poor compliance with local guidelines.

Association between opioid utilization and patient reported outcome measures following lumbar spine surgery

BACKGROUND CONTEXTThe patient-reported outcomes measurement information system (PROMIS), created by the National institute of Health, is a reliable and valid survey for patients with lumbar spine pathology. Preoperative opioid use has been shown to be an important predictor variable of self-reported health status in legacy patient reported outcome measures. PURPOSETo investigate the impact of chronic preoperative opiate use on PROMIS survey scores. STUDY DESIGNRetrospective database analysis. PATIENT SAMPLEBetween March 2019 and November 2021, 227 patients underwent lumbar decompression ± ≤ 2 level fusion. Fifty-seven patients (25.11%) had chronic preoperative opioid use. OUTCOME MEASURESOswestry disability index (ODI) and PROMIS survey scores. METHODSA retrospective analysis of a prospectively maintained single center patient-reported outcome database was performed with a minimum of 2 year follow-up. PROMIS Anxiety, Depression, Fatigue, Pain Interference (PI), Physical Function (PF), Sleep disturbance (SD), and Social Roles (SR) surveys were recorded at preoperative intake with subsequent follow-up at 6, 12, and 24 months postoperatively. Patients were grouped into chronic opioid users as defined by >6-month duration of use. Differences in mean survey scores were evaluated using Welch t-tests. RESULTSTwo hundred and twenty-seven patients met our inclusion criteria of completed PROMIS surveys at the designated timepoints. A total of 57 (25.11%) were chronic opioid users (COU) prior to surgery. Analysis of patient-reported health outcomes shows that long term opioid use correlated with worse ODI and PROMIS scores at baseline compared to nonchronic users (NOU). At 1 and 2 year follow-up, the COU cohort continued to have significantly worse ODI, PROMIS Fatigue, PF, PI, SD, and SR scores. There is a statistical difference in the magnitude of change in health status between the 2 cohorts at 1 year follow-up in PROMIS Depression (-5.04±7.88 vs. -2.49±8.73, p=.042), PF (6.25±7.11 vs. 9.03±9.04, p=.019), and PI (-7.40±7.37 vs. -10.58±9.87, p=.011) and 2 year follow-up in PROMIS PF (5.58±6.84 vs. 7.99±9.64, p=.041) and PI (-6.71±8.32 vs. -9.62±10.06, p=.032). Mean improvement in PROMIS scores for the COU cohort at 2 year follow-up exceeded minimal clinically important difference (MCID) in all domains except PROMIS Depression, SR and SD. CONCLUSIONPatients with chronic opioid use status have worse baseline PROMIS scores compared with patients who had nonchronic use. However, patients in the COU cohort displayed clinically significant postoperative improvement in multiple PROMIS domains. These results show that patients with chronic opioid use can benefit greatly from surgical intervention and will allow physicians to better set expectations with their patients.

New Developments in Understanding and Treating Opiate and Cannabis Use Disorders.

New Developments in Understanding and Treating Opiate and Cannabis Use Disorders.

Annotation of Opioid Use Disorder Entity Modifiers in Clinical Text.

Natural Language Processing can be used to identify opioid use disorder in patients from clinical text1. We annotate a corpus of clinical text for mentions of concepts associated with unhealthy use of opiates including concept modifiers such as negation, subject, uncertainty, relation to document time and illicit use.

Effect of revision sacroiliac joint fusion on unresolved pain and disability: a retrospective cohort study.

The sacroiliac (SI) joint is recognized as a source of low back pain in 15-30% of patients. Though randomized controlled trials have shown clinical improvement following SI joint fusion in 83.1% of patients, revision rates of 2.9% within 2years have been reported. There is a paucity of literature reviewing this small yet significant population of patients requiring revision surgery. Following IRB approval, retrospective review of patients, who underwent a revision SI joint fusion from 2009 to 2021 was completed. Patient-reported outcomes were measured before and at each clinic visit after surgery with visual analoge scale (VAS) for back pain and Oswestry Disability Index (ODI). Patient characteristics (chronic opiate use and prior lumbar fusion) and surgical factors (operative approach, type/number of implants and use of bone graft) were recorded. Patient-reported outcomes were evaluated with Paired t and Wilcoxon signed rank tests. Univariate and multivariate logistic regression determined if patients met the minimally clinical important differences (MCID) for VAS-back pain and ODI scores at 1year. Fifty-two patients (77% female) with an average age of 49.1 (SD ± 11.1) years met inclusion criteria. Forty-four had single sided revisions and eight bilateral revisions. At 1year follow-up there was no significant improvement in VAS-Back (p = 0.06) or ODI (p = 0.06). Patients with chronic opioid use were 8.5 times less likely to achieve the MDC for ODI scores (OR 0.118, p = 0.029). There was no difference in outcomes when comparing the different surgical approaches (p = 0.41). Our study demonstrates patients undergoing revision surgery have moderate improvement in low back pain, however, few have complete resolution of their symptoms. Specific patient factors, such as chronic opiate use and female sex may decrease the expected improvement in patient-reported outcomes following surgery. Failure to obtain relief may be due to incorrect indications, lack of biologic fusion and/or presence of co-pathologies. Further clinical examination and consistent long-term follow-up, clarify the role revision surgery plays in long-term patient outcomes.

Comparing attention, impulsivity, and executive functions between patients with opiate use disorder: Buprenorphine maintenance treatment versus active users, in comparison with healthy controls.

Opioid use disorders (OUDs) affect over 16 million people worldwide, with a particularly high prevalence rate in Asia. OUDs are associated with significant health consequences, including neurocognitive impairment, which affects individuals' ability to make decisions, respond to stressful situations, and regulate behavior. Understanding the specific ways in which OUDs affect cognitive functioning is important in treatment considerations. This study compared the attention, impulsivity, and executive functions of Turkish men with active OUD (n = 40) with those of men in remission from OUD who were on buprenorphine/naloxone maintenance (BMT; n = 41) and with those of a comparison group of healthy controls (HC; n = 43). The Cambridge Neuropsychological Test Automated Battery (CANTAB) was used to assess neurocognitive functioning. Analyses found significant impairment in measures of continuous attention, cognitive impulsivity, motor impulsivity, and executive functions in the two patient groups compared to the control group, but the two patient groups did not differ from each other. The data from this study indicate that individuals with OUD exhibit neurocognitive damage, and those in remission from OUD who receive maintenance treatment do not show improvement in this domain. Neurocognitive damages should be considered in long-term treatment planning of patients with OUD.

Reduction of Postoperative Delirium and Opioid Use in Hip Fracture Patients Through Utilization of Emergency Department Physician Administered Regional Nerve Blocks.

The complication of delirium for hip fracture patients is a predictor of mortality. Use of opioid medication increases the incidence of delirium in the pre- and postoperative periods. Regional nerve blocks are effective in managing acute pain for acute hip fractures. This study aims to evaluate the utilization of ED physicians to perform fascia iliaca nerve blocks on hip fracture patients to decrease the incidence of delirium by decreasing usage of opioid medication. A quality improvement project for performing regional nerve blocks on patients with femoral neck fractures was implemented during fiscal year 2019. Data was collected retrospectively for frequency of ED nerve block procedures, amount of opioid medication use, and incidence of delirium in patients diagnosed with hip fracture. This data was compared to baseline data to determine success of the intervention. Utilization of regional nerve blocks in the ED increased from 2% in 2018 to 96% in 2021 and 89% in 2022. Preoperative opioid usage decreased from 38 MMEs to 16.9 and 18 MMEs respectively. Daily average MMEs decreased from 34 to 12.1 and 14 respectively. Postoperative delirium decreased from 6% in 2018 to 0% from 2020 to 2022. ED provider administration of fascia iliaca blocks and follow-up is a novel practice in our region to decrease the adverse effects of opiate use and decrease delirium rates. There was a reduction in length of stay and increased discharge home rate despite the Covid-19 pandemic. Administration of regional nerve blocks by ED physicians to hip fracture patients presenting to the ED results in a decrease in opioid medication usage. This also results in a decreased delirium rates in the hip fracture patient population.

Prevalence and determinants of opioid use disorder among long-term opiate users in Golestan Cohort Study

BackgroundNumber of opiate users worldwide has doubled over the past decade, but not all of them are diagnosed with opioid use disorder. We aimed to identify the prevalence and risk factors for OUD after ten years of follow-up.MethodsAmong 8,500 chronic opiate users at Golestan Cohort Study baseline (2004–2008), we recalled a random sample of 451 subjects in 2017. We used three questionnaires: a questionnaire about current opiate use including type and route of use, the drug use disorder section of the Composite International Diagnostic Interview lifetime version, and the validated Kessler10 questionnaire. We defined opioid use disorder and its severity based on the DSM-5 criteria and used a cutoff of 12 on Kessler10 questionnaire to define psychological distress.ResultsMean age was 61.2 ± 6.6 years (84.7% males) and 58% were diagnosed with opioid use disorder. Starting opiate use at an early age and living in underprivileged conditions were risk factors of opioid use disorder. Individuals with opioid use disorder were twice likely to have psychological distress (OR = 2.25; 95%CI: 1.44–3.52) than the users without it. In multivariate regression, former and current opiate dose and oral use of opiates were independently associated with opioid use disorder. Each ten gram per week increase in opiate dose during the study period almost tripled the odds of opioid use disorder (OR = 3.18; 95%CI: 1.79–5.63).ConclusionsChronic opiate use led to clinical opioid use disorder in more than half of the users, and this disorder was associated with psychological distress, increasing its physical and mental burden in high-risk groups.

Transanal open haemorrhoidopexy: a well-tolerated, minimally invasive surgical method for haemorrhoids grade II to IV.

To determine 1-year postoperative recurrence rates, postoperative pain and complication rates of transanal open haemorrhoidopexy applied also in grade IV haemorrhoids. Single-centre retrospective observational study without control group. The primary outcome was recurrence rate after 1 year postoperatively. Secondary outcomes were length of postoperative pain, use of opiates and postoperative complications. The recurrence rate was assessed with the Sodergren haemorrhoid symptom severity score questionnaire. For information on the early postoperative period, a retrospective chart review based on the routine 3-month clinical follow-up was done. 135 consecutive patients with haemorrhoids Goligher grades II-IV were operated with transanal open haemorrhoidopexy. 88 patients (65%) consented to participate in the study when approached later via mail. 23% of patients had haemorrhoids Goligher grade IV. 15 patients (17%) needed a second transanal open haemorrhoidopexy for residual haemorrhoidal prolapse. The recurrence rate of prolapsing haemorrhoids was 15% (13 patients) 1 year postoperatively. 21% of patients reported no postoperative pain, 54% described pain for a duration of up to 1 week and 22% for up to 2 weeks. Two patients reported a longer duration of pain of 3 and 4 weeks, respectively. No complications grade Clavien-Dindo III or higher were detected. The results of our study indicate that transanal open haemorrhoidopexy has a recurrence rate comparable to traditional haemorrhoidectomy including grade IV haemorrhoids and is associated with less pain and tissue damage. A randomized controlled trial may provide further support for the routine application of this method, but may pose challenges.

A pilot study of intraoperative application of cooled radiofrequency to reduce post-operative pain following total knee arthroplasty

BackgroundTotal Knee Arthroplasty (TKA) is a successful treatment for end stage knee osteoarthritis (OA), but can be associated with significant pain in the early post-operative period. Cooled radiofrequency ablation (CRFA) has reported to reduce knee OA pain by targeting the periarticular nerves. The objective of this pilot study was to assess the effectiveness of intra-operative CRFA for reducing pain and opiate use after TKA. MethodsThis was a non randomised prospective study with control group. Participants were sequentially recruited preoperatively and underwent TKA, with CRFA to 6 targeted sites prior to cementing of implants, and were compared to controls who underwent TKA without CRFA. The primary outcome was Day 3 pain scores, and secondary outcomes included week one pain scores, and opiate use up to six weeks post-operative. Results17 participants were recruited to the control group and 12 were recruited to the CRFA group. There was no significant difference in demographics or baseline pain scores between the groups. On day 2 the CRFA group had a lower mean pain VAS score of 3.2 compared to 4.4 in the control group (p = 0.03). The mean post operative VAS pain score did not differ between the groups for Day 1, 3, 4, or any other time points up to 6 weeks. There were no significant reduction in opiate use in the CRFA group compared to the control group. There were no adverse events. ConclusionThis study demonstrated intra-operative CRFA was not effective in reducing pain by 50% after TKA in a pilot study.

Risk factors for not reaching minimal clinically important difference at 90 days and 1 year after elective lumbar spine surgery: a cohort study.

Patient-perceived functional improvement is a core metric in lumbar surgery for degenerative disease. It is important to identify both modifiable and nonmodifiable risk factors that can be evaluated and possibly optimized prior to elective surgery. This case-control study was designed to study risk factors for not achieving the minimal clinically important difference (MCID) in Patient-Reported Outcomes Measurement Information System Function 4-item Short Form (PROMIS PF) score. The authors queried the Michigan Spine Surgery Improvement Collaborative database to identify patients who underwent elective lumbar surgical procedures with PROMIS PF scores. Cases were divided into two cohorts based on whether patients achieved MCID at 90 days and 1 year after surgery. Patient characteristics and operative details were analyzed as potential risk factors. The authors captured 10,922 patients for 90-day follow-up and 4453 patients (40.8%) did not reach MCID. At the 1-year follow-up period, 7780 patients were identified and 2941 patients (37.8%) did not achieve MCID. The significant demographic characteristic-adjusted relative risks (RRs) for both groups (RR 90 day, RR 1 year) included the following: symptom duration > 1 year (1.34, 1.41); previous spine surgery (1.25, 1.30); African American descent (1.25, 1.20); chronic opiate use (1.23, 1.25); and less than high school education (1.20, 1.34). Independent ambulatory status (0.83, 0.88) and private insurance (0.91, 0.85) were associated with higher likelihood of reaching MCID at 90 days and 1 year, respectively. Several key unique demographic risk factors were identified in this cohort study that precluded optimal postoperative functional outcomes after elective lumbar spine surgery. With this information, appropriate preoperative counseling can be administered to assist in shaping patient expectations.