Pain Management Program Research Articles

Moving pain management programmes into the digital age: development and evaluation of an online PMP for people with chronic pain.

In response to Coronovirus Disease (COVID-19) health care restrictions, the pain management programme delivered group treatment digitally (OPMP). We aimed to: 1) evaluate pain related outcomes of the OPMP, 2) evaluate patient satisfaction and qualitive feedback of the OPMP and 3) compare OPMP outcomes with the pre-pandemic face to face (F2F) PMP outcomes. Age, gender, pain duration, occupational status, referral information and patient satisfaction data were collected. Pre- and post-treatment pain related outcomes were compared by calculating mean difference, benchmarking with effect size (Cohen's d) and determining clinically significant change (CSC) for OPMP and F2F PMP. Two-hundred and thirty-seven patients provided outcome data, with 60 completing the OPMP and 177 completing the F2F PMP. OPMP patients were 10 years younger than the F2F PMP (44.8 vs 53.3), more were female (6.5:1 vs 2.8:1), more were working (45% vs 27%) and fewer were retired (3% vs 17%). The OPMP showed improvements comparable to the F2F PMP. Large effect size was reported across all outcome domains including objective physical outcomes. Eighty-one percent of OPMP patients were 'extremely likely' to recommend the programme but just over 50% of patients felt F2F would provide greater clinical benefits. The results support that OPMP is effective for carefully selected patients following a multidisciplinary team assessment however more complex cases still require F2F PMP.

Leveraging a Qualitative Evaluation of a Telehealth Pain Management Program

Leveraging a Qualitative Evaluation of a Telehealth Pain Management Program

Dysregulation of sphingolipid metabolism in pain.

Pain is a clinical condition that is currently of great concern and is often caused by tissue or nerve damage or occurs as a concomitant symptom of a variety of diseases such as cancer. Severe pain seriously affects the functional status of the body. However, existing pain management programs are not fully satisfactory. Therefore, there is a need to delve deeper into the pathological mechanisms underlying pain generation and to find new targets for drug therapy. Sphingolipids (SLs), as a major component of the bilayer structure of eukaryotic cell membranes, also have powerful signal transduction functions. Sphingolipids are abundant, and their intracellular metabolism constitutes a huge network. Sphingolipids and their various metabolites play significant roles in cell proliferation, differentiation, apoptosis, etc., and have powerful biological activities. The molecules related to sphingolipid metabolism, mainly the core molecule ceramide and the downstream metabolism molecule sphingosine-1-phosphate (S1P), are involved in the specific mechanisms of neurological disorders as well as the onset and progression of various types of pain, and are closely related to a variety of pain-related diseases. Therefore, sphingolipid metabolism can be the focus of research on pain regulation and provide new drug targets and ideas for pain.

Inpatients’ Experiences with Pharmacist-Led Pain Management Programs: Exploring Patients’ Perspectives on the Effectiveness and Impact of Pharmacist-Managed Pain Management Plans During Their Hospital Stay

This qualitative study explores inpatients’ experiences with pharmacist-led pain management programs in a hospital setting. Through semi-structured interviews, 15 participants’ perspectives on the effectiveness and impact of pharmacist-managed pain interventions were investigated. Findings highlight the role of pharmacists in optimizing pain relief, enhancing patient communication, and improving overall hospital experiences. Participants valued pharmacist involvement in pain management, emphasizing personalized care and education. Recommendations for program enhancement include increased pharmacist presence and streamlined communication channels. This study contributes to understanding patient-centered approaches to pain management in hospital settings.

Qualitative Evaluation Informs the Implementation of a Telehealth Program to Manage Chronic Pain

In response to the opioid epidemic and high rates of chronic pain among the veteran population, the U.S. Department of Veterans Affairs implemented the TelePain-Empower Veterans Program (EVP), a nonpharmacological pain management program for veterans. Delivered virtually, TelePain-EVP incorporates integrated health components (Whole Health, Acceptance and Commitment Therapy, and Mindful Movement) through interdisciplinary personalized coaching. The objective of this quality improvement project was to evaluate the implementation of TelePain-EVP to identify determinants to implementation, benefits and challenges to participation, and recommendations for future direction. We used a qualitative descriptive design to conduct semistructured telephone interviews with TelePain-EVP leaders (n = 3), staff (n = 10), and veterans (n = 22). The interview guides aligned with the Consolidated Framework for Implementation Research (CFIR). Thematic content analysis organized and characterized findings. Several CFIR domains emerged as determinants relevant to program implementation, including innovation (eg, design); individuals (eg, deliverers, recipients); inner (eg, communications) and outer settings (eg, local conditions); and implementation process (eg, reflecting and evaluating). Identified determinants included facilitators (eg, virtual delivery) and barriers (eg, staff shortages). Participants reported improvements in pain management coping skills, interpersonal relationships, and sense of community, but no self-reported reductions in pain or medication use. Program improvement recommendations included using centralized staff to address vacancies, collecting electronic data, offering structured training, and providing course materials to veteran participants. Qualitative data can inform the sustained implementation of TelePain-EVP and other similar telehealth pain management programs. These descriptive data should be triangulated with quantitative data to objectively assess participant TelePain-EVP outcomes and associated participant characteristics. PerspectiveA qualitative evaluation of a telehealth program to manage chronic pain, guided by the CFIR framework, identified determinants of program implementation. Additionally, participants reported improvements in pain management coping skills, interpersonal relationships, and sense of community, but no self-reported reductions in pain or medication use.

Intersectional Risk and the Significant Gap in Care for Persons With Co-occurring Chronic Pain and Opioid Withdrawal.

Persons with chronic pain and women tend to enter treatment for opioid use disorder with greater opioid withdrawal severity than persons without chronic pain and men, respectively. This study examined characteristics of facilities with opioid withdrawal treatment, including gender-based services, as a function of whether they reported having a tailored pain management program. The National Survey of Substance Abuse Treatment Services 2020 was used to examine 3942 facilities with opioid withdrawal treatment in the United States. Using a multivariable binary logistic regression model, facilities were examined for the presence of a tailored program for individuals with co-occurring pain. Regional location of the facility, ownership status, and availability of tailored gender programs, nonhospital residential services, and outpatient services served as independent variables in the analysis. A slight majority of the sample had a program for both adult men and adult women ( n = 2010, 51.0%). Most facilities had outpatient services ( n = 3289, 83.4%) and did not have a tailored program for addressing co-occurring pain ( n = 2756, 69.9%). Binary logistic regression analysis showed that among opioid withdrawal facilities, programs with nonhospital residential services, government or private nonprofit funding, or tailored gender programming had higher odds of reporting having a tailored program for pain and substance use disorder. Facilities in the Western United States were most likely to have tailored programs for pain and substance use disorder. Future research should investigate what support patients may receive and how to better scale access to pain management during opioid withdrawal treatment.

‘Nursing Care Pain Management Program’ for children with cancer: novel views by a qualitative study

Background & objective: Pain management is always a practical challenging issue in pediatric oncology. Nurses should be fortified with essential knowledge, attitude, and skills according to required standard.
 This study aimed to develop a nursing care pain management program in children with cancer.
 Methodology: This qualitative study will be conducted through two phases of interviewing and modified Delphi to develop a pain management nursing care program in children with cancer.
 Results: Three main categories (nursing, pediatrics’ parents, and health care organizations related factors) were achieved in qualitative phase as the base of initial pain management nursing care needs and Delphi technique revealed the contents in 13 pain management items.
 Conclusion: The development of a pain management nursing care program provides professional educational opportunities for optimal pain management in children with cancer.
 Key words: Children; Cancer; Nursing Care; Pain; Pain Management Program; Qualitative Study
 Citation: Naseri N, Irajpour A, Shamsi A. ‘Nursing Care Pain Management Program’ for children with cancer: novel views by a qualitative study. Anaesth. pain intensive care 2024;28(1):10−19; DOI: 10.35975/apic.v28i1.2375
 Received: July 03, 2022; Reviewed: February 10, 2023; Accepted: April 04, 2023

(O-K4) Two-year Results from a New Model Pain Coach Educator Program and Integrative Discharge Toolkit for Pain Management in an Urban US Teaching Hospital and Emergency Department During COVID-19 Pandemic

(O-K4) Two-year Results from a New Model Pain Coach Educator Program and Integrative Discharge Toolkit for Pain Management in an Urban US Teaching Hospital and Emergency Department During COVID-19 Pandemic

Tackling pain and inflammation: The impact of analgesics in sports medicine

Throughout their careers, athletes frequently struggle with pain and inflammation, which frequently reduces performance and slows recovery. The use of analgesics in sports medicine is examined here, with a focus on how athletes might manage their pain and inflammation. In the opening section of the chapter, a general overview of pain and inflammation in relation to sports injuries is given, emphasizing the negative consequences these conditions have on athletic performance. We explored the numerous analgesics used in sports medicine, such as acetaminophen, opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. The mode of action, indications, advantages, drawbacks, and potential side effects of each analgesic class are examined, highlighting the importance of comprehending how each affects the well-being and performance of athletes. The article also explored the effects of analgesics on athletic performance, outlining both the advantages of temporary pain relief and potential drawbacks such as hiding underlying problems or encouraging dependency. It is highlighted how crucial it is for athletes to have individualized pain management programs, as the fine line between pain management and injury aggravation is discussed. In addition, ethical issues surrounding the use of analgesics in sports, such as doping laws, fair play, and possible analgesic abuse for the purpose of enhancing performance, are discussed. To maintain the integrity of sports and safeguard athletes' wellbeing, the responsible use of and adherence to rules are strongly encouraged. This review examines integrative treatments in sports medicine, such as physical therapy, mind-body interventions, and nutritional interventions, which provide effective alternatives for managing pain and inflammation without relying primarily on analgesics in light of alternative approaches. Examples of analgesic use in sports medicine are highlighted in real-world case studies, highlighting how it affects players' careers and well-being. The review's conclusion looks at potential long-term consequences for athletes' health as well as future directions.

Pain Education in the Wellness, Training Performance, and Pain Intensity of Youth Athletes: An Experimental Study.

Although pain management programs reduce pain and improve wellness perception in the general population, few studies have explored these effects in athletes. This study evaluated the effects of an educational program about pain neuroscience on wellness, training performance, and pain in youth athletes. Differences according to sex were also explored. For 12 weeks, 52 athletes were randomly assigned to an intervention group (IG: educational program about healthy sports habits and pain neuroscience) or a control group (CG: education on healthy sports habits only). Before the start of the study and weekly until its end, wellness, training performance, and pain intensity were monitored via a questionnaire. After the intervention, IG decreased stress (p = 0.028) compared to the baseline, and a higher number of training sessions were performed without health problems (76.6%) compared to the number in the CG (63.0%) (χ2 = 8.31, p = 0.004). Regarding pain, the IG perceived lower pain than the CG did (p = 0.028). Females in the IG had lower pain than those in the CG did (p < 0.05), without differences in other variables or in males (p > 0.05). An educational program that includes pain neuroscience may help youth athletes improve their wellness status, pain intensity perception, and training session performance.

Empowered management for pelvic pain: The experiences of women with persistent pelvic pain participating in an online self-directed self-management program while they wait for interprofessional care.

Persistent pelvic pain is pain sensed in or around the pelvis and is often associated with negative cognitive, behavioral, sexual, and emotional consequences. The lack of interprofessional persistent pelvic pain management programs that address the complex interplay of biopsychosocial factors result in lengthy wait times and negative health outcomes. Limited access to evidence informed self-management educational resources contributes to poor coping strategies. Evidence shows that self-management education and strategies support patients while they wait for care. However, very few studies explore the patient's lived experience of participating in an online educational program designed for persistent pelvic pain. This study aims to understand the experience of women with persistent pelvic pain participating in an online, self-management education program ("Pelvic Pain Empowered Management" program) while awaiting care at an interprofessional pelvic pain clinic. A descriptive qualitative approach was used to explore the experiences of women participating in an online educational program designed for cis women with persistent pelvic pain. We conducted semi-structured interviews with 11 women, transcribed the data verbatim using NVivo software (NVivo 12, QSR International Pty Ltd.), and analyzed inductively using previously established methods. We identified four main themes relevant to women's experiences of the program: (1) the program shaped expectations around upcoming pelvic pain appointments, (2) the program content is relevant and resonates with people with lived experience of persistent pelvic pain, (3) the program enhanced understanding of persistent pelvic pain, and (4) the program empowered people with skills and strategies to better manage their persistent pelvic pain. Our findings highlight how self-directed online patient education can be leveraged while persistent pelvic pain patients wait for care to support them in setting expectations around care and in engaging in pain self-management.

An investigation into perceived autonomy support, motivation and competence in chronic pain patients in Ireland: A cross-sectional study.

Autonomy supportive healthcare settings are associated with enhanced behaviour change and self-management strategies in individuals living with chronic disease. The level of autonomy support provided by healthcare professionals to individuals living with chronic pain in Ireland is unknown. A cross-sectional study was completed on participants living with chronic pain (>3 months) in Ireland. Participants (n = 389) completed an anonymous survey constructed of patient reported outcome measures relating to autonomy support (HCCQ), motivation (TSRQ), competence in physical activity (PCS), pain interference (BPI) and psychological factors (PHQ-9, GAD-7). Results showed the median HCCQ (H = 39.287, p < .001), Autonomous Motivation (H = 13.568, p = 0.019) and PCS (H = 30.701, p < .001) scores were significantly different when patients received care from different healthcare professionals. There was a negative correlation between PCS and pain severity (r = -0.32, <0.01), pain interference (r = -0.44, p = <0.01), PHQ-9 (r = -0.50, p = <0.01) and GAD-7 (r = -0.34, p = <0.01). This study has identified that perceived healthcare support in Ireland varies according to the healthcare professional leading pain care. Furthermore, higher levels of self-determination were associated with decreased depression and anxiety in individuals with chronic pain. Given the limited number of multidisciplinary team clinics to provide pain management programs, an alternative cost-effective community led solution is required. The results of this study indicate that allied health professionals may be well placed to fill this void. Future research exploring the barriers to providing healthcare supportive settings is required.

Trends in co-prescribed opioids and benzodiazepines, non-prescribed opioids and benzodiazepines, and schedule-I drugs in the United States, 2013 to 2019

Concurrent opioid and benzodiazepine users are at increased risk of overdose death, compared to opioid-only users.The objective of this study was to understand recent time trends in opioid and benzodiazepine concurrent use, misuse, and schedule-I drug use, and how these differ by age, sex and geographic region. Commercial, United States medical insurance claims data and urine drug test results from 2013 to 2019 were used to study the outcomes of concurrent use (n = 756,258), schedule-I drug use (n = 746,672) and prescription misuse (n = 452,523). Drug use outcomes were studied at quarterly time points for each year.Data analysis included joinpoint regression models to estimate quarterly drug use rates, determined by positive urine tests for corresponding drug categories, and was conducted from November 2021 through January 2022. Concurrent use decreased from 19.3% to 9.8%, misuse generally decreased from 75.6% to 55.1%, and schedule-I use increased from 8.9% to 13.8%, from 2013 to 2019. Concurrent use decreased at greater rates after 2016, after the Centers for Disease Control and Food and Drug Administration guidelines against concurrent use were released, while schedule-I use increased, notably after the 2014 hydrocodone reschedule. This indicates a potential shift from prescription use to non-prescribed drug use, where most affected groups included males, younger individuals, and those residing in Northeastern regions.Study results support public health initiatives focused on policy that increases access to multimodal pain management and substance use disorder management programs—critical steps in preventing patients from seeking non-prescribed drugs for self- medicating due to pain or addiction.

Picturing oneself over time: a multi-modal interpretative phenomenological analysis of pain management trajectories.

Chronic pain (CP) can be a disabling condition with impacts that affect the sense of identity of those who live with it. This article idiographically describes the longitudinal evolution of the sense of self of participants following their referral to a pain management service and participation in a pain management programme (PMP). Participants were interviewed three times: before they attended a PMP, and 1 and 6 months after the PMP. Data included the drawings of themselves that participants created at each interview and the transcripts of the interviews guided by the drawings, analysed longitudinally using interpretative phenomenological analysis. This paper describes in detail the cases of four participants: two who experienced a positive albeit troubled trajectory following their PMP and two who did not experience any positive change. The results provide a nuanced account of how the impacts of CP on identity can evolve, with different people engaging with different aspects of a PMP and some people not engaging at all, and how pain self-management strategies enable those that do engage to cope in times of difficulty. Participant responses to PMP participation are idiosyncratic and interviews with drawings of self analysed longitudinally can help illustrate processes of change. Not enough is understood about why some people get limited benefits from pain services. This idiographic longitudinal study illustrates how the impact of CP on identity can evolve when people are introduced to pain self-management, with some embracing change and others resisting it. For clinicians, this study describes four detailed CP individual paths, showing the interaction between contextual and idiosyncratic aspects. This is also the first study to use multiple drawings of self to explore the impacts of illness on identity longitudinally. In a person-centred approach to treatment, the drawings of self could also be adopted as a tool in clinician-patient conversations to gain a deeper understanding of the impacts of living with CP.

Influence of central aspects of pain on self-management in people with chronic low back pain

ObjectiveThis observational study investigated whether central aspects of pain are associated with self-management domains in individuals with chronic low back pain (CLBP) undertaking a pain management program. MethodsIndividuals with CLBP provided pain sensitivity and self-management data at baseline (n = 97) and 3-months (n = 87). Pressure pain detection threshold (PPT) at the forearm, temporal summation (TS) and conditioned pain modulation (CPM), Widespread Pain Index (WPI), and a Central Aspects of Pain factor (CAPf) were considered as central aspects of pain. Self-management was measured using the 8 domains of the Health Education Impact Questionnaire, as well as Pain Self Efficacy and Health Care Utilisation questionnaires. ResultsPPT, CPM, WPI and CAPf predicted worse performance in several self-management domains at 3-months (r = 0.21 to 0.54, p < 0.05 overall). In multivariable regression models (adjusted for baseline scores of self-management, depression, catastrophization, pain and fatigue) low PPT, high TS, and high CAPf at baseline predicted poorer self-management at 3 months (R2 =0.14 to 0.52, β = −0.37 to 0.35, p < 0.05). ConclusionsCentral aspects of pain are associated with impaired self-management, over and above effects of pain intensity, fatigue, depression and catastrophizing. Practice implicationsTreatments that target central aspects of pain might help improve self-management in people with CLBP.

Home-Use and Portable Biofeedback Lowers Anxiety and Pain in Chronic Pain Subjects

In this study, we investigated the use of novel, home-use and portable biofeedback devices in a remote program for managing chronic pain. In three separate 4-week pilot studies, participants engaged in twice-daily, 10-minute biofeedback sessions, with self-assessed reductions in anxiety and pain levels using the 6-item State-Trait Anxiety Inventory (STAI-6) and Visual Analogue Scale (VAS), respectively, in Studies 2 and 3. Among these 113 (Study 2) and 237 (Study 3) biofeedback sessions, 81 (∼72%) and 130 (∼55%) showed reductions in pain, while 93 (∼82%) and 184 (∼78%) experienced reductions in anxiety. A positive relationship was found between anxiety and pain reduction, indicating that larger reductions in anxiety correspond to larger reductions in pain. In Study 1, only anxiety reductions were measured: across 143 biofeedback sessions, 127 experienced reductions in anxiety (∼89%). Participants in all studies demonstrated reductions in baseline to final results in pain, anxiety, and showed increases in satisfaction and recovery. Our results provide strong evidence that portable biofeedback devices can enhance pain management programs by helping to alleviate anxiety and pain in individuals living with chronic conditions. This study can provide a basis for the integration of biofeedback devices into the expanding research of lifestyle and integrative medicine.

“I will try anything” the experience of working age stroke survivors living with chronic post-stroke pain: an interpretative phenomenological analysis

Purpose To investigate the experience of working age adults living with chronic post-stroke pain in the United Kingdom (UK). Methods Semi-structured interviews were conducted with eight working age (46–64 years) UK-based stroke survivors who experience chronic post-stroke pain (≥3 months). The interviews were analysed using interpretative phenomenological analysis. Results The analysis led to three Group Experiential Themes: “The Solitude of the Pain Experience,” “Unsatisfactory Healthcare and the Need for Self-Care” and “The Development of Pain Acceptance.” Findings suggest that individuals see their post-stroke pain as an invisible disability, which is overlooked and misunderstood by others. Furthermore, in the absence of a differential post-stroke pain diagnosis, clear, accurate information and alternatives to pharmacological treatments, individuals with post-stroke pain invest their own resources in finding answers and a way to live with the pain. Conclusions The findings suggest the need for further education on post-stroke pain for healthcare professionals, the consideration of pain in post-stroke assessments, the need for clear differential pain diagnoses and the provision of accurate information to patients. Research is needed to establish non-pharmacological evidence-based treatment approaches, such as pain management programmes, peer support and psychological interventions.

An Exploration of Physical Therapy Outcomes and Psychometric Properties of the Patient-Specific Functional Scale Following an Interdisciplinary Pain Management Program.

The Patient-Specific Functional Scale (PSFS) has been used to assess physical functioning in various chronic pain populations. There is a lack evidence for its use with diverse pain populations who have high impact chronic pain (HICP). The primary aim of this study was to assess the psychometric properties of the PSFS with a heterogeneous sample of patients with HICP. A retrospective observational study of prospective functional outcomes collected before and after participation an intensive pain management program (IPMP): (PSFS, Disabilities of the Arm, Shoulder, and Hand; Lower Extremity Functional Scale; Neck Disability Index; Oswestry Disability Index), Multidimensional Patient Impression of Change, pain intensity, pain limitation, and fear avoidance from the charts of 509 IPMP completers. The reliability, validity, and responsiveness of the PSFS were analyzed using Cronbach's alpha, Pearson correlations, and receiver operating characteristic. Significant improvements were found for all outcomes following program participation (all p's <0.0001). Correlations of the PSFS with similar outcomes (convergent validity) were lower than expected (r's 0.16 - 0.33). A low correlation (r=-0.12) with an unrelated measure, fear-avoidance, supported divergent validity. PSFS change score correlations with similar outcome measures ranged from 0.46 to 0.53. The area under the curve values for the PSFS ranged from 0.801 to 0.857 suggesting a moderate ability for the PSFS to detect improvement. The psychometric properties of the PSFS showed mixed support for construct validity but good support for the responsiveness of the PSFS when used with a heterogeneous sample of patients with HICP.

Health literacy and pain neuroscience education in an interdisciplinary pain management programme: a qualitative study of patient perspectives.

Pain neuroscience education is part of interdisciplinary pain management programs (IPMPs). To date, the role of health literacy on patients' understanding of pain neuroscience education has not sufficiently been examined. Drawing on interviews with patients with diverse levels of health literacy, this article explores patient perspectives on pain neuroscience education. Purposively sampled patients from an IPMP were interviewed twice (waiting list and after 4 weeks). A directed qualitative content analysis was performed with the Integrated Conceptual Model of Health Literacy as an analytic framework. Thirteen patients with chronic musculoskeletal pain were interviewed: 4 men and 9 women aged from 21 to 77 years with diverse educational and mostly low health literacy. One participant dropped out after baseline. Some participants gained access to health information actively; others relied on the expertise of their healthcare providers. Most participants did not seem to receive the information in the pain neuroscience education as intended, experienced difficulties with understanding the message, negatively appraised the information, and were not able to apply this in their daily lives. Health literacy levels likely played a role in this. Pain neuroscience education tailored to patients' health literacy levels, information needs, and learning strategies is needed.

Take precaution with choice of pastry: poppy seed-containing products cause significantly positive results in urine drug tests

Abstract Background Chronic pain management programs utilize urine drug testing to ensure patient compliance. Because treatment can be discontinued if diversion or misuse occurs, it is imperative to carefully interpret each urine drug screen, particularly with respect to potential interferences and exposure to opioid-containing foods. Poppy seeds, derived from the opium-producing poppy Papaver cominferum L., are used widely in food products. While the seeds themselves do not contain opiates, during the harvesting process, the seeds can be contaminated with poppy latex, which does contain numerous alkaloids, including morphine and codeine. Published guidelines suggest urinary codeine concentrations exceeding 300 ng/mL, together with a morphine-to-codeine ratio &amp;lt;2, were most consistent with codeine use, effectively ruling out poppy seed ingestion. Methods To assess the validity of these guidelines, we performed an internal quality improvement project, which consisted of 15 participants split into three groups. Each group consumed one of three different poppy seed-containing food products (i.e., poppy seed muffin, poppy seed bagel, or poppy seed roll). Participants collected urine samples midstream at baseline and at 3, 6, and 24 hr after ingestion. Opiates in urine were qualitatively detected via immunoassay (Beckman Coulter AU 680) and quantified by liquid chromatography-tandem mass spectrometry. Results For the group of participants that ingested a poppy seed roll, which contains a thick paste made from poppy seeds, all urine specimens at all time points had positive opiate immunoassay results, while the group of participants that ingested a poppy seed muffin had positive immunoassay results only at the 3- and 6-hr time-points. In contrast, all but one participant for all time points after consumption of a poppy seed bagel had negative immunoassay results. Codeine and metabolites were observed in all three groups; however, codeine concentrations were significantly higher after ingestion of a muffin or a roll, notably resulting in levels well above 1,000 ng/mL and 10,000 ng/mL of codeine and codeine-6-glucuronide, respectively. Codeine:morphine ratios ranged from 100 to 250:1 in poppy seed muffin and roll groups at 3- and 6-hour time points. There was significant variability in urine opiate concentrations among all participants in each group at each time-point. Conclusions Although urine opiate concentrations vary due to the metabolism of the individual as well as the origin, processing, and preparation of the poppy seed product, it is clear that previously established guidelines for interpreting urine codeine concentrations may no longer be appropriate to rule out poppy seed ingestion. When evaluating urine drug test results for chronic pain management, providers should interpret results with caution and ultimately recommend that patients generally avoid poppy seed products to prevent the risk of care mismanagement.