Pain-related Complaints Research Articles

Emergency department encounters and opioid prescribing following orthopaedic trauma among Black and White patients with substance use disorders

IntroductionPatients living with substance use disorder (SUD) have complex pain management needs, which may be mismanaged during hospital admission. Ineffectively managed pain following orthopaedic trauma, influenced by clinician biases related to race or SUD diagnosis, may subject patients to worse pain outcomes and subsequent emergency department (ED) encounters. This study examined ED encounters and opioid prescribing for pain-related complaints following orthopaedic trauma, among patients with SUD who identify as Black or African American relative to White patients. MethodsThis retrospective analysis included 1089 patients with a SUD diagnosis discharged from a Level I trauma center, following hospitalization for orthopaedic injuries, between 2016 and 2021. Multivariable regressions assessed the associations among race, opioid prescribing, and ED encounters within 90 days for pain-related care. ResultsAmong the 1089 patients included in the sample, the proportion of individuals with an ED encounter within 90 days for pain-related care was 12.4 % and 4.5 % for Black and White patients, respectively (odds ratio [OR] = 3.0, p < .001). When adjusting for injury severity and demographics, the difference in ED encounters between Black and White patients remained significant (OR = 2.8, p = .002). Opioid prescription doses did not statistically differ by race. ConclusionsThe difference in ED encounters between Black and White patients with SUDs following orthopaedic trauma may indicate a need to optimize pain management prior to initial discharge and improve post-injury care.

Determinants of appropriate antibiotic and NSAID prescribing in unscheduled outpatient settings in the veterans health administration

BackgroundDespite efforts to enhance the quality of medication prescribing in outpatient settings, potentially inappropriate prescribing remains common, particularly in unscheduled settings where patients can present with infectious and pain-related complaints. Two of the most commonly prescribed medication classes in outpatient settings with frequent rates of potentially inappropriate prescribing include antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs). In the setting of persistent inappropriate prescribing, we sought to understand a diverse set of perspectives on the determinants of inappropriate prescribing of antibiotics and NSAIDs in the Veterans Health Administration.MethodsWe conducted a qualitative study guided by the Consolidated Framework for Implementation Research and Theory of Planned Behavior. Semi-structured interviews were conducted with clinicians, stakeholders, and Veterans from March 1, 2021 through December 31, 2021 within the Veteran Affairs Health System in unscheduled outpatient settings at the Tennessee Valley Healthcare System. Stakeholders included clinical operations leadership and methodological experts. Audio-recorded interviews were transcribed and de-identified. Data coding and analysis were conducted by experienced qualitative methodologists adhering to the Consolidated Criteria for Reporting Qualitative Studies guidelines. Analysis was conducted using an iterative inductive/deductive process.ResultsWe conducted semi-structured interviews with 66 participants: clinicians (N = 25), stakeholders (N = 24), and Veterans (N = 17). We identified six themes contributing to potentially inappropriate prescribing of antibiotics and NSAIDs: 1) Perceived versus actual Veterans expectations about prescribing; 2) the influence of a time-pressured clinical environment on prescribing stewardship; 3) Limited clinician knowledge, awareness, and willingness to use evidence-based care; 4) Prescriber uncertainties about the Veteran condition at the time of the clinical encounter; 5) Limited communication; and 6) Technology barriers of the electronic health record and patient portal.ConclusionsThe diverse perspectives on prescribing underscore the need for interventions that recognize the detrimental impact of high workload on prescribing stewardship and the need to design interventions with the end-user in mind. This study revealed actionable themes that could be addressed to improve guideline concordant prescribing to enhance the quality of prescribing and to reduce patient harm.

Sex differences in pain catastrophizing and its relation to the transition from acute pain to chronic pain

Background and importanceDifferences exist between sexes in pain and pain-related outcomes, such as development of chronic pain. Previous studies suggested a higher risk for pain chronification in female patients. Furthermore, pain catastrophizing is an important risk factor for chronification of pain. However, it is unclear whether sex differences in catastrophic thinking could explain the sex differences in pain chronification.ObjectivesThe aim of this study was to examine sex differences in pain catastrophizing. Additionally, we investigated pain catastrophizing as a potential mediator of sex differences in the transition of acute to chronic pain.Design, settings and participantsAdults visiting one of the 15 participating emergency departments in the Netherlands with acute pain-related complaints. Subjects had to meet inclusion criteria and complete questionnaires about their health and pain.Outcomes measure and analysisThe outcomes in this prospective cohort study were pain catastrophizing (short form pain catastrophizing) and pain chronification at 90 days (Numeric Rating Scale ≥ 1). Data was analysed using univariate and multivariable logistic regression models. Finally, stratified regression analyses were conducted to assess whether differences in pain catastrophizing accounted for observed differences in pain chronification between sexes.Main resultsIn total 1,906 patients were included. Females catastrophized pain significantly more than males (p < 0.001). Multiple regression analyses suggested that pain catastrophizing is associated with pain chronification in both sexes.ConclusionsThis study reported differences between sexes in catastrophic cognitions in the development of chronic pain. This is possibly of clinical importance to identify high-risk patients and ensure an early intervention to prevent the transition from acute to chronic pain.

Uncovering brain functional connectivity disruption patterns of lung cancer-related pain.

Pain is a pervasive symptom in lung cancer patients during the onset of the disease. This study aims to investigate the connectivity disruption patterns of the whole-brain functional network in lung cancer patients with cancer pain (CP+). We constructed individual whole-brain, region of interest (ROI)-level functional connectivity (FC) networks for 50 CP+ patients, 34 lung cancer patients without pain-related complaints (CP-), and 31 matched healthy controls (HC). Then, a ROI-based FC analysis was used to determine the disruptions of FC among the three groups. The relationships between aberrant FCs and clinical parameters were also characterized. The ROI-based FC analysis demonstrated that hypo-connectivity was present both in CP+ and CP- patients compared to HC, which were particularly clustered in the somatomotor and ventral attention, frontoparietal control, and default mode modules. Notably, compared to CP- patients, CP+ patients had hyper-connectivity in several brain regions mainly distributed in the somatomotor and visual modules, suggesting these abnormal FC patterns may be significant for cancer pain. Moreover, CP+ patients also showed increased intramodular and intermodular connectivity strength of the functional network, which could be replicated in cancer stage IV and lung adenocarcinoma. Finally, abnormal FCs within the prefrontal cortex and somatomotor cortex were positively correlated with pain intensity and pain duration, respectively. These findings suggested that lung cancer patients with cancer pain had disrupted connectivity in the intrinsic brain functional network, which may be the underlying neuroimaging mechanisms.

Chronic pain in the paramedic practice setting – a qualitative study of patients’ perspective

Background Chronic pain is highly prevalent among the global population and has a significant impact on a patient's livelihood in multiple areas. Chronic pain is now more widely recognised as a standalone medical condition by most healthcare disciplines, separate from that of acute pain. This has allowed for the development of a unique evidence-based approach to caring for these patients, which incorporates the biological, psychological, and social dimensions in which chronic pain transverses. However, in the paramedic practice setting, chronic pain has received scant mention. This knowledge gap leaves many paramedics operating without guidelines suitable for the care of chronic pain patients or an epidemiological foundation describing the incidence or treatment requirements of this patient cohort. Most importantly, the perspectives and experiences of chronic pain patients who are treated by paramedics have yet to be investigated which is vital to ensure relevant care. Aims To describe and understand the experience of patients requiring ambulance attendance for chronic pain-related complaints. Methods Six participants were enlisted using convenience sampling. Participants responded, via Zoom, to an inductive, semi-structured interview. Analysis was performed using qualitative reflexive thematic analysis with a non-positivist, constructive approach. Results The themes identified were ‘the impact of stigma’ and ‘inadequate paramedic education’. Most participants shared similar attitudes and experiences regarding paramedic management, expressing dissatisfaction with the current standard of practice in relation to chronic pain complaints. Conclusion Patients experiencing chronic pain are underserved by the standard of care being offered in this practice setting. Concerns raised by patients centred around the impact both stigma and educational understanding have on treatment. These findings indicate a need for further research, including the revision of guidelines and consideration of the patient perspective to be conducted in this area.

Clinical Outcome of Fungal Keratitis after Topical use of Injectable Fluconazole

Objectives: To evaluate the clinical outcome of fungal keratitis after topical use of injectable Fluconazole. Materials and Methods: This cross sectional study was conducted in the Department of ophthalmology in Nishtar Medical University, Multan and the duration of this study were from January 2022 to June 2022. Totally 100 patients who were suffering from fungal keratitis were enrolled. The enrolled patients were given topical 2% Fluconazole using Injectable fluconazole 2mg/ml and making it to 2% topical solution. They were also added topical 1% Atropine, lubricant and Cyclosporin A 0.05% was used for corneal melting. Patients were followed after 1 week and 1 month. A predesign questionnaire was used to collect data. Results: Out of total 100 patients, 79 were male and 21 were female with mean age of 38.70 ±9.41 years. The most common age group was 20-35 years and 36-50 years, followed by &gt;50 years of age group. Out of total patients, 69 (69.0%) patients had full recovery of appreciable vision, quality of life and pain related complaints. 30 (30%) patients had no improvement in vision. 1 (1%) patient had worsening of keratitis. Practical implication: This study suggest that topical use of injectable fluconazole is a safe and effective antifungal drug for the treatment of fungal keratitis. So this study will help the ophthalmologist to select better treatment option in order to recover the patients at time. Conclusion: It is concluded that Fluconazole in the form of injection can be a very useful treatment for severe fungal keratitis. Keywords: Fluconazole, Fungal Keratitis, Topical, Injectable, Ophthalmology, Sight-Threatening,

High quality interventions that reduced the overall number of frequent emergency department visitors for pain-related complaints

Background: Pain is one of the most common complaints that patients present to the emergency department for; emergency medicine providers are tasked with providing appropriate pain relief while simultaneously limiting the risk of personal and societal harm that may result from opioid misuse. The Lakeland Regional Medical Center developed a medical management program that identified frequent emergency department visitors with a chief complaint of pain. Individualized care plans were developed for these patients. Summary: Generation and dissemination of care plans led to a decrease in emergency room visits and hospital admissions. The authors describe their experience with a quality improvement initiative that identifies frequent emergency department visitors with a chief complaint of pain and provides individualized care plans to these patients. The goals of the program are to improve patient's quality and consistency of care, through interventions that eliminate the prescribing of opioids while providing non-opioid alternatives.

Association Between Visual Impairment and Neck Pain in Computer Users; A Cross-Sectional Study

The most common cause of disability in the world is visual impairment. It is a condition that impairs vision and may not be improved by corrective lenses. The key factor for visual impairment is near vision. Nearly 10–21% of people report having neck pain at work, which contributes to forward head position and neck pain. Objective: This study examined the relationship between visual impairment and neck pain-related complaints brought on by awkward or bad posture among computer users between the ages of 21 and 30. Methods: 141 computer users between the ages of 21 and 30 were chosen for a cross-sectional study based on inclusion and exclusion criteria. The Neck Disability questionnaire and the Visual Functioning Questionnaire - Near Activities Subscale (VFQ-NAS) were used, respectively, to evaluate neck discomfort and visual impairment. Results: When performed one at a time with each group, and when the whole set of data was considered to correlate each other, there is a correlation between visual and neck-related complaints that provided significant value (P0.05) of the Chi-square. Conclusions: It is concluded that there is a strong relationship between visual impairment (nearsightedness) and neck pain.

Altered Functional Connectivity in Pain-Related Brain Regions and Its Correlation with Pain Duration in Bone Metastasis with Cancer Pain.

Bone metastatic pain is thought to be a severe type of cancer pain that has refractory characteristics and a long duration. This study is aimed at exploring the brain functional connectivity (FC) pattern in lung cancer patients with bone metastatic pain. In this study, 27 lung cancer patients with bone metastatic pain (CP+), 27 matched lung cancer patients without pain-related complaints (CP−), and 27 matched healthy controls (HC) were recruited. All participants underwent fMRI data acquisition and clinical assessments. One-way ANOVA or a Mann–Whitney U test was applied to compare clinical data according to data distribution. Seventeen hypothesis-driven pain-related brain regions were selected as regions of interest (ROIs). FC values among pain-related brain regions across the three groups were computed by using ROI–ROI functional connectivity analysis. ANCOVA with a post hoc test was applied to compare FC differences among the three groups. p < 0.05 indicated statistical significance. Correlation analysis was conducted to explore the potential relationship between the FC values and clinical characteristics. Except for years of education, no significant differences were revealed among the three groups in age, gender, or neuropsychological assessment. In the CP+ group, FC alterations were mainly concentrated in the dorsal lateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC), secondary somatosensory cortex (SII), and amygdala compared to the CP− group. Among these brain regions with statistical differences, FC between the right DLPFC and the right ACC showed a positive correlation with the duration of cancer pain in the CP+ group. In addition, in the CP− group, altered FC was found in the bilateral SII, ACC, and thalamus compared to the HC group. Altered FC in pain-related brain regions may be a brain pattern of bone metastatic pain and may be associated with the long duration of cancer pain.

Evaluation of the use of individualized patient care plans in frequent emergency department visitors with pain complaints

BackgroundPain is one of the most common complaints that patients present to the emergency department for; emergency medicine providers are tasked with providing appropriate pain relief while simultaneously limiting the risk of personal and societal harm that may result from opioid misuse. The Lakeland Regional Medical Center developed a medical management program that identified frequent emergency department visitors with a chief complaint of pain. Individualized care plans were developed for these patients. A retrospective review was then conducted to assess the efficacy of these care plans in reducing the number of emergency department visits for pain-related complaints by the patients entered into the medical management program.ResultsThere were 294 patients; 65% were male, and the median age was 41 (interquartile range: 33 to 51). A total of 80% percent of the patients were white, and the payors were as follows: 53% were self-pay, 42% were government programs, and 5% had private insurance. The three most common chronic pain complaints were 39% abdominal pain, 24% back/neck pain, and 23% headache/migraine (patients could have more than one area of pain). A total of 60% of the patients had a primary care provider, and another 18% had a pain management provider in addition to primary care.Post plan admissions were significantly reduced to a median of 1 (IQR 0 to 3) with the Wilcoxon signed-rank test’s p-value of less than 0.001.ConclusionThe authors describe their experience with a quality improvement initiative that identifies frequent emergency department visitors with a chief complaint of pain and provides individualized care plans to these patients. The goals of the program are to improve patient’s quality and consistency of care, through interventions that eliminate the prescribing of opioids while providing non-opioid alternatives.

Utilization of Pediatric Standing Orders by Triage Nurses in a Free-Standing Emergency Department.

Pediatric pain-related complaints continue to be a common presenting factor of most emergency departments (EDs). Studies have shown that several barriers in assessing and treating pediatric pain exist, including nursing knowledge regarding appropriate pain level assessment. This quality improvement study aimed to provide and evaluate specific education regarding pediatric pain management for free-standing ED triage nurses to expedite medication administration during the triage phase of an ED visit. This pre/post-test intervention study was used to measure whether the education provided to nurses working in a primarily adult patient free-standing ED increased the utilization of triage standing orders related to pediatric pain management. Paired sample t-tests results indicated a statistically significant increase (p = .000) in the percentage of patients that received pain medication during the triage phase of an ED visit after specific education was provided to triage nurses. Free-standing ED triage nurses are more likely to follow and implement triage standing orders if education explicitly related to pain management in pediatric patients has been provided. Pediatric pain management education should be revisited annually to re-educate nurses on the importance of early interventions.

Impact of Enhanced Recovery After Cesarean protocol on opioid use in patients with depression

Mothers with major depressive disorder (MDD) have more pain-related complaints during recovery after cesarean delivery (CD) and often require additional pain medication. We aimed to evaluate whether the Enhanced Recovery After Cesarean (ERAC) protocol reduces inpatient outpatient opioid use in patients with MDD.

Development and Implementation of an Emergent Documentation Aggression Rating Tool: Quality Improvement

IntroductionWorkplace violence is prevalent in the emergency department, putting patients and staff at risk for harm. An ED-specific standardized tool is needed to promote a consistent assessment process to strengthen documentation of escalating patient behaviors, give justification for de-escalating interventions, and reduce restraints. The purpose of this project was to design, implement, and evaluate feasibility of an ED-specific tool to help nurses proactively identify and intervene with patients’ escalating behaviors, capture better documentation of aggressive/violent patient events, and reduce restraint usage. MethodsA quality improvement design was used. The Emergent Documentation Aggression Rating Tool was constructed by combining evidence-based behavioral cues for potential aggression/violence with observed behaviors and successfully implemented interventions in patients. Nurses were trained on how to use the tool to rate patients’ behaviors and take necessary action. Chart data were collected from August 2018 to December 2019 at a Midwestern suburban hospital emergency department. Chart audits and just-in-time education were conducted after implementation. Survey data were collected to evaluate nurses’ perception of the tool's usefulness. ResultsUse of the novel Emergent Documentation Aggression Rating Tool increased over time (67.36% in Quarter 3 2018 to 97.55% in Quarter 4 2019). After Emergent Documentation Aggression Rating Tool implementation, visual inspection of the time series indicated a decrease in percent restraints, and there was an overall increase in documented escalations de-escalations over time. The patients that escalated most frequently had diagnoses of alcohol use, suicidal ideations, pain-related complaints, or mental health issues. ConclusionThe Emergent Documentation Aggression Rating Tool was feasible for emergency nurses to proactively identify and intervene with patients at risk for aggression/violence.

Emergency Department Visits Following Suboccipital Decompression for Adult Chiari Malformation Type I

INTRODUCTIONThe unnecessary overuse of ED services in the United States leads to an estimated wasteful spending of $38 billion yearly. The burden of these visits is multiplied in pandemics and times of crisis, such as the COVID-19 pandemic, during which ED resources may already be overwhelmed. Post-operative Emergency Department (ED) visits following suboccipital decompression in CM-1 patients are not well described.METHODSA prospectively maintained database of CM-1 patients seen at our institution between January 1, 2006 and December 31, 2019 was used. Pre-operatively and post-operatively prior to hospital discharge, patients are counselled extensively on activity restrictions after surgery, incision care, expectations of severe headache and neck stiffness for the first few weeks after surgery, the variability in degree and timing of symptom improvement from patient to patient, and the proper intake of analgesics, as prescribed. ED visits occurring within 30 days after surgery were tracked for postoperative patients, while comparing clinical, imaging, and operative characteristics between patients with and without an ED visit. Clinical improvement at last follow-up was compared between both groups of patients in a univariable and multivariable analysis using the Chicago Chiari Outcome Scale (CCOS).RESULTSIn 175 surgically treated patients, 44 (25%) visited an ED in the 1-month period after surgery. The most common reason for seeking care was isolated headache (41%). Concentration disturbance at presentation was the only factor significantly associated with a post-operative ED visit (P = .023). The occurrence of a post-operative ED visit was independently associated with a lower chance of clinical improvement at last follow-up (adjusted OR of CCOS≥13 = 0.35, P = .021; adjusted OR of CCOS≥14 = 0.38, P = .016).CONCLUSIONAdult CM-1 patients undergoing surgery at a tertiary referral center have an elevated rate of post-operative ED visits, which are mostly due to pain-related complaints, despite preoperative and postoperative counselling. Such visits are hard to predict but are associated with worse long-term clinical outcome. Interventions that decrease the magnitude of post-operative ED service utilization are warranted.

Primary care management of patients with pain complaints and the influence of physician training in mechanical diagnosis and therapy

Chronic pain affects 20% of the adult population, and pain-related consultations comprise a significant amount of all primary care visits. The purpose of this study was to describe health care utilization by primary care physicians for patients with a consultation for pain and to compare subsequent health care utilization and costs for a physician trained in the McKenzie method, or mechanical diagnosis and therapy (MDT), with a group of physicians that were not trained in MDT. This study was a single-center retrospective quality and cost metrics data analysis performed at a community regional health-care system; patients seen by primary care physicians for a consultation for pain had subsequent health care utilization and costs compared for a physician trained in MDT with a group of 19 physicians who were not trained in MDT. A total of 22,907 continuously eligible patients were seen during the 12-month period for a pain-related complaint; 1282 patients (6%) were seen by the physician trained in MDT, and 21,625 patients (94%) were seen by the group of physicians that were not trained in MDT (n = 19). The patients seen by the physician trained in MDT had a decreased likelihood of medication use including both opioids and non-opioid pain pills, diagnostic imaging, electromyography/nerve conduction velocity testing, specialty referrals, injections (joint and spinal injections), surgeries, emergency room visits, and inpatient admissions. Also, patients who were seen by the physician trained in MDT cost significantly less to the system ($3481 per member per year versus $4852, p < 0.001), despite being older and having more medical problems and pain complaints. Although further research is necessary to either support or refute these findings, these results may have important implications for health policy decisions for designing optimal primary care models and consideration of MDT in primary care.

Emergency Department Visits Following Suboccipital Decompression for Adult Chiari Malformation Type I

BackgroundPostoperative emergency department (ED) visits following suboccipital decompression in Chiari malformation type I (CM-1) patients are not well described. We sought to evaluate the magnitude, etiology, and significance of postoperative ED service utilization in adult CM-1 patients at a tertiary referral center.MethodsA prospectively maintained database of CM-1 patients seen at our institution between January 1, 2006 and December 31, 2019 was used. ED visits occurring within 30 days after surgery were tracked for postoperative patients, while comparing clinical, imaging, and operative characteristics between patients with and without an ED visit. Clinical improvement at last follow-up was also compared between both groups of patients in a univariable and multivariable analysis using the Chicago Chiari Outcome Scale (CCOS).ResultsIn 175 surgically treated patients, 44 (25%) visited an ED in the 1-month period after surgery. The most common reason for seeking care was isolated headache (41%), and concentration disturbance at presentation was the only factor significantly associated with a postoperative ED visit (P = 0.023). The occurrence of a postoperative ED visit was independently associated with a lower chance of clinical improvement at last follow-up (adjusted odds ratio of CCOS ≥13 = 0.35, P = 0.021; adjusted odds ratio of CCOS ≥14 = 0.38, P = 0.016).ConclusionsAdult CM-1 patients undergoing surgery at a tertiary referral center have an elevated rate of postoperative ED visits, which are mostly due to pain-related complaints. Such visits are hard to predict but are associated with worse long-term clinical outcome. Interventions that decrease the magnitude of postoperative ED service utilization are warranted.

Taking the Pain out of Somatization: Development and Implementation of a Hospital-Based Clinical Practice Guideline to Address Pediatric Somatic Symptom and Related Disorders.

The diagnostic category of somatic symptom and related disorders (SSRDs), although common, is often poorly recognized and suboptimally managed in inpatient pediatric care. Little literature exists to address SSRDs in the inpatient pediatric setting. The purpose of the study was to characterize current SSRD practice, identify problem areas in workflow, and develop a standardized approach to inpatient evaluation and management at a tertiary care academic children's hospital. A multidisciplinary group identified patients with SSRD admitted between May 2012 and October 2014. A retrospective chart review on a convenience sample was performed to identify population characteristics and current practice. Lean methodology was used to define current state practice and future state intervention. These methods were used to guide identification of problem areas, which informed protocol, a clinical practice guideline, and resource development. Thirty-six patients aged 8 to 17 years met inclusion criteria for chart review. Most patients presented with either neurologic or pain-related complaints. The mean length of stay was 5.44 days (SD = 6.3), with few patients receiving a mental health consultation within 24 hours of hospitalization. Patients averaged 5.8 medical and/or psychiatric diagnoses on discharge (SD = 5.2), and two-thirds did not have an SSRD diagnosis. Half of patients had comorbid psychiatric diagnoses, whereas one-quarter were discharged with no mental health follow-up. In this study, we describe the process and content development of a single-site institutional protocol, clinical practice guideline, and resources for the evaluation and management of pediatric SSRDs. This study may serve as a model for similar standardization of SSRD care in other inpatient pediatric medical settings.

Race-related differences in acute pain complaints among inner-city women: the role of socioeconomic status.

Previous research has shown that African Americans (AA) report higher pain intensity and pain interference than other racial/ethnic groups as well as greater levels of other risk factors related to worse pain outcomes, including PTSD symptoms, pain catastrophizing, and sleep disturbance. Within a Conservation of Resources theory framework, we tested the hypothesis that socioeconomic status (SES) factors (i.e., income, education, employment, perception of income meeting basic needs) largely account for these racial/ethnic differences. Participants were 435 women [AA, 59.1%; Hispanic/Latina (HL), 25.3%; Non-Hispanic/White (NHW), 15.6%] who presented to an Emergency Department (ED) with an acute pain-related complaint. Data were extracted from psychosocial questionnaires completed at the participants' baseline interview. Structural equation modeling was used to examine whether racial/ethnic differences in pain intensity and pain interference were mediated by PTSD symptoms, pain catastrophizing, sleep quality, and sleep duration, and whether these mediation pathways were, in turn, accounted for by SES factors. Results indicated that SES factors accounted for the mediation relationships linking AA race to pain intensity via PTSD symptoms and the mediation relationships linking AA race to pain interference via PTSD symptoms, pain catastrophizing, and sleep quality. Results suggested that observed racial/ethnic differences in AA women's pain intensity, pain interference, and common risk factors for elevated pain may be largely due to racial/ethnic differences in SES. These findings highlight the role of social inequality in persistent health disparities facing inner-city, AA women.

Trends in emergency physician opioid prescribing practices during the United States opioid crisis

BackgroundPrescription opioid related deaths have increased dramatically over the past 17 years. Although emergency physicians (EPs) have not been the primary force behind this rise, previous literature have suggested that EPs could improve their opioid prescribing practices. We designed this study to evaluate the trend in emergency department (ED) opioid prescriptions over time during the US opioid epidemic. MethodsWe conducted a retrospective cohort study from July 1, 2012 to June 30, 2018, evaluating all adult patients who presented to two study EDs for a pain-related complaint and received an analgesic prescription upon ED discharge. We compared these data to trends in lay media and medical literature regarding the opioid epidemic. We also evaluated the incidence of repeat ED visits based on the type of analgesic prescriptions provided. ResultsOpioid prescriptions decreased from 37.76% to 13.29% over the six year study period. This coupled with an increase in non-opioid medications from 6.12% to 11.33% and an increase in “no prescription” from 56.12% to 75.37%. This corresponded with an increase in the number of publications on the opioid epidemic within the lay-public and medical literature. Additionally, those patients that received no opiates were less likely to require a repeat ED visit. ConclusionsED physicians are prescribing less opiates, while increasing the amount of non-narcotic analgesic prescriptions. This may be in response to the literature suggesting that prescription opioids play a large role in the opioids crisis. This decrease in opioid prescriptions did not increase the need for repeat ED visits.

A comparison of lumbar transverse pedicle angles between ethnic groups: a retrospective review

BackgroundSpinal surgery requires an intimate understanding of pedicle morphology to provide safe and effective outcomes. Although current research has attempted to identify morphological vertebral pedicle trends, no study has utilized computed tomography (CT) scans to compare the lumbar transverse pedicle angle (TPA) with patient demographics factors in a diverse population throughout multiple hospital centers.MethodsAnalysis of randomly selected CT scans from L1-L5 of 97 individuals who underwent imaging over a two-week period for non-back pain related complaints was conducted. Measuring 970 TPAs in total allowed for comparison of each patients’ pedicle angle with important patient specific demographics including ethnicity, age, gender, height and weight. Statistical analysis utilized multiple comparisons of demographics at each level with post-hoc Bonferroni correction analysis to compare demographics at each level.ResultsWith relation to gender, age, height or weight, no statistically significant differences were identified for TPAs at any vertebral level. However, when stratified by ethnicity, the differences in transverse pedicle angles averages (TPA –Avg) at L2 and L3 were found to be statistically significant (p < 0.05).ConclusionWe have identified a previously unknown and significant relationship between ethnicity and TPA at lumbar vertebral levels. These findings provide critical information that may be added to the operating surgeons’ knowledge of pedicle morphology. We hope this novel information can assist in preoperative planning of pedicle screw placement and potentially help improve surgical outcomes.