Study Of Opioid Use Research Articles

Genetic Associations of Persistent Opioid Use After Surgery Point to OPRM1 but Not Other Opioid-Related Loci as the Main Driver of Opioid Use Disorder.

Persistent opioid use after surgery is a common morbidity outcome associated with subsequent opioid use disorder, overdose, and death. While phenotypic associations have been described, genetic associations remain unidentified. Here, we conducted the largest genetic study of persistent opioid use after surgery, comprising ~40,000 non-Hispanic, European-ancestry Michigan Genomics Initiative participants (3198 cases and 36,321 surgically exposed controls). Our study primarily focused on the reproducibility and reliability of 72 genetic studies of opioid use disorder phenotypes. Nominal associations (p < 0.05) occurred at 12 of 80 unique (r2 < 0.8) signals from these studies. Six occurred in OPRM1 (most significant: rs79704991-T, OR = 1.17, p = 8.7 × 10-5), with two surviving multiple testing correction. Other associations were rs640561-LRRIQ3 (p = 0.015), rs4680-COMT (p = 0.016), rs9478495 (p = 0.017, intergenic), rs10886472-GRK5 (p = 0.028), rs9291211-SLC30A9/BEND4 (p = 0.043), and rs112068658-KCNN1 (p = 0.048). Two highly referenced genes, OPRD1 and DRD2/ANKK1, had no signals in MGI. Associations at previously identified OPRM1 variants suggest common biology between persistent opioid use and opioid use disorder, further demonstrating connections between opioid dependence and addiction phenotypes. Lack of significant associations at other variants challenges previous studies' reliability.

Feasibility and validity of using healthcare databases to conduct cross-national comparative studies of opioid use, its determinants and consequences.

A cross-national comparative (CNC) study about opioid utilization would allow the identification of strategies to improve pain management and mitigate risk. However, little is known about the accessibility and validity of information in healthcare databases internationally. This study aimed to identify the feasibility of using healthcare databases to conduct a CNC study of opioid utilization and its associated consequences. A cross-sectional survey was launched in March 2018, including experts interested in CNC studies comparing opioid utilization by purposeful sampling. An electronic survey was used to collect database characteristics, medicine information, and linkage information of each aggregate-level dataset (AD) and individual patient-level dataset (IPD). Overall, participants from 21 geographical regions reported 18 ADs and 19 IPDs. Information on dispensed medications is available from 17 ADs and 17 IPDs. Of the 16 ADs that include primary care settings, only 9 ADs can obtain information from secondary care settings. Fourteen IPDs included patients' characteristics or could be retrieved from linkage databases. Although most ADs are publicly accessible (n = 13), only five IPDs can be accessed without extra cost. Most ADs could be used to report opioid utilization in a primary care setting. IPDs with linkage databases should be applied to identify potential determinants, clinical outcomes, and policy impact. Data access restrictions and governance policies across jurisdictions can be challenging for timely analysis and require further collaboration.

Opioid Use After Gastric Bypass, Sleeve Gastrectomy or Intensive Lifestyle Intervention.

To compare opioid use in patients with obesity treated with bariatric surgery versus adults with obesity who underwent intensive lifestyle modification. Previous studies of opioid use after bariatric surgery have been limited by small sample sizes, short follow-up, and lack of control groups. Nationwide matched cohort study including individuals from the Scandinavian Obesity Surgery Registry and the Itrim health database with individuals undergoing structured intensive lifestyle modification, between August 1, 2007 and September 30, 2015. Participants were matched on Body Mass Index, age, sex, education, previous opioid use, diabetes, cardiovascular disease, and psychiatric status (n = 30,359:21,356). Dispensed opioids were retrieved from the Swedish Prescribed Drug Register from 2 years before to up to 8 years after intervention. During the 2-year period before treatment, prevalence of individuals receiving ≥1 opioid prescription was identical in the surgery and lifestyle group. At 3 years, the prevalence of opioid prescriptions was 14.7% versus 8.9% in the surgery and lifestyle groups (mean difference 5.9%, 95% confidence interval 5.3-6.4) and at 8 years 16.9% versus 9.0% (7.9%, 6.8-9.0). The difference in mean daily dose also increased over time and was 3.55 mg in the surgery group versus 1.17 mg in the lifestyle group at 8 years (mean difference [adjusted for baseline dose] 2.30 mg, 95% confidence interval 1.61-2.98). Bariatric surgery was associated with a higher proportion of opioid users and larger total opioid dose, compared to actively treated obese individuals. These trends were especially evident in patients who received additional surgery during follow-up.

Opioid PrEscRiptions and usage After Surgery (OPERAS): protocol for a prospective multicentre observational cohort study of opioid use after surgery

IntroductionPostoperative pain is common and frequently addressed through opioid analgesia. This practice must balance the benefits of achieving adequate pain relief against the harms of adverse effects such as opioid-induced...

Perioperative and persistent opioid utilization following pancreatectomy in the United States.

Opioids are central to analgesia for pancreatic diseases. Individuals undergoing pancreatectomy have largely been excluded from studies of opioid use, because of malignancy or chronic use. Surgeons need to understand usage patterns, and practices that may incline patients toward persistent post-operative use. A retrospective study using IBM Watson Health MarketScan database examined patterns of peri-pancreatectomy opioid use between 2009 and 2017. Patients were grouped by opioid use 12 months to 31 days prior to pancreatectomy and followed for persistent use (refills 90-180 days postoperatively). Morphine milligram equivalents (MME) were calculated. Multivariable models explored associations between clinical characteristics, perioperative use and persistent use. Opioids were used within the year prior to surgery by 35.6% of 8325 patients. The median MME for opioid naïve patients (400mg) was a fraction of the 1800mg prescribed to chronic opioid users for peri-operative analgesia. The rate of persistent opioid use was 15.1% among naïve, 27.2% among intermittent and 77.3% among chronic opioid users. Multivariable models demonstrated naïve and intermittent users who filled a prescription within 30 days prior to pancreatectomy, those who were prescribed total MME ≥1500mg, and a ≥14 day supply were most at risk of persistent opioid use. Almost 23% of chronic users stopped using opioids post-operatively, suggesting surgery can provide relief. Preoperative and persistent opioid use after pancreatectomy is substantially greater than expected based on other operations. Providers may mitigate this by recognizing the issue, managing expectations, and altering the timing and quantities of opioids prescribed.

Opioid availability statistics from the International Narcotics Control Board do not reflect the medical use of opioids: comparison with sales data from Scandinavia.

Opioid analgesics are essential in clinical practice, but their excessive use is associated with addiction risk. Increases in opioid prescription rates have fuelled an epidemic of opioid addiction in the USA, making statistics on medical opioid use a critical warning signal. A dramatic 150% increase in Swedish opioid access 2001-2013 was recently reported based on data from the International Narcotics Control Board (INCB; Berterame et al. 2016) in conflict with other studies of opioid use in the Nordic countries. This article aims to analyse to what degree published INCB statistics on opioids in Scandinavia (Denmark, Norway and Sweden) reflect actual medical use and study the methodological reasons for putative discrepancies. Data on aggregated total national sales of opioids for the whole population, including hospitals, were collected from the Swedish e-Health Authority. Total sales data for Denmark and drugs dispensed at pharmacies in Norway are publicly available through the relevant authorities' websites. INCB opioid statistics during the period 2001-2013 were markedly inconsistent with sales data from Scandinavia, calling the reliability of INCB data into question. INCB-data were flawed by (a) over-representing the volume of fentanyl, (b) under-reporting of codeine, and (c) by not including tramadol. Opioid availability, as expressed by INCB statistics, does not reflect medical opioid use. It is crucial to underline that INCB statistics are based on the manual compilation of national production, import and export data from manufacturers and drug companies. This is not the same amount that is prescribed and consumed within the health care system. Moreover, there are methodological problems in the INCB reports, in particular concerning fentanyl, codeine and tramadol. We suggest that INCB should carefully review the quality of their data on medical opioids.

The Effect of Perioperative Ketorolac Administration on Opioid Use After Hip Arthroscopy.

Patients undergoing hip arthroscopy often have postoperative pain that is managed in part with opioids. The hypothesis of this study was that administration of ketorolac at the conclusion of the case may improve postoperative pain control and reduce opioid use. This investigation was a retrospective, observational study of opioid use, pain, and time spent in the postanesthesia care unit (PACU) among opioid-naïve patients undergoing primary hip arthroscopy (Current Procedural Terminology code 29914 or 29916) for femoroacetabular impingement syndrome before and after the institution of a surgeon-driven policy to administer ketorolac at the end of the case. Baseline characteristics and perioperative ketorolac administration were recorded. Outcomes included opioids used in the PACU through discharge measured in oral morphine equivalents, time spent in the PACU, and pain reported by the patient in the PACU. Comparative statistics, including multivariable main effects linear regression modeling, were performed to determine the effect of ketorolac administration on outcomes. Patients who did not receive ketorolac consumed a median of 22.5 oral morphine equivalents in the PACU through discharge, whereas patients who received ketorolac consumed a median of 17.5 oral morphine equivalents. No significant difference was found in pain reported or time spent in the PACU through discharge, although the results favored ketorolac administration. This study showed a modest but statistically significant reduction in early postoperative opioid use among patients receiving ketorolac at closure. Ketorolac could be part of a multimodal preemptive pain management strategy to help to reduce postoperative opioid use. [Orthopedics. 2021;44(3):e417-e421.].

Patient Experience with Postpartum Pain Management in the Face of the Opioid Crisis.

Professional societies have urged providers to reduce opioid use for pain management. Accordingly, the objective of this study was to assess patient experiences related to postpartum pain management in an effort to better understand potential paths to achieve such a reduction. This is a planned secondary analysis of a prospective observational study of opioid use following birth. In the primary study, women who received opioids as inpatients were queried about their pain management, including questions about pain experience, pain satisfaction, perceived areas for practice improvement, and the opportunity to leave additional comments. Participants who were prescribed opioids upon discharge completed postdischarge surveys with a similar opportunity for qualitative input. Data were analyzed using the constant comparative method to identify themes and subthemes. Of the 493 women enrolled in the primary analysis, 125 provided qualitative data. Three overarching themes regarding pain management were identified: positive experiences (n = 22), negative experiences (n = 19), and beliefs and preferences on opioid use and pain management (n = 28). Women with positive experiences reported satisfaction with timely pain medication administration and appreciation of open dialogue with their care team. In contrast, several negative experiences centered on tardy administration of pain medications, resulting in increased pain. Patients also perceived judgment, accusation, and excessive lecturing by staff when requesting opioid medications. Finally, participants expressed the necessity for opioids for postpartum pain management, as well as their desires for limiting opioid use, improved options for multimodal pain management, and increased communication with providers about pain regimens. Understanding women's perspectives and experiences regarding postpartum pain control is essential to improving care. Amid growing research on the role of maternity care providers in addressing the opioid crisis, women's voices are rarely solicited. These findings stress the importance of open and frequent dialogue between patients and providers and a need for multimodal pain management options.

Prospective cohort study of opioid use after total knee arthroplasty in a single center

ObjectivesFewer opioids prescribed for postoperative pain may help reduce the number of surplus opioids available in the community and decrease the risk of opioid dependence. Published data on patients’ opioid use after total knee arthroplasty (TKA) are limited. MethodsThis was a prospective study designed to characterize opioid use after TKA. Patients who have undergone TKA and met inclusion criteria were recruited to complete a survey after orthopedic surgeon follow-up appointments approximately 2 and 6 weeks postoperatively. Questions included satisfaction with pain management strategies, type and quantity of medication prescribed, and quantity of leftover medication. Additional data on opioid use and baseline characteristics were determined through chart review. ResultsA total of 60 patients completed surveys after TKA. All patients spent at least 1 night in the hospital or skilled nursing facility with an average length of stay of 1.2 days and an average consumption of 5.2 tablets of oxycodone 5 mg equivalents. After discharge, the mean number of oxycodone 5 mg tablet equivalents prescribed in the initial prescription was 38.6, with an average of 72.6 prescribed over 6 weeks. Patients reported an average of 15.7 unused oxycodone 5 mg tablet equivalents. ConclusionThese results could help guide the development of TKA-specific opioid prescribing guidelines and confirm that patients are generally prescribed more opioids than they consume.

Prescription opioid use and associated factors among US construction workers.

Construction workers are among the segments of the US population that were hit hardest by the opioid prescription and overdose deaths in the past decades. Factors that underlie opioid use in construction workers have been compartmentalized and isolated in existing studies of opioid use and opioid overdose, but they ignore the overall context of their use. This study examines prescription opioid use and its association with a variety of occupational and nonoccupational factors in construction workers in the United States. Data from the 2011-2017 Medical Expenditure Panel Survey (n = 7994) were analyzed. The prevalence of prescribed opioid use and the association with occupational and nonoccupational characteristics among construction workers were examined in four multiple logistic regression models. The odds of prescription opioid use for workers with occupational injuries was more than triple that of their noninjured counterparts when demographics and occupational factors were controlled (odds ratio = 3.38, 95% confidence interval: 2.38-4.81). Odds of prescription opioid use were higher in older construction workers, workers who were white, non-Hispanic, working part-time, and in poorer health, while Hispanic workers and those without health insurance were much less likely to report prescription opioid use. Prescription opioid use among construction workers encompasses both occupational and nonoccupational factors. As an insight into opioid use among construction workers becomes clearer, effectively responding to the opioid crisis remains a challenge.

Steps toward a theory of place effects on drug use: Risk, marginality, and opportunity in small and remote California towns

The risk environment concept provides a framework for documenting ecological influences on drug use, and a platform to engage with social theory to identify mechanisms behind place-based health disparities. Health scientists conceptualize these mechanisms in terms of social determinants of health, social scientists in terms of syndemics and structural violence. I supplement these perspectives with Pierre Bourdieu's concepts of social space, practice, and habitus to offer a broader analysis of how place shapes drug-related health risks, particularly outside of the large cities where most research is conducted. This approach encompasses inequality, conflict, and social change at multiple levels of social organization, from macrodistributions of power to trajectories of individual drug use. I offer three pointers for scholarship on drug use in nonurban places, which I illustrate with findings from an ethnographic study of opioid use and opioid-related services in California. First, replace the folk notion of “rural” with geographic categories grounded in relevant social structures and institutions, such as social networks or illicit drug markets. Second, examine how variation in the structure of social and physical space affects processes of marginalization and criminalization. Third, avoid negative definitions of nonurban places, and instead explore their distinctive institutions and opportunity structures. Following this approach, I define acquainted marginality and small-town habitus to explain how dense networks and geographic isolation shape local government and survival strategies among people who use drugs. I find that in small and remote towns, personal and professional relationships overlap in ways that augment surveillance and stigma, but can also facilitate leniency and progressive policy change. I conclude by using these findings to outline a theory of place effects on drug use and addiction to encourage future research in these directions.

A prospective study of opioid use for postoperative pain management after breast operation

BackgroundThe opioid epidemic has necessitated increased attention to prescribing practices. This study seeks to prospectively quantify postoperative opioid use after breast operation. MethodsConsecutive patients undergoing breast operation at a single institution in 2018 prospectively tracked each dose of medication and completed a survey of perceptions regarding their opioid prescription. ResultsOf 100 patients, 88 completed log, survey, or both. The tab quantity required to fulfill the needs of 80% of patients was: Partial mastectomy (PM) 3, PM with sentinel lymph node biopsy 6, PM with bilateral reduction 8, total mastectomy 34, and bilateral mastectomy 47. Of survey respondents, 51.2% felt they had been prescribed too much pain medication. Most (83.0%) had leftover tabs, and 67.9% indicated they kept them in their home. ConclusionsThe majority of patients were overprescribed opioids after breast operation. A reduction could be achieved by targeting the needs of 80% of the population.

Time trends in opioid prescribing among Ontario long-term care residents: a repeated cross-sectional study.

Opioids are an important pain therapy, but their use may be associated with adverse events in frail and cognitively impaired long-term care residents. The objective of this study was to investigate trends in opioid prescribing among Ontario long-term care residents over time, given the paucity of data for this setting. We used linked clinical and health administrative databases to conduct a population-based, repeated cross-sectional study of opioid use among Ontario long-term care residents between Apr. 1, 2009, and Mar. 31, 2017. We identified prevalent opioid use by drug type, dosage and coprescription with benzodiazepines, and within certain vulnerable subgroups. We used log-binomial regression to quantify the percent change between 2009/10 and 2016/17. Among an average of 76 147 long-term care residents per year, the prevalence of opioid use increased from 15.8% in 2009/10 to 19.6% in 2016/17 (p < 0.001). Over the study period, the use of hydromorphone increased by 233.2%, whereas the use of all other opioid agents decreased. The use of high-dose opioids (> 90 mg of morphine equivalents) and the coprescription of opioids with benzodiazepines decreased significantly, by 17.7% (p < 0.001) and 23.8% (p < 0.001), respectively. Increases in opioid prevalence were more notable among frail residents (37.6% v. 18.8% among nonfrail residents, p < 0.001) and those with dementia (38.6% v. 21.6% among those without dementia, p < 0.001). Within Ontario long-term care, trends suggest a shift toward increased use of hydromorphone but reduced prevalence of use of other opioid agents and potentially inappropriate opioid prescribing. Further investigation is needed on the impact of these trends on resident outcomes.

Abstract P4-11-05: Opioid prescriptions in the military health system breast cancer population, FY2007 – FY2014

Abstract Purpose: Opioid use among individuals with breast cancer is a safety concern because of adverse events including misuse, overdose, and death. To date, there are two published U.S. population-based studies of opioid use among breast cancer patients, both which address persistent opioid use after surgery. Here, we examine rates, amount, and cost of opioids prescribed to breast cancer patients over an 8-year period. Methods: We used Military Health System (MHS) outpatient, inpatient, and pharmacy claims data to select beneficiaries with a primary diagnoses of breast cancer, fiscal years (FY) 2007- 2014. Logistic regression models were used to identify predictors of having received &amp;gt; 1 opioid prescription within a year, and having received &amp;gt; 4 filled opioid prescriptions within a year. Simple linear regression and multiple regression were used to examine trends and predictors of reimbursed opioid cost. Results: Among 25,500 non-elderly breast cancer patients treated in the MHS each year, most were age 55-64, located in the southern U.S., and treated in civilian facilities only. On average per year, 75% had surgery, 90% radiation therapy, 19% chemotherapy, and 8% hospice care. Annual rates of receiving &amp;gt; 1 opiate prescription were stable across 8 years, 48.1% (FY2007) to 50.5% (FY2012 and FY2013). The annual number of opioid prescriptions per patient was also stable, 4.26 (FY2014) to 4.39 (FY2007). Average reimbursed cost of opioids steadily increased over time, $135 (FY2007) to $260 (FY2014) (p &amp;lt; 0.001). Based on regression models, the strongest predictors (p &amp;lt; 0.001) of having received &amp;gt; 1 opioid prescription were (in order of statistical significance): surgery, chemotherapy, civilian care only or mixed use civilian and military care, number of physical comorbid conditions, hospice use, and depression. The strongest predictors (p &amp;lt; 0.001) of &amp;gt; 4 opioid prescriptions per year were: depression, hospice use, number of physical comorbidities, and chemotherapy, followed by anxiety disorder, alcohol use disorder, and drug use disorder. The strongest predictors (p &amp;lt; 0.001) of high reimbursed opioid cost were: drug use disorder, hospice use, depression, civilian care only or mixed use civilian and military care, alcohol use disorder, number of physical comorbid conditions, receipt of chemotherapy, fiscal year, and anxiety disorder. Discussion: Half of individuals with a primary breast cancer diagnosis receive &amp;gt; 1 opioid prescription per year. Four overlapping constructs predict opioid prescriptions and cost: treatment modalities, physical and mental health comorbidities, severity of illness, and system of care. Increased cost over time coincides with current U.S. population reports suggesting rising daily opioid dosage. Despite limitations with claims data, the results suggest that opioid use among breast cancer patients need to be monitored and accompanied by documented clinical management plans. We recommend that oncology providers implement risk reduction strategies including screening for history of substance use and mental health comorbidities, and implementing guidelines specific for cancer patients such as those found in the Veterans Administration/Department of Defense Clinical Practice Guidelines for Opioid Therapy for Chronic Pain, v. 3.0. Citation Format: Jeffery DD, Hopkins L, Spevak CJ, Burke HB. Opioid prescriptions in the military health system breast cancer population, FY2007 – FY2014 [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-11-05.

Prospective, Observational Study of Opioid Use After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

To provide estimates of postoperative opioid use after hip arthroscopy for femoroacetabular impingement (FAI) syndrome and to identify risk factors for increased postoperative opioid use. All patients aged at least 18years who were undergoing hip arthroscopy for FAI syndrome performed by 1 of 2 hip-preservation surgeons between November 2015 and August 2016 were eligible for inclusion in this study. Target minimum enrollment was set at 30 patients per surgeon based on an a priori sample size calculation. Enrolled patients completed the International Hip Outcome Tool, visual analog pain scale, Pain Catastrophizing Scale, abbreviated Patient Health Questionnaire, and questions regarding demographic characteristics and opioid and anti-inflammatory use. Opioid consumption was assessed through pill counting at 2- and 6-week postoperative appointments. Of 80 patients enrolled, 67 had complete 2- and 6-week opioid use data. Patient and operative factors were correlated with outcomes in multivariate models. Opioid use in the 2weeks before surgery was significantly associated with higher postoperative opioid use at 2weeks postoperatively (253.8 additional oral morphine equivalents [OMEs]; 95% confidence interval [CI], 171.2-336.5 additional OMEs; P < .0001; n= 73) and 6weeks postoperatively (385.3 additional OMEs; 95% CI, 241.6-529.0 additional OMEs; P < .0001; n= 67). By 6weeks postoperatively, 41 of 52 patients (79%) without opioid use in the 2weeks before surgery used 30 or fewer 5-mg oxycodone pills compared with only 2 of 15 patients (13%) with preoperative use (odds ratio, 24.9; 95% CI, 4.2-148.5; P < .0001). Among patients undergoing hip arthroscopy for FAI syndrome, any opioid use in the 2weeks preceding surgery was the strongest predictor of opioid use after hip arthroscopy. The impact of preoperative opioid use far exceeded the impact of other baseline patient and operative factors. Assessment of preoperative opioid use could be an important factor in guiding postoperative opioid prescribing. Level II, prospective observational study.

Self-loathing aspects of depression reduce postoperative opioid cessation rate.

We previously reported that increased preoperative Beck Depression Inventory II (BDI-II) scores were associated with a 47% (95% CI 24%-64%) reduction in the rate of opioid cessation following surgery. We aimed to identify the underlying factors of the BDI-II (affective/cognitive vs somatic) associated with a decreased rate of opioid cessation after surgery. We conducted a secondary analysis of the data from a previously reported prospective, longitudinal, observational study of opioid use after five distinct surgical procedures (total hip replacement, total knee replacement, thoracotomy, mastectomy, and lumpectomy) in 107 patients. The primary endpoint was time to opioid cessation. After exploratory factor analysis of the BDI-II, mean summary scores were calculated for each identified factor. These scores were evaluated as predictors of time to opioid cessation using Cox proportional hazards regression. The exploratory factor analysis produced three factors (self-loathing symptoms, motivational symptoms, emotional symptoms). All three factors were significant predictors in univariate analysis. Of the three identified factors of the BDI-II, only preoperative self-loathing symptoms (past failure, guilty feelings, self-dislike, self-criticalness, suicidal thoughts, worthlessness) independently predicted a significant decrease in opioid cessation rate after surgery in the multivariate analysis (HR 0.86, 95% CI 0.75-0.99, P value 0.037). Our results identify a set of negative cognitions predicting prolonged time to postoperative opioid cessation. Somatic symptoms captured by the BDI-II were not primarily responsible for the association between preoperative BDI-II scores and postoperative prolonged opioid use.

Genetics of Opioid Dependence: A Review of the Genetic Contribution to Opioid Dependence.

This narrative review aims to provide an overview of the impact of opioid dependence and the contribution of genetics to opioid dependence. Epidemiological data demonstrate that opioid dependence is a global trend with far-reaching effects on the social, economic, and health care systems. A review of classical genetic studies of opioid use suggests significant heritability of drug use behavior, however the evidence from molecular genetic studies is inconclusive. Nonetheless, certain genetic variants are important to consider given their role in the pathophysiology of addictive behavior. We undertook a literature review to identify the current state of knowledge regarding the role of genes in opioid dependence. Determining the association of genetic markers could change the current understanding of the various factors contributing to opioid dependence and therefore may improve recognition of individuals at risk for the disorder and prevention and treatment strategies.

Opioid Use in Fibromyalgia Is Associated with Negative Health Related Measures in a Prospective Cohort Study

As pain is the cardinal symptom of fibromyalgia (FM), strategies directed towards pain relief are an integral component of treatment. Opioid medications comprise a category of pharmacologic treatments which have impact on pain in various conditions with best evidence for acute pain relief. Although opioid therapy other than tramadol has never been formally tested for treatment of pain in FM, these agents are commonly used by patients. We have examined the effect of opioid treatments in patients diagnosed with FM and followed longitudinally in a multidisciplinary pain center over a period of 2 years. In this first study reporting on health related measures and opioid use in FM, opioid users had poorer symptoms and functional and occupational status compared to nonusers. Although opioid users may originally have had more severe symptoms at the onset of disease, we have no evidence that these agents improved status beyond standard care and may even have contributed to a less favourable outcome. Only a formal study of opioid use in FM will clarify this issue, but until then physicians must be vigilant regarding the multiple adverse consequences of opioid therapy.

PDB95 A Descriptive Study of Opioid Use in the Management of Diabetic Peripheral Neuropathy (DPN) in a Large Commercially Insured Population

PDB95 A Descriptive Study of Opioid Use in the Management of Diabetic Peripheral Neuropathy (DPN) in a Large Commercially Insured Population