Use Of Analgesic Medications Research Articles

Perceived risk of opioid use disorder secondary to opioid analgesic medication use by the general population in France.

In Europe and France, the use of opioid analgesic drugs has become widespread as an option for pain management. However, their use can lead to nonmedical use and/or opioid use disorder (OUD). This work aimed to assess the perceived risk of OUD secondary to opioid analgesic drugs use by the general population. We conducted a cross-sectional observational study using the GrippeNet web-based cohort, comprising about 10,000 French volunteers from the general population, using a self-administered questionnaire. The main outcome was the perceived risk of OUD secondary to opioid analgesic drugs use, assessed by a 4-item scale and modelled using logistic regression (backward procedure). Among 5046 French respondents, after adjustment, 65% believed that the use of analgesic drugs could likely or very likely lead to OUD. Factors associated with the perception of a higher risk were being over 50 and having heard about opioids in the media. Previous opioid use and a high level of education decreased the perception of the risk. Among those having used opioids in the past 2years (N=1770), 71.1% reported being not at all concerned by this risk. The majority of the sample perceived the risk of OUD but those having already used opioid analgesics drugs expressed no concern about this risk for themselves. This finding highlight the need to reinforce warning on the package insert documents, therapeutic education and collaborative care between the prescribing general practitioners and pharmacists to increase awareness of opioid medications users on the risk of OUD. This study found that the risk of OUD secondary to opioid analgesics use is well perceived in the general population, but that those having already used opioid analgesics expressed little concern for themselves. This finding could potentially help to raise awareness of healthcare providers and policy makers on the lack of perceived risk regarding these drugs and the need to inform and identify at-risk patients in primary care.

Role of Dexamethasone in Post-tonsillectomy Morbidities

Objective: The aim of this study was to find out the effect of Dexamethasone on pain following tonsillectomy. In addition topost-tonsillectomy pain, this study also explore the comparative outcome of use of additional analgesic, fever, nausea &vomiting as well as oral intake of semisolid food between the groups. Methods: A double blind, randomized control trial using a single pre-operative dose of Dexamethasone (0.15mg/kg bodyweight) or normal saline in the randomly selected 100 patients of age more than 3 years, undergoing tonsillectomy fulfillinginclusion criteria of this study, in the Department of Otolaryngology and head Neck surgery, Dhaka Medical College Hospital,Dhaka during July 2009 to June 2010. Surgical techniques, anesthetic drugs, use of analgesic and other medication werestandardized. Both groups were assessed clinically at 6, 12 and 24 hours post-operatively for pain, requirement of analgesic,fever, nausea & vomiting, oral intake, condition of the tonsillar fossa and reactionary haemorrhage. Visual Analogue Scale(VAS) used for the assessment of pain. Results: Post-operative pain was assessed by Visual Analogue Scale (VAS) in both Dexamethasone and Control groups.Mean+/-SD of the VAS in Dexamethasone and Control groups at 6 hours was 5.04 +/- 1.09 vs 5.96 +/- 1.03 (p= < 0.0001), at 12hours was 3.94 +/- 0.93 vs 5.14 +/- 0.61 (p=< 0.0001) and at 24 hours was 2.64 +/- 0.69 vs 3.84 +/- 0.87 (p=< 0.0001). Requirement ofadditional analgesic (p<0.05), fever (P<0.001), Post-Operative Nausea and Vomiting (PONV) (P < 0.005), oral intake ofsemisolid food (P<0.005) between Dexamethasone and control group were significantly different. Regarding condition of thetonsillar fossa and reactionary haemorrhage, no significant differences were observed. Conclusion: A single preoperative IV dose of Dexamethasone (0.15 mg/kg), given just before starting surgery, provided goodand prolonged analgesia. It also reduces fever, nausea & vomiting and odynophagia. Those enhance earlier and betterpostoperative quality of oral intake and decrease morbidities.

Perioperative Pain Management Practices Vary Across Time and Setting for Pediatric ACL Reconstruction: Trends From a National Database in the United States.

Background:Surgical and anesthetic techniques have enabled a shift to the ambulatory setting for the majority of patients with anterior cruciate ligament (ACL) tears. While this change likely reflects improvements in acute pain management, little is known about national trends in pediatric perioperative pain management after ACL reconstruction (ACLR).Purpose:To describe recent trends in the United States in perioperative pain management for pediatric ACLR.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Pediatric patients (age, ≤18 years) who underwent ACLR with peripheral nerve blocks between January 2008 and December 2017 were identified in the Pediatric Health Information System database. We modeled the use of oral and intravenous analgesic medications over time using Bayesian logistic mixed models. Models were adjusted for patient age, sex, race, primary payer, and treatment setting (ambulatory, observation, or inpatient).Results:The study criteria produced a sample of 18,605 patients. Older children were more likely to receive intravenous acetaminophen, intravenous ketorolac, and oral and intravenous opioids. Younger children were more likely to receive ibuprofen. In our adjusted logistic model, treatment setting was found to be an independent predictor of the utilization of all medications. We found an increase in the overall utilization of oral acetaminophen (adjusted odds ratio [adj OR], 1.14 [95% CI, 1.04-1.23]), intravenous acetaminophen (adj OR, 1.42 [95% CI, 1.22-1.65]), and oral opioids (adj OR, 1.16 [95% CI, 1.06-1.28]) over the study period at a typical hospital. We found significant heterogeneity in medication use across hospitals, with the most heterogeneity in intravenous acetaminophen. Other studied descriptive variables did not appear to predict practices.Conclusion:After adjusting for patient characteristics and treatment settings, pain management strategies varied among hospitals and over time. Patient age and treatment setting predicted practices. Regional anesthesia, opioid medications, and intravenous ketorolac remained the mainstays of treatment, while intravenous acetaminophen emerged in use over the course of the study period. The variability in the pain management of pediatric patients undergoing ACLR suggests that further study is necessary to establish the most effective means of perioperative pain management in these patients.

Implanted spinal neuromodulation interventions for chronic pain in adults.

Implanted spinal neuromodulation interventions for chronic pain in adults.

Review: Outcome measures in calcium pyrophosphate deposition.

This review highlights outcomes for patients with calcium pyrophosphate deposition (CPPD) reported in prior studies and underscores challenges to assessing outcomes of this condition. Prior clinical studies of interventions for CPPD focused on joint damage and calcification on imaging tests, joint pain, swelling, and inflammatory biomarkers. Qualitative interviews with patients with CPPD and healthcare providers additionally identified flares, overall function, and use of analgesic medications as important outcomes. Imaging evidence of joint damage and calcification is likely to be outcomes in future clinical studies of CPPD, though reliability and sensitivity to change in CPPD require further testing for several imaging modalities. Challenges to outcome measurement in CPPD include questions of attribution of signs and symptoms to CPPD versus co-existing forms of arthritis, lack of therapies to prevent or dissolve calcium pyrophosphate crystal deposition, absence of validated patient- or physician-reported CPPD outcome measures, and scarcity of large cohorts in which to study outcomes of different clinical presentations of CPPD.

Long-Term Outcomes Following Lumbar Nucleus Replacement.

Nucleus replacement devices are designed to replace the native pain-generating lumbar nucleus while preserving the annulus fibrosus, endplates, and natural motion. The DASCOR Disc Arthroplasty Device seemed to perform well clinically but was discontinued in 2009. While there are no commercially available NRDs today, the potential advantages of using such devices have prompted a renewed interest in further developing the technology and assessing long-term outcomes for the DASCOR device. A retrospective review of hospital records from a single institution was performed to identify all patients that underwent implantation of a DASCOR device between 2006 and 2009. Clinical outcome and imaging data were gathered to assess device performance of the DASCOR device over an extended period of time. Clinical data were assessed using a visual analog scale for back pain (VAS), Oswestry Disability Index (ODI) scores, and analgesic medication use score (ANS). Magnetic resonance images were systematically evaluated at the index and adjacent disc levels: disc height, Modic changes, Pfirrmann grade, and any implant-associated findings. Twenty-six patients received DASCOR implants. Follow-up data were available for 22 patients. The mean age at time of implantation was 34.9 years. Long-term data were available for 14 patients (mean, 11.5 years) with a mean improvement in VAS of 4.0 +/- 2.8 (P < 0.0001), ODI 33.4 +/- 18.4 (P < 0.0001), and ANS 0.5 (P = 0.07) compared to baseline values, while 46% developed radiological adjacent segment degeneration on MRI and 54% did not. In total, 6 patients underwent revision surgery at the index level and 3 underwent surgery at adjacent lumbar levels. While any conclusions should be interpreted with caution, there was a subgroup of patients that had excellent clinical and radiological outcomes. Additional studies on this device or other similar devices would add to our knowledge regarding ideal treatment of discogenic low back pain in younger patients. Treatment of discogenic low back pain. 4.

144 Characterizing the Pain Experience of Children with Acute Gastroenteritis Based on Identified Pathogens

Abstract Primary Subject area Emergency Medicine - Paediatric Background Many children with acute gastroenteritis (AGE) experience moderate-to-severe pain. To date, the relationship between specific enteropathogens and pain intensity in children with AGE is poorly characterized. Objectives To describe pain severity experienced by children with AGE, by enteropathogen type (i.e., bacteria, virus, co-detection) during the 24 hours prior to emergency department (ED) presentation and while in the ED. We also sought to describe analgesic medication use in AGE. Design/Methods Children 0 to under 18 years with symptoms of AGE (vomiting and/or diarrhea, less than 7 days duration) were prospectively recruited in two pediatric EDs from December 2014 to August 2018. Rectal swabs and stool specimens were analyzed with a commercial enteric panel, an in-house viral panel, and standard enteric bacterial culture. Pain severity was reported by caregivers, with input from the child whenever possible, using a validated 11-point Verbal Numerical Rating Scale from 0 (no pain) to 10 (maximum pain). Results 2686 children with AGE participated in the study. The overall maximal mean pain score was 5.50 (SD 3.00) during the 24 hours preceding the ED visit. Children with bacteria detected in their stool had a significantly higher mean pain score (difference: 1.10 [95% CI: 0.36, 1.84]) prior to ED visit and 1.32 (95% CI: 0.54, 2.10) while in the ED, compared to those with no pathogen identified. They also had significantly higher mean pain scores (difference: 1.10 [95%CI: 0.39, 1.81]) prior to ED visit and 1.44 (95%CI: 0.69, 2.20) while in the ED when compared to AGE caused by a single virus. Using a multivariable regression model, the association between pain severity and enteropathogen type was no longer demonstrated; however, longer illness duration (p=0.01), fever (p &amp;lt; 0.0001), increased number of diarrheal (p &amp;lt; 0.0001) and vomiting (p=0.03) episodes, and respiratory symptoms (p=0.03) were all associated with greater pain at home. Overall, analgesic use was low, with 41.6% (1117/2686) and 20.0% (538/2686) of participants receiving an analgesic at home and in the ED, respectively. Conclusion Enteropathogen type was not predictive of greater pain severity after adjustment for clinical symptoms (i.e., vomiting and diarrhea). The clinical constellation of symptoms accompanying any particular pathogen may differ between pathogens, and this clinical picture may play the greater role in pain experience. Analgesic use was low in children with this painful condition.

Use of continuous passive motion device after arthroscopic hip surgery decreases post-operative pain: A randomized controlled trial

BackgroundWe sought to determine whether continuous passive motion (CPM) usage improves outcomes following arthroscopic hip surgery involving acetabular labral repair. Our hypothesis is that CPM usage reduces pain and pain medication use and improves quality of life in individuals who undergo hip arthroscopy. MethodsWe created a randomized controlled trial consisting of 54 patients who underwent arthroscopic acetabular labral repair. Patients were randomized to two groups, one with CPM use post-operatively and one without. Primary outcomes measured were pain level, patient satisfaction, and quality of life. Parameters used to measure these outcomes were self-reported pain scores on Likert scale, frequency of analgesic medication use, and self-reported scores on Hip Outcome Score Activity of Daily Living (HOS ADL). These parameters were compared between the two randomized groups using t-test for statistical analysis. ResultsThere was no statistical difference between the treatment and control groups in terms of patient characteristics. There was no statistical difference between the two groups in terms of HOS ADL scores, although the patients in the control group demonstrated a trend toward higher HOS ADL scores. The patients in the CPM group had a statistically significant decrease in pain levels after surgery compared to patients in the control group. The total morphine equivalent dose consumed in the first two post-operative weeks was higher in the control group compared to the CPM group, although this difference was not statistically significant. ConclusionsUse of CPM resulted in lower pain level scores in patients after hip arthroscopy. Although there is no statistical difference in quality of life or quantity of analgesics consumed post-operatively, patients who used CPM tended to have lower HOS ADL scores (which is desirable) and less consumption of pain medication. A study with a larger sample of patients might elucidate more differences between the two groups. Level of EvidenceII, therapeutic.

Randomized Trial of Poloxamer 407-Based Ropivacaine Hydrogel After Thoracoscopic Pulmonary Resection

BackgroundWe conducted a comparative study to evaluate the efficacy of poloxamer 407-based ropivacaine hydrogel at the wound site (Gel) and continuous thoracic paravertebral block using On-Q PainBuster (On-Q; B. Braun Medical) for postoperative pain after thoracoscopic pulmonary resection. MethodsThis prospective, randomized, noninferiority study included 89 patients randomized to the Gel group (poloxamer 407-based 0.75% ropivacaine, 22.5 mg) or the On-Q group (0.2% ropivacaine, 4 mg/h for 48 hours). The primary outcome measure was total fentanyl consumption, and secondary outcome measures were the need for rescue analgesia and pain intensity using the numeric rating scale (NRS). ResultsThere was no significant difference in total fentanyl consumption between the Gel group and the On-Q group (1504.29 ± 315.72 μg vs 1560.32 ± 274.81 μg, P = .374). Pain intensity using the NRS between the Gel group and the On-Q group demonstrated no statistical differences at 6 hours (3.56 vs 3.55, P = .958), 24 hours (3.21 vs 3.00, P = .25), 48 hours (2.75 vs 2.49, P = .233), and 72 hours (2.39 vs 2.33, P = .811), and there was no significant difference in the frequency of analgesic rescue medication use (3.70 vs 3.33, P = .417). ConclusionsWe confirm the noninferiority of Gel compared with On-Q for acute postoperative pain after thoracoscopic pulmonary resection. Considering a technical simplicity and low systemic toxicity of the local injection of Gel, this analgesic modality may be worthy of further research and is thus considered to have potential as a viable alternative to On-Q for regional analgesia.

The Utility of Dynamic Movement Orthoses in the Management of Complex Regional Pain Syndrome-A Case Series.

Complex regional pain syndrome (CRPS) is a relatively rare, but debilitating condition that may occur after limb or peripheral nerve trauma. Typical symptoms of CRPS include swelling, allodynia, hyperalgesia, and skin temperature changes. Although a variety of pharmacological and non-pharmacological approaches are commonly used in caring for individuals with CRPS, they are frequently ineffective and often associated with side effects and/or additional risks. Previously, elastomeric orthotic garments have been shown to decrease neuropathic pain, reduce edema, and increase proprioception, but no previous reports have described their use in treating CRPS. Accordingly, this case series describes our experiences using a Lycra-based, custom-fabricated Dynamic Movement Orthosis (DMO) as a novel treatment to reduce the symptoms of CRPS and promote function. Four patients were included in this case series, all of whom had very different causes for their CRPS, including a combat-related gunshot injury resulting in multiple foot fractures with a partial nerve injury, a post-metatarsophalangeal fusion, an L5 radiculopathy, and a case of post-lower leg fasciotomies. These four patients all reported subjective improvement in their pain, function, and exercise tolerance in association with their DMO use. All patients demonstrated reduced use of analgesic medications. The pre- and post-DMO lower extremity functional scale showed clinically significant improvement in the two patients for which it was obtained.

Choosing wisely in burn care

BackgroundThe Choosing Wisely Campaign was launched in 2012 and has been applied to a broad spectrum of disciplines in almost thirty countries, with the objective of reducing unnecessary or potentially harmful investigations and procedures, thus limiting costs and improving outcomes. In Canada, patients with burn injuries are usually initially assessed by primary care and emergency providers, while plastic or general surgeons provide ongoing management. We sought to develop a series of Choosing Wisely statements for burn care to guide these practitioners and inform suitable, cost-effective investigations and treatment choices. MethodsThe Choosing Wisely Canada list for Burns was developed by members of the Canadian Special Interest Group of the American Burn Association. Eleven recommendations were generated from an initial list of 29 statements using a modified Delphi process and SurveyMonkey™. ResultsRecommendations included statements on avoidance of prophylactic antibiotics, restriction of blood products, use of adjunctive analgesic medications, monitoring and titration of opioid analgesics, and minimizing ‘routine’ bloodwork, microbiology or radiological investigations. ConclusionsThe Choosing Wisely recommendations aim to encourage greater discussion between those involved in burn care, other health care professionals, and their patients, with a view to reduce the cost and adverse effects associated with unnecessary therapeutic and diagnostic procedures, while still maintaining high standards of evidence-based burn care.

The Effect of an Abdominal Binder on Postoperative Pain After Laparoscopic Incisional Hernia Repair–A Multicenter, Randomized Pilot Trial (ABIHR-I) of the Intraperitoneal Onlay-Mesh Technique.

Incisional hernias with apertures measuring less than 7 cm can generally be treated adequately with the laparoscopic intraperitoneal onlay-mesh (IPOM) technique. The wearing of an abdominal binder after surgery is often recommended in order to promote wound healing and prevent recurrent herniation. We carried out a multicenter, randomized pilot trial to evaluate the utility of abdominal binders. The trial was conducted from May 2019 to December 2020. Persons with a laparoscopic IPOM procedure for treatment of an incisional hernia were included in the trial and randomized preoperatively (1:1). The patients in the abdominal binder group wore an abdominal binder during the day for 14 days after surgery, while those in the control group wore no binder. The primary endpoint was pain at rest on postoperative days 1, 2, and 14, as measured on a visual analog scale. The secondary endpoints were overall subjective well-being, the rates of wound infection, recurrence, and complications, mobility, and the rate and size of postoperative seromas (on postoperative days 1, 2, and 14). Forty patients were included. Three were excluded because of conversion to an open surgical technique. The biometric and perioperative data of the abdominal binder group (n = 18) and the control group (n = 19) did not differ to any statistically significant extent. The patients in the binder group had significantly less postoperative pain (F [dfn, dfd]) 4.44, 95% confidence interval [1; 35]; p = 0.042).The patients in the binder group also had better overall subjective well-being and a higher rate of postoperative seroma formation, but these differences did not reach statistical significance. There was less limitation of mobility than in the control group; however, this difference also did not attain statistical significance. An abdominal binder may reduce pain after incisional hernia repair with the IPOM technique. The postoperative use of analgesic medication was not measured.

Defining Vaso-Occlusive Crises in Sickle Cell Disease from the Perspective of the Patient: Development of a New Toolbox to Measure Treatment Outcomes

Defining Vaso-Occlusive Crises in Sickle Cell Disease from the Perspective of the Patient: Development of a New Toolbox to Measure Treatment Outcomes

A cross-sectional study of traditional Chinese medicine practitioner\u2019s knowledge, treatment strategies and integration of practice of chronic pelvic pain in women

BackgroundChronic pelvic pain (CPP) in women is persistent, intermittent cyclical and non-cyclical lower abdominal pain, lasting for more than 6 months. Traditional Chinese Medicine (TCM) is a popular treatment option for women’s health conditions, but little is known about how treatment for CPP is delivered by TCM practitioners. The aim of this survey was to explore practitioners understanding and treatment of women with CPP, and how they integrate their management and care into the health care system.MethodAn online cross-sectional survey of registered TCM practitioners in Australia and New Zealand between May and October 2018. Survey domains included treatment characteristics (e.g. frequency), evaluation of treatment efficacy, referral networks, and sources of information that informed clinical decision making.ResultsOne hundred and twenty-two registered TCM practitioners responded to this survey, 91.7% reported regular treatment of women with CPP. Treatment decisions were most-often guided by a combination of biomedical and TCM diagnosis (77.6%), and once per week was the most common treatment frequency (66.7%) for acupuncture. Meditation (63.7%) and dietary changes (57.8%) were other commonly used approaches to management.The effectiveness of treatment was assessed using multiple approaches, most commonly pain scales, (such as the numeric rating scale) and any change in use of analgesic medications. Limitations to TCM treatment were reported by over three quarters (83.7%) of practitioners, most commonly due to cost (56.5%) and inconvenience (40.2%) rather than safety or lack of efficacy. Sources informing practice were most often Integration within the wider healthcare system was common with over two thirds (67.9%) receiving referrals from health care providers.ConclusionTCM practitioners seeing women with various CPP symptoms, commonly incorporate both traditional and modern diagnostic methods to inform their treatment plan, monitor treatment progress using commonly accepted approaches and measures and often as a part of multidisciplinary healthcare for women with CPP.

Effects of Acupuncture on Postoperative Pain After Total Knee Replacement: Systematic Literature Review and Meta-Analysis.

To identify the analgesic effectiveness of acupuncture after total knee replacement by systematic review. A search of randomized controlled trials was conducted in five English medical electronic databases and five Chinese databases. Two reviewers independently searched in five English medical electronic databases and five Chinese databases. Two reviewers independently retrieved related studies, assessed the methodological quality, and extracted data with a standardized data form. Meta-analyses were performed with all-time-points meta-analysis. A total of seven studies with 891 participants were included. The meta-analysis results indicated that acupuncture had a statistically significant influence on pain relief (standardized mean difference = -0.705, 95% CI -1.027 to -0.382, P = 0.000). The subgroup analysis results showed that acupuncture's effects on analgesia had a statistically significant influence (standardized mean difference= -0.567, 95% CI -0.865 to -0.269, P = 0.000). The main acupuncture points that produced an analgesic effect when they were used after total knee replacement included the Xuehai, Liangqiu, Dubi, Neixiyan, Yanglingquan, and Zusanli points. Electroacupuncture frequency ranged between 2 and 100 Hz. As an adjunct modality, the use of acupuncture is associated with reduced pain and use of analgesic medications in postoperative patients. In particular, ear acupuncture 1 day before surgery could reduce analgesia .

Knowledge and Reasons for Use of Analgesic Medications among Haramaya University College of Health and Medical Science Students, Harar Town, East Ethiopia

Background: Analgesics, NSAIDs and opioids, commonly known as painkillers, are substances which work in various ways to relieve different types of pain experienced in the body. Approximately 25% of the patients taking non-steroidal anti-inflammatory drugs face several adverse events even in case of prescribed drug and several cases of deaths are reported. Objective: The aim of this study is to assess knowledge and reasons for use of analgesic medications at Haramaya University, College of Health and Medical Science students of Harar town, Eastern Ethiopia from March 1 2020 to February, 2021. Method: Institution based cross sectional study was conduct from March 1, 2020 to February 30, 2021. Data was collected using self-administered structured questionnaire prepared in English. Stratified sampling and simple random sampling was used to select the study participants. A total sample size of 317 was taken. Then the collected data was coded, entered and analyzed by using statistical package for social science version 23. The result is presented using tables. Results: The 90.5% of participants had used analgesic in their life time and the 63.8% them had used analgesic in the last six months. The analgesic usage prevalence in of the study is Ibuprofen (28.7%), Diclofenac (25.7%) and Paracetamol (21.7%). The 78.5% of the respondents reported that large dose of Paracetamol may cause liver. With regard to the use of alcohol with paracetamol, the 77.8% of the respondents replied that alcohols should be avoided when Paracetamol is being taken. The 60.7% of the respondents were aware of the daily maximum dose of Paracetamol. The 78.3% of respondents replied that long time use of codeine can cause addiction. In the current study the 32.4%, 13.2%, and 12.5 %, of the respondents took analgesics for the reason of headache, menstrual pain and fever pain management respectively. The 38.7% of the respondents chose the analgesics due to previous experience, the 19.9% by reading a publication and the 17.5% based on recommendations from others. Conclusion: This study showed the majority of the participants used analgesics for different reasons mainly for management of headache, menstrual pain and fever. Significant proportions of the study participants lack the appropriate knowledge about analgesics usage of analgesics.

Enhancing sleep quality for nursing home residents with dementia: a pragmatic randomized controlled trial of an evidence-based frontline huddling program

BackgroundDisturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents’ sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer’s disease and or related dementias—almost two-thirds of long-stay nursing home residents—are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency.MethodsThis study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention’s sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention’s impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program’s implementation and sustainability.DiscussionThis is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study’s strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia.Trial registrationNCT04533815, ClinicalTrials.gov, August 20, 2020.

Post-operative pain management in dental implant surgery: a systematic review and meta-analysis of randomized clinical trials.

To evaluate the clinical efficacy of various analgesic medications in mitigating orofacial pain following dental implant surgery. A systematic search was conducted to identify randomized controlled clinical trials (RCTs). The primary outcomes examined were post-operative pain (POP) and consumption of rescue analgesics following implant placement; secondary outcomes included adverse effects, post-operative inflammation, infection, swelling, bleeding, patient satisfaction, and quality of life. Random effects meta-analysis was conducted for risk ratios of dichotomous data. Nine RCTs fulfilled the eligibility criteria. Individual studies and meta-analysis of two studies indicated that nonsteroidal anti-inflammatory drugs (NSAIDs) significantly reduced POP and consumption of rescue analgesics after dental implant placement compared to placebo. Transdermal administration of NSAIDs may be superior to the oral route as it was similarly effective for POP control and resulted in fewer side effects. Glucocorticoids administered as primary analgesics or NSAID adjuvants resulted in comparable pain sensation compared to NSAIDs alone. Caffeine-containing analgesics were reported as acceptable and effective for the treatment of POP and swelling when compared to codeine adjuvants. With regard to analgesic dosing schedules, pain modulation may be most critical during the first 72 h following dental implant placement. Risk of bias assessment indicated an overall low risk of bias across the included trials. Within the limitations of this review, POP following implant surgery may be effectively treated with the short-term use of analgesic medications. However, given the heterogeneity in the available RCTs, there is insufficient evidence to recommend an analgesic regimen following dental implant surgery. Short-term use of analgesic medications may be sufficient for post-operative pain management in dental implant surgery. Ultimately, the clinician's analgesic prescription should be directed by a patient's medical history, in order to increase the success of pain management in a short period of time and decrease potential adverse effects. CRD42018099324.

Language Use and Generation Status are Associated with Chronic Pain Differences in Mexican Americans.

Little is known about the pain experience of the Mexican American (MA) population. We investigated the associations between language use and generation status with chronic pain prevalence, health insurance coverage, and analgesic medication use. We examined 3373 MA respondents from the National Health and Nutrition Examination Survey. We found higher levels of English use and generation status were associated with higher odds of reporting chronic pain. For respondents reporting chronic pain, higher levels of English use and generation status were associated with higher odds of being covered by health insurance, lower odds of having a period of time last year without health insurance, and higher odds of being prescribed any analgesic medication, especially opioid medications. We found language use and generation status play a role in MAs' experience, access, and treatment of chronic pain. Patient-, provider-, and systems-level interventions may be needed to reduce these disparities.

882 The effect of body mass index on post-cesarean inpatient opioid consumption

To examine the effect of body mass index (BMI) on inpatient opioid use after cesarean delivery (CD). This was a retrospective cohort study of patients that had a CD between 2015 and 2018 in a single academic center. The primary outcome was post CD opioid consumption measured as morphine milliequivalents (MME) per hour starting 24 hours after delivery in order to standardize opioid consumption across patients with varying lengths of postpartum stay. Secondary outcome was the highest quartile for the MME/hr consumption. Opioid consumption was assessed by totaling opioid milligrams and converting to MME and compared between three BMI groups: 1) 18.5-29.9; 2) 30.0-39.9; and 3) ≥ 40.0 kg/m2 using univariable and multivariable analyses. Of the 1,620 patients, 496 (30.6%) were in the normal/overweight group, 753 (46.5%) in the obese group, and 371 (22.9%) in the morbidly obese group. In the univariable analysis, obese or morbidly obese patients were more likely to require more MME/hr than patients with BMI in the normal/overweight group [1.3, (IQR 0.1, 2.4) vs. 1.6 (IQR 0.5, 2.8) vs. 1.8 (IQR 0.8, 2.9), for BMI group 1, 2 and 3), respectively, p<0.001]. In the multivariable analysis, controlling for maternal sociodemographic, clinical and obstetric factors, as well as for the use of non-opioid analgesic medications, this association did not persist (Table 1). In regard to the secondary outcome, the BMI group of 30.0-39.9kg/m2 (aOR 1.38, 95% CI 1.03-1.85) and ≥ 40.0 kg/m2 (aOR 1.55, 95% CI 1.11-2.18) were more likely to be in the highest quartile of MME/hr opioid consumption compared with 18.5-29.9 kg/m2 group (Table 1). In this analysis, maternal BMI was not associated with mean higher hourly consumption of MME during inpatient stay after CD. However, obese patients were more likely to be in the top quartile of MME hourly consumption.