Use Of Opioid Analgesics Research Articles

(212) Reductions in postoperative pain intensity and opioid analgesia use with the bupivacaine-collagen matrix (INL-001) after open inguinal hernia repair

Clinical studies of the bioresorbable bupivacaine-collagen matrix (INL-001) have supported its safety and tolerability and found reductions in both selected measures of pain intensity (PI) and opioid analgesia use. It is currently in development for postoperative analgesia as part of multi-modal therapy for patients undergoing hernia repair. In 2 identical, Phase 3, multicenter, randomized, double-blind, placebo-controlled studies (MATRIX-1 and MATRIX-2), patients having elective open, tension-free inguinal hernia repair, with mesh, under general anesthesia were randomized to 300-mg bupivacaine HCl (ie, 3 INL-001 matrices) or 3 placebo matrices. Parenteral morphine was available in the immediate postsurgical period. When able to tolerate oral medication, patients began oral acetaminophen (650 mg tid) and were prescribed immediate-release morphine for breakthrough pain. Time-weighted sum of PI (SPI) and total use of opioid analgesia (TOpA) were determined through 72 hours after implantation. For each patient, the percentage difference of their rank for SPI from the mean rank for SPI and the percentage difference of their rank for TOpA from the mean rank for TOpA were obtained and the two percentage differences were summed with equal weight to create the integrated score (I-SPI-TOpA). Mean I-SPI-TOpA scores at 0-24 and 0-48 hours were significantly lower in the INL-001 group vs placebo for MATRIX-1, -2, and a pooled analysis of the 2 identical studies (P≤0.0237 for all). I-SPI-TOpA at 0-72 hours was significantly reduced for INL-001 vs placebo for MATRIX-2 as well as the pooled analysis (P≤0.0075 for both). Opioid-related treatment-emergent adverse events (TEAEs) were less common in the INL-001 group (16.6% INL-001, 28.4% placebo, P=0.0007). Overall rates of TEAEs were comparable between groups (62.3% INL-001, 68.8% placebo) most were mild or moderate and unrelated to treatment. These findings support the use of INL-001 as a long-acting, opioid-sparing analgesic for postoperative pain management. Funding provided by Innocoll, Inc.

Relationship between the incidence and risk factors of postoperative nausea and vomiting in patients with intravenous patient-controlled analgesia

This study aims to evaluate retrospectively the electronic medical records of surgical patients who received intravenous patient-controlled analgesia, to identify potential relationships between the incidence and risk factors of postoperative nausea and vomiting (PONV). Records of 6773 adult patients who received fentanyl-based intravenous patient-controlled analgesia after surgery at Chung-Ang University Hospital between January 1, 2010 and December 31, 2015 were reviewed. Multiple logistic regressions were used to identify risk factors for PONV. Of 6773 patients, 1216 (18.0%) were recorded to have PONV. In multiple logistic regression analysis, female gender, nonsmoking status, history of motion sickness or PONV, use of desflurane and nitrous oxide, and preintubation use of opioid analgesia were independent risk factors for PONV. Despite the use of antiemetic prophylaxis, 18.0% of patients with intravenous patient-controlled analgesia had PONV. Use of desflurane and nitrous oxide, in addition to risk factors included in the Apfel score (female gender, nonsmoking status, history of PONV or motion sickness, and use of postoperative opioids) were identified as independent risk factors. As the incidence of PONV was 2.8%, 6.0%, 11.7%, 15.2%, 21.1%, 50.0%, and 100% for patients who had 0, 1, 2, 3, 4, 5, and all these risk factors, respectively, risk-adapted, multimodal, or combination therapy should be applied for patients receiving general anesthesia.

(214) Timing of reduction of postoperative pain intensity and opioid analgesia use with the bupivacaine-collagen matrix (INL-001) after open inguinal hernia repair

(214) Timing of reduction of postoperative pain intensity and opioid analgesia use with the bupivacaine-collagen matrix (INL-001) after open inguinal hernia repair

Effectiveness and Safety of Once-Daily Extended-Release Hydrocodone in Individuals Previously Receiving Immediate-Release Oxycodone for Chronic Pain.

ObjectivesThis study evaluated the safety and effectiveness of a once-daily, single-entity, extended-release hydrocodone bitartrate (HYD) among patients with chronic noncancer and non-neuropathic pain who required opioid rotation from a previous analgesic regimen that primarily consisted of immediate-release (IR) oxycodone.MethodsPost hoc analyses of a primary study that assessed HYD 20 to 120 mg over a 52-week period are presented. The primary study included a dose titration period (up to 45 days), a 52-week maintenance period, and an optional taper period (up to 14 days).ResultsRelative to baseline, mean “average pain over the last 24 hours” declined by 1.9 points at the end of the titration period and by 2.6 points at the end of the maintenance period. Additionally, interference and severity of pain as measured by the Brief Pain Inventory–Short Form decreased by 2.3 and 1.9 points, respectively, during the maintenance period. The use of supplemental opioid analgesics decreased. Most patients remained on a stable HYD dose throughout the maintenance period. Most patients indicated satisfaction with HYD and considered it convenient and easy to use. HYD demonstrated a safety profile typical of µ opioids; nausea, constipation, vomiting, and dizziness were the most frequently reported opioid-related adverse events during the study.ConclusionsIn patients with chronic pain who received HYD over a 52-week period, treatment was generally well tolerated and provided effective analgesia among those who rotated from a pain regimen primarily consisting of IR oxycodone.

Polysubstance use and misuse or abuse of prescription opioid analgesics: a multi-level analysis of international data.

Increasing mortality and morbidity associated with opioid analgesics has led to concerns about their misuse and abuse, even when obtained through a prescription. These concerns have been most pronounced in the United States, but limited data make it difficult to determine whether it is a problem in other countries. We investigated opioid analgesic misuse and abuse in participants from the Global Drug Survey 2015 resident in the United States (N = 1334), United Kingdom (N = 1199), France (N = 1258), Germany (N = 866), and Australia (N = 1013) who had used at least 1 prescription opioid analgesic medication in the past year. We also investigated the relationship with polysubstance use, one of the most consistent predictors of problematic opioid analgesic use. Data included misuse and abuse of codeine, hydrocodone, oxycodone, and tramadol; ability to obtain a prescription; different sources for obtaining drugs; and past-year use of benzodiazepines and illicit drugs. In multilevel models, country of residence accounted for less than 3% of the variance in opioid analgesic misuse or abuse. Adjusting for country of residence and sociodemographic factors, use of illicit drugs and benzodiazepines was associated with 4-fold greater odds of misuse (odds ratio 4.36, 95% confidence interval 3.29-5.93) and 6-fold greater odds of abuse compared with not using either drug (odds ratio 6.49, 95% confidence interval 4.0-10.48), although the strength of the association with abuse varied by country. Misuse and abuse by those prescribed opioid analgesics seem to be a problem that is not limited to the United States and warrant attention on an international scale.

Early postoperative oral fluid intake in paediatric day case surgery influences the need for opioids and postoperative vomiting: a controlled randomized trial

BackgroundIn children younger than 4 yr, it is difficult to distinguish the cause of postoperative distress, such as thirst, pain, and emergence delirium. This may lead to inappropriate treatment, such as administration of opioids. The aim of this study was to evaluate the influence of early postoperative oral fluid intake on the use of opioid analgesics and the incidence of postoperative vomiting (POV) after paediatric day case surgery. MethodsAfter ethics committee approval and with parental informed consent, planned day surgery patients aged 6 months to 4 yr were randomized to the liberal group (LG), in which apple juice (10 ml kg−1) was offered first if the Face Legs Activity Cry COnsolability (FLACC) score was ≥4 in the PACU, or to the control group (CG), in which children were treated after surgery according to the institutional opioid protocol, and drinking was allowed only upon the return to the ward. Bayesian statistical analysis was used to compare POV incidence and opioid use across groups. ResultsData from 231 patients were analysed. The incidence of POV in the LG and the CG was 11.40 and 23.93%, respectively. An opioid was needed in 14.04% (mean total dose: 0.18 mg kg−1) and 35.89% (mean total dose: 0.20 mg kg−1) of the patients in the LG and the CG. The PACU stay was 53.45 and 65.05 min in the LG and the CG, respectively (all differences were statistically significant). ConclusionsIn our paediatric outpatient setting, early postoperative oral fluid intake was associated with a reduction in opioid use and POV incidence. These results deserve confirmation in other settings. Clinical trial registrationNCT02288650.

Breakthrough cancer pain and rational drug use

Recent data indicate that there are large disparities in the use of opioid analgesics to control breakthrough cancer pain (BTcP) in Europe and worldwide. While it is clear that affordability is a key factor, it is certainly not the only one, and other factors, such as cultural differences and overall awareness, are undoubtedly responsible. More work remains to be done to overcome barriers in the use of these medications when warranted. When prescribing a medication for BTcP, it must be considered that its time profile is different from chronic persistent pain. The best control of background pain can best be achieved with a low dose of an extended opioid, and managing BTcP with a rapid-onset opioid, providing a good combination of overall pain control and lower opioid exposure. Notwithstanding their efficacy, greater attention needs to be paid to inappropriate use of opioids. It is important to evaluate patients for potential opioid misuse, including assessment of risk factors, and aberrant drug-taking behaviours must be investigated. In our institution, several measures have been adopted in this patient population in order to prevent aberrant opioid-induced behaviours. The adoption of some or all of these principles, depending on the individual patient and treatment setting, can undoubtedly help to reduce the risk of developing an aberrant behaviour related to opioid use as rescue medication for BTcP.

A systematic review of the impact of pain on overall survival in patients with cancer.

Pain commonly occurs in cancer patients, and has been associated with shorter survival. However, the importance of pain is less clear when analyzed with other known prognostic variables. This systematic review was performed to better understand how pain impacts overall survival (OS) in common cancers when key clinical variables are included in multivariate analysis. A Medline search was completed to find studies examining the relationship between pain, clinical variables, and OS in patients with breast, colorectal, lung, or prostate cancer. Multivariate analysis included known prognostic variables including age, performance status, disease burden, and laboratory parameters. Fifty studies met inclusion criteria. In patients with breast, colorectal, and lung cancer, pain was not a significant prognostic factor for OS on multivariate analysis in most studies. In contrast, several studies suggest that pain is an independent prognostic factor for OS in advanced prostate cancer, even when relevant clinical prognostic variables are included. However, analgesic use was often used as a surrogate for prostate cancer pain, making it difficult to determine whether pain or opioid exposure was more important in influencing survival. Pain may be associated with shorter survival in patients with cancer, but the mechanism for this relationship is unknown. The available evidence is insufficient to definitively determine if pain independently influences survival in patients with breast, colorectal, or lung cancer. The majority of studies in prostate cancer show pain to be an independent prognostic factor for OS, and often also incorporate opioid analgesic use in multivariate analysis. Prospective studies are needed to better understand how opioid utilization and pain may affect cancer progression and survival in diverse malignancies.

Polypharmacy in Older Patients ≥70 Years Receiving Palliative Radiotherapy.

Many older cancer patients receive five or more daily medications (polypharmacy). The purpose of this study was to assess the prevalence of polypharmacy in older patients undergoing palliative radiotherapy and its influence on the risk of being unable to complete the prescribed number of fractions, as well as the 30-day mortality and overall survival. Retrospective review of 289 patients aged 70 years or older. The median and mean Charlson comorbidity index (11) was 2, ranging between 0-7 (presently treated cancer not included). The median and mean number of daily medications was 7, ranging between 0-18. Only 27% of patients used less than 5 daily medications. Corticosteroids were used by 59% of the patients and opioid analgesics by 55%. Comorbidity, but also symptom severity, as indexed by pain medication, correlated significantly with the prevalence of polypharmacy. In multivariate analysis, neither polypharmacy nor use of corticosteroids or opioid analgesics influenced overall survival. No trends were seen for 30-day mortality or failure to complete radiotherapy. Polypharmacy is a common phenomenon in older patients receiving palliative radiotherapy and it does not predict adverse radiotherapy outcomes.

Language competence and communication skills in 3-year-old children after prenatal exposure to analgesic opioids.

An increasing consumption of opioids in the general population has been reported in several countries also among pregnant women. Limited information is available regarding the effect of prenatal exposure to analgesic opioids on long-term neurocognitive function in children. The primary aim of the study was to determine the association between prenatal exposure to analgesic opioids and language competence and communication skills at 3years of age. The Norwegian Mother and Child Cohort Study (MoBa) prospectively included pregnant women during the period from 1999 to 2008. Participants reported medication use at pregnancy weeks 17-18 and 30, and 6months after birth. Children's language competence and communication skills were reported by mothers on validated scales. A total of 45211 women with 51679 singleton pregnancies were included. The use of analgesic opioids was reported in 892 pregnancies (1.7%). In adjusted analyses, no association between opioid use and reduced language competence or communication skills was found, OR=1.04 (95%CI: 0.89-1.22) and OR=1.10 (95%CI: 0.95-1.27), respectively. Both pain and use of paracetamol were associated with a small reduction in communication skills. No such association was found for language competence. The use of analgesic opioids in pregnant women does not seem to affect language development or communication skills in children at 3years of age. Copyright © 2017 John Wiley & Sons, Ltd.

Secular trends in opioid prescribing in the USA.

Opioid abuse and misuse in the USA is a public health crisis. The use of prescription opioid analgesics increased substantially from 2002 through 2010, then plateaued and began to decrease in 2011. This study examined prescriptions of branded and generic immediate- and extended-release opioid analgesics from 1992 to 2016. This was juxtaposed against state and federal policies designed to decrease overutilization and abuse, as well as the launch of new opioid products, including opioids with abuse-deterrent properties (OADPs). The data indicate that these health policies, including the utilization and reimbursement of OADPs, have coincided with decreased opioid utilization. The hypothesis that OADPs will paradoxically increase opioid prescribing is not supported.

Taking ACTION to reduce pain: ACTION study rationale, design and protocol of a randomized trial of a proactive telephone-based coaching intervention for chronic musculoskeletal pain among African Americans

BackgroundRates of chronic pain are rising sharply in the United States and worldwide. Presently, there is evidence of racial disparities in pain treatment and treatment outcomes in the United States but few interventions designed to address these disparities. There is growing consensus that chronic musculoskeletal pain is best addressed by a biopsychosocial approach that acknowledges the role of psychological and environmental factors, some of which differ by race.Methods/DesignThe primary aim of this randomized controlled trial is to test the effectiveness of a non-pharmacological, self-regulatory intervention, administered proactively by telephone, at improving pain outcomes and increasing walking among African American patients with hip, back and knee pain. Participants assigned to the intervention will receive a telephone counselor delivered pedometer-mediated walking intervention that incorporates action planning and motivational interviewing. The intervention will consist of 6 telephone counseling sessions over an 8–10 week period. Participants randomly assigned to Usual Care will receive an informational brochure and a pedometer. The primary outcome is chronic pain-related physical functioning, assessed at 6 months, by the revised Roland and Morris Disability Questionnaire, a measure recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). We will also examine whether the intervention improves other IMMPACT-recommended domains (pain intensity, emotional functioning, and ratings of overall improvement). Secondary objectives include examining whether the intervention reduces health care service utilization and use of opioid analgesics and whether key contributors to racial/ethnic disparities targeted by the intervention mediate improvement in chronic pain outcomes Measures will be assessed by mail and phone surveys at baseline, three months, and six months. Data analysis of primary aims will follow intent-to-treat methodology.DiscussionWe will tailor our intervention to address key contributors to racial pain disparities and examine the effects of the intervention on important pain treatment outcomes for African Americans with chronic musculoskeletal pain.Trial registrationClinicalTrials.gov: NCT01983228. Registered 6 November 2013.

The Use of Pterugoplatine Blockade with Dexamethasone for Anesthetization in Enucleation and Evisceration

Introduction. Traditionally the well proven retrobulbar anesthesia as an independent method of pain relief is used in ophthalmology, but there are also disadvantages of this type of anesthesia. Objectives. To develop and evaluate the clinical efficacy of the combined method of pain relief during evisceration or enucleation of the eyeball, including the blockade of the pterygopalatine ganglion by local anesthetic and dexamethasone as an adjuvant, and inhalation anesthesia with sevorane. Material and Methods. A comparative analysis of the effectiveness of intraoperative anesthesia and course of postoperative period in patients of two clinical groups, which were formed according to the method of anesthesia, were held. Results. The nature of pain sensation in patients of comparable groups had significant differences; except the presence and intensity of pain, the degree of edema and conjunctival injection were assessed. Conclusions. The use of pterygopalatine blockade with lidocaine and naropin in combination with dexamethasone as adjuvant provides a prolonged analgesic, anti-inflammatory and anti-edematous effect. This makes it possible to avoid the use of opioid analgesics in early postoperative period, i. e. to avoid systemic side effects such as nausea, dizziness, vomiting, in rare cases, which generally improves the quality of the postoperative period. Application of the pterygopalatine ganglion blockade with mixture of local anesthetics with different durations of action and dexamethasone as an adjuvant based on inhalation anesthesia with sevorane provides safe and effective analgesia in patients during evisceration or enucleation of eyeball, both intra- and postoperatively.

PP013 Pain Management And Substance Abuse In Sickle Cell Disease Patients

INTRODUCTION:Drug abuse is a social and public health problem because of its negative consequences of emotional and physical development in individuals. There are few studies evaluating substance abuse by individuals with sickle cell disease (SCD). These patients have severe and recurrent pain crises (1), frequently needing opioids to control it (2). The compromised quality of life can predispose this population to the occurrence of non-psychotic disorders such as depression, making them vulnerable to substance abuse (3).METHODS:We evaluated the consumption of alcohol and drugs in a cohort followed at the Sickle Cell Disease Reference Center (CRAF), at Hospital de Clínicas de Porto Alegre, estimating the percentage of patients in treatment of SCD who abuse alcohol and drugs, mainly opioids. A cross-sectional study was of a convenience sample of 139 patients with SCD treated at CRAF. The pattern of substance use was evaluated using the Brazilian version of Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The exposure to opioids was measured by their use and prescription in the 24 months before the interview. The Self-Reporting Questionnaire (SRQ-20) was used to estimate the occurrence of non-psychotic disorders in this population. Descriptive analyses were performed using absolute and relative frequencies. The association between the variables was verified using the chi-square test or Fisher's exact test.RESULTS:The prevalence of abusive use was 1.5 percent for alcohol and 3.0 percent for tobacco, with no abusive use of any other substance including opioids was identified. Of note was the pattern for substance use that was not influenced by exposure to substances or the presence of non-psychotic disorders.CONCLUSIONS:Our data shows that use of opioid analgesics for the management of SCD painful crises is safe and does not induce substance abuse. Regular follow-up of these patients is recommended. The results of this study might be useful in other countries.

Use of risk mitigation practices by family nurse practitioners prescribing opioids for the management of chronic nonmalignant pain

ABSTRACTBackground: Ongoing opioid analgesic use in patients suffering from chronic nonmalignant pain (CNMP) has been associated with the development of opioid misuse, abuse, addiction, and overdose. To prevent these adverse outcomes, it is important that family nurse practitioners (FNPs) implement recommended risk mitigation practices (RMPs) when treating CNMP patients with opioids. Methods: A national sample of 856 FNPs was invited to answer an online survey about their utilization of opioids and RMPs in treating CNMP. Results: One hundred sixty-eight FNPs responded (20% response rate), of whom 51.2% affirmed that they prescribe opioids for CNMP. Of the 86 FNPs who prescribe opioids, 66.7% said that less than 25% of their patients were receiving ongoing opioid therapy. The most frequently prescribed opioids were hydrocodone (77.9%) and oxycodone (58.1%). With respect to RMPs, 50 of the 86 opioid-prescribing FNPs (58.8%) reported using treatment contracts with their CNMP patients. Far fewer (20.9%) used formal screening tools to gauge the risk of opioid abuse and misuse. Most respondents (54.94%) reported using prescription monitoring programs, whereas only 33.0% reported using urine toxicology to monitor opioid use. Of the prescribing FNPs, 15.1% reported using abuse-deterrent opioid formulations. Age was found to be a correlate for prescribing opioids for CNMP, with those under 40 years of age less likely to use urine toxicology than those over 41 (45.2% vs. 4.2%; χ2(6) = 11.90, P = .06). Additionally, respondents who did not use treatment contracts reported significantly fewer years in practice (10.5 years, SD = 6.1) than those who did (13.6 years, SD = 1.54, df = 2.82, P = .02). Conclusions: Although RMPs are recommended for use in all CNMP patients receiving ongoing opioid therapy, FNPs do not consistently implement them. In the midst of the current opioid epidemic, FNPs must be vigilant about using appropriate opioid prescription practices.

Ultrasound-guided transversus abdominis plane block: What are the benefits of adding dexmedetomidine to ropivacaine?

Background:Ultrasound-guided transversus abdominis plane (TAP) block has recently come up as a modality to take care of postoperative pain. It can somewhat avoid the use of intravenous opioid analgesics and hence to avoid its complications. We have performed a prospective, double-blinded, randomized study to assess the analgesic effect of adding dexmedetomidine to local ropivacaine on TAP block for patients undergoing lower abdominal surgeries.Aim:The aim is to assess whether addition of dexmedetomidine to ropivacaine may bring some improvements to the analgesic efficacy of TAP blocks in patients undergoing lower abdominal surgeries.Materials and Methods:The study was conducted on forty patients undergoing lower abdominal surgeries under general anesthesia. The patients were divided into two groups: one receiving plain ropivacaine (Group 1) and other receiving ropivacaine with dexmedetomidine (Group 2) during TAP block. The patients in the two groups were compared for age, sex, body mass index, incidence of postoperative nausea, and vomiting and pain as measured on visual analog scale (VAS).Results:There was significantly lower pain score on VAS at 1, 3, 6, 12, and 18 h in Group 2 than in Group 1.Conclusion:The addition of dexmedetomidine to ropivacaine during TAP block improves analgesic effect of TAP block and prolongs the duration of analgesia as well.

Opioid analgesic use among patients presenting with acute abdominal pain and factors associated with surgical diagnoses.

The prevalence of chronic opioid use among non-cancer patients presenting with acute abdominal pain (AAP) is unknown. The aim was to characterize opioid use, constipation, diagnoses, and risk factors for surgical diagnoses among non-cancer patients presenting with AAP to an emergency department (ED). We performed a retrospective, observational cohort study of all (n=16,121) adult patients (88% from MN, IA and WI) presenting during 2014 with AAP. We used electronic medical records, and focused on 2352 adults with AAP who underwent abdominal CT scan within 24hours of presentation. We determined odds ratios of association with constipation and features predicting conditions that may require surgery (surgical diagnosis). There were 2352 eligible patients; 18.8% were opioid users. Constipation was more frequent in opioid (35.1%) compared to non-opioid users [OR 2.88 (95% CI 2.28, 3.62)]. Prevalence of surgical diagnosis in the opioid and non-opioid users was 35.3% and 41.7% respectively (P=.019). By univariate analysis, age and neutrophil count independently predicted increased risk, and chronic opioid use decreased risk of surgical diagnosis. Internal validation of logistic models using a randomly selected validation subset (25% of entire cohort, 587/2352) showed receiver operating characteristic (ROC) curves for the validation and full cohorts were similar. Approximately 19% of adults presenting with AAP were opioid users; constipation is almost three times as likely in opioid users compared to non-opioid users presenting with AAP. Factors significantly associated with altered risk of surgical diagnoses were age, opioid use, and neutrophil count.

Characteristics of new depression diagnoses in patients with and without prior chronic opioid use

Chronic use (>90 Days) of opioid analgesics significantly increases the risk of development of new depression episodes (NDE). It is unclear whether depression that develops in this manner is similar to or different from NDE in persons not exposed to opioid analgesic use (OAU). MethodsVA patients were classified into two groups, those who did not receive an opioid and developed depression (non-OAU+NDE, n=4314) and those that had >90 days OAU and developed NDE (OAU+NDE, n=444). OAU+NDE patients were compared to non-OAU+NDE in terms of depression severity (PHQ-9 scores), incidence of PTSD, other anxiety disorders and substance use disorders after NDE, receipt of acute phase antidepressant treatment, dual antidepressant treatment, mood stabilizers and atypical antipsychotics. Prior to computing bivariate analysis, the prevalence of pain conditions and average maximum pain scores were equalized between the two groups using propensity scores and inverse probability of treatment weighting. ResultsControlling for pain, OAU+NDE patients had more depression symptoms (p=.012), more incident PTSD (p=.04) and opioid abuse/dependence and were more likely to receive 12 weeks of antidepressant treatment (p<.0001). Last, non-OAU+NDE were more likely to have incident diagnoses for any other anxiety disorder (p=.014). ConclusionsWithin the limitations of electronic medical record data, results indicate OAU+NDE patients have more depression symptoms, greater treatment adherence and different comorbid psychiatric conditions compared to non-OAU+NDE, independent of pain. Overall OAU related depression is as severe as non-OAU related depression and repeated depression screening in chronic opioid therapy may be warranted for pain patients, regardless of pain severity.

Complementary and Integrative Therapies for Persistent Pain Management in Older Adults: A Review

Management of persistent pain in older adults is challenging given the prevalence of multiple comorbid painful conditions, polypharmacy, age-related changes restricting pharmacological options, and socioeconomic factors. The influences of these factors along with current concern for the use of opioid analgesics highlight the importance of incorporating complementary and integrative medicine approaches. Evidence suggests efficacy and satisfaction with integrating complementary pain management strategies for older adults, especially yoga, massage, and natural products. Nurses and other providers, given their emphasis on holistic care, are in a unique position to lead the transformation of pain management to a patient-centered, self-management style that integrates complementary therapies. [Journal of Gerontological Nursing, 42(12), 40-48.].

Opioid receptor agonists may favorably affect bone mechanical properties in rats with estrogen deficiency-induced osteoporosis

The results of epidemiological, clinical, and in vivo and in vitro experimental studies on the effect of opioid analgesics on bone are inconsistent. The aim of the present study was to investigate the effect of morphine (an agonist of opioid receptors), buprenorphine (a partial μ opioid receptor agonist and κ opioid receptor antagonist), and naloxone (an antagonist of opioid receptors) on the skeletal system of female rats in vivo. The experiments were carried out on 3-month-old Wistar rats, divided into two groups: nonovariectomized (intact; NOVX) rats and ovariectomized (OVX) rats. The bilateral ovariectomy was performed 7 days before the start of drug administration. Morphine hydrochloride (20 mg/kg/day s.c.), buprenorphine (0.05 mg/kg/day s.c.), or naloxone hydrochloride dihydrate (2 mg/kg/day s.c.) were administered for 4 weeks to NOVX and OVX rats. In OVX rats, the use of morphine and buprenorphine counteracted the development of osteoporotic changes in the skeletal system induced by estrogen deficiency. Morphine and buprenorphine beneficially affected also the skeletal system of NOVX rats, but the effects were much weaker than those in OVX rats. Naloxone generally did not affect the rat skeletal system. The results confirmed the role of opioid receptors in the regulation of bone remodeling processes and demonstrated, in experimental conditions, that the use of opioid analgesics at moderate doses may exert beneficial effects on the skeletal system, especially in estrogen deficiency.