Use Of Opioid Medications Research Articles

Pain profile and opioid medication use in patients with idiopathic inflammatory myopathies.

Pain is commonly reported in people living with myositis. This study assesses the presence of pain in the subtypes of myositis as well as the frequency of opioid and non-opioid pain medication use. A survey was developed and distributed by Myositis Support and Understanding, a patient-led advocacy organization, to members of its group. Multivariate logistic regression analysis and chi-squared tests were performed. A total of 468 participants completed the survey. A total of 423 participants (DM n = 183, PM n = 109 and IBM n = 131) were included, based on reported diagnosis, for final analysis. Some 91.5% of myositis participants reported current or past pain, with 99% attributing their pain to myositis. There was a lower likelihood of pain in participants aged >60 years [odds ratio (OR) 0.2, 95% confidence interval (CI)0.1, 0.6, P = 0.003]. The percentage of participants reporting pain was statistically different based on myositis type (DM 97.2%, IBM 80.9% and PM 94.5%, P < 0.001), with a higher likelihood of pain in DM compared with IBM (OR 3.7, 95% CI 1.3, 10.2, P = 0.011). There was a lower likelihood of pain in participants aged >60 years (OR 0.2, 95% CI 0.1, 0.6, P = 0.003). Of the 387 participants reporting pain, 335 reported using pain medications (69% prescribed opioids). Male sex, age >60 years and myositis subtype were not associated with likelihood of non-opioid use. Pain is a commonly reported symptom in myositis with variable treatment strategies, including opioid medications. This study highlights the importance of addressing pain as part of myositis treatment as well as the need for future studies understanding treatment effectiveness.

The clinical and genetic features of hereditary pancreatitis in South Australia

ObjectiveTo characterise the clinical phenotypes and genetic variants of hereditary pancreatitis in people diagnosed in South Australia.Design, setting, participantsCross‐sectional study of people who received molecular diagnoses of hereditary pancreatitis from one of four major diagnostic services in South Australia, 1 January 2006 – 30 June 2021.Main outcome measuresGenotypic and clinical features of people with hereditary pancreatitis, including age at onset, attack frequency, pain indices, use of opioid medications, and physical and mental health impact of hereditary pancreatitis.ResultsWe identified 44 people from ten families who received molecular diagnoses of hereditary pancreatitis during 2006–21 (including 25 Indigenous people [57%] and 27 women [61%]): 36 with PRSS1, five with SPINK1, and three with PRSS1 and SPINK1 mutations (determined by whole exome sequencing). Symptom onset before the age of ten years was reported by 37 people (84%). Pancreatitis‐related pain during the preceding four weeks was described as moderate or high by 35 people (79%); 38 people regularly used opioids (86%). Fifteen patients had diabetes mellitus (34%), and eight had undergone pancreatic surgery (18%). The estimated prevalence of hereditary pancreatitis was 1.1 (95% CI, 0.72–1.4) cases per 100 000 population for non‐Indigenous and 71 (95% CI, 66–77) cases per 100 000 population for Indigenous South Australians. Among people with adult‐onset chronic pancreatitis admitted to South Australian public hospitals during 2001–2019, the proportions of Indigenous people (12%) and women (38%) were smaller than we report for hereditary pancreatitis.ConclusionThe estimated prevalence of hereditary pancreatitis in South Australia is higher than in Europe. PRSS1 gene mutations are important causes, particularly among Indigenous young people.

Preemptive multimodal analgesia and post-operative pain outcomes in total hip and total knee arthroplasty.

Use of multimodal analgesia (MMA) prior to orthopedic surgery has been adopted by many practitioners as a strategy to minimize use of opioid medications. The purpose of this investigation was to quantify the effect of a preemptive three-drug regimen (acetaminophen, celecoxib, and gabapentin) in terms of post-operative opioid consumption and pain control in the field of total joint arthroplasty. A retrospective chart review was conducted on 1691 patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) and stratified by whether they received a preemptive three medication analgesic therapy (acetaminophen, celecoxib, and gabapentin) within 30 to 60min prior to entering the operating room. Post-operative opioid consumption as well as subjectively reported patient pain scores were assessed throughout their hospital stay. A total of 1416 eligible patients were identified with 485 undergoing THA and 931 undergoing TKA. Statistically significant reductions in oral morphine equivalents were shown on post-operative day zero and two within the TKA cohort, and non-significant reductions were demonstrated in other intervals for both procedure types. Statistically significant reductions in patient reported pain scores were shown in nearly every time interval in both procedure types. The receipt of preemptive acetaminophen, celecoxib, and gabapentin 30-60min prior to total joint arthroplasty demonstrated modest reductions in opioid requirements post-operatively. Patients receiving preemptive MMA reported lower pain scores throughout nearly every time interval during their admission after surgery. Further investigations are warranted regarding optimal preoperative medication therapies to promote adequate post-operative pain control-and ultimately diminished opioid consumption-in the setting of total joint arthroplasty.

Temporal trend of opioid and nonopioid pain medications: results from a national in-home survey, 2001 to 2018.

The opioid epidemic persists in the United States. The use of opioid medications is often assessed by claims data but potentially underestimated. We evaluated the temporal trend in the use of opioid and nonopioid pain medications from a national survey. Using data from the 2001 to 2018 National Health and Nutrition Examination Survey (NHANES), we examined the current use of prescription analgesics in the past 30 days among 50,201 respondents aged 20 years or older. Joinpoint regressions were used to test statistically meaningful trends of opioid vs nonopioid analgesics. The mean percentage of people who had pain medications in the past 30 days was 6.4% (5.3%-7.1%) for opioid and 11.3% (9.0%-14.8%) for nonopioid analgesics. The availability of opioid and nonopioid prescriptions at home has remained stable, except for the slight decline of opioids among cancer-free patients in 2005 to 2018. The most frequently used opioid analgesic medications included hydrocodone/acetaminophen, tramadol, and hydrocodone. We uniquely measured the proportion of people who had opioid and nonopioid pain medications at home in the United States and supplemented the previous knowledge of prescription rates mainly obtained from claims data.

PD27-08 PREDICTORS AND TRENDS OF OPIOID-SPARING RADICAL PROSTATECTOMY FROM A LARGE NATIONAL COHORT

You have accessJournal of UrologyCME1 May 2022PD27-08 PREDICTORS AND TRENDS OF OPIOID-SPARING RADICAL PROSTATECTOMY FROM A LARGE NATIONAL COHORT Aaron Brant, Patrick Lewicki, Alec Zhu, Christina Sze, Jeffrey Johnson, Christopher Gaffney, Ilon Weinstein, Anise Bowman, and Jonathan Shoag Aaron BrantAaron Brant More articles by this author , Patrick LewickiPatrick Lewicki More articles by this author , Alec ZhuAlec Zhu More articles by this author , Christina SzeChristina Sze More articles by this author , Jeffrey JohnsonJeffrey Johnson More articles by this author , Christopher GaffneyChristopher Gaffney More articles by this author , Ilon Weinstein Ilon Weinstein More articles by this author , Anise BowmanAnise Bowman More articles by this author , and Jonathan ShoagJonathan Shoag More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002575.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Amidst a nationwide opioid epidemic, multiple urologic societies have published guidelines to encourage judicious use of opioids after urologic surgery. We used a large national database to examine trends in use of opioid and non-opioid pain medications after radical prostatectomy. METHODS: The Premier Hospital Database was queried to identify all robotic and/or laparoscopic radical prostatectomies (RALP) from 2015 – 2020 with length of stay ≥1 day. “Opioid-sparing” was defined as absence of intravenous opioid use after post-operative day 0 and absence of oral opioid use throughout admission. Comparisons were made between opioid-sparing and non-opioid-sparing RALPs. Logistic multivariable regression was used to identify predictors of opioid-sparing RALP. Trends of opioid prescribing patterns over time were plotted, as were density plots of surgeon prescribing behavior. RESULTS: A total of 62,728 patients met inclusion criteria. The overall opioid-sparing rate was 24%. Opioid-sparing RALPs were associated with older age (65 vs. 63 years, p <0.01), white race (76.3% vs. 73.3%, p <0.01), high-volume surgeons (75.2% vs. 70.0%, p <0.01), IV ketorolac (62.2% vs. 48.0%, p <0.01), IV acetaminophen (32.5% vs. 30.0%, p <0.01), and liposomal bupivacaine (5.4% vs. 4.9%, p <0.01). On multivariable regression, IV ketorolac was the strongest predictor of opioid-sparing RALP (OR 1.77 [1.71 – 1.83], p <0.01). The proportion of procedures that used IV ketorolac, liposomal bupivacaine, and were opioid-sparing increased in frequency over time, while the proportion that used IV acetaminophen decreased (Figure 1). IV ketorolac was not associated with increased postoperative bleeding (0.3% vs. 0.3%, p=0.9) or inpatient dialysis (<0.1% vs. <0.1%, p=0.8). Density plots of ketorolac prescribing behavior showed a bimodal distribution with the majority of providers either frequently (>75%) or infrequently (<25%) prescribing ketorolac. CONCLUSIONS: Opioid-sparing RALP was associated with IV ketorolac, IV acetaminophen, and liposomal bupivacaine use. On multivariable regression, IV ketorolac was the strongest predictor of opioid-sparing RALP and was not associated with increased risk of bleeding or dialysis. There were large discrepancies in ketorolac prescribing behavior among urologists. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e496 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Brant More articles by this author Patrick Lewicki More articles by this author Alec Zhu More articles by this author Christina Sze More articles by this author Jeffrey Johnson More articles by this author Christopher Gaffney More articles by this author Ilon Weinstein More articles by this author Anise Bowman More articles by this author Jonathan Shoag More articles by this author Expand All Advertisement PDF DownloadLoading ...

Integration of Life Care Specialists Into Orthopaedic Trauma Care to Improve Postoperative Outcomes: A Pilot Study

Background AimThis pilot study assessed the feasibility and impact of integrating a Life Care Specialist (LCS) into orthopaedic trauma care. DesignThis was a prospective feasibility single group pilot study at a level 1 trauma center. MethodThe LCS is a paraprofessional behavior-based “pain coach” and delivered patient-centered opioid safety education, trained participants on nonpharmacologic pain management approaches, conducted opioid risk assessments, and coordinated care. Numeric Rating Scale pain scores were assessed on admission, at discharge, and at 2-week follow-up. Daily morphine milligram equivalents (MME) during hospitalization, opioid medication use at 2-weeks, and patient satisfaction were recorded. T test compared mean morphine milligram equivalents (MME) to historical orthopaedic trauma patient population's mean dosage at discharge from the study site. Generalized linear models assessed pain scores over time. ResultsTwenty-two percent of 121 total participants met criteria for moderate to severe risk of opioid misuse at initial hospitalization. On average, 2.8 LCS pain management interventions were utilized, most frequently progressive muscle relaxation (80%) and sound therapy (48%). Mean inpatient MME/day was 40.5, which was significantly lower than mean historical MME/day of 49.7 (p < .001). Pain scores improved over time from admission to 2-weeks postoperatively (p < .001). Nearly all participants agreed that the LCS was helpful in managing pain (99%). ConclusionsThe findings indicate feasibility to integrate LCS into orthopaedic trauma care, evident by participant engagement and satisfaction, and that LCS serve as valuable resources to assist with pain management and opioid education.

Use of paclitaxel carried in lipid core nanoparticles in patients with late-stage solid cancers with bone metastases: Lack of toxicity and therapeutic benefits

BackgroundPatients with heavily pretreated, late-stage cancer and bone metastasis are usually poor candidates for further chemotherapy. Previously, we showed that association to lipid nanoparticles (LDE) drastically decreases the toxicity of anti-cancer drugs. Here, we tested the hypothesis that paclitaxel (PTX) carried in LDE could benefit end-of-life patients with painful bone metastases that had been previously treated with conventional PTX. Methods: Eighteen consecutive patients with late-stage cancer, 8 with breast, 5 with prostate and 5 with lung carcinoma, aged 59±9 years, were included in this study. All were receiving opioid medication. LDE-PTX was administered at 175 mg/m 2 every 3 weeks until disease progression. Clinical imaging examinations and serum biochemistry determinations were performed to monitor disease progression. Intensity of bone pain, use of opioid medications and occurrence of pathological bone fractures were also evaluated. Results: In total, 104 chemotherapy cycles were performed and none of the patients showed clinical and laboratorial toxicities or pathological bone fractures. In all patients, pain was reduced so as to allow substitution of non-opioid for opioid medication. Median progression-free survival (PFS) was four months (95% CI 2.4-5.5), but in five patients PFS was longer than 6 months. Conclusions: Absence of observable clinical and laboratorial toxicities from LDE-PTX treatment, improvement of bone pain and the possible effect on PFS in some patients, despite previous use of conventional PTX, suggest that LDEPTX merits further clinical investigation.

Early Postoperative Opioid Requirement Is Associated With Later Pain Control Needs After Supratentorial Craniotomies.

Despite a renewed focus in recent years on pain management in the inpatient hospital setting, postoperative pain after elective craniotomy remains under investigated. This study aims to identify which perioperative factors associate most strongly with postoperative pain and opioid medication requirements after inpatient craniotomy. Using an existing dataset, we selected a restricted cohort of patients who underwent elective craniotomy surgery requiring an inpatient postoperative stay during a 7-year period at our institution (n=1832). We examined pain scores and opioid medication usage and analyzed the relative contribution of specific perioperative risk factors to postoperative pain and opioid medication intake (morphine milligram equivalents). Postoperative pain was found to be highest on postoperative day 1 and decreased thereafter (up to day 5). Factors associated with greater postoperative opioid medication requirement were preoperative opioid medication use, duration of anesthesia, degree of pain in the preoperative setting, and patient age. Notably, the most significant factor associated with a higher postoperative pain score and Morphine milligram equivalents requirement was the time elapsed between the end of general anesthesia and a patient's first intravenous opioid medication. Postcraniotomy patients are at higher risk for requiring opioid pain medications if they have a history of preoperative opioid use, are of younger age, or undergo a longer surgery. Moreover, early requirement of intravenous opioid medications in the postoperative period should alert treating physicians that a patient's pain may require additional or alternative methods of pain control than routinely administered, to avoid over-reliance on opioid medications.

Pain management after third molar extractions in adolescents: a qualitative study

BackgroundUnderstanding how adolescent patients make decisions about pain management after complex dental procedures could help reduce the use of opioid medications and the potential for future opioid misuse in this population. This qualitative study explores how adolescents manage pain, including how decision making with parents and providers affect their experience with opioid and non-opioid analgesics after third molar dental extractions.MethodsWe used a qualitative approach for the analysis of 30 telephone-based semi-structured interviews completed by 15 dyads between May and August 2019, which included 15 adolescents (15–17 years) who underwent a dental extraction, and a parent or guardian for each adolescent. The total sample included 30 participants. Interviews were conducted separately for patients and parents. De-identified interview transcripts were analyzed using qualitative analysis software using a directed content analysis approach.ResultsA total of 15 patient/parent dyads were interviewed. Key themes associated with pain management included sources of information, pain management behaviors engaged in by the adolescents and their caregivers, and the use of medication. In addition to conversations with their dental provider, most patients and their parents discussed pain management plans that included non-medication options, over-the-counter medications, and opioid medications to be taken as needed, which guided their post-extraction behaviors. All participants reported that the adolescent received an opioid prescription for post-extraction pain management, to be taken on an “as needed” basis, but most only took it the day of the extraction and up to 2 days following, usually based on the patient’s reported pain levels and perceptions of over-the-counter medication adequacy. Participants said they did not receive guidance from their provider concerning disposal of unused opioid medications.ConclusionsInvolving adolescents in the pain management decision making process and allowing them to carry out the plan with some caregiver support was acceptable and well executed following third molar extractions. Providers may have an opportunity to reduce the number of opioids prescribed, since respondents reported little to no use of opioids that they were prescribed. Providers should educate patients and their parents about safe disposal of opioids to mitigate the potential for diversion.

Preoperative opioid use is associated with a more painful postoperative course after reverse total shoulder arthroplasty

BackgroundStudies investigating preoperative use of opioid medication and early postoperative outcomes are lacking in reverse total shoulder arthroplasty (RTSA), findings that would be relevant in the setting of bundled payment plans. This study compared patients with chronic preoperative opioid use with patients who were opioid naïve in regard to pain, opioid use, length of hospital stay, and complications after RTSA. MethodsPatients using opioids chronically (>3 months) preoperatively and those not using opioid medications before RTSA were identified through an institutional database. Visual analog scale (VAS) pain scores were recorded at the preoperative visit and 12 weeks after surgery. Oral morphine equivalents (OME) were recorded from in-hospital use, discharge, and subsequent opioid prescriptions, and a search of a statewide controlled substances monitoring database was performed during the 3-month postoperative period. The hospital length of stay and complications also were recorded. Statistical analyses for preoperative and postoperative measurements were performed using Mann-Whitney testing. Differences with P < .05 were considered statistically significant. ResultsThere were 55 patients with chronic preoperative opioid use and 134 nonusers included in the study. Preoperative VAS scores (6.7 vs. 5.6; P = .01) were found to be higher for the opioid group. At 3 months postoperatively, VAS (3.5 vs. 1.9; P = .04) was again found to be higher for the opioid group. However, the degree of improvement in VAS (4.1 vs. 3.6; P = .65) was similar between groups. The amount of inpatient OME (66.6 vs. 55; P = .76) and postdischarge OME (606 vs. 559; P = .76) consumed were similar between groups. The cumulative 3-month postoperative OME use (1457 vs. 569; P = .07) was higher in the opioid group and trended toward statistical significance. No differences were noted in the length of stay between the 2 groups, with each averaging 2.3 days. Complication rates were similar between the 2 groups in the 90-day episode of care (9.1% vs. 10.4%). ConclusionThese results indicate that chronic preoperative opioid use is associated with increased postoperative pain after RTSA, although VAS improvement was similar to narcotic-naïve patients. Furthermore, cumulative OME usage only trended toward statistical significance but, nevertheless, reflected an over 2.5-fold increased requirement in the group of patients using opioids preoperatively. Although opioid users did not require substantially more perioperative resources, these data can be used to further counsel patients regarding opioid use, manage postoperative expectations, and aid in risk stratification during the evolution of bundled payments and the transition to value-based care. Level of EvidenceLevel III; Retrospective Case-Control Treatment Study

28 Risk Factors and Outcomes of Opioid Dependence After Burn Injury: A Single Center Study

IntroductionPatients with severe burns often have a prolonged recovery course and frequently opioid pain medications. Several studies showed patients who receive frequent and high doses of opioid medications are at elevated risk of developing opioid dependence. Risk factors for opioid dependence have been established in several fields, including in trauma patients, however opioid dependence within the burn population has not been well studied. In this study we identify risk factors and outcomes for burned patients with opioid dependence.MethodsWe performed a review of a deidentified database that covers our institution comprising over 1.9 million patients. ICD-10 codes were used to identify those with burns. We identified 9150 patients who received treatment for a burn injury between January 1, 2010 and December 31, 2020. From this cohort 130 patients (1.4%) developed documented opioid dependence. Patients from each cohort were balanced by propensity score matching. The database was then examined to determine treatment type and concomitant diagnoses.ResultsPrior to matching we found a significant increase in mortality, chronic pain, non-opioid substance abuse, depression, and use of opioid and non-opioid medication (p< 0.05) for those with opioid dependence. After propensity score matching, we found no significant increase in mortality or depression (p >0.05). Chronic pain and non-opioid substance abuse remained elevated (OR 2.7, CI 1.6, 4.4; OR 2.4, CI 1.3, 4.5, p< 0.05, respectively). Those who developed opioid dependence were more likely to receive opioid and non-opioid pain medication (p< 0.05), but these were not more likely to receive IV opioid pain medication (p >0.05). However, they were more likely to receive IV opioid pain medication more frequently (p< 0.05). Interestingly, patients who developed opioid dependence were more likely to follow up post-operatively and to receive anti-depressant and anti-epileptic (gabapentin and pregabalin) medications (p< 0.05).ConclusionsHere we presented data on patients who developed opioid dependence following burn injury. These patients appear to receive more pain medication and receive it more frequently. We did not find a correlation of opioid dependence to depression or patient compliance. Characterizing the patient who develops opioid dependence will better help clinicians to identify patients at risk and direct their care accordingly. Further investigation is indicated to determine the impact these factors have and how these might be mitigated.

Opioids and older adults: Increasing trends in opioid usage in a dental population compared to a National Database (NHANES).

AimTo examine self‐reported opioid prevalence at a dental school clinic for patients ≥65 years old as compared to national data, comparing gender, ethnicity/race and older adult age groupings.Methods and resultsSelf‐reported prescription opioid medication use was extracted from the medical record for dental patients ≥65 years old who visited the school's general dental clinic (GDC) in 2012 or 2017. This data was compared to the National Health and Nutrition Examination Survey (NHANES) data for 2011–2012 and 2017–18. There was a significant increase in prevalence of opioid use in adults ≥65 between 2012 (4.5%) and 2017 (6.5%) and for ages 65–79 (from 4.7% to 6.3%) and ≥80 (3.4% to 7.9%), women (4.8% to 7.0%), and African Americans (4.7% to 8.4%) in the GDC. Older adults at the GDC reported less opioid use than the NHANES national average for both periods no matter the gender or the age with variable results for race/ethnicity.ConclusionThe prevalence of older adults taking opioids in our general dental school clinic population increased significantly in 2017 as compared to 2012 but was lower than the national average for the respective periods. Awareness of existing opioid usage in older adult patients and its higher adverse risk potential is critical when prescribing analgesics for dental pain for this age group.

Nonmedical use of gabapentin and opioid agonist medications in treatment-seeking individuals with opioid use disorder

BackgroundAs prescriptions for gabapentin have increased in recent years, nonmedical use and risk of adverse outcomes (e.g., hospitalizations and overdose) have been identified, particularly in association with opioids, including opioid agonist medications (OAMs) buprenorphine and methadone. However, there is a lack of systematic, nationwide data assessing the relationship between the nonmedical use of gabapentin and OAMs. MethodsData were sourced from two nationwide opioid surveillance programs of treatment-seeking individuals with opioid use disorder (OUD). Both programs utilized an identical serial, cross sectional survey of 12,792 new entrants to one of 163 substance use treatment programs for OUD in 46 states and the District of Columbia from January 2019 to December 2020. ResultsPast month nonmedical use of gabapentin was endorsed by 9.3% of the sample. Of those using gabapentin nonmedically, 64.1% also endorsed nonmedical use of an OAM, including concomitant use of methadone (35.3%), and buprenorphine (49.0%). Concomitant nonmedical use of gabapentin and OAMs was more prevalent (versus nonmedical use of gabapentin alone) in the Southern region, among those living in a street dwelling, those with chronic pain and healthcare professionals. ConclusionsNonmedical use of gabapentin in people with OUD appears to frequently coincide with nonmedical use of OAMs. As prescriptions and off-label use of gabapentin increase, provider education should include the risks of concomitant gabapentin and OAM use, particularly amongst buprenorphine prescribers. Future research should investigate motivations (e.g., OUD self-management) for nonmedical use of gabapentin and OAMs within the context of OUD treatment access and retention.

203 Opioid Reduction After SCS

INTRODUCTION: Spinal cord stimulation (SCS) is frequently used as a primary method to treat intractable back and extremity pain with the secondary goal of replacing or reducing adjunct opioid use. Our study investigates pre and post-operative changes in morphine milligram equivalents (MME) for patients who have undergone SCS. METHODS: Data was extracted from the Henry Ford Department of Neurosurgery RedCap spinal cord stimulator database. Descriptive statistics of means, standard deviations, medians, interquartile ranges (IQR) and percentages were computed for the outcomes of interest. Signed rank tests were done to compare pre to post measurements of MME. The testing level was set at 0.05 and all analyses were done using SAS version 9.4. RESULTS: There were a total of 241 cases included in the RedCap SCS database out of which 196 were included in our analysis. A significant reduction was seen in the use of opioid pain medication from the pre-operative MME measurement as compared to the 3-month postoperative MME measurement (median = 9.5, IQR = (0, 27.5), p &lt; 0.001). However, the differences in opioid use between pre and postoperative week 6 and 2-year measurements were not significant. CONCLUSION: SCS has traditionally been used in patients with intractable back and/or extremity pain and potentially helps to decrease opioid use as the primary method of pain relief in these patients. Careful consideration should be given when choosing candidates for SCS implantation as well a long-term follow up to track post-operative MME use.

A descriptive analysis of concomitant opioid and benzodiazepine medication use and associated adverse drug events in United States adults between 2009 and 2018

BackgroundIn 2016, the Centers for Disease Control and Prevention (CDC) published guidelines for prescribing opioids for chronic pain in response to the opioid epidemic and recommended avoiding concomitant use of opioid and benzodiazepine medications whenever possible. However, based on a recent report, 16% of overdose deaths involving opioids also involved benzodiazepines. ObjectiveThe objectives of this study were to examine 1) trends in concomitant opioid and benzodiazepine usage and factors associated with utilization 2) and related adverse event reporting before and after the publication of CDC chronic pain prescribing guidelines. MethodsThis study employed a retrospective data analysis of the National Health and Nutrition Examination Survey (NHANES) and FDA Adverse Event Reporting System (FAERS) databases between 2009 and 2018. Descriptive statistics and logistic regression were used to examine characteristics and temporal trends in people taking or reporting adverse events with opioid, benzodiazepine, and both medications. ResultsAmong those taking an opioid medication, 19.7% were also taking a benzodiazepine within the same 30 days. Characteristics for those who reported taking both medications together include being female, non-Hispanic White, being middle aged, and having a lower household income. Concomitant medication use rose between 2009 and 2016 and declined in 2017–2018. Among FAERS reports examined with an opioid suspect medication, 17.9% also included a benzodiazepine suspect medication. Over time, there was an increase in identified FAERS reports involving concomitant opioid and benzodiazepine medications. ConclusionsConcomitant opioid and benzodiazepine use was detected in a small but notable proportion of NHANES survey participants and FAERS reports between 2009 and 2018. Further research examining causal associations between opioids, benzodiazepines, and identified social risk factors are needed to inform prescribing and to best tailor public health interventions to address physical and mental illness safely and effectively across the population.

Comment on Häuser et al.: Medical use of opioids in Europe—Methodological concerns about data from the International Narcotics Control Board

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The impact of preexisting maternal anxiety on pain and opioid use following cesarean delivery: a retrospective cohort study

Anxiety disorders are the most common mental health condition. They are associated with negative pain experiences and can hinder rehabilitation in the hospital setting. Anxiety has been shown to be predictive of increasedpostoperative pain in patients undergoing nonobstetrical surgery. To evaluate the impact of preexisting maternal anxiety disorders on average self-reported pain scores and opioid use in the first 24 hours following cesarean delivery STUDY DESIGN: This was a single-center retrospective cohort study of cesarean deliveries between January 1, 2016 and December 31, 2017. The primary outcome was average pain, calculated by averaging all documented self-reported pain scores (0-10 scale) during the first 24 hours postdelivery. The secondary outcome included the oral morphine milligram equivalents used in the first 24 hours postdelivery. Analysis of the impact of anxiety disorders on these outcomes was performed using multivariable linear regression to control for confounding variables. A total of 2228 cesarean deliveries were analyzed, of which 578 (25.9%) had an anxiety disorder documented. Women with a diagnosis of anxiety had higher average pain scores (3.9 vs 3.5; P<.001) and morphine milligram equivalents use (110.4 mg vs 102.2 mg; P<.001) than women without anxiety. Patients with preexisting anxiety diagnoses reported higher average pain scores and opioid pain medication use in the first 24 hours following cesarean delivery.

BRAIN FOG IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE, AND ASSOCIATION WITH USE OF PROBIOTICS

Abstract INTRODUCTION Brain fog has been extensively studied in patients with inflammatory bowel disease (IBD). Probiotics have been shown to increase the incidence of brain fog in patients independently. There is a high prevalence of probiotic consumption in patients with IBD in clinical practice, whether by a physician or not. We aimed to study if there was an association between brain fog and IBD patients who took probiotics and those who did not. METHODS We conducted a cross-sectional study of patients visiting IBD clinic. Patients over the age of 18 with a biopsy-proven diagnosis of inflammatory bowel disease, without any known pre-existing psychiatric illness or current use of opioid medications were included. They were divided into 2 groups: those with history of probiotic use and those without. Patients were given a questionnaire that included details about symptoms of brain fog. Groups were analyzed by chi-square for differences in baseline demographics, and Mann Whitney U test with repeated measures to compare outcomes between groups. A p value &amp;lt; 0.05 was considered statistically significant. RESULTS Of the 66 patients included (mean age 44±2 years), 35 (53%) were female and 59 (89.4%) were Caucasian. Among these patients, 31.8% (n=21) were on probiotics as dietary supplement with majority (67%, n= 14) taking probiotics for over a year. Overall, there was trend for an association between probiotic use and brain fog in all patients (p=0.080) but no statistical significance was attained. However, brain fog was significantly associated with probiotic use among Caucasian patients (p=0.044). Furthermore, there was a statistically significant association between brain fog and male patients using probiotics (p=0.004). Duration of probiotic use was also associated with brain fog (p=0.038). CONCLUSION Consumption of probiotics was independently associated with brain fog in men, as well as Caucasian patients with IBD respectively. Future prospective studies are warranted to examine causal relationship between probiotics and IBD-associated brain fog to guide prescription of probiotic supplements for IBD.

BRAIN FOG IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE, AND ASSOCIATION WITH USE OF PROBIOTICS

Brain fog has been extensively studied in patients with inflammatory bowel disease (IBD). Probiotics have been shown to increase the incidence of brain fog in patients independently. There is a high prevalence of probiotic consumption in patients with IBD in clinical practice, whether by a physician or not. We aimed to study if there was an association between brain fog and IBD patients who took probiotics and those who did not. We conducted a cross-sectional study of patients visiting IBD clinic. Patients over the age of 18 with a biopsy-proven diagnosis of inflammatory bowel disease, without any known pre-existing psychiatric illness or current use of opioid medications were included. They were divided into 2 groups: those with history of probiotic use and those without. Patients were given a questionnaire that included details about symptoms of brain fog. Groups were analyzed by chi-square for differences in baseline demographics, and Mann Whitney U test with repeated measures to compare outcomes between groups. A p value < 0.05 was considered statistically significant. Of the 66 patients included (mean age 44±2 years), 35 (53%) were female and 59 (89.4%) were Caucasian. Among these patients, 31.8% (n=21) were on probiotics as dietary supplement with majority (67%, n= 14) taking probiotics for over a year. Overall, there was trend for an association between probiotic use and brain fog in all patients (p=0.080) but no statistical significance was attained. However, brain fog was significantly associated with probiotic use among Caucasian patients (p=0.044). Furthermore, there was a statistically significant association between brain fog and male patients using probiotics (p=0.004). Duration of probiotic use was also associated with brain fog (p=0.038). Consumption of probiotics was independently associated with brain fog in men, as well as Caucasian patients with IBD respectively. Future prospective studies are warranted to examine causal relationship between probiotics and IBD-associated brain fog to guide prescription of probiotic supplements for IBD.

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.