Pain Medication Use Research Articles

Concurrent and lagged associations among pain medication use, pain, and negative affect: a daily diary study of people with chronic low back pain.

People with chronic pain often attempt to manage pain and concurrent emotional distress with analgesic substances. Habitual use of such substances-even when not opioid-based-can pose side effect risks. A negative reinforcement model has been proposed whereby relief of pain and emotional distress following medication consumption increases the likelihood that the experience of elevated pain and distress will spur further medication use. People with chronic low back pain (N = 105) completed electronic diary assessments 5 times/day for 14 consecutive days. Lagged and cross-lagged analyses focused on links between time 1 pain and negative affect (NA) and time 2 analgesic medication use and vice versa. Sex differences were also explored. Primary results were as follows: (1) participants on average reported taking analgesic medication during 41.3% of the 3-hour reporting epochs (29 times over 14 days); (2) time 1 within-person increases in pain and NA predicted time 2 increases in the likelihood of ingesting analgesic medications; (3) time 1 within-person increases in medication use predicted time 2 decreases in pain and NA; and (4) lagged associations between time 1 pain/NA and time 2 medication use were strongest among women. Findings suggest that the use of analgesic medications for many people with chronic pain occurs frequently throughout the day. Results support the validity of a negative reinforcement model where pain and distress lead to pain medication use, which in turn leads to relief from pain and distress.

Neuropathic Pain With and Without Diabetic Peripheral Neuropathy in Type 1 Diabetes.

Diabetic peripheral neuropathy (DPN) is common; however, the features and burden of neuropathic pain (NP) in type 1 diabetes (T1D) are poorly understood. We evaluated the incidence of first occurrence, annual prevalence, remission, and risk factors for NP during long-term follow-up of participants with T1D. The Michigan Neuropathy Screening Instrument (MNSI) was administered annually (1994-2020) for 1,324 participants in the Epidemiology of Diabetes Interventions and Complications (EDIC) study. NP with clinical signs of DPN (NP DPN+) was defined according to self-reported NP plus an examination score >2, while NP without clinical signs of DPN (NP DPN-) was defined according to self-reported NP and an examination score ≤2. At EDIC year 1, median age for participants was 36 years (interquartile range 30, 41), diabetes duration 13 years (10, 18), and HbA1c 7.9% (7.2, 8.9). At year 26 (median diabetes duration 39 years), cumulative incidence of NP was 57%, regardless of concomitant clinical signs of DPN (36% NP DPN+ vs. 46% NP DPN-). NP prevalence was 20% at 26 years (11% NP DPN+ and 9% NP DPN-), suggesting frequent remission. Annualized remission rates were similar regardless of pain medication use. In addition to HbA1c, female sex was associated with NP DPN-. NP incidence in T1D was high and frequently occurred in the absence of clinical signs of neuropathy, as assessed with the MNSI. Pain remission was not explained by pain medication use. Effective clinical strategies for identification and management are needed.

Neuropathic Pain Medication and Antidepressant Use after Disability Pension in Patients with Spinal Cord Stimulation for Persistent Spinal Pain Syndrome.

Treatment of persistent spinal pain syndrome (PSPS) is challenging. Chronic pain associated with PSPS can lead to an impaired ability to work. To obtain information on whether receiving a disability pension (DP) affects pain and pain treatments in retiring working-age PSPS patients. Neuropathic pain medication and antidepressant use were considered as an indicator of neuropathic pain. The study group comprised 129 consecutive PSPS patients with spinal cord stimulation (SCS) devices implanted at Kuopio University Hospital Neurosurgery between January 1, 1996, and December 31, 2014. Purchase data of gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors from January 1995 to March 2016, as well as the data on working ability, were retrieved from national registries. The data showed that 28 of 129 (21.7%) SCS permanent patients had a DP, and 27 had a sufficient follow-up time (two years before and one year after DP). Most patients (61%) used neuropathic pain medications during the follow-up, while 44% used antidepressants. Most patients (70%, n = 19) retired because of dorsopathies. The dose of gabapentinoids started to increase before the DP; after the DP, the doses started to increase again after the decrease but remained at a lower level. Neuropathic pain medication and antidepressant use suggest that pain continues after the DP-that is, pensioners continue to experience inconvenient chronic pain. Resources for patient care are therefore needed after the DP. However, the DP reduces the dose increase of gabapentinoids; the dose is higher immediately before retirement than at the end of the follow-up.

Improvement in functional outcome 1 year after nonsurgical multidisciplinary treatmentfor chronic pain after total knee arthroplasty: Aprospective cohort study.

The purpose of this study was to evaluate a multidisciplinary intervention developed for patients with debilitating chronic pain after total knee arthroplasty (TKA) unresponsive to existing treatment options. A treatment-based prospective cohort study was caried out in 30 TKA patients with debilitating chronic pain at least 1 year after TKA. The treatment was a multidisciplinary intervention. Main inclusion criteria: no indication for surgery. Primary outcome was function measured by KOOS-PS, OKS, OKS-APQand WORQ. Secondary outcome measures were pain, fear of movement, self-efficacy, quality of life (QoL), health care and pain medication use, work rehabilitationand patient satisfaction. The assessments took place pre- and directly posttreatment, at 1, 3and 12 months follow-up. The clinical relevance was assessed by predefined minimal important clinical change (MCIC). At baseline patients were on average 64.7 (±7.9) years old, 67% were female, and they had knee pain for 42 (10-360) months. The results at 12-month follow-up: first, a significant improvement was shown in function, pain, fear of movement, self-efficacy and QoL. Second, in 38.5%-69.2% of patients clinical relevant improvement was shown for functional outcome, 31% for pain,and 50% for self-efficacy. Third, 42% of patients reported 'no healthcare use in the past three months'. One year after a multidisciplinary treatment a clinically relevant improvement was shown in terms of function, pain, self-efficacy and QoL. It seems to be a promising treatment option in this difficult-to-treat patient group with debilitating chronic pain after TKA. Future research should examine the effect of the treatment in a larger study population, considering a control group, and focusing on the working population and evaluating cost-efficacy. Level II.

Factors influencing pain medication and opioid use in patients with musculoskeletal injuries: a retrospective insurance claims database study

Opioid use is only recommended in selected cases of musculoskeletal (MSK) injuries. We assessed factors associated with increased opioid use in MSK injuries. In a retrospective analysis of over four million workers with MSK injuries using the Swiss National Accident Insurance Fund (Suva) database, we analyzed risk factors by multivariate logistic regression. Injury severity was associated with pain medication, opioid, and strong opioid use. Whereas fractures, contusions, and ruptures had higher odds for any pain medication use, increased odds for strong opioids were observed in fractures, superficial injuries, and other injuries. Injuries of the shoulders, elbow, chest, back/spine, thorax, and pelvis/hips showed high odds for opioid use (odds ratio (OR) > 2.0). Injuries of the shoulders had higher odds for strong opioid use (OR 1.136; 95% CI 1.040–1.241). The odds for using strong opioids increased from 2008 OR 0.843 (95% confidence interval (CI) 0.798–0.891) to 2018 OR 1.503 (95% CI 1.431–1.578), compared to 2013. Injury severity, type of injury, and injured body parts influenced the use of pain medication and overall opioid use in musculoskeletal injuries. Strong opioids were more often used in fractures but also in superficial and other minor injuries, which indicates that other factors play a role when prescribing strong opioids.

Cannabis for chronic pain: cardiovascular safety in a nationwide Danish study.

A rising number of countries allow physicians to treat chronic pain with medical cannabis. However, recreational cannabis use has been linked with cardiovascular side effects, necessitating investigations concerning the safety of prescribed medical cannabis. Using nationwide Danish registers, patients with chronic pain initiating first-time treatment with medical cannabis during 2018-21 were identified and matched 1:5 to corresponding control patients on age, sex, chronic pain diagnosis, and concomitant use of other pain medication. The absolute risks of first-time arrhythmia (atrial fibrillation/flutter, conduction disorders, paroxysmal tachycardias, and ventricular arrhythmias) and acute coronary syndrome were reported comparing medical cannabis use with no use. Among 1.88 million patients with chronic pain (46% musculoskeletal, 11% cancer, 13% neurological, and 30% unspecified pain), 5391 patients claimed a prescription of medical cannabis [63.2% women, median age: 59 (inter-quartile range 48-70) years] and were compared with 26 941 control patients of equal sex- and age composition. Arrhythmia was observed in 42 and 107 individuals, respectively, within 180 days. Medical cannabis use was associated with an elevated risk of new-onset arrhythmia {180-day absolute risk: 0.8% [95% confidence interval (CI) 0.6%-1.1%]} compared with no use [180-day absolute risk: 0.4% (95% CI 0.3%-0.5%)]: a risk ratio of 2.07 (95% CI 1.34-2.80) and a 1-year risk ratio of 1.36 (95% CI 1.00-1.73). No significant association was found for acute coronary syndrome [180-day risk ratio: 1.20 (95% CI 0.35-2.04)]. In patients with chronic pain, the use of prescribed medical cannabis was associated with an elevated risk of new-onset arrhythmia compared with no use-most pronounced in the 180 days following the initiation of treatment.

The Use of Honey for Cicatrization and Pain Control of Obstetric Wounds: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Several studies point to antibacterial properties and beneficial effects of honey on scar tissue formation, which is a low-cost and easy-to-use option. This study aimed to compare honey versus a placebo for cicatrization and pain control of obstetric wounds, and determine if one is superior to the other, in terms of efficacy, through a meta-analysis. We searched PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science. Two independent investigators identified randomized controlled trials (RCTs) comparing honey and a placebo for obstetric wounds. The primary outcomes were wound healing and pain control. Five randomized controlled trials and 353 patients were included, of whom, 177 (50.1%) were treated with honey. Differences were not found in the final wound healing between the honey and placebo groups (MD -0.34; 95% CI -1.13, 0.44; p = 0.39); however, there was a decrease in pain levels in the middle of the treatment (SMD -0.54; 95% CI 0.83 to 0.25, p = 0.03), reduction in the use of pain medication (ORR 0.26; 95% CI 0.08, 0.86; p = 0.03), increase in personal satisfaction in women who underwent the intervention (ORR 0.81; 95% CI 0.65, 0.98), and reduction in complications. According to the study results, honey treatments showed greater efficiency and provided benefits to the patients by accelerating wound healing and decreasing reported pain.

Craniocervical instability in patients with Ehlers-Danlos syndromes: outcomes analysis following occipito-cervical fusion

Craniocervical instability (CCI) is increasingly recognized in hereditary disorders of connective tissue and in some patients following suboccipital decompression for Chiari malformation (CMI) or low-lying cerebellar tonsils (LLCT). CCI is characterized by severe headache and neck pain, cervical medullary syndrome, lower cranial nerve deficits, myelopathy, and radiological metrics, for which occipital cervical fusion (OCF) has been advocated. We conducted a retrospective analysis of patients with CCI and Ehlers-Danlos syndrome (EDS) to determine whether the surgical outcomes supported the criteria by which patients were selected for OCF. Fifty-three consecutive subjects diagnosed with EDS, who presented with severe head and neck pain, lower cranial nerve deficits, cervical medullary syndrome, myelopathy, and radiologic findings of CCI, underwent open reduction, stabilization, and OCF. Thirty-two of these patients underwent suboccipital decompression for obstruction of cerebral spinal fluid flow. Questionnaire data and clinical findings were abstracted by a research nurse. Follow-up questionnaires were administered at 5–28 months (mean 15.1). The study group demonstrated significant improvement in headache and neck pain (p < 0.001), decreased use of pain medication (p < 0.0001), and improved Karnofsky Performance Status score (p < 0.001). Statistically significant improvement was also demonstrated for nausea, syncope (p < 0.001), speech difficulties, concentration, vertigo, dizziness, numbness, arm weakness, and fatigue (p = 0.001). The mental fatigue score and orthostatic grading score were improved (p < 0.01). There was no difference in pain improvement between patients with CMI/LLCT and those without. This outcomes analysis of patients with disabling CCI in the setting of EDS demonstrated significant benefits of OCF. The results support the reasonableness of the selection criteria for OCF. We advocate for a multi-center, prospective clinical trial of OCF in this population.

Laparoscopic renal denervation: A treatment option for management of refractory loin pain

Background: Intractable loin pain is a debilitating condition with a significant impact on the patient's quality of life. Loin pain haematuria syndrome (LPHS) is a disease of exclusion and can be of two subtypes, Primary or Type 2 and secondary or Type 1. The type 1 LPHS could be a result of congenital anomalies, or acquired due infections, trauma, or surgery. Management of these patients can be pharmacological, nerve blocks, renal denervation, auto-transplantation and nephrectomy. Laparoscopic renal denervation (LRDN) has emerged as a minimally invasive surgical procedure, with acceptable results. Materials and Methods: All patients who underwent laparoscopic renal denervation in our unit from 2007 to 2022 by a single surgeon were included in this study. The indications for surgical intervention were loin pain refractory to medical therapy in the absence of any physical causes of pain. All patients were assessed by a multidisciplinary team, involving a urologist, a nephrologist, a pain consultant, and a pain psychologist. Baseline and postoperative pain scores of the patients were obtained. The patients underwent splanchnic or coeliac nerve blocks under local anaesthesia and were reviewed in the outpatient clinic post-procedure. If there were an improvement in the pain control and pain scores, they were offered LRDN. During the surgery, the renal vessels and proximal ureter were stripped from the neuronal and lymphatic tissues. Results: The 20 patients included in the study underwent 23 procedures. All patients were female. The mean age was 44 years, and the median follow up was 24 months. The median operating time was 90 minutes, excluding anaesthetic time. There were no significant adverse events other than one patient needed antibiotics for chest infection. There was significant improvement of pain scores with the mean pain scores falling to 2.47 postoperatively from 8.40. Fifty percent of patients had complete resolution of pain, while 30% had significant reduction in use of pain medication. Patients with primary LPHS did not have significant improvement in their pain scores, and one of these patients required auto-transplantation of her kidney.

Impact of anesthesia handover on postoperative pain, nausea, and vomiting among adults undergoing general anesthesia

Objective: This study aimed to investigate the impact of intraoperative anesthesia care handovers on mortality, hospital readmission, and intraoperative/postoperative complications in patients undergoing major surgery in Saudi Arabia. Methods: It was a retrospective cohort study conducted in Riyadh, Saudi Arabia. An Excel sheet was used for data entry. A convenient sampling method was used in the study. Results: The majority of the patients were female (53.7%) and aged between 21 and 60 years (71.5%). Overweight and obese individuals accounted for a significant proportion of the sample. Anesthesia handover was performed for a small percentage of patients (11.3%). Postoperative pain was reported by 37.5% of patients, while nausea and vomiting were experienced by a smaller percentage. The use of pain medications was relatively low (22.2%), with morphine being the most common choice. Vital parameters such as heart rate and blood pressure showed significant changes after the procedure. Anesthesia handover was associated with higher rates of postoperative pain and had a significant correlation with postoperative nausea and vomiting. Conclusion: The findings of this study contributed to improving perioperative care and optimizing patient outcomes in the field of anesthesia. The study highlighted the importance of tailored pain management strategies and standardized protocols for anesthesia handover. Further research is needed to refine perioperative practices and enhance overall patient care.

Community Pharmacists' Knowledge and Attitude Towards Opioid Pain Medication Use in Bahir Dar City, North-West Ethiopia.

Opioid use is a major global public health problem, affecting 16 million individuals worldwide. According to a 2023 WHO report, out of the 600,000 substance-related deaths worldwide, 80% were attributed to opioid use. Pharmacists play a vital role in reducing unnecessary opioid exposure while facilitating access to non-opioid alternatives. To do so, pharmacists should have sufficient knowledge regarding opioid-containing medications and a positive attitude about opioid use problems. This study aimed to evaluate community pharmacists' knowledge of opioid-containing medications and their attitude toward opioid use problems. A cross-sectional study was conducted using a self-administered, structured questionnaire distributed to 105 community pharmacists from July 1-30, 2023 in Bahir Dar City, Ethiopia. The tool included demographic information and questions designed to assess participants' knowledge and attitudes. Out of the 105 pharmacists included in this study, majority were males (54.3%), nearly half held a bachelor's degree (49.5%), and slightly above one-third had over a decade experience (39%). Regarding knowledge and attitude towards opioids, 62 individuals (59%) exhibited good knowledge, and 64 (61%) demonstrated less stigma toward opioid usage. Factors affecting knowledge include: education level (AOR (95% CI): 8.43 (1.76-40.35) and 9.93 (1.04-85.33) for bachelors and postgraduates respectively and age 1.45 (1.20-1.77)]. Meanwhile, experience [AOR (95% CI): 4.64(1.20-17.90) and 4.29 (1.23-15.05)] for 5-9 years and ≥10 years respectively and education level [AOR (95% CI): 4.08 (1.40-11.93) for bachelors and 6.40 (1.42-28.96)] for postgraduates were linked to attitude. A gap in knowledge and more stigmatizing behavior was observed among community pharmacists. These findings imply the importance of tailored educational interventions to address knowledge gaps and promote positive attitudes toward opioid usage among community pharmacists. Therefore, it is imperative to deliver up-to-date information on opioids, emphasizing their high addiction potential, to ensure pharmacists are well-equipped with the latest information.

Greater Mental Health Burden is Associated With Poor Postoperative Pain Control and Increased Opioid Utilization Following Total Shoulder Arthroplasty.

Prolonged opioid use is associated with higher complications and worse patient-reported outcomes following total shoulder arthroplasty (TSA). Identified risk factors for prolonged postoperative use are related to several medical comorbidities, gender, diagnoses of anxiety or depressive disorders, and preoperative opioid use. In this study, we hypothesized that patient-reported mental health characteristics can help to identify patients at risk of worse postoperative pain control, worse sleep, and higher opioid utilization following TSA. Ninety-three consecutive patients were asked to fill out 2 mental health questionnaires prior to undergoing TSA. Following surgery, patients filled out a daily pain diary to track their daily pain, pain medication use, and quality and duration of their sleep for 30 days. Preoperative opioid use and postoperative refill were determined by the New York State Prescription Monitoring Program. Mixed-model linear regressions were conducted. Significance was defined as p < 0.05. Postoperative opioid refill was associated with female gender, preoperative opioid therapy, higher inpatient opioid use, worse anxiety, depression, somatization, and pain catastrophizing scores. The number of days using opioids postoperatively was associated with worse pain catastrophizing scale (PCS) and somatization scores (patient health questionnaire-15). Preoperative opioid therapy was associated with worse somatization scores, whereas no opioids used after surgery were associated with better somatization scores. Worse sleep quality and duration were associated with worse PCS scores. A greater mental health burden is associated with worse postoperative pain control and higher opioid utilization during the acute postoperative period. This is especially evident in the pain catastrophizing and somatization domains.

Pain Management during Pregnancy and Lactation

Pregnancy and lactation are important stages in a woman’s existence, and pain management becomes a difficult problem at some point. The well-being of each mother and the growing fetus or breastfeeding toddler must be cautiously considered when selecting appropriate pain management techniques. This abstract evaluates modern knowledge and guidelines for pain control during pregnancy and lactation, focusing on the dangers and advantages of numerous pharmacological and nonpharmacological interventions. During pregnancy, women usually experience physiological changes that may exacerbate their current pain conditions or result in new ones. The use of certain pain medications, especially non-steroidal anti-inflammatory capsules (NSAIDs) and opioids has been linked to potentially destructive effects on fetal development. Consequently, healthcare providers often choose non-pharmacological interventions, including physical therapy, acupuncture, and relaxation techniques, as first-line remedies. Furthermore, a thorough evaluation of the risk-to-benefit ratio is essential when considering the use of any medication throughout pregnancy, and a session with a healthcare expert is important. During the lactation period, the ability to transfer medication through breast milk to infants raises issues regarding the protection of medications used for pain management. Healthcare companies have to remember the drug’s pharmacokinetics, its potential effect on the little one’s health, and the mother’s potential to care for the infant while on medicine. Opioid use at some point during breastfeeding is a concern because of the hazards of sedation, respiratory despair, and withdrawal signs inside the infant. In comparison, a few medicines are considered, especially those that are safe throughout lactation, and alternative non-pharmacological interventions have to be explored where possible. An interdisciplinary approach involving obstetricians, anesthesiologists, pediatricians, and lactation consultants is essential for developing comprehensive pain control plans during pregnancy and lactation. Alternatively, pain relief for the mother is critical to ensuring her well-being and a successful bond with the little one. Concurrently, minimizing any capacity risk to the fetus or breastfeeding infants is of maximum significance. Moreover, affected person education and shared selection-making play a critical role in supporting ladies to make informed choices about pain management strategies that stabilize their pain alleviation wishes and the safety of their unborn or breastfeeding child.

Relationship between Nociplastic Pain Involvement and Medication use, Symptom Relief, and Adverse effects Among People using Medical Cannabis for Chronic Pain.

Cannabis is commonly used for chronic pain management, but cannabis' effects remain poorly characterized in chronic nociplastic pain (NPP), which is posited to be caused by disturbances in nervous system pain processing. In this cross-sectional study (n=1,213), we used the 2011 Fibromyalgia (FM) Survey Criteria as a surrogate measure for degree of NPP among individuals using medical cannabis for chronic pain. Using a quartile-split, we investigated associations between degree of NPP and medication use, cannabis use characteristics, and symptom relief. Continuous variables were assessed using one-way analysis of variance (ANOVA) and categorical variables with Pearson's Chi-square test (2) and binomial logistic regression for calculation of odds ratios (OR). Participants were predominately female (59%), with mean ±SD age 49.4±13.6 years. Higher FM scores were associated with less self-reported improvement in pain and health since initiating medical cannabis use, as well as more cannabis-related side effects. Paradoxically, higher FM scores were also associated with higher usage of concomitant medication use (including opioids and benzodiazepines) but also with substituting cannabis for significantly more medication classes, including opioids and benzodiazepines. This article presents evidence that individuals in higher NPP quartiles have higher analgesic intake, higher odds of substituting cannabis for medications, higher side effect burden, and lower therapeutic effect from cannabis. These seemingly contradictory findings may reflect higher symptom burden, polypharmacy at baseline, or that NPP may be challenging to treat with cannabis. Further research is necessary to further explain cannabinoid effects in NPP.

Incisional hernia: open abdominal wall reconstruction. Current state of the technique and results

The treatment of complex midline hernias remains aparticular challenge. The currently refined knowledge of the anatomy in the cadaver laboratory and advancing clinical experience have changed our present approach. The aim of this review is to present adescription of the updated surgical procedures and outcomes. We favor the retromuscular or preperitoneal layer for mesh implantation, including the Rives-Stoppa procedure (sublay mesh) and posterior component separation with the Madrid modification. We operated on 334 complex midline incisional hernias: 6.3% retromuscular preperitoneal, 15% after Rives-Stoppa, 2.4% anterior component separation and 76% posterior component separation. Abridging procedure was used in 31%. Acomplication occurred in 35.3%, most of which were wound healing disorders (SSO). The average length of hospital stay was 7.2days. We recorded avery low incidence of long-term complications: 3.3% recurrence, 0.9% chronic pain (daily use of pain medication), 6% bulging, 1.8% chronic seroma and 2.6% chronic mesh infection. Despite the associated morbidity, retromuscular/preperitoneal treatment offers excellent long-term results.

Veterans’ lived experiences with the VA's Whole Health system and perceived impact on dimensions of wellness

Research questionWhat are the lived experiences and wellness related outcomes of veterans engaged in the Department of Veterans’ Affairs (VA) Whole Health (WH) system of care? Theoretical frameworkThis qualitative work was conducted with a pragmatic phenomenological approach to understand patients’ lived experience within the WH system of care. Data were contextualized within a multi-dimensional wellness model. MethodologyThis descriptive quality improvement project used semi-structured telephone interviews. Interview script elicited veterans’ WH participation experiences and perceived wellness related outcomes. ContextData were collected within a WH Service, at a large Veterans Health Administration Hospital in the Southeast United States. Sample selectionData were collected with a purposive sample of veterans that participated in at least 2 WH activities. Data collectionPatients were recruited by WH clinical team collaborators to participate in qualitative data collection. Analysis and interpretationRapid content analysis and interpretation of results were conducted in alignment with dimensions of wellness constructs. Main resultsWH offers veterans’ non-pharmacological tools to improve mental, physical, and social wellness. Participants (n = 50) represented the larger veteran population. Most veterans perceived a positive WH experience with improvement of three primary dimensions including mental and emotional, physical, and social wellness – impacts on other dimensions gleaned less perceived impact. Veterans reported adopting mindfulness and coping strategies, better mobility, pain management, and sleep quality, and enhanced social engagement. Even those who did benefit personally from all aspects of WH, felt the services are needed to support the larger veteran population. Reduced suicidal ideation and pain medication use emerged as a WH effect among approximately 10% of the sample.

PAIN MEDICATION AND FALL RISKS AMONG COMMUNITY-DWELLING OLDER ADULTS WITH ARTHRITIS

Abstract Pain medication is commonly used among older adults with arthritis. Research indicates an elevated fall risk among older adults with arthritis, yet this association among those who take medication for pain is not fully studied. This population-based study investigated the association of falls with pain medication use by arthritis status. A sample of community-dwelling Medicare beneficiaries in the 2015 National Health and Aging Trends Study, representing older adults who reported arthritis (n = 4,229) and no arthritis (n = 3,258), were analyzed using survey-weighted logistic regression analysis. Sensitivity analysis was performed to investigate differences in associations by the frequency of taking pain medication. All analyses were controlled for sociodemographic characteristics, living arrangements, balance problems, and chronic conditions. The majority of participants was 70 years or older (70.7%), female (55.3%), White (80.1%), had a high school or higher education (58.4%) and had two or more chronic conditions (53.6%). Significantly higher proportions of those with arthritis reported pain (67.9% vs. 32.1%) and pain medication use (63.1% vs. 36.9%) than those with no arthritis. Pain medication use (OR = 1.11, 95% CI: 1.03, 1.20) and balance problems (OR = 4.39, 95% CI 3.45, 5.59) were associated with falls among those with arthritis. Taking medication for pain every day a week (OR = 1.48, 95% CI: 1.05, 2.09) was associated with falls among those with arthritis. Findings suggest that the heavy use of pain medication may increase fall risk. Nonpharmacological pain management education is encouraged for supporting active living among older adults with arthritis.

A preliminary study evaluating self-reported effects of cannabis and cannabinoids on neuropathic pain and pain medication use in people with spinal cord injury.

Approximately 60% of individuals with a spinal cord injury (SCI) experience neuropathic pain, which often persists despite the use of various pharmacological treatments. Increasingly, the potential analgesic effects of cannabis and cannabinoid products have been studied; however, little research has been conducted among those with SCI-related neuropathic pain. Therefore, the primary objective of the study was to investigate the perceived effects of cannabis and cannabinoid use on neuropathic pain among those who were currently or had previously used these approaches. Additionally, the study aimed to determine if common pain medications are being substituted by cannabis and cannabinoids. Participants (N = 342) were recruited from existing opt-in listserv sources within the United States. Of those, 227 met the inclusion criteria and were enrolled in the study. The participants took part in an anonymous online survey regarding past and current use of cannabis and their perceived effects on neuropathic pain, including the use of pain medication. Those in the sample reported average neuropathic pain intensity scores over the past week of 6.8 ± 2.1 (0 to 10 scale), reflecting a high moderate to severe level of pain. Additionally, 87.9% noted that cannabis reduced their neuropathic pain intensity by more than 30%, and 92.3% reported that cannabis helped them to better deal with their neuropathic pain symptoms. Most participants (83.3%) also reported substituting their pain medications with cannabis, with the most substituted medication categories being opioids (47.0%), gabapentinoids (42.8%) and over-the-counter pain medications (42.2%). These preliminary results suggest that cannabis and cannabinoids may be effective in reducing neuropathic pain among those with SCI and may help to limit the need for certain pain medications.

Opioid prescription patterns in a children's hospital from 2012 to 2016.

Pain management is a widely discussed topic, especially in the setting of the current opioid epidemic. Previous studies have shown that the use of opioids increased in the adult population. We aimed to look at the use of narcotic and non-narcotic pain medications at a large pediatric hospital to discern if patterns of pediatric pain management changed over time. 58,402 analgesic prescriptions of patients 0-21 years of age were analyzed from May 2012 to November 2016. A logistic regression model was fitted to examine the association of age, sex, primary diagnosis, and the length of hospital stay with probability of opioid prescription. 36,560 patients aged 0-21 years (mean: 10.5, median: 11.0, and standard deviation (SD): 7.42) received analgesic pain medications. 21,847 (59.8 percent) patients were prescribed more than one analgesic. There was a male predominance in patients <15 years of age; however, in adolescents >16 years, females constituted 57.1 percent of patients. Data also showed a statistically significant reduction of opioid prescriptions from 2012 to 2016 (p < 0.001). Age and length of hospital stay were directly associated with opioid prescription (p < 0.001). Data show that there is a decrease in overall opioid prescriptions among pediatric patients, which may be secondary to new Food and Drug Administration regulations and increased awareness of morbidity associated with opioid use. Not surprisingly, increased hospital stay and increase in age lead to more analgesic prescriptions. Further investigation is needed to determine the differences within opioid prescription patterns.

Incidence and Prevalence of Pain Medication Prescriptions in Pathologies with a Potential for Chronic Pain.

Heightened risks of dependence, addiction, anxiolytic effects, or prescription overdose death due to long-term use of pain medication have increased awareness about extended pain medication use in chronic pain populations. The goal of this study was to evaluate the incidence and prevalence of pain medication prescriptions from 2012 to 2022 in common pathologies with a potential for chronic pain. A retrospective cohort study was conducted using electronic health records from TriNetX (Cambridge, Massachusetts) Global Collaborative Network. For 10 distinct cohorts (total n = 9,357,584 patients), pain medication prescriptions were extracted for five classes, namely nonsteroidal anti-inflammatory drug (NSAIDs) and acetaminophen, opioids, gabapentinoids, neuropathic mood agents, and muscle relaxants. Annual incidence and prevalence of each class of medication were evaluated for the past 11 yr. From 2012 to 2022, there was a significant increase in prescriptions of NSAIDs, except for patients with fibromyalgia, and persistent spinal pain syndrome (PSPS) type 2. Interestingly, over time, prescriptions of opioids in patients with complex regional pain syndrome, endometriosis, osteoarthritis, and PSPS type 2 increased, as did prescriptions of muscle relaxants for all cohorts except those with fibromyalgia. Incidence of prescriptions of neuropathic mood agents is high for patients with complex regional pain syndrome (both types) and PSPS type 2. Only for benzodiazepines did there seem to be a decline over the years, with a significantly decreased time trend in patients with complex regional pain syndrome type 1, fibromyalgia, and PSPS type 2. During the last 11 yr, an increase in incidence of NSAIDs and acetaminophen, opioids, neuropathic agents, and muscle relaxants was observed. Only prescriptions of benzodiazepines significantly decreased over time in specific cohorts. Overall, patients with PSPS type 2 and complex regional pain syndrome (both types) consume a broad variety of pain medication classes.