scholarly journals Risk Factors for Severe Pain Scores after Delivery in Women with Opioid Use Disorder

2022 ◽  
Vol 226 (1) ◽  
pp. S535
Author(s):  
Mia A. Heiligenstein ◽  
Anna Fuchs ◽  
Lama R. Noureddine ◽  
Richelle Fassler ◽  
Omar Abuzeid ◽  
...  
Keyword(s):  
Risk Factors ◽  
Severe Pain ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Pain Scores

scholarly journals Participants with mild, moderate, or severe pain following total hip arthroplasty. A sub-study of the PANSAID trial on paracetamol and ibuprofen for postoperative pain treatment

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Luma Mahmoud Issa ◽  
Kasper Højgaard Thybo ◽  
Daniel Hägi-Pedersen ◽  
Jørn Wetterslev ◽  
Janus Christian Jakobsen ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Severe Pain ◽  
Pain Treatment ◽  
Opioid Analgesic ◽  
Opioid Use ◽  
Mild Pain ◽  
Total Hip ◽  
Pain Scores

AbstractObjectivesIn this sub-study of the ‘Paracetamol and Ibuprofen in Combination’ (PANSAID) trial, in which participants were randomised to one of four different non-opioids analgesic regimen consisting of paracetamol, ibuprofen, or a combination of the two after planned primary total hip arthroplasty, our aims were to investigate the distribution of participants’ pain (mild, moderate or severe), integrate opioid use and pain to a single score (Silverman Integrated Approach (SIA)-score), and identify preoperative risk factors for severe pain.MethodsWe calculated the proportions of participants with mild (VAS 0–30 mm), moderate (VAS 31–60 mm) or severe (VAS 61–100 mm) pain and the SIA-scores (a sum of rank-based percentage differences from the mean rank in pain scores and opioid use, ranging from −200 to 200%). Using logistic regression with backwards elimination, we investigated the association between severe pain and easily obtainable preoperative patient characteristics.ResultsAmong 556 participants from the modified intention-to-treat population, 33% (95% CI: 26–42) (Group Paracetamol + Ibuprofen (PCM + IBU)), 28% (95% CI: 21–37) (Group Paracetamol (PCM)), 23% (95% CI: 17–31) (Group Ibuprofen (IBU)), and 19% (95% CI: 13–27) (Group Half Strength-Paracetamol + Ibuprofen (HS-PCM + IBU)) experienced mild pain 6 h postoperatively during mobilisation. Median SIA-scores during mobilisation were: Group PCM + IBU: −48% (IQR: −112 to 31), Group PCM: 40% (IQR: −31 to 97), Group IBU: −5% (IQR: −57 to 67), and Group HS-PCM + IBU: 6% (IQR: −70 to 74) (overall difference: p=0.0001). Use of analgesics before surgery was the only covariate associated with severe pain (non-opioid: OR 0.50, 95% CI: 0.29–0.82, weak opioid 0.56, 95% CI: 0.28–1.16, reference no analgesics before surgery, p=0.02).ConclusionsOnly one third of participants using paracetamol and ibuprofen experienced mild pain after total hip arthroplasty and even fewer experienced mild pain using each drug alone as basic non-opioid analgesic treatment. We were not able, in any clinically relevant way, to predict severe postoperative pain. A more extensive postoperative pain regimen than paracetamol, ibuprofen and opioids may be needed for a large proportion of patients having total hip arthroplasty. SIA-scores integrate pain scores and opioid use for the individual patient and may add valuable information in acute pain research.

Pre-exposure of adolescent mice to morphine results in stronger sensitization and reinstatement of conditioned place preference than pre-exposure to hydrocodone

2020 ◽  
Vol 34 (7) ◽  
pp. 771-777
Author(s):  
Caitlin A Madison ◽  
Paul J Wellman ◽  
Shoshana Eitan
Keyword(s):  
Conditioned Place Preference ◽  
Severe Pain ◽  
Opioid Use Disorder ◽  
Place Preference ◽  
High Rate ◽  
Locomotor Sensitization ◽  
Locomotor Response ◽  
Opioid Use ◽  
Drug Induced ◽  
Extinction Rates

Background: Opioids are commonly prescribed to treat moderate-to-severe pain. However, their use can trigger the development of opioid use disorder. A major problem in treating opioid use disorder remains the high rate of relapse. Aim: The purpose of this study was to determine whether there are differences among opioids in their ability to trigger relapse after pre-exposure during adolescence. Methods: On postnatal day 33, mice were examined for the acute locomotor response to saline, morphine, or hydrocodone (5 mg/kg). They were administered with the corresponding opioid or saline during postnatal days 34–38 (20 mg/kg) and 40–44 (40 mg/kg). On postnatal day 45, they were recorded for the development of locomotor sensitization (5 mg/kg). Starting on postnatal day 55, mice were examined for the acquisition (1, 5, 10, 20, and 40 mg/kg), extinction, and drug-induced reinstatement (1, 2.5, and 5 mg/kg) of conditioned place preference. Results: There were no significant differences in the acute locomotor response to morphine and hydrocodone. Morphine induced significantly stronger locomotor sensitization as compared to hydrocodone. Pre-exposure to morphine, but not hydrocodone, sensitized the acquisition of conditioned place preference. There were no significant differences in extinction rates. Mice pre-exposed to morphine reinstate conditioned place preference after priming with a 1 mg/kg dose. In contrast, higher priming doses were required for reinstatement in all other experimental groups. Conclusions: Adolescent mice administered with morphine develop greater sensitization to its effects and subsequently reinstate conditioned place preference more readily than mice administered with hydrocodone. This suggests higher risk for relapse after pre-exposure to morphine during adolescence as compared to hydrocodone.

scholarly journals Pluri Psychopathology and Risk of Opioid Use Disorder

2018 ◽  
Vol 3 (7) ◽  
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Risk Factor ◽  
Cancer Pain ◽  
Gender Dysphoria ◽  
Psychiatric Comorbidity ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Transdermal Fentanyl ◽  
Case Presentation

Background: Psychiatric comorbidty is an important risk factor when predicting risk of opioid use disorder in chronic non-cancer pain. We present a case with gender dysphoria, in wich psychiatric comorbidity was not taken into account for de prescription of pharmacological treatment for pain. Case presentation: We report the case of a 51-year-old man with gender dysphoria, personality disorder, chronic pain disorder and opioid use disorder. For the last 9 years he has taken continuousy transdermal fentanyl prescribed by chronic non-cancer pain. Despite of presenting a pluripathology that discouraged the use of opioids in this patient, throughout his evolution, he has gone to different non-psychiatrists and has shown himself with a querulous, confictive and demanding attitude, so that he managed to keep on raising his dose of prescribed opioids. Conclusions: This case shows the importance of knowing the risk factors of consumption due to the use of opioids patients with chronic non-cancer pain, the importance of psychiatric comorbidity associated with prognosis and the neeed to know exactly how opioids are managed by some prescribers, as well as to carry out an interdisciplinary therapeutic plan to avoid risks.

scholarly journals Predictors of Premature Discontinuation of Opioid Use Disorder Treatment in the United States

2021 ◽  
Author(s):  
Celia Stafford ◽  
Wesley Marrero ◽  
Rebecca B. Naumann ◽  
Kristen Hassmiller Lich ◽  
Sarah Wakeman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Substance Use ◽  
The United States ◽  
Opioid Use Disorder ◽  
Geographic Region ◽  
Influential Factors ◽  
Opioid Use ◽  
Living Situation ◽  
Data Set ◽  
Targeted Interventions

Over the last few decades, opioid use disorder (OUD) and overdose have dramatically increased. Evidence shows that treatment for OUD, particularly medication for OUD, is highly effective; however, despite decreases in barriers to treatment, retention in OUD treatment remains a challenge. Therefore, understanding key risk factors for OUD treatment discontinuation remains a critical priority. We built a machine learning model using the Treatment Episode Data Set-Discharge (TEDS-D). Included were 2,446,710 treatment episodes for individuals in the U.S. discharged between January 1, 2015 and December 31, 2018 (the most recent available data). Exposures contain 32 potential risk factors, including treatment characteristics, substance use history, socioeconomic status, and demographic characteristics. Our findings show that the most influential risk factors include characteristics of treatment service setting, geographic region, primary source of payment, referral source, and health insurance status. Importantly, several factors previously reported as influential predictors, such as age, living situation, age of first substance use, race and ethnicity, and sex had far weaker predictive impacts. The influential factors identified in this study should be more closely explored to inform targeted interventions and improve future models of care.

Explainable Deep Learning Applied to Understanding Opioid Use Disorder and Its Risk Factors

2019 ◽  
Author(s):  
T. Elizabeth Workman ◽  
Yijun Shao ◽  
Joel Kupersmith ◽  
Friedhelm Sandbrink ◽  
Joseph L. Goulet ◽  
...  
Keyword(s):  
Risk Factors ◽  
Deep Learning ◽  
Opioid Use Disorder ◽  
Opioid Use

Sex-specific Risk Factors and Health Disparity Among Hepatitis C Positive Patients Receiving Pharmacotherapy for Opioid Use Disorder

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Brittany B. Dennis ◽  
Leslie J. Martin ◽  
Leen Naji ◽  
Daud Akhtar ◽  
George Cholankeril ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatitis C ◽  
Health Disparity ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Specific Risk

scholarly journals Perioperative Continuation of Buprenorphine at Low–Moderate Doses Was Associated with Lower Postoperative Pain Scores and Decreased Outpatient Opioid Dispensing Compared with Buprenorphine Discontinuation

Pain Medicine ◽  
2020 ◽  
Vol 21 (9) ◽  
pp. 1955-1960 ◽  
Author(s):  
Aurora Quaye ◽  
Kevin Potter ◽  
Sarah Roth ◽  
Gregory Acampora ◽  
Jianren Mao ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Opioid Use Disorder ◽  
Postanesthesia Care Unit ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Medication Assisted Treatment ◽  
Pain Scores ◽  
Surgical Subspecialty ◽  
Number Of Individuals ◽  
Buprenorphine Treatment

Abstract Objective An increasing number of individuals are prescribed buprenorphine as medication-assisted treatment for opioid use disorder. Our institution developed guidelines for perioperative buprenorphine continuation with an algorithm for dose reduction based upon the surgical procedure and patient's maintenance dose. The objective of this study was to compare the effects of buprenorphine continuation with those of discontinuation on postoperative pain scores and outpatient opioid dispensing. Design Retrospective observational study. Subjects Surgical patients on buprenorphine from March 2018 to October 2018. Patients on buprenorphine for chronic pain and those with minor procedures were excluded from analysis. Methods We compared postoperative outpatient opioid dispensing and postanesthesia care unit (PACU) pain scores in patients where buprenorphine was continued compared with held perioperatively, collecting single surgical subspecialty prescriber data on outpatient full mu-opioid agonist prescriptions dispensed, converted into mean morphine equivalents. Buprenorphine formulations were not included in our morphine milligram equivalents (MME) total. Results There were 55 patients total (38 cont. vs 17 held). There was no difference in postoperative buprenorphine treatment adherence (91% cont. vs 88% held, P = 0.324). The number of opioid prescriptions dispensed was significantly higher with buprenorphine discontinuation (53% cont. vs 82% held, P = 0.011), as was MME dispensed (mean of 229 cont. vs mean of 521 held, P = 0.033). PACU pain scores were higher with buprenorphine discontinuation (mean 2.9 cont. vs mean 7.6 held, P < 0.001). Conclusions There was a significant reduction in opioid prescriptions filled, MME dispensed, and PACU pain scores in patients where buprenorphine was continued vs held perioperatively. We provide evidence to support that buprenorphine can be continued perioperatively and that continuation is associated with decreased postoperative pain and decreased outpatient opioid dispensing. These results contribute to the existing literature supporting the perioperative continuation of buprenorphine.

scholarly journals The Genomics of Opioid Addiction Longitudinal Study (GOALS): study design for a prospective evaluation of genetic and non-genetic factors for development of and recovery from opioid use disorder

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Jessica Heil ◽  
Stefan Zajic ◽  
Emily Albertson ◽  
Andrew Brangan ◽  
Iris Jones ◽  
...  
Keyword(s):  
Risk Factors ◽  
Longitudinal Study ◽  
Treatment Outcomes ◽  
Genetic Risk ◽  
Genetic Risk Factors ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Addiction ◽  
Complex Data ◽  
Opioid Use

Abstract Background The opioid use disorder and overdose crisis in the United States affects public health as well as social and economic welfare. While several genetic and non-genetic risk factors for opioid use disorder have been identified, many of the genetic associations have not been independently replicated, and it is not well understood how these factors interact. This study is designed to evaluate relationships among these factors prospectively to develop future interventions to help prevent or treat opioid use disorder. Methods The Genomics of Opioid Addiction Longitudinal Study (GOALS) is a prospective observational study assessing the interplay of genetic and non-genetic by collecting comprehensive genetic and non-genetic information on 400 participants receiving medication for opioid use disorder. Participants will be assessed at four time points over 1 year. A saliva sample will be collected for large-scale genetic data analyses. Non-genetic assessments include validated surveys measuring addiction severity, depression, anxiety, and adverse childhood experiences, as well as treatment outcomes such as urine toxicology results, visit frequency, and number of pre and post-treatment overdoses extracted from electronic medical records. Discussion We will use these complex data to investigate the relative contributions of genetic and non-genetic risk factors to opioid use disorder and related treatment outcomes.

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