Racial differences in postpartum pain management and opioid use after cesarean

Abstract High rates of opioid prescribing and comorbid medical conditions increase risk of overdose among older adults. As the US population ages and the rates of opioid use disorder (OUD) increase in the elderly population, there is a need to characterize trends and correlates of overdose in order to more effectively target policy and practice. Using a ~40% random sample of 2015-2017 Medicare beneficiaries ages 65 and older with Part D pharmacy coverage, this study examined medically treated opioid overdoses among US older adults. The sample included 13-14 million beneficiaries per year. The rate of medically treated opioid overdoses among elderly Medicare beneficiaries increased by 15% from 6 per 10,000 in 2015 to 6.9 per 10,000 in 2017. Those with overdose were disproportionately female (63%), non-Hispanic white (83%), with diagnoses of pain conditions (96%), with diagnoses of major depression (63%), and with high rates of conditions that decrease respiratory reserve such as chronic obstructive pulmonary disease. 13% had co-occurring diagnosed alcohol use disorder, 36% were diagnosed with opioid dependence or abuse, and 12% were diagnosed with hepatitis C. Older individuals with overdose represent a complex mix of risk factors; identifying those most at risk (as well as those who have very low risk, whose pain management may be compromised by overly-rigid interpretation of opioid use guidelines) is key in order to address multiple risks, balancing risk reduction with appropriate pain management.

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548 Use of ketamine infusion in post cesarean pain management in patients with opioid use disorder

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2020.12.569 ◽

2021 ◽

Vol 224 (2) ◽

pp. S346-S347

Author(s):

Katie Andrinas ◽

Wendy Craig ◽

Joseph R. Wax ◽

Johanna Cobb ◽

Elizabeth Snow ◽

...

Keyword(s):

Pain Management ◽

Opioid Use Disorder ◽

Opioid Use ◽

Ketamine Infusion

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Older Adults and Opioid Education: Lessons Learned From Experiences in Rural Arkansas

Innovation in Aging ◽

10.1093/geroni/igaa057.177 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 54-54

Author(s):

Robin McAtee ◽

Leah Tobey ◽

Corey Hayes ◽

Laura Spradley ◽

Sajni Kumpuris

Keyword(s):

Older Adults ◽

Pain Management ◽

Rural Areas ◽

Term Treatment ◽

Lessons Learned ◽

Opioid Use ◽

Farm Bureau ◽

Department Of Health ◽

Long Term Treatment ◽

Agricultural Areas

Abstract Nearly one-third of all Medicare participants were prescribed an opioid by their physician in 2015 (AARP, 2017) and in 2017, Arkansas had the 2nd highest opioid prescribing rate in the nation (CDC, 2019). Approaching older adults (OA) about opioids and pain management can be a sensitive topic. Educating and altering long-term treatment with opioids is especially challenging in rural areas where literacy, especially health literacy, is suboptimal. The Arkansas Geriatric Education Collaborative (AGEC) is a HRSA Geriatric Workforce Enhancement Program with an objective to improve health outcomes including an emphasis to decrease the misuse and abuse of opioids among older Arkansans. To address this crisis, the AGEC partnered with local leaders such as the AR Drug Director, academia, Department of Health and Human Services, and multiple community based organizations to create age-tailored educational programs. Unique aspects of approaching and educating rural OA about opioids and pain management will be reviewed. Outcomes will be discussed such as their lack of knowledge about: what is an opioid, why they were prescribed, and what are viable alternatives. Also discussed will be lessons learned that resulted in more effective methods of reaching and teaching rural OA. Partnering with the AR Farm Bureau helped the AGEC reach 100’s of farmers in the extremely rural and mostly agricultural areas. Learning to not use the word opioid resulted in more participants and in a more positive attitude and outlook on attempts to change the culture of opioid use, misuse and abuse among older Arkansans.

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Implementation of a Standardized Perioperative Pain Management Protocol to Reduce Opioid Prescriptions in Otolaryngologic Surgery

Otolaryngology ◽

10.1177/01945998211071116 ◽

2022 ◽

pp. 019459982110711

Author(s):

Michael T. Chang ◽

M. Lauren Lalakea ◽

Kimberly Shepard ◽

Micah Saste ◽

Amanda Munoz ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Lower Amount ◽

Opioid Use ◽

Protocol Implementation ◽

Perioperative Pain ◽

Management Protocol ◽

Before And After ◽

Perioperative Pain Management ◽

Low Levels

Objective To evaluate the efficacy of implementing a standardized multimodal perioperative pain management protocol in reducing opioid prescriptions following otolaryngologic surgery. Study Design Retrospective cohort study. Setting County hospital otolaryngology practice. Methods A perioperative pain management protocol was implemented in adults undergoing otolaryngologic surgery. This protocol included preoperative patient education and a postoperative multimodal pain regimen stratified by pain level: mild, intermediate, and high. Opioid prescriptions were compared between patient cohorts before and after protocol implementation. Patients in the pain protocol were surveyed regarding pain levels and opioid use. Results We analyzed 210 patients (105 preprotocol and 105 postprotocol). Mean ± SD morphine milligram equivalents (MMEs) prescribed decreased from 132.5 ± 117.8 to 53.6 ± 63.9 ( P < .05) following protocol implementation. Mean MMEs prescribed significantly decreased ( P < .05) for each procedure pain tier: mild (107.4 to 40.5), intermediate (112.8 to 48.1), and high (240.4 to 105.0). Mean MMEs prescribed significantly decreased ( P < .05) for each procedure type: endocrine (105.6 to 44.4), facial plastics (225.0 to 50.0), general (160.9 to 105.7), head and neck oncology (138.6 to 77.1), laryngology (53.8 to 12.5), otology (77.5 to 42.9), rhinology (142.2 to 44.4), and trauma (288.0 to 24.5). Protocol patients reported a mean 1-week postoperative pain score of 3.4, used opioids for a mean 3.1 days, and used only 39% of their prescribed opioids. Conclusion Preoperative counseling and standardization of a multimodal perioperative pain regimen for otolaryngology procedures can effectively lower amount of opioid prescriptions while maintaining low levels of postoperative pain.

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Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use

Children ◽

10.3390/children5120163 ◽

2018 ◽

Vol 5 (12) ◽

pp. 163

Author(s):

Genevieve D’Souza ◽

Anava A Wren ◽

Christina Almgren ◽

Alexandra C. Ross ◽

Amanda Marshall ◽

...

Keyword(s):

Pain Management ◽

Side Effects ◽

Stress Responses ◽

Physiological Stress ◽

Opioid Therapy ◽

Outpatient Basis ◽

Opioid Use ◽

Pediatric Populations ◽

Special Expertise ◽

Pain Symptoms

As awareness increases about the side effects of opioids and risks of misuse, opioid use and appropriate weaning of opioid therapies have become topics of significant clinical relevance among pediatric populations. Critically ill hospitalized neonates, children, and adolescents routinely receive opioids for analgesia and sedation as part of their hospitalization, for both acute and chronic illnesses. Opioids are frequently administered to manage pain symptoms, reduce anxiety and agitation, and diminish physiological stress responses. Opioids are also regularly prescribed to youth with chronic pain. These medications may be prescribed during the initial phase of a diagnostic workup, during an emergency room visit; as an inpatient, or on an outpatient basis. Following treatment for underlying pain conditions, it can be challenging to appropriately wean and discontinue opioid therapies. Weaning opioid therapy requires special expertise and care to avoid symptoms of increased pain, withdrawal, and agitation. To address this challenge, there have been enhanced efforts to implement opioid-reduction during pharmacological therapies for pediatric pain management. Effective pain management therapies and their outcomes in pediatrics are outside the scope of this paper. The aims of this paper were to: 1) Review the current practice of opioid-reduction during pharmacological therapies; and 2) highlight concrete opioid weaning strategies and management of opioid withdrawal.

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