Changes in Opioid Use for Pain Management in Adult Trauma Patients

Abstract Purpose Pain is a frequent finding in surgical and trauma patients, and effective pain control remains a common challenge in the hospital setting. Opioids have traditionally been the foundation of pain management; however, these agents are associated with various adverse effects and risks of dependence and diversion. Summary In response to the rising national opioid epidemic and the various risks associated with opioid use, multimodal pain management through use of nonopioid analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs, α 2 agonists, N-methyl-d-aspartate (NMDA) receptor antagonists, skeletal muscle relaxants, sodium channel blockers, and local anesthetics has gained popularity recently. Multimodal analgesia has synergistic therapeutic effects and can decrease adverse effects by enabling use of lower doses of each agent in the multimodal regimen. This review discusses properties of the various nonopioid analgesics and encourages pharmacists to play an active role in the selection, initiation, and dose-titration of multimodal analgesia. The choice of nonopioid agents should be based on patient comorbidities, hemodynamic stability, and the agents’ respective adverse effect profiles. A multidisciplinary plan for management of pain should be formulated during transitions of care and is an area of opportunity for pharmacists to improve patient care. Conclusion Multimodal analgesia effectively treats pain while decreasing adverse effects. There is mounting evidence to support use of this strategy to decrease opioid use. As medication experts, pharmacists can play a key role in the selection, initiation, and dose-titration of analgesic agents based on patient-specific factors.

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The effect of a Life Care Specialist on pain management and opioid-related outcomes among patients with orthopedic trauma: study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-021-05841-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Nicholas A. Giordano ◽

Jesse Seilern und Aspang ◽

J‘Lynn Baker ◽

Cammie Wolf Rice ◽

Bailey Barrell ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Substance Use ◽

Pain Management ◽

Controlled Trial ◽

Trauma Patients ◽

Orthopedic Trauma ◽

Life Care ◽

Opioid Use ◽

Randomized Controlled ◽

Care Specialist

Abstract Background Orthopedic trauma patients face complex pain management needs and are frequently prescribed opioids, leaving them at-risk for prolonged opioid use. To date, post-trauma pain management research has placed little emphasis on individualized risk assessments for misuse and systematically implementing non-pharmacologic pain management strategies. Therefore, a community-academic partnership was formed to design a novel position in the healthcare field (Life Care Specialist (LCS)), who will educate patients on the risks of opioids, tapering usage, safe disposal practices, and harm reduction strategies. In addition, the LCS teaches patients behavior-based strategies for pain management, utilizing well-described techniques for coping and resilience. This study aims to determine the effects of LCS intervention on opioid utilization, pain control, and patient satisfaction in the aftermath of orthopedic trauma. Methods In total, 200 orthopedic trauma patients will be randomized to receive an intervention (LCS) or a standard-of-care control at an urban level 1 trauma center. All patients will be assessed with comprehensive social determinants of health and substance use surveys immediately after surgery (baseline). Follow-up assessments will be performed at 2, 6, and 12 weeks postoperatively, and will include pain medication utilization (morphine milligram equivalents), pain scores, and other substance use. In addition, overall patient wellness will be evaluated with objective actigraphy measures and patient-reported outcomes. Finally, a survey of patient understanding of risks of opioid use and misuse will be collected, to assess the influence of LCS opioid education. Discussion There is limited data on the role of individualized, multimodal, non-pharmacologic, behavioral-based pain management intervention in opioid-related risk-mitigation in high-risk populations, including the orthopedic trauma patients. The findings from this randomized controlled trial will provide scientific and clinical evidence on the efficacy and feasibility of the LCS intervention. Moreover, the final aim will provide early evidence into which patients benefit most from LCS intervention. Trial registration ClinicalTrials.govNCT04154384. Registered on 11/6/2019 (last updated on 6/10/2021).

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Ketamine for Acute Pain After Trauma: KAPT Trial

10.21203/rs.3.rs-604124/v1 ◽

2021 ◽

Author(s):

Thaddeus J Puzio ◽

James Klugh ◽

Michael W Wandling ◽

Charles Green ◽

Julius Balogh ◽

...

Keyword(s):

Pain Management ◽

Acute Pain ◽

Elective Surgery ◽

Supporting Evidence ◽

Trauma Patients ◽

Opioid Use ◽

Patient Centered ◽

Ketamine Infusion ◽

Lengths Of Stay ◽

Parallel Group

Abstract BackgroundEvidence for effective pain management and opioid minimization of intravenous ketamine in elective surgery has been extrapolated to acutely injured patients, despite limited supporting evidence in this population. This trial seeks to determine the effectiveness of the addition of sub-dissociative ketamine to a pill-based, opioid-minimizing multi-modal pain regimen (MMPR) for post traumatic pain.MethodsThis is a single-center, parallel-group, randomized, controlled comparative effectiveness trial comparing a MMPR to a MMPR plus a sub-dissociative ketamine infusion. All trauma patients 16 years and older admitted following a trauma which require intermediate (IMU) or intensive care unit (ICU) level of care are eligible. Prisoners, patients who are pregnant, patients not expected to survive, and those with contraindications to ketamine are excluded from this study. The primary outcome is opioid use, measured by morphine milligram equivalents (MME) per patient per day (MME/patient/day). The secondary outcomes include total MME, pain scores, morbidity, lengths of stay, opioid prescriptions at discharge, and patient centered outcomes at discharge and six months.DiscussionThis trial will determine the effectiveness of sub-dissociative ketamine infusion as part of a MMPR in reducing in-hospital opioid exposure in adult trauma patients. Furthermore, it will inform decisions regarding acute pain strategies on patient centered outcomes.Trial Registration:The Ketamine for Acute Pain Management After Trauma (KAPT) with registration # NCT04129086 was registered on 10/16/2019 and is available at https://clinicaltrials.gov/ct2/show/NCT04129086?term=ketamine+injury&draw=2&rank=6

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The Effect of a Life Care Specialist on Pain Management and Opioid-Related Outcomes Among Patients with Orthopaedic Trauma: Study Protocol for a Randomized Controlled Trial

10.21203/rs.3.rs-659890/v1 ◽

2021 ◽

Author(s):

Nicholas A. Giordano ◽

Jesse Seilern und Aspang ◽

J'Lynn Baker ◽

Cammie Wolf Rice ◽

Bailey Barrell ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Substance Use ◽

Pain Management ◽

Controlled Trial ◽

Trauma Patients ◽

Orthopaedic Trauma ◽

Life Care ◽

Opioid Use ◽

Randomized Controlled ◽

Care Specialist

Abstract Background:Orthopaedic trauma patients face complex pain management needs and are frequently prescribed opioids, leaving them at-risk for prolonged opioid use. To date, post-trauma pain management research has placed little emphasis on individualized risk assessments for misuse and systematically implementing non-pharmacologic pain management strategies. Therefore, a community-academic partnership was formed to design a novel position in the healthcare field (Life Care Specialist (LCS)), who will educate patients on the risks of opioids, tapering usage, safe disposal practices, and harm reduction strategies. In addition, the LCS teaches patients behavior-based strategies for pain management, utilizing well-described techniques for coping and resilience. This study aims to determine the effects of LCS intervention on opioid utilization, pain control, and patient satisfaction in the aftermath of orthopaedic trauma.Methods: In total, 200 orthopaedic trauma patients will be randomized to receive an intervention (LCS) or a standard-of-care control at an urban level 1 trauma center. All patients will be assessed with comprehensive social determinants of health and substance use surveys immediately after surgery (baseline). Follow-up assessments will be performed at 2-, 6-, and 12-weeks postoperatively, and will include pain medication utilization (morphine milligram equivalents), pain scores, and other substance use. In addition, overall patient wellness will be evaluated with objective actigraphy measures and patient-reported outcomes. Finally, a survey of patient understanding of risks of opioid use and misuse will be collected, to assess the influence of LCS opioid education.Discussion: There is limited data on the role of individualized, multimodal, non-pharmacologic, behavioral-based pain management intervention in opioid related risk-mitigation in high-risk populations, including the orthopaedic trauma patients. The findings from this randomized controlled trial will provide scientific and clinical evidence on the efficacy and feasibility of the LCS intervention. Moreover, the final aim will provide early evidence into which patients benefit most from LCS intervention. Trial registration: ClinicalTrials.gov NCT04154384. Registered on 11/6/2019 (last updated on 6/10/2021). https://clinicaltrials.gov/ct2/show/NCT04154384?term=life+care+specialist&draw=2&rank=1

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Magnesium Infusion for Pain Management in Critically Ill Trauma Patients

Case Medical Research ◽

10.31525/ct1-nct04166877 ◽

2019 ◽

Author(s):

Keyword(s):

Pain Management ◽

Critically Ill ◽

Trauma Patients

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Faculty Opinions recommendation of Educating Patients Regarding Pain Management and Safe Opioid Use After Surgery: A Narrative Review.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.736688126.793571556 ◽

2020 ◽

Author(s):

Peter John Lee

Keyword(s):

Pain Management ◽

Narrative Review ◽

Opioid Use

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Medically Treated Opioid Overdoses Among the U.S. Elderly: Trends and Correlates

Innovation in Aging ◽

10.1093/geroni/igaa057.176 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 54-54

Author(s):

Peter Treitler ◽

Stephen Crystal ◽

Richard Hermida ◽

Jennifer Miles

Keyword(s):

Older Adults ◽

Pain Management ◽

The Elderly ◽

Opioid Use Disorder ◽

Chronic Obstructive ◽

Medicare Beneficiaries ◽

Older Individuals ◽

Opioid Use ◽

Policy And Practice ◽

Obstructive Pulmonary Disease

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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