311 Prolonged Preoperative Opioid Therapy in Patients with Degenerative Lumbar Stenosis In a Worker's Compensation Setting

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 266-266
Author(s):  
Erik Y Tye ◽  
Joshua T Anderson ◽  
Jay M Levin ◽  
Arnold Haas ◽  
Stephen T Woods ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Multivariate Regression Analysis ◽  
Opioid Therapy ◽  
Current Evidence ◽  
Workers Compensation ◽  
Preoperative Treatment ◽  
Lumbar Stenosis ◽  
Opioid Use ◽  
Relationship Of ◽  
The Impact

Abstract INTRODUCTION Opiates are commonly used for the initial treatment of degenerative lumbar stenosis (DLS). However, current evidence suggests that overuse of opioids may alter pain-modulatory systems and increase pain sensitivity, which may worsen the underlying condition. As such, patients undergoing operative treatment for DLS with concomitant opioid use represent a clinically challenging population. Moreover, patients with Workers' compensation (WC) are a clinically distinct population with variable outcomes. Our objective was to investigate the impact of prolonged opioid use in the preoperative treatment plan for WC patients with DLS. METHODS 1901 WC subjects from the Ohio Bureau of Workers' Compensation (BWC) with DLS were identified. 140 subjects were then identified that were on opioid therapy before index surgery. The Short-Term Opioid (STO) use group included 60 subjects who received opioids for less than 3 months and a Long-Term Opioid (LTO) use group included 80 subjects who received opioids for greater than 3 months before their surgery. Our primary outcome was if patients were able to make a stable return to work (RTW). A multivariate regression analysis was used to examine the relationship of duration of opioid therapy with RTW. RESULTS >Patients in the STO cohort had a significantly higher RTW rate compared to the LTO cohort (25/60[42%] vs. 18/80[23%]; P = 0.01). A logistic regression was performed to examine the effect of preoperative opioid therapy duration on RTW status. Our regression model showed that opioid use greater than 3 months remained a significant negative predictor of RTW(OR: 0.35, 95% CI: 0.13-0.89; P = 0.02). Costs accrued over the 3 years after index surgery was significantly higher in the LTO cohort. CONCLUSION Prolonged preoperative opioid use was associated with poor clinical outcomes after lumbar decompression. These results suggest that a shorter course of opioid therapy and earlier surgical intervention may improve outcomes and lower postoperative morbidity in patients with DLS.

scholarly journals Current Evidence of Natural Agents in Oral and Periodontal Health

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 585 ◽  
Author(s):  
Gaetano Isola
Keyword(s):  
Stress Reduction ◽  
Inflammatory Diseases ◽  
Periodontal Diseases ◽  
Current Evidence ◽  
Clinical Approach ◽  
Natural Agents ◽  
Periodontopathogenic Bacteria ◽  
Oral Conditions ◽  
Relationship Of ◽  
The Impact

Oral and periodontal diseases, chewing disorders, and many destructive inflammatory diseases of the supporting tissues of the teeth are usually caused by an imbalance between host defense and environmental factors like smoking, poor nutrition, and a high percentage of periodontopathogenic bacteria. For these reasons, it is important also to focus attention on plaque control and also on improving host resistance through smoking and stress reduction, and a healthy diet. During the last decades, the importance of micronutrients has been extensively reviewed, and it was concluded that the prevention and treatment of periodontitis should include correct daily nutrition and a correct balance between antioxidants, probiotics, natural agents, vitamin D, and calcium. Recently, there has been growing interest in the literature on the impact of nutraceutical dietary aliments on oral and general health. This Special Issue provides a current and thoughtful perspective on the relationship of diet and natural agents on oral and periodontal diseases through a correct clinical approach with the last and most important evidence that may determine good oral conditions and high quality of life.

Prolonged Preoperative Opioid Therapy in Patients with Degenerative Lumbar Stenosis in a Workers” Compensation Setting

2017 ◽  
Vol 17 (10) ◽  
pp. S203 ◽  
Author(s):  
Erik Tye ◽  
Joshua T. Anderson ◽  
Jeffrey A. O'Donnell ◽  
Jay M. Levin ◽  
Arnold Haas ◽  
...  
Keyword(s):  
Opioid Therapy ◽  
Workers Compensation ◽  
Lumbar Stenosis

scholarly journals Unraveling the Relationship of Asthma and COVID-19

2021 ◽  
Vol 11 (12) ◽  
pp. 1374
Author(s):  
Agamemnon Bakakos ◽  
Petros Bakakos ◽  
Nikoletta Rovina
Keyword(s):  
Molecular Mechanisms ◽  
Viral Infections ◽  
Asthma Severity ◽  
Current Evidence ◽  
Asthma Exacerbations ◽  
Inflammatory Phenotypes ◽  
Relationship Of ◽  
The Impact ◽  
The Relationship

Viral infections are one of the main causes of asthma exacerbations. During the COVID-19 era, concerns regarding the relationship of SARS-CoV2 with asthma have been raised. The concerns are both for COVID severity and asthma exacerbations. Many studies on COVID-19 epidemiology and comorbidities have assessed whether asthma represents a risk factor for SARS-CoV2 infection and/or more severe course of the disease. This review covers the current evidence on the prevalence of asthma in COVID-19 and its association with susceptibility to and severity of SARS-CoV2 infection. It will examine the possible role of underlying asthma severity in COVID-19 related outcomes as well as the molecular mechanisms involved in the co-existence of these entities. The possible role of asthma inflammatory phenotypes will also be evaluated. Finally, the impact of asthma comorbidities and the implications of asthma medication on COVID-19 will be addressed.

scholarly journals Impact of Spinal Cord Stimulation on Opioid Dose Reduction: A Nationwide Analysis

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 193-201
Author(s):  
Syed M Adil ◽  
Lefko T Charalambous ◽  
Charis A Spears ◽  
Musa Kiyani ◽  
Sarah E Hodges ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Chronic Pain ◽  
Dose Reduction ◽  
Spinal Cord Stimulation ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Patient Centered ◽  
Opioid Dose ◽  
The Impact

Abstract BACKGROUND Opioid misuse in the USA is an epidemic. Utilization of neuromodulation for refractory chronic pain may reduce opioid-related morbidity and mortality, and associated economic costs. OBJECTIVE To assess the impact of spinal cord stimulation (SCS) on opioid dose reduction. METHODS The IBM MarketScan® database was retrospectively queried for all US patients with a chronic pain diagnosis undergoing SCS between 2010 and 2015. Opioid usage before and after the procedure was quantified as morphine milligram equivalents (MME). RESULTS A total of 8497 adult patients undergoing SCS were included. Within 1 yr of the procedure, 60.4% had some reduction in their opioid use, 34.2% moved to a clinically important lower dosage group, and 17.0% weaned off opioids entirely. The proportion of patients who completely weaned off opioids increased with decreasing preprocedure dose, ranging from 5.1% in the >90 MME group to 34.2% in the ≤20 MME group. The following variables were associated with reduced odds of weaning off opioids post procedure: long-term opioid use (odds ratio [OR]: 0.26; 95% CI: 0.21-0.30; P < .001), use of other pain medications (OR: 0.75; 95% CI: 0.65-0.87; P < .001), and obesity (OR: 0.75; 95% CI: 0.60-0.94; P = .01). CONCLUSION Patients undergoing SCS were able to reduce opioid usage. Given the potential to reduce the risks of long-term opioid therapy, this study lays the groundwork for efforts that may ultimately push stakeholders to reduce payment and policy barriers to SCS as part of an evidence-based, patient-centered approach to nonopioid solutions for chronic pain.

Prolonged Preoperative Opioid Therapy in Patients With Degenerative Lumbar Stenosis in a Workers’ Compensation Setting

Spine ◽  
2017 ◽  
Vol 42 (19) ◽  
pp. E1140-E1146 ◽  
Author(s):  
Erik Y. Tye ◽  
Joshua T. Anderson ◽  
Mhamad Faour ◽  
Arnold R. Haas ◽  
Rick Percy ◽  
...  
Keyword(s):  
Opioid Therapy ◽  
Workers Compensation ◽  
Lumbar Stenosis

Treatment navigation to reduce emergency room (ER) visits in cancer patients.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 199-199
Author(s):  
Henrique Zanoni Fernandes ◽  
Carlos Frederico Pinto ◽  
Fernanda Navarro Loiola ◽  
Stela Maris Coelho ◽  
Michele Felix ◽  
...  
Keyword(s):  
Side Effects ◽  
Best Practice ◽  
Treatment Plan ◽  
Visual Signals ◽  
Pilot Phase ◽  
Opioid Use ◽  
Care Needs ◽  
Patient Centered ◽  
Pain Symptoms ◽  
The Impact

199 Background: The practice of conventional oncology has undoubtedly changed in the last 15 years, becoming more efficient, but also more complex and expensive. This complex care needs significant coordination. In the last 2 years in half of the continuing development of our care coordination working in the "Navigation Treatment" domain, the impact on reducing ER visits was, in media, 75%. Methods: In 2015 IOV developed a patient-centered Navigation System based on Kanban (board and visual signals-KNS) for managing the treatment plan of our patients that was successful. In 2016 with support of an educational grant from QTP-ASCO, we extended this system to manage pain to others cancers and treatment-related symptoms, education, resource referral or Coordination of multi-disciplinary care. This study addresses only decreased ER visits between Dec 15 and May 20 by all patients monitored by Nurses navigators. We measured the proportional reduction of ER visits related to pain to the total ER visits in three successive periods: development of the NKS (dec15-jul16), pilot phase (aug16-oct17), and as an adopted best practice (oct17-until today). The KNS comprises a set of standardized procedures and successive checks for patients in treatment based on three procedures: (a) standardized treatments prescriptions to pain and symptoms controls; (b) standardized follow up in 24 and 48 hours, 1, 2 and 4 weeks; and (c) manage side effects of opioids or other emerging problem (constipation, confusion, mucositis, diarrhea, fever, etc.). Any patient initiating opioid use is included in the KNS until opioid is discontinued. Once pain is adequately controlled, the frequency of checks become wider up to once a month if no toxicity is identified. Any new condition (will restart the 24-48 hours loop. The KNS is managed by oncology nurses using phone or video calls, messaging, and appointments; Mon-Sun from 6 AM to 8 PM. Results: The KNS managed a median of 204 (table*) patients per month during the last 32 months (Oct 17 to May 20). Patients with pain, symptoms, or side effects that were effectively managed by the team avoided an unwanted visit to the ER, in media by 75%. Pain represents 20% of ER visits generally; in pilot phase 15% of ER visits, and actually 4% of ER visits, an 80% reduction in pain-related ER visits. ER visits represent patients with uncontrolled pain and not effectively managed by the KNS. Conclusions: The development of a system to deliver more effective care patients resulted in a 75% reduction of ER visits and adequate pain control in our practice.

A Public Health Approach to Protecting Workers from Opioid Use Disorder and Overdose Related to Occupational Exposure, Injury, and Stress

2021 ◽  
pp. 104829112110310
Keyword(s):  
Public Health ◽  
Opioid Use Disorder ◽  
Public Health Approach ◽  
Workers Compensation ◽  
Care Providers ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Opioid Crisis ◽  
Key Policy ◽  
The Impact

Opioid overdose mortality, in combination with increased deaths from alcohol and suicide, is having a profound impact on American workplaces, compromising occupational health and safety and increasing workers’ compensation and health insurance costs, absenteeism, and lost productivity. The President’s Council of Economic Advisers estimates that more than 1 million workers are out of the workforce due to the opioid crisis. The impact on workers is equally profound, including job loss, divorce and family disruption, and potentially imprisonment, injury, illness, and death. Pain from occupational injuries and illnesses and stress are important pathways to opioid use disorder. Effective workplace programs that incorporate the public health approach to prevention offer a significant opportunity to prevent and respond to the opioid crisis. To date, the nation’s efforts at combating the crisis have not included the necessary policy reforms to transform the workplace from a pathway to opioid misuse to a pathway to prevention, including education of workers, unions, employers, and health care providers and treatment and recovery of affected workers. Several key policy interventions are recommended to address this disconnect, including prevention of workplace injury, illness, and emotional distress; worker education and training; and replacement of stigmatizing, punitive workplace substance use programs with supportive programs. Increasing access to alternative pain treatment and preventing opioid misuse in workers’ compensation systems are other key policy recommendations.

scholarly journals Access to Opioids for Patients with Advanced Disease

2019 ◽  
Vol 25 (30) ◽  
pp. 3203-3208 ◽  
Author(s):  
Helen Edwards ◽  
Michael Bennett
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Complex Interventions ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Pharmacological Management ◽  
Pain Outcomes ◽  
Barriers To Use ◽  
Strong Opioids ◽  
The Impact

Pain at the end of life is common in both malignant and non-malignant disease. It is feared by patients, their families and careers, and professionals. Effective pain control can be achieved for the majority of patients at the end of life using a multimodal approach. Pharmacological management relies predominantly on strong opioids. In spite of this, evidence suggests that under treatment of pain is common resulting in unnecessary suffering. Multiple barriers to use of opioids have been identified. Patient barriers include reluctance to report pain and to take analgesics. Professional barriers include inadequate pain assessment and lack of specialist knowledge and confidence in opioid therapy. Fear of side effects including respiratory depression affects patients and professionals alike. The impact of the “opioid epidemic”, with increasing prescribed and illicit opioid use around the world, has also led to increasingly stringent regulation and concern about under prescribing in palliative care. System barriers to use of opioids at the end of life result from limited opioid availability in some countries and also inconsistent and limited access to palliative care. Multiple interventions have been developed to address these barriers, targeted at patients, professionals and systems. There is increasing evidence to suggest that complex interventions combining a number of different approaches are most effective in optimising pain outcomes for patients at the end of life.

scholarly journals Abnormal Glycemic Control, Obesity, and Increased Infection Risk in Patients on Chronic Opioid Therapy

2018 ◽  
Vol 2 (2) ◽  
Keyword(s):  
Glycemic Control ◽  
Opioid Therapy ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Care Workers ◽  
Increased Risk ◽  
Potential Risks ◽  
Prescription Opioid Use ◽  
Relationship Of ◽  
The Relationship

Since 2007, the rate of opioids prescribing has steadily increased among physicians more likely to manage acute and chronic pain. Most health care workers are well aware of prescription opioid-related risks of addiction and overdose; however, the recent studies have shown other potential risks such as: abnormal glycemic control, obesity, and increased risk of infections. In this review, we discuss the latest available evidence examining the relationship of prescription opioid use with increased obesity, abnormal glycemic control, and risk of infections.

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