scholarly journals Persistent Post-Mastectomy Pain: The Impact of Regional Anesthesia Among Patients with High vs Low Baseline Catastrophizing

Pain Medicine ◽  
2021 ◽  
Author(s):  
Nantthasorn Zinboonyahgoon ◽  
Megan E Patton ◽  
Yun-Yun K Chen ◽  
Rob R Edwards ◽  
Kristin L Schreiber
Keyword(s):  
Regional Anesthesia ◽  
Severity Index ◽  
Estimating Equation ◽  
Pain Severity ◽  
Psychosocial Assessment ◽  
Emotional Impact ◽  
Opioid Use ◽  
Variable Success ◽  
Long Term Impact ◽  
The Impact

Abstract Background Persistent post-mastectomy pain (PPMP) varies both in its severity and impact, with psychosocial factors such as catastrophizing conferring greater risk. Preoperative regional anesthesia (RA) is an important nonopioid therapy, but with variable success at preventing PPMP in previous reports. We previously reported that RA was associated with lower acute post-mastectomy pain and opioid use, but more prominently among patients with higher baseline catastrophizing. The current longitudinal investigation at 3, 6, and 12 months postop aimed to detect differential long-term impact of RA on PPMP among patients with high vs low catastrophizing. Methods In this prospective observational study, patients (n = 123) completed preoperative psychosocial assessment and underwent mastectomy either with (n = 56) or without (n = 67) preoperative RA. Generalized estimating equation (GEE) regression analysis assessed impact of baseline catastrophizing, RA, and their interaction, on the primary outcome of pain severity index, as well as secondary outcomes including cognitive and emotional impact of pain, and persistent opioid use. Results We observed a significant interaction between the effect of catastrophizing and RA on PPMP. Specifically, RA was associated with reduced pain severity and pain impact 3, 6, and 12 months postoperatively, but only among those with high baseline catastrophizing scores. In addition, both RA and lower catastrophizing scores were associated with lower incidence of persistent opioid use. Conclusions The efficacy of therapies to prevent PPMP may be importantly influenced by pain-modulatory psychosocial characteristics. These findings underscore the importance of considering individual patient factors when applying preventive treatments, and of including their assessment in future trials.

Polypharmacy, Opioid Use, and Fibromyalgia

2016 ◽  
Vol 19 (1) ◽  
pp. 97-105 ◽  
Author(s):  
Victoria Menzies ◽  
Leroy R. Thacker ◽  
Sallie D. Mayer ◽  
Anna M. Young ◽  
Shelby Evans ◽  
...  
Keyword(s):  
Symptom Management ◽  
Patient Population ◽  
Adverse Drug Events ◽  
Predictor Variable ◽  
Chronic Widespread Pain ◽  
Pain Severity ◽  
Pain Interference ◽  
Widespread Pain ◽  
Opioid Use ◽  
The Impact

The major therapeutic approach for treating fibromyalgia (FM), a chronic widespread pain syndrome, is pharmacotherapy-centered symptom management. Complexity of treatment often leads to multiple medication prescriptions. While there is no current alternative to the probable need for polypharmacy in this patient population, there remains concern related to potential side effects and adverse drug events. In this secondary analysis of data on medications taken collected from two parent studies, all medications were broken down into the following categories: opioid, nonopioid, antidepressant, anticonvulsant, muscle relaxant, and benzodiazepine. The impact on pain severity and pain interference of these medication categories as well as perceived stress, fatigue, and depression scores was assessed. Baseline pain severity ( p = .0106) and pain interference ( p = .0002) were significantly correlated with opioid use as compared to nonopioid use. A multivariate regression with backward elimination resulted in a model for pain severity with one significant predictor variable, fatigue ( p < .0001); pain interference had three significant predictor variables: opioid use ( p = .04), fatigue ( p < .0001), and depression ( p = .04). While future studies should further address the utility of opioids and examine the role of polypharmacy as part of symptom management strategies for individuals with FM, study findings suggest that, for those who suffer chronic widespread pain as the predominant symptom experience, a challenge equally as perplexing for nurses and nursing research alike as managing the pain lies in addressing the fatigue and depression in this patient population.

scholarly journals A Scoping Review of the Psychological and Emotional Impact of the COVID-19 Pandemic on Children and Young People

2021 ◽  
pp. 105413732110471
Author(s):  
K. Jones ◽  
Sharon Mallon ◽  
Katy Schnitzler
Keyword(s):  
Young People ◽  
Evidence Base ◽  
Rapid Review ◽  
Emotional Impact ◽  
Daily Lives ◽  
Children And Young People ◽  
Long Term Impact ◽  
Meta Analyses ◽  
The Impact

Background The COVID-19 pandemic has resulted in many changes to the lives of children and young people. Our aim is to explore the impact of the pandemic on the mental health of children and young people (ages 5–21). Methods The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines was used to report the findings of this rapid review. Results Children and young people are potentially very vulnerable to the emotional impact of traumatic events that disrupt their daily lives. Key areas of concern include: Death Anxiety and Fear of Infection; lack of social interaction and loss of routine. Conclusions Despite some early and responsive studies, the evidence base for pandemic impact on children and young people is very limited. Such evidence is urgently needed if adequate and responsive services, that can mitigate the long-term impact of the pandemic for children and young people can be established.

scholarly journals Impact of Current Pain Status on Low-Barrier Buprenorphine Treatment Response Among Patients with Opioid Use Disorder

Pain Medicine ◽  
2021 ◽  
Author(s):  
Kelly R Peck ◽  
Taylor A Ochalek ◽  
Joanna M Streck ◽  
Gary J Badger ◽  
Stacey C Sigmon
Keyword(s):  
Treatment Outcomes ◽  
Severity Index ◽  
Opioid Use Disorder ◽  
Addiction Severity Index ◽  
Brief Symptom Inventory ◽  
Opioid Use ◽  
Global Severity Index ◽  
Pain Status ◽  
The Impact ◽  
Buprenorphine Treatment

Abstract Objective Chronic non-cancer pain (CNCP) is prevalent among individuals with opioid use disorder (OUD). However, the impact of CNCP on buprenorphine treatment outcomes is largely unknown. In this secondary analysis, we examined treatment outcomes among individuals with and without CNCP who received a low-barrier buprenorphine maintenance regimen during waitlist delays to more comprehensive opioid treatment. Methods Participants were 28 adults with OUD who received 12 weeks of buprenorphine treatment involving bimonthly clinic visits, computerized medication dispensing, and phone-based monitoring. At intake and monthly follow-up assessments, participants completed the Brief Pain Inventory, Beck Anxiety Inventory, Beck Depression Inventory (BDI-II), Brief Symptom Inventory (BSI), Addiction Severity Index, and staff-observed urinalysis. Results Participants with CNCP (n = 10) achieved comparable rates of illicit opioid abstinence as those without CNCP (n = 18) at weeks 4 (90% vs 94%), 8 (80% vs 83%), and 12 (70% vs 67%) (P = 0.99). Study retention was also similar, with 90% and 83% of participants with and without CNCP completing the 12-week study, respectively (P = 0.99). Furthermore, individuals with CNCP demonstrated significant improvements on the BDI-II and Global Severity Index subscale of the BSI (P &lt; 0.05). However, those with CNCP reported more severe medical problems and smaller reductions in legal problems relative to those without CNCP (P = 0.03). Conclusions Despite research suggesting that chronic pain may influence OUD treatment outcomes, participants with and without CNCP achieved similar rates of treatment retention and significant reductions in illicit opioid use and psychiatric symptomatology during low-barrier buprenorphine treatment.

A Perspective On The Impact of COVID-19 Pandemic in Basic Science Research and its Future implications

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Yam Nath Paudel ◽  
Efthalia Angelopoulou ◽  
Bhupendra Raj Giri ◽  
Christina Piperi ◽  
Iekhsan Othman ◽  
...  
Keyword(s):  
Basic Science ◽  
Large Scale ◽  
Preventive Measure ◽  
Science Research ◽  
Research Institutes ◽  
Basic Science Research ◽  
Long Term Consequences ◽  
Long Term Impact ◽  
The Impact

: COVID-19 has emerged as a devastating pandemic of the century that the current generations have ever experienced. The COVID-19 pandemic has infected more than 12 million people around the globe and 0.5 million people have succumbed to death. Due to the lack of effective vaccines against the COVID-19, several nations throughout the globe has imposed a lock-down as a preventive measure to lower the spread of COVID-19 infection. As a result of lock-down most of the universities and research institutes has witnessed a long pause in basic science research ever. Much has been talked about the long-term impact of COVID-19 in economy, tourism, public health, small and large-scale business of several kind. However, the long-term implication of these research lab shutdown and its impact in the basic science research has not been much focused. Herein, we provide a perspective that portrays a common problem of all the basic science researchers throughout the globe and its long-term consequences.

scholarly journals Suicide Risk and Addiction: The Impact of Alcohol and Opioid Use Disorders

2021 ◽  
Author(s):  
Mina M. Rizk ◽  
Sarah Herzog ◽  
Sanjana Dugad ◽  
Barbara Stanley
Keyword(s):  
Suicide Risk ◽  
Opioid Use ◽  
Opioid Use Disorders ◽  
The Impact

scholarly journals Assessment of the impact of an opioid-specific education series on rates of medication-assisted treatment for opioid use disorder in veterans

2020 ◽  
Author(s):  
Taylor Kirby ◽  
Robert Connell ◽  
Travis Linneman
Keyword(s):  
Multivariate Analysis ◽  
Hospital Admission ◽  
Intervention Group ◽  
Opioid Use Disorder ◽  
Control Group ◽  
Opioid Use ◽  
Motivation To Change ◽  
Heroin Use ◽  
Ed Visits ◽  
The Impact

Abstract Purpose The impact of a focused inpatient educational intervention on rates of medication-assisted therapy (MAT) for veterans with opioid use disorder (OUD) was evaluated. Methods A retrospective cohort analysis compared rates of MAT, along with rates of OUD-related emergency department (ED) visits and/or hospital admission within 1 year, between veterans with a diagnosis of OUD who completed inpatient rehabilitation prior to implementation of a series of group sessions designed to engage intrinsic motivation to change behavior surrounding opioid abuse and provide education about MAT (the control group) and those who completed rehabilitation after implementation of the education program (the intervention group). A post hoc, multivariate analysis was performed to evaluate possible predictors of MAT use and ED and/or hospital readmission, including completion of the opioid series, gender, age (&gt;45 years), race, and specific prior substance(s) of abuse. Results One hundred fifty-eight patients were included: 95 in the control group and 63 in the intervention group. Rates of MAT were 25% (24 of 95 veterans) and 75% (47 of 63 veterans) in control and intervention groups, respectively (P &lt; 0.01). Gender, completion of the opioid series, prior heroin use, and marijuana use met prespecified significance criteria for inclusion in multivariate regression modeling of association with MAT utilization, with participation in the opioid series (odds ratio [OR], 9.56; 95% confidence interval [CI], 4.36-20.96) and prior heroin use (OR, 3.26; 95% CI, 1.18-9.01) found to be significant predictors of MAT utilization on multivariate analysis. Opioid series participation and MAT use were independently associated with decreased rates of OUD-related ED visits and/or hospital admission (hazard ratios of 0.16 [95% CI, 0.06-0.44] and 0.32 [95% CI, 0.14-0.77], respectively) within 1 year after rehabilitation completion. Conclusion Focused OUD-related education in a substance abuse program for veterans with OUD increased rates of MAT and was associated with a decrease in OUD-related ED visits and/or hospital admission within 1 year.

scholarly journals 309. The Impact of Addiction Medicine Consultation on Discharges Against Medical Advice in Patients with Opioid Use Disorder and Staphylococcus Aureus Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S152-S152
Author(s):  
Stephanie Spivack ◽  
Daniel Mueller ◽  
Peter Axelrod ◽  
Joseph D’Orazio
Keyword(s):  
Staphylococcus Aureus ◽  
Patient Population ◽  
Medical Advice ◽  
Index Admission ◽  
Opioid Use ◽  
Urban Hospital ◽  
Addiction Medicine ◽  
Against Medical Advice ◽  
Number Of Patients ◽  
The Impact

Abstract Background People who inject drugs (PWID) are at risk for infectious complications of their injection practices, including Staphylococcus aureus (SA) bacteremia. Prolonged hospitalization is sometimes required; however, rates of discharges against medical advice (AMA) are elevated in this patient population. Inadequate control of pain and opioid withdrawal are commonly cited. Our aim was to assess the effectiveness of addiction medicine consultation for preventing AMA discharges. Methods We performed a retrospective chart review of adult PWID admitted to an urban hospital with SA bacteremia between August 2016 and May 2018. Demographics, HIV and HCV status, and presence or absence of addiction medicine consultation were recorded. We assessed whether discharges were planned or AMA; the number of hospitalizations at 30 days, 90 days, and 1 year from index admission; and death within one year. EpiInfo6 was used for data analysis. Results A total of 360 patients with SA bacteremia were reviewed. Of these, 101 reported intravenous opioid use at admission. Average age was 37 years, and 64% were male. HIV and HCV were present in 13% and 82% of patients, respectively. Addiction medicine was consulted on 29 patients. Of these, 4/29 (13.8%) left AMA, compared to 27/72 (37.5%) of patients without an addiction consult (RR = 0.3678 [95% CI = 0.1412 - 0.9583], p = 0.02). Patients receiving addiction medicine consultation averaged 0.17 readmissions within 30 days of their index admission, compared to 0.39 readmissions in the group without addiction medicine consult (p = 0.27). Readmissions at 90 days and 1 year were also lower but not statistically significant. At 1 year, 6 deaths were observed; 2 who had addiction medicine consultation and 4 who did not. Conclusion Consultation with an addiction medicine specialist significantly reduced the number of patients discharged AMA in a high-risk cohort of PWID presenting with SA bacteremia. Numerically fewer readmissions occurred after consultation, though this difference was not statistically significant. Mortality in both groups was low. There were high rates of HIV and HCV in this patient population, suggesting a particularly vulnerable patient population, which warrants further study. Disclosures All Authors: No reported disclosures

The impact of patient age and procedure type on postoperative opioid use following ambulatory pediatric urologic procedures

2021 ◽  
Author(s):  
Michael F. Basin ◽  
Zoë G. Baker ◽  
Melissa Trabold ◽  
Terry Zhu ◽  
Lorraine I. Kelley-Quon ◽  
...  
Keyword(s):  
Opioid Use ◽  
Patient Age ◽  
Patient Âgé ◽  
The Impact ◽  
Procedure Type
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