scholarly journals Relationship Between Opioid Analgesic Prescription and Unemployment in Patients Seeking Acupuncture for Chronic Pain in Urban Primary Care

Pain Medicine ◽  
2018 ◽  
Vol 20 (8) ◽  
pp. 1528-1533 ◽  
Author(s):  
Elizabeth Chuang ◽  
Eric N Gil ◽  
Qi Gao ◽  
Benjamin Kligler ◽  
M Diane McKee
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Pain Treatment ◽  
Opioid Analgesic ◽  
Opioid Analgesics ◽  
Baseline Survey ◽  
Patient Reported ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain ◽  
Analgesic Use

Abstract Objective The widespread use of opioid analgesics to treat chronic nonmalignant pain has contributed to the ongoing epidemic of opioid-related morbidity and mortality. Previous studies have also demonstrated a relationship between opioid analgesic use and unemployment due to disability. These studies have been limited to mainly white European and North American populations. The objective of this study is to explore the relationship between opioid analgesic use for chronic nonmalignant pain in an urban, mainly black and Hispanic, low-income population. Design This is a cross-sectional observational study. Setting Subjects were recruited from six urban primary care health centers. Subjects Adults with chronic neck, back, or osteoarthritis pain participating in an acupuncture trial were included. Methods Survey data were collected as a part of the Acupuncture Approaches to Decrease Disparities in Pain Treatment two-arm (AADDOPT-2) comparative effectiveness trial. Participants completed a baseline survey including employment status, opioid analgesic use, the Brief Pain Inventory, the global Patient Reported Outcomes Measurement Information Systems quality of life measure, the Patient Health Questionnaire-9 (PHQ-9), and demographic information. A multivariable logistic regression model was built to examine the association between opioid analgesic use and unemployment. Results Opioid analgesic use was associated with three times the odds of unemployment due to disability while controlling for potential confounders, including depression, pain severity, pain interference, global physical and mental functioning, and demographic characteristics. Conclusions This study adds to the growing body of evidence that opioid analgesics should be used with caution in chronic nonmalignant pain.

scholarly journals Factors Associated with Prescription Opioid Analgesic Use in the US Population, 2011–2014

Pain Medicine ◽  
2018 ◽  
Vol 20 (7) ◽  
pp. 1338-1346 ◽  
Author(s):  
Steven M Frenk ◽  
Susan L Lukacs ◽  
Qiuping Gu
Keyword(s):  
Opioid Analgesic ◽  
Opioid Analgesics ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Factors Associated ◽  
The Past ◽  
The Us ◽  
Opioid Users ◽  
Analgesic Use

Abstract Objective This study examined factors associated with prescription opioid analgesic use in the US population using data from a nationally representative sample. It focused on factors previously shown to be associated with opioid use disorder or overdose. Variations in the use of different strength opioid analgesics by demographic subgroup were also examined. Methods Data came from respondents aged 16 years and older who participated in the National Health and Nutrition Examination Survey (2011–2014). Respondents were classified as opioid users if they reported using one or more prescription opioid analgesics in the past 30 days. Results Opioid users reported poorer self-perceived health than those not currently using opioids. Compared with those not using opioids, opioid users were more likely to rate their health as being “fair” or “poor” (40.4% [95% confidence interval {CI} = 34.9%–46.2%] compared with 15.6% [95% CI = 14.3%–17.1%]), experienced more days of pain during the past 30 days (mean = 14.3 [95% CI = 12.9–15.8] days compared with 2.3 [95% CI = 2.0–2.7] days), and had depression (22.5% [95% CI = 17.3%–28.7%] compared with 7.1% [95% CI = 6.2%–8.0%]). Among those who reported using opioids during the past 30 days, 18.8% (95% CI = 14.4%–24.1%) reported using benzodiazepine medication during the same period and 5.2% (95% CI = 3.5%–7.7%) reported using an illicit drug during the past six months. When opioid strength was examined, a smaller percentage of adults aged 60 years and older used stronger-than-morphine opioids compared with adults aged 20–39 and 40–59 years. Conclusions Higher percentages of current opioid users than nonusers reported having many of the factors associated with opioid use disorder and overdose.

Overcoming Obesity: A Mixed Methods Study of the Impact of Primary Care Physician Counseling on Low-Income African American Women Who Successfully Lost Weight

2017 ◽  
Vol 32 (2) ◽  
pp. 374-380 ◽  
Author(s):  
Elaine Seaton Banerjee ◽  
Sharon J. Herring ◽  
Katelyn E. Hurley ◽  
Katherine Puskarz ◽  
Kyle Yebernetsky ◽  
...  
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
African American ◽  
Mixed Methods ◽  
African American Women ◽  
Low Income ◽  
Positive Deviance ◽  
American Women ◽  
Patient Reported ◽  
The Impact

Purpose: Low-income, African American women are disproportionately impacted by obesity. Little is known about the interactions between low-income, African American women who successfully lost weight and their primary care physicians (PCPs). Design: Mixed methods, positive deviance study. Setting: Urban university-based family medicine practice. Participants: The positive deviance group comprised low-income, African American women who were obese, lost 10% body weight, and maintained this loss for 6 months. Measures: The PCP- and patient-reported weight-related variables collected through the electronic medical record (EMR), surveys, and interviews. Analysis: Logistic regression of quantitative variables. Qualitative analysis using modified grounded theory. Results: The EMR documentation by PCPs of dietary counseling and a weight-related medical problem were significant predictors of positive deviant group membership. Qualitative analyses of interviews revealed 5 major themes: framing obesity in the context of other health problems provided motivation; having a full discussion around weight management was important; an ongoing relationship with the physician was valuable; celebrating small successes was beneficial; and advice was helpful but self-motivation was necessary. Conclusion: The PCP counseling may be an important factor in promoting weight loss in low-income, African American women. Patients may benefit from their PCPs drawing connections between obesity and weight-related medical conditions and enhancing intrinsic motivation for weight loss.

Academic family medicine physicians' confidence and comfort with opioid analgesic prescribing for patients with chronic nonmalignant pain

2014 ◽  
Vol 10 (4) ◽  
pp. 255 ◽  
Author(s):  
Allison A. Macerollo, MD ◽  
Donald O. Mack, MD ◽  
Rupal Oza, MD, MPH ◽  
Ian M. Bennett, MD, PhD ◽  
Lorraine S. Wallace, PhD
Keyword(s):  
Pain Management ◽  
Family Medicine ◽  
Family Physicians ◽  
Opioid Analgesics ◽  
Comfort Level ◽  
Opioid Prescription ◽  
Opioid Prescribing ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain ◽  
Level Of Concern

Objective: To examine academic family medicine physicians' current practices, experiences, beliefs, level of concern about negative outcomes, and confidence and comfort when prescribing opioid analgesics for chronic nonmalignant pain management. Design: Electronic cross-sectional survey.Participants: This study was part of the Council of Academic Family Medicine (CAFM) Educational Research Alliance omnibus survey of active academic US family physicians.Main outcome measures: Respondents completed survey items addressing their 1) sociodemographic and practice characteristics, 2) current opioid prescribing practices, 3) experiences and beliefs toward prescribing opioid analgesics for chronic nonmalignant pain management, 4) level of concern about negative opioid-related outcomes, and 5) confidence and comfort when prescribing opioid analgesics.Results: The majority of the sample (n = 491) were male (57.8 percent) with 84.1 percent identifying themselves as non-Hispanic white. Nearly all respondents (91.0 percent) reported currently prescribing opioids to patients with chronic nonmalignant pain. Most respondents reported being confident (88.4 percent) and comfortable (76.2 percent) in their prescribing for patients with chronic nonmalignant pain. Family physicians who were comfortable in their opioid prescribing skills were more likely to report satisfaction in prescribing opioids to patients with chronic pain (ρ = 0.494, p < 0.001), while those who were confident in their opioid prescribing skills were more likely to identify pain management as high priority (ρ = -0.287, p < 0.001).Conclusions: Most academic family physicians currently prescribed opioid analgesics to patients with chronic nonmalignant pain. There was a strong inverse relationship between confidence regarding opioid prescription and concern about negative consequences. Similarly, comfort level was tied to increased satisfaction with the overall process of opioid prescription.

Adverse effects and cognitive function among primary care patients taking opioids for chronic nonmalignant pain

2006 ◽  
Vol 2 (3) ◽  
pp. 137 ◽  
Author(s):  
Randall T. Brown, MD ◽  
Megan Zuelsdorff, BS ◽  
Michael Fleming, MD, MPH
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Chronic Pain ◽  
Cognitive Function ◽  
Adverse Effects ◽  
Primary Care Physicians ◽  
Opioid Therapy ◽  
Chronic Opioid Therapy ◽  
Nonmalignant Pain ◽  
Chronic Nonmalignant Pain

Chronic opioid therapy is commonly prescribed for chronic nonmalignant pain. Few published data describe the adverse effects experienced by patients with chronic nonmalignant pain being treated by primary care physicians. A prevalence study was conducted on a sample of 1,009 patients (889 receiving chronic opioids) being treated by 235 primary care physicians. Standardized questionnaires and medical record reviews were used to assess rates of addiction, pain diagnosis and severity, opioid adverse effects, and mental health. The mean daily dose of opioids was 92 mg using a morphine-equivalent conversion. Side effects included constipation (40 percent), sleeping problems (25 percent), loss of appetite (23 percent), and sexual dysfunction (18 percent), with patients on daily opioids experiencing more side effects than subjects on intermittent medication. The Medical Outcomes Study Mental Health Inventory (MOS-MHI) cognitive functioning scale indicated poorer cognitive function in the overall sample of chronic pain patients as compared to a general clinical sample (Δ x 95 percent CI = 9.28, 13.76). However, there were limited differences in MOS scores between chronic pain subjects on daily opioids vs. intermittent opioids vs. no prescription opioids. A regression model suggests that psychological measures and pain severity are more predictive of decrements in cognitive function than specific opioid preparations or daily opioid dose. Physicians should closely monitor patients for adverse effects and adequacy of pain control when using chronic opioid therapy for chronic pain treatment. Psychological health, an important predictor of cognitive dysfunction, is a particularly important measure to actively monitor and manage.

scholarly journals Clinical and demographic covariates of chronic opioid and non-opioid analgesic use in rural-dwelling older adults: the MoVIES project

2013 ◽  
Vol 25 (11) ◽  
pp. 1801-1810 ◽  
Author(s):  
Jordan F. Karp ◽  
Ching-Wen Lee ◽  
Jonathan McGovern ◽  
Gary Stoehr ◽  
Chung-Chou H. Chang ◽  
...  
Keyword(s):  
Sleep Problems ◽  
Opioid Analgesic ◽  
Secondary Analysis ◽  
Opioid Analgesics ◽  
Epidemiological Data ◽  
Population Based ◽  
Opioid Use ◽  
Original Cohort ◽  
Analgesic Use ◽  
Chronic Use

ABSTRACTBackground:To describe covariates and patterns of late-life analgesic use in the rural, population-based MoVIES cohort from 1989 to 2002.Methods:Secondary analysis of epidemiologic survey of elderly people conducted over six biennial assessment waves. Potential covariates of analgesic use included age, gender, depression, sleep, arthritis, smoking, alcohol, and general health status. Of the original cohort of 1,681, this sample comprised 1,109 individuals with complete data on all assessments. Using trajectory analysis, participants were characterized as chronic or non-chronic users of opioid and non-opioid analgesics. Multivariable regression was used to model predictors of chronic analgesic use.Results:The cohort was followed for mean (SD) 7.3 (2.7) years. Chronic use of opioid analgesics was reported by 7.2%, while non-opioid use was reported by 46.1%. In the multivariable model, predictors of chronic use of both opioid and non-opioid analgesics included female sex, taking ≥2 prescription medications, and “arthritis” diagnoses. Chronic opioid use was also associated with age 75–84 years; chronic non-opioid use was also associated with sleep continuity disturbance.Conclusions:These epidemiological data confirm clinical observations and generate hypotheses for further testing. Future studies should investigate whether addressing sleep problems might lead to decreased use of non-opioid analgesics and possibly enhanced pain management.

Evaluation of the benefits from the introduction meeting for patients with chronic non-malignant pain and their relatives in interdisciplinary pain center

2017 ◽  
Vol 16 (1) ◽  
pp. 188
Author(s):  
H.L.A. Kristensen ◽  
M. Madsen ◽  
P.B.F. Jensen ◽  
W.Z. Pawlak
Keyword(s):  
Chronic Pain ◽  
Research Study ◽  
Pain Treatment ◽  
Multidisciplinary Therapy ◽  
Social Phobias ◽  
Nonmalignant Pain ◽  
Pain Center ◽  
Chronic Nonmalignant Pain ◽  
In The Beginning ◽  
Multidisciplinary Pain Center

AbstractBackgroundTreatment of patients with chronic nonmalignant pain (CNMP) is challenging and requires a multidisciplinary effort. In a multidisciplinary pain center, patients are treated by a team of doctor, nurse, physiotherapist, psychologist and social worker. Especially in the beginning of treatment patients receive much information. Many patients and their relatives have problems with comprehending it.ObjectiveThis is an action research study aimed to find the optimal mode for to introduce patients with CNMP and their relatives to the multidisciplinary pain treatment.MethodIn the fall of 2016, we began to invite patients and their relatives to the introduction meeting (IM), which takes place in groups of up to 20 people, has duration of 1 hour and is led by the physiotherapist and nurse, but the physician is also present. Invited patients are able to understand written and oral Danish and are not suffering from social phobias. During IM facts about the center, treatment course and pain physiology are presenter. Immediately after IM, participants are anonymously asked about their experiences.ResultsUp to date (February 2017) 254 patients were invited. Invitation was rejected by 63 patients (24,8%). Question about understanding of chronic pain was answered by 108 participants (both patients and their relatives), and 103 participants declared better understanding of chronic pain after IM end before. 69 participants answered question about understanding of treatment course in the center. All but 2 participants declared after IM at their understanding was better end before. In fact, 31 (44,9%) participants estimated changes in understanding of treatment course as much significant.ConclusionThe IM at the beginning of multidisciplinary therapy seems to be a promising activity for patients with CNMP referred to the multidisciplinary pain center, as well as for their relatives. Study is ongoing and updated results will be presented at the conference.

Sign in / Sign up

Export Citation Format

Share Document