Challenges in Managing Acute on Chronic Pain in a Pregnant Woman at High Risk for Opioid Use Disorder in the General Hospital Setting

2015 ◽  
Vol 23 (2) ◽  
pp. 157-166 ◽  
Author(s):  
Karthik Sivashanker ◽  
Michael Mufson ◽  
Leena Mittal ◽  
Edgar Ross ◽  
Joji Suzuki
Keyword(s):  
Chronic Pain ◽  
Pregnant Woman ◽  
High Risk ◽  
General Hospital ◽  
Hospital Setting ◽  
Opioid Use Disorder ◽  
Opioid Use

The Impact of Chronic Pain on Opioid Use Disorder Treatment Outcomes

2021 ◽  
Author(s):  
R. Ross MacLean ◽  
Suzanne Spinola ◽  
Gabriella Garcia-Vassallo ◽  
Mehmet Sofuoglu
Keyword(s):  
Chronic Pain ◽  
Treatment Outcomes ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Disorder Treatment ◽  
The Impact

Chronic pain in patients with opioid use disorder receiving methadone

2017 ◽  
Vol 381 ◽  
pp. 165
Author(s):  
Z. Samaan ◽  
B. Dennis ◽  
M. Bawor ◽  
M. Bhatt ◽  
L. Zielinski ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Opioid Use Disorder ◽  
Opioid Use

scholarly journals Mindfulness-Oriented Recovery Enhancement remediates anhedonia in chronic opioid use by enhancing neurophysiological responses during savoring of natural rewards

2021 ◽  
pp. 1-10
Author(s):  
Eric L. Garland ◽  
Spencer T. Fix ◽  
Justin P. Hudak ◽  
Edward M. Bernat ◽  
Yoshio Nakamura ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Skin Conductance Level ◽  
Opioid Therapy ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Natural Reward ◽  
Before And After ◽  
Natural Rewards ◽  
Chronic Opioid Use ◽  
Opioid Users

Abstract Background Neuropsychopharmacologic effects of long-term opioid therapy (LTOT) in the context of chronic pain may result in subjective anhedonia coupled with decreased attention to natural rewards. Yet, there are no known efficacious treatments for anhedonia and reward deficits associated with chronic opioid use. Mindfulness-Oriented Recovery Enhancement (MORE), a novel behavioral intervention combining training in mindfulness with savoring of natural rewards, may hold promise for treating anhedonia in LTOT. Methods Veterans receiving LTOT (N = 63) for chronic pain were randomized to 8 weeks of MORE or a supportive group (SG) psychotherapy control. Before and after the 8-week treatment groups, we assessed the effects of MORE on the late positive potential (LPP) of the electroencephalogram and skin conductance level (SCL) during viewing and up-regulating responses (i.e. savoring) to natural reward cues. We then examined whether these neurophysiological effects were associated with reductions in subjective anhedonia by 4-month follow-up. Results Patients treated with MORE demonstrated significantly increased LPP and SCL to natural reward cues and greater decreases in subjective anhedonia relative to those in the SG. The effect of MORE on reducing anhedonia was statistically mediated by increases in LPP response during savoring. Conclusions MORE enhances motivated attention to natural reward cues among chronic pain patients on LTOT, as evidenced by increased electrocortical and sympathetic nervous system responses. Given neurophysiological evidence of clinical target engagement, MORE may be an efficacious treatment for anhedonia among chronic opioid users, people with chronic pain, and those at risk for opioid use disorder.

Pharmacotherapy for Opioid Use Disorders in Special Populations

2020 ◽  
pp. 185-202
Author(s):  
Tricia E. Wright
Keyword(s):  
At Risk ◽  
Pregnant Woman ◽  
Mental Disorder ◽  
Opioid Use Disorder ◽  
Special Populations ◽  
Opioid Use ◽  
Adverse Childhood ◽  
Psychiatric Conditions ◽  
Opioid Use Disorders ◽  
The Life Course

Three populations are most at risk for opioid use disorder: adolescents, pregnant women, and those with comorbid psychological or psychiatric disorders. Opioid use disorders present throughout the life course of an individual, often developing during adolescence. For women, these disorders commonly occur during peak childbearing years. In addition, the twin vulnerabilities of genetics and adverse childhood events often interact to impart a greater chance for co-occurring psychiatric conditions. Caring for the pregnant woman, the adolescent, or the person with a co-occurring mental disorder presents special challenges. This chapter focuses on special considerations when treating opioid use disorders in these populations.

scholarly journals 0259 Shiftworkers are at Increased Risk of Developing Chronic Pain and Opioid Use Disorders: A Study of 116,000 UK Biobank Participants Over a Decade

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A98-A99
Author(s):  
L Gao ◽  
P Li ◽  
L Cui ◽  
Y Luo ◽  
C Vetter ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Bone Fractures ◽  
Inflammatory Diseases ◽  
Opioid Use Disorder ◽  
Uk Biobank ◽  
Opioid Use ◽  
Logistic Regression Models ◽  
Diagnostic Coding ◽  
Increased Risk ◽  
Opioid Use Disorders

Abstract Introduction In the current epidemic of opioid-related deaths, and widespread use of opioids to treat chronic pain, there is a pressing need to understand the underlying risk factors that contribute to such devastating conditions. Shiftwork has been associated with adverse health outcomes. We tested whether shiftwork during middle age is linked to the development of chronic pain and opioid misuse. Methods We studied 116,474 participants in active employment between 2006–2010 (mean age 57±8; range 37–71) from the UK Biobank, who have been followed for up to 10 years until 2017. We included participants who were free from all forms of self-reported pain, and were not taking opioid medications at baseline. Chronic pain and opioid use disorder diagnoses were determined using hospitalization records and diagnostic coding from ICD-10. Multivariate logistic regression models were performed to examine the associations of shiftwork status (yes/no) and nightshift frequency (none/occasional/permanent) and with incident chronic pain and/or opioid use disorder during follow-up. Models were adjusted for demographics, education, Townsend deprivation index, major confounders (BMI, diabetes, bone fractures/injuries, operations, peripheral vascular disease, joint/inflammatory diseases, cancer, standing/manual labor at work) and covariates (smoking, alcohol, high cholesterol, depression/anxiety, and cardiovascular diseases). Results In total, 190 (1.6/1,000) developed chronic pain or opioid use disorders. Shiftworkers (n=17,673) saw a 1.5-fold increased risk (OR 1.56, 95% CI: 1.08–2.24, p=0.01) relative to day workers. Within shiftworkers, those who reported occasional nightshift work (n=3,966) were most vulnerable (OR 1.57, 95% CI: 1.06–2.34, p=0.02). Results remained similar after adjusting for baseline sleep duration, chronotype and insomnia. Conclusion Shiftwork, and in particular rotating nightshift work is associated with increased risk for developing chronic pain and opioid use disorders. Replication is required to confirm the findings and to examine underlying mechanisms. Support This work was supported by NIH grants T32GM007592, RF1AG064312, and RF1AG059867.

Predicting opioid use disorder in patients with chronic pain who present to the emergency department

2018 ◽  
Vol 25 (5) ◽  
pp. 386-391
Author(s):  
Robert Andrew Gardner ◽  
Kori L Brewer ◽  
Dennis B Langston
Keyword(s):  
Emergency Department ◽  
Chronic Pain ◽  
Opioid Therapy ◽  
Opioid Use Disorder ◽  
Small Sample ◽  
Pain Medicine ◽  
Dose Increase ◽  
Emergency Physicians ◽  
Opioid Use ◽  
Prescription Monitoring

BackgroundEmergency department (ED) patients with chronic pain challenge providers to make quick and accurate assessments without an in-depth pain management consultation. Emergency physicians need reliable means to determine which patients may receive opioid therapy without exacerbating opioid use disorder (OUD).MethodsEighty-nine ED patients with a chief complaint of chronic pain were enrolled. Researchers administered questionnaires and reviewed medical and state prescription monitoring database information. Participants were classified as either OUD or non-OUD. Statistical analysis included a bivariate analysis comparing differences between groups and multivariate logistic regression evaluating ORs.ResultsThe 45 participants categorised as OUD had a higher proportion of documented or reported psychiatric diagnoses (p=0.049), preference of opioid treatment (p=0.005), current oxycodone prescription (p=0.043), borrowed pain medicine (p=0.004) and non-authorised dose increase (p<0.001). The state prescription monitoring database revealed the OUD group to have an increased number of opioid prescriptions (p=0.005) and pills (p=0.010). Participants who borrowed pain medicine and engaged in non-authorised dose increase were 5.2 (p=0.025, 95% CI 1.24 to 21.9) and 6.1 times (p=0.001, 95% CI 1.55 to 24.1) more likely to have OUD, respectively.LimitationsMajor limitations of our study include a small sample size, self-reported measures and convenience sample which may introduce selection bias.ConclusionPatients with chronic pain with OUD have distinguishable characteristics. Emergency physicians should consider such evidence-based variables prior to opioid therapy to ameliorate the opioid crisis and limit implicit bias.

Dual diagnosis inpatient treatment outcomes for individuals with co-occurring chronic pain and opioid use disorder

2018 ◽  
Vol 19 (3) ◽  
pp. S32
Author(s):  
C. Cutter ◽  
F. Buono ◽  
S. Ackerman ◽  
M. Brennan ◽  
D. Mueller ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Treatment Outcomes ◽  
Dual Diagnosis ◽  
Inpatient Treatment ◽  
Opioid Use Disorder ◽  
Opioid Use

The Epidemiology of Pain and Addiction (DRAFT)

2018 ◽  
Author(s):  
Emily Brunner ◽  
Robert Levy
Keyword(s):  
Chronic Pain ◽  
Opioid Use Disorder ◽  
Graphical Representations ◽  
Opioid Use

The chapter on the epidemiology of pain and addiction opens with a discussion of epidemiological principles and then proceeds to review two categories of data: that which are available on the use of opioids to treat chronic pain, and that reflecting opioid use disorder (OUD). The data are provided with graphical representations that may aid in discussions and in teaching. An accompanying glossary of epidemiological terminology facilitates understanding of the data. Conclusions are drawn from the prevalence of use and of mortality that contribute to an understanding of the origins and direction of the opioid use crisis. An accompanying text box provides resources for further exploration of the topics discussed in the chapter.

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