scholarly journals Chronic use of tramadol after acute pain episode: cohort study

BMJ ◽  
2019 ◽  
pp. l1849 ◽  
Author(s):  
Cornelius A Thiels ◽  
Elizabeth B Habermann ◽  
W Michael Hooten ◽  
Molly M Jeffery
Keyword(s):  
Acute Pain ◽  
Elective Surgery ◽  
Risk Difference ◽  
Administrative Claims ◽  
Opioid Use ◽  
Short Acting ◽  
Adjusted Risk ◽  
Post Surgery ◽  
Percentage Points ◽  
Chronic Opioid Use

AbstractObjectiveTo determine the risk of prolonged opioid use in patients receiving tramadol compared with other short acting opioids.DesignObservational study of administrative claims data.SettingUnited States commercial and Medicare Advantage insurance claims (OptumLabs Data Warehouse) January 1, 2009 through June 30, 2018.ParticipantsOpioid-naive patients undergoing elective surgery.Main outcome measureRisk of persistent opioid use after discharge for patients treated with tramadol alone compared with other short acting opioids, using three commonly used definitions of prolonged opioid use from the literature: additional opioid use (defined as at least one opioid fill 90-180 days after surgery); persistent opioid use (any span of opioid use starting in the 180 days after surgery and lasting ≥90 days); and CONSORT definition (an opioid use episode starting in the 180 days after surgery that spans ≥90 days and includes either ≥10 opioid fills or ≥120 days’ supply of opioids).ResultsOf 444 764 patients who met the inclusion criteria, 357 884 filled a discharge prescription for one or more opioids associated with one of 20 included operations. The most commonly prescribed post-surgery opioid was hydrocodone (53.0% of those filling a single opioid), followed by short acting oxycodone (37.5%) and tramadol (4.0%). The unadjusted risk of prolonged opioid use after surgery was 7.1% (n=31 431) with additional opioid use, 1.0% (n=4457) with persistent opioid use, and 0.5% (n=2027) meeting the CONSORT definition. Receipt of tramadol alone was associated with a 6% increase in the risk of additional opioid use relative to people receiving other short acting opioids (incidence rate ratio 95% confidence interval 1.00 to 1.13; risk difference 0.5 percentage points; P=0.049), 47% increase in the adjusted risk of persistent opioid use (1.25 to 1.69; 0.5 percentage points; P<0.001), and 41% increase in the adjusted risk of a CONSORT chronic opioid use episode (1.08 to 1.75; 0.2 percentage points; P=0.013).ConclusionsPeople receiving tramadol alone after surgery had similar to somewhat higher risks of prolonged opioid use compared with those receiving other short acting opioids. Federal governing bodies should consider reclassifying tramadol, and providers should use as much caution when prescribing tramadol in the setting of acute pain as for other short acting opioids.

scholarly journals Targeted Antibiotics for Trachoma: A Cluster-Randomized Trial

2021 ◽  
Author(s):  
Jason S Melo ◽  
Solomon Aragie ◽  
Ambahun Chernet ◽  
Zerihun Tadesse ◽  
Adane Dagnew ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Cluster Randomized Trial ◽  
Risk Difference ◽  
Only Children ◽  
Adjusted Risk ◽  
Percentage Points ◽  
The Mean ◽  
Cluster Randomized ◽  
Current Guidelines ◽  
Noninferiority Margin

Abstract Background Current guidelines recommend community-wide mass azithromycin for trachoma, but a targeted treatment strategy could reduce the volume of antibiotics required. Methods In total, 48 Ethiopian communities were randomized to mass, targeted, or delayed azithromycin distributions. In the targeted arm, only children aged 6 months to 5 years with evidence of ocular chlamydia received azithromycin, distributed thrice over the following year. The primary outcome was ocular chlamydia at months 12 and 24, comparing the targeted and delayed arms (0–5 year-olds, superiority analysis) and the targeted and mass azithromycin arms (8–12 year-olds, noninferiority analysis, 10% noninferiority margin). Results At baseline, the mean prevalence of ocular chlamydia in the 3 arms ranged from 7% to 9% among 0–5 year-olds and from 3% to 9% among 8–12 year-olds. Averaged across months 12–24, the mean prevalence of ocular chlamydia among 0–5 year-olds was 16.7% (95% confidence interval [CI]: 9.0%–24.4%) in the targeted arm and 22.3% (95% CI: 11.1%–33.6%) in the delayed arm (P = .61). The final mean prevalence of ocular chlamydia among 8–12 year-olds was 13.5% (95% CI: 7.9%–19.1%) in the targeted arm and 5.5% (95% CI: 0.3%–10.7%) in the mass treatment arm (adjusted risk difference 8.5 percentage points [pp] higher in the targeted arm, 95% CI: 0.9 pp–16.1 pp higher). Conclusions Antibiotic treatments targeted to infected preschool children did not result in significantly less ocular chlamydia infections compared with untreated communities and did not meet noninferiority criteria relative to mass azithromycin distributions. Targeted approaches may require treatment of a broader segment of the population in areas with hyperendemic trachoma.

Hydromorphone use for acute pain: Misconceptions, controversies, and risks

2018 ◽  
Vol 14 (1) ◽  
pp. 61 ◽  
Author(s):  
Maryann Mazer-Amirshahi, PharmD, MD, MPH ◽  
Sergey Motov, MD ◽  
Lewis S. Nelson, MD
Keyword(s):  
Acute Pain ◽  
Adverse Drug Events ◽  
Opioid Analgesic ◽  
Opioid Analgesics ◽  
Abuse Liability ◽  
Prescription Opioid ◽  
Potential Contribution ◽  
Limited Data ◽  
Opioid Use ◽  
Chronic Opioid Use

Hydromorphone (HM) is a potent opioid analgesic that is commonly administered in the emergency department (ED) and other acute care settings, such as medical surgical wards. In recent years, there has been a significant increase in the ED administration of HM relative to other opioids. Although HM is an effective analgesic, its use has been commonly implicated in adverse drug events and medication errors. In addition, intravenous HM has potent euphoric effects that may contribute to its abuse liability. There are limited data regarding how acute parenteral administration of opioid analgesics in the setting of high rates of preexisting chronic opioid use (medical or nonmedical) may contribute to or reinforce addictive behavior, making the potential contribution of rising HM administration to subsequent prescription opioid abuse and overdose uncertain. This review addresses the pharmacology of HM, recommended dosing, its efficacy for acute pain, as well as its tolerability, safety, and abuse profiles. Controversies and strategies for appropriate use of this medication are also described.

scholarly journals Ketamine for Acute Pain After Trauma: KAPT Trial

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

Risk of chronic opioid use in older persons with pre-existing anxiety

2020 ◽  
Vol 16 (1) ◽  
pp. 59-66
Author(s):  
Anna K. Moffat, PhD ◽  
Nicole L. Pratt, PhD ◽  
Mhairi Kerr, MSc ◽  
Lisa M. Kalisch Ellett, PhD ◽  
Elizabeth E. Roughead, PhD
Keyword(s):  
Older People ◽  
Proportional Hazards ◽  
Significant Proportion ◽  
Administrative Claims ◽  
Opioid Use ◽  
Prior Surgery ◽  
History Of ◽  
Chronic Opioid Use ◽  
Older Populations ◽  
Chronic Use

Objective: Work that has shown a relationship between anxiety and chronic opioid use has not focused on older people specifically, despite the additional risks in older populations. This study aimed to understand whether anxiety prior to opioid initiation increased the likelihood of chronic opioid use over time in persons aged 60 years or older.Design: Administrative claims data were used to calculate time between initiation of opioids and a first chronic episode of opioid use. Patients were classified as having a history of anxiety if they were dispensed medicines in the anxiolytics class or had a hospitalization event for anxiety prior to treatment with an opioid. Proportional hazards models were used to compare the likelihood of experiencing a chronic episode of opioid use between those with and without a history of anxiety.Results: The cohort was 15,000 persons, of which, 5,076 (34 percent) had history of anxiety. Those with anxiety prior to their first opioid dispensing were 30 percent more likely to have an episode of chronic use after adjustment for age, gender, number of comorbidities, and prior surgery (HR = 1.30, 95% CI = 1.16-1.47). The risk of a chronic episode in patients who had surgery prior to initiation of an opioid was 60 percent greater in those with anxiety compared to no anxiety (HR = 1.60, 95% CI = 1.21-2.11) and 24 percent greater in those with anxiety but no prior surgery (HR = 1.24, 95% CI = 1.08-1.42).Conclusions: A significant proportion of older people will have a chronic episode of opioid use. This risk is increased where a history of anxiety is present.

scholarly journals How acute pain leads to chronic opioid use

2018 ◽  
Vol 85 (11) ◽  
pp. 837-841
Author(s):  
Charles Reznikoff
Keyword(s):  
Acute Pain ◽  
Opioid Use ◽  
Chronic Opioid Use

scholarly journals Acute Pain Is Associated With Chronic Opioid Use After Total Knee Arthroplasty

2018 ◽  
pp. 1 ◽  
Author(s):  
Hung-Lun Hsia ◽  
Steven Takemoto ◽  
Thomas van de Ven ◽  
Srinivas Pyati ◽  
Thomas Buchheit ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Acute Pain ◽  
Opioid Use ◽  
Total Knee ◽  
Chronic Opioid Use

Opioid Use for Treatment of Acute Pain Among Children and Adolescents Enrolled in the Mississippi Medicaid Program

2019 ◽  
pp. 089719001988376
Author(s):  
Yiqiao Zhang ◽  
Yi Yang ◽  
Marie Barnard ◽  
John P. Bentley ◽  
Sujith Ramachandran
Keyword(s):  
Mental Health ◽  
Children And Adolescents ◽  
Acute Pain ◽  
The United States ◽  
Mental Health Disorder ◽  
Administrative Claims ◽  
Opioid Use ◽  
Pain Episode ◽  
Obstructive Sleep ◽  
Significant Difference

Background: Abuse of opioids among children and adolescents has become a major public concern in the United States. Understanding the epidemiology of opioid use in this vulnerable population is critical to address opioid abuse. Objective: The aim of this study is to characterize opioid use for the treatment of acute pain among children and adolescents enrolled in Mississippi Medicaid and to determine the effects of related clinical factors (ie, mental health disorders and obstructive sleep apnea [OSA] on patterns of opioid use. Methods: A retrospective cohort study was conducted using the Mississippi Medicaid administrative claims data from October 2015 through December 2017. We examined the proportion of children and adolescents less than 21 years of age using opioids within 7 days following any qualifying acute pain episode, as well as the difference in opioid use patterns between individuals with various demographic and clinical characteristics. Results: Over 5% of the eligible population received opioids within 7 days of a qualifying pain episode. The majority received schedule II or schedule III to IV short-acting opioids. There was no significant difference in opioid use for acute pain between individuals with and without a mental health disorder. Opioid use for acute pain was significantly more likely among those with a history of OSA than those without OSA. Conclusion: This study characterizes the nature and patterns of opioid use among children and adolescents with acute pain. Further research is needed to understand the role of clinical and other demographic factors in the prescribing of opioids for acute pain in this population.

scholarly journals Chronic opioid use and complication risks in women with endometriosis: a cohort study in US administrative claims

2021 ◽  
Author(s):  
Stephanie E. Chiuve ◽  
Ryan D. Kilpatrick ◽  
Mark D. Hornstein ◽  
Natalia Petruski‐Ivleva ◽  
Lani R. Wegrzyn ◽  
...  
Keyword(s):  
Cohort Study ◽  
Administrative Claims ◽  
Opioid Use ◽  
Chronic Opioid Use

scholarly journals Predictors of Chronic Opioid Use: A Population-level Analysis of North Carolina Cancer Survivors Using Multi-Payer Claims

2021 ◽  
Author(s):  
Devon K Check ◽  
Christopher D Bagett ◽  
KyungSu Kim ◽  
Andrew W Roberts ◽  
Megan C Roberts ◽  
...  
Keyword(s):  
North Carolina ◽  
Substance Use ◽  
Cancer Survivors ◽  
Low Income ◽  
Opioid Therapy ◽  
Adjusted Relative Risk ◽  
Opioid Use ◽  
Chronic Opioid Therapy ◽  
Increased Risk ◽  
Chronic Opioid Use

Abstract Background No population-based studies have examined chronic opioid use among cancer survivors who are diverse with respect to diagnosis, age group, and insurance status. Methods We conducted a retrospective cohort study using North Carolina (NC) cancer registry data linked with claims from public and private insurance (2006–2016). We included adults with non-metastatic cancer who had no prior chronic opioid use (N = 38,366). We used modified Poisson regression to assess the adjusted relative risk of chronic opioid use in survivorship (&gt;90-day continuous supply of opioids in the 13–24 months following diagnosis) associated with patient characteristics. Results Only 3.0% of cancer survivors in our cohort used opioids chronically in survivorship. Predictors included younger age (adjusted risk ratio [aRR], 50–59 vs 60–69 = 1.23, 95% confidence interval [CI] = 1.05–1.43), baseline depression (aRR = 1.22, 95% CI = 1.06–1.41) or substance use (aRR = 1.43, 95% CI = 1.15–1.78) and Medicaid (aRR vs Private = 1.93, 95% CI = 1.56–2.40). Survivors who used opioids intermittently (vs not at all) before diagnosis were twice as likely to use opioids chronically in early survivorship (aRR = 2.62, 95% CI = 2.28–3.02). Those who used opioids chronically (vs intermittently or not at all) during active treatment had a nearly 17-fold increased likelihood of chronic use in survivorship (aRR = 16.65, 95 CI = 14.30–19.40). Conclusions Younger and low-income survivors, those with baseline depression or substance use, and those who require chronic opioid therapy during treatment are at increased risk for chronic opioid use in survivorship. Our findings point to opportunities improve assessment of psychosocial histories and to engage patients in shared decision-making around long-term pain management, when chronic opioid therapy is required during treatment.

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