Postoperative Opioid Use and Pain Management Following Otologic and Neurotologic Surgery

2019 ◽  
Vol 129 (2) ◽  
pp. 175-180
Author(s):  
Christopher Boyd ◽  
Matthew Shew ◽  
Joseph Penn ◽  
Thomas Muelleman ◽  
James Lin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Management ◽  
Academic Medical Center ◽  
The United States ◽  
Pain Medication ◽  
Prescription Opioid ◽  
Patient Questionnaire ◽  
Opioid Use

Objectives: The topic of prescription opioid overuse remains a growing concern in the United States. Our objective is to provide insight into pain perception and opioid use based on a patient cohort undergoing common otologic and neurotologic surgeries. Study Design: Prospective observational study with patient questionnaire. Setting: Single academic medical center. Subjects and Methods: Adult patients undergoing otologic and neurotologic procedures by two fellowship trained neurotologists between June and November of 2018 were included in this study. During first postoperative follow-up, participants completed a questionnaire assessing perceived postoperative pain and its impact on quality of life, pain management techniques, and extent of prescription opioid use. Results: A total of 47 patients met inclusion and exclusion criteria. The median pain score was 3 out of 10 (Interquartile Range [IQR] = 2-6) with no significant gender differences ( P = .92). Patients were prescribed a median of 15.0 (IQR = 10.0-15.0) tablets of opioid pain medication postoperatively, but only used a median of 4.0 (IQR = 1.0-11.5) tablets at the time of first follow-up. Measured quality of life areas included sleep, physical activity, work, and mood. Sleep was most commonly affected, with 69.4% of patients noting disturbances. Conclusions: This study suggests that practitioners may over-estimate the need for opioid pain medication following otologic and neurotologic surgery. It also demonstrates the need for ongoing patient education regarding opioid risks, alternatives, and measures to prevent diversion.

scholarly journals SAFE AND EFFECTIVE PAIN CONTROL FOR GERIATRIC PATIENTS: A MULTIDISCIPLINARY APPROACH DURING THE OPIOID EPIDEMIC

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S401-S402
Author(s):  
Tatyana Gurvich
Keyword(s):  
Quality Of Life ◽  
Pain Management ◽  
Physical Therapy ◽  
Integrative Medicine ◽  
The United States ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescription ◽  
Pain Medications

Abstract Opioid use is at a crisis level. According to the CDC, an estimated 20 % of patients presenting to physician offices with non-cancer pain receive an opioid prescription (1). According to the Administration on Aging and Substance Abuse and Mental Health Services Administration, the population of older adults who misuse opioids is expected to double by 2020. Today’s mandate to reduce opioid use and to manage patients safely with adjuvant medications comes with many challenges in geriatrics. Many patients have comorbidities which limit the use of adjuvant pain medications. A careful balance must be achieved, in order to provide good pain management and improve quality of life in this patient population. This symposium will explore multidisciplinary approaches to managing pain in geriatrics to reduce opioid use and manage safe opioid use where necessary. Pharmacological strategies for adjusting dosing and managing compliance will be discussed. Cooperative education to improve prescribing practices along with patient education to improve safe use, are important elements. Adjunct use of physical therapy and integrative medicine are also discussed as viable and effective adjuncts or alternatives to traditional pain management. You will learn how to use medications safely, utilize physical therapy to its maximum potential and learn more about innovative integrative medicine techniques, all of which decrease pain and improve function and most importantly quality of life. (1) Daubresse M, Chang HY, Yu Y, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 200-2010. Med Care 2013; 51:870-8

scholarly journals Managing Pain in Patients With Cancer: The Chinese Good Pain Management Experience

2017 ◽  
Vol 3 (5) ◽  
pp. 583-595 ◽  
Author(s):  
Shi-Ying Yu ◽  
Jie-Jun Wang ◽  
Yu-guang Huang ◽  
Bing Hu ◽  
Kun Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Management ◽  
High Standard ◽  
Management Training ◽  
Drug Dose ◽  
Dose Titration ◽  
Patients With Cancer ◽  
Opioid Drugs

Purpose The number of cancer cases in China has increased rapidly from 2.1 million in 2000 to 4.3 million in 2015. As a consequence, pain management as an integral part of cancer treatment became an important health care issue. In March 2011, the Good Pain Management (GPM) program was launched to standardize the treatment of cancer pain and improve the quality of life for patients with cancer. With this work, we will describe the GPM program, its implementation experience, and highlight key lessons that can improve pain management for patients with cancer. Methods We describe procedures for the selection, implementation, and assessment procedures for model cancer wards. We analyzed published results in areas of staff training and patient education, pain management in practice, analgesic drugs administration, and patient follow-up and satisfaction. Results Pain management training enabled medical staff to accurately assess the level of pain and to provide effective pain relief through timely dispensation of medication. Patients with good knowledge of treatment of pain were able to overcome their aversion to opioid drugs and cooperate with nursing staff on pain assessment to achieve effective drug dose titration. Consumption of strong opioid drugs increased significantly; however, there was no change for weaker opioids. Higher pain remission rates were achieved for patients with moderate-to-severe pain levels. Proper patient follow-up after discharge enabled improved outcomes to be maintained. Conclusion The GPM program has instituted a consistent and high standard of care for pain management at cancer wards and improved the quality of life for patients with cancer.

Anxiety and depression are independent predictors of quality of life of patients with chronic musculoskeletal pain

2012 ◽  
Vol 18 (2) ◽  
pp. 167-175 ◽  
Author(s):  
Tage Orenius ◽  
Taru Koskela ◽  
Petteri Koho ◽  
Timo Pohjolainen ◽  
Hannu Kautiainen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Management ◽  
Musculoskeletal Pain ◽  
Management Programme ◽  
Chronic Musculoskeletal Pain ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

We examined the relative impact of baseline anxiety, depression and fear of movement on health related quality of life at 12-month follow-up after a multidisciplinary pain management programme. One hundred and eleven patients who had chronic musculoskeletal pain (mean age 45 years, 65% women) attended during 2003–2005 a multidisciplinary three-phase pain management programme with a total time frame of six to seven months, totalling 19 days. The Beck Anxiety Inventory was used to rate anxiety, the Beck Depression Inventory depression, the Tampa Scale of Kinesiophobia fear of movement. The generic 15D questionnaire was used to assess health related quality of life. Baseline data were collected at admission, follow-up data at 12 months. Mean health related quality of life increased significantly from baseline to 12-month follow-up. Anxiety at baseline predicted significant negative change in the health related quality of life, depression predicted significant positive change in the health related quality of life. Fear of movement did not predict any significant change in the health related quality of life. We concluded that patients with chronic musculoskeletal pain and mild to moderate depression benefit from a multidisciplinary pain management programme in contrast to anxious patients. The findings imply further research with bigger sample sizes, other than HRQoL outcome measures as well as with other groups of patients.

scholarly journals 2-Week Post-Operative Opioid Use after Primary Hallux Valgus Correction

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0046
Author(s):  
Zachary T. Thier ◽  
Kenna C. Altobello ◽  
Tyler A. Gonzalez ◽  
J. Ben Jackson
Keyword(s):  
Body Weight ◽  
Pain Management ◽  
Hallux Valgus ◽  
The United States ◽  
Pain Medication ◽  
Clinic Visit ◽  
Objective Data ◽  
Opioid Use ◽  
Adductor Canal ◽  
Post Operative Pain

Category: Bunion; Other Introduction/Purpose: More than 200,000 surgeries for hallux valgus correction occur annually in the United States. Due to the post-operative pain associated with the procedure, opioids are often prescribed to help manage pain. The opioid epidemic has led to a 78-billion-dollar economic impact. Given the lack of objective data on opioid use and the difficulty of addressing a patient’s post-operative pain, we sought to quantify, through a prospective analysis, patient’s narcotic use after hallux valgus surgery. Objective data may help guide the surgeon in the type and number of opioids utilized after surgery. Methods: Adult patients undergoing primary hallux valgus surgery were recruited from two surgeon’s institution. At the pre- operative visit, patients were consented and completed a demographical questionnaire. Data was collected from the operative and PACU record, as well as the 2-week post-operative visit. A simple statistical analysis was performed to determine average quantity and type of opioid and non-opioid pain medication used in the PACU and for post-operative pain management. Results: 33 subjects were prospectively enrolled and followed. The average time until the first post-operative clinic visit was 13.53 days. The average opioid pain medication consumption during this period was 20.766 (0-66) pills, with a morphine milligram equivalents (MME)/kg of body weight at 1.69. (78.8%) were prescribed hydrocodone/acetaminophen 5/325mg and 7 subjects (21.2%) were prescribed oxycodone/acetaminophen 5/325 for post-operative pain management. 84.8% of subjects (28/33) received a local block, including 2 femoral, 2 ankle, 13 popliteal, 3 sciatic, 3 adductor canal, 4 popliteal and saphenous, and 1 popliteal and adductor canal. 24.2% (8/33) of subjects received opioid pain medication in the PACU post-operatively with a MME/kg of body weight at 0.135 per subject. Conclusion: Based on our prospective study, we recommend an initial prescription of 30 5mg hydro/oxycodone pain pills, as this represents the 3rd quartile of consumption.

Epidemiology of Obsessive-Compulsive Disorder: Cross Culture and Economy

CNS Spectrums ◽  
1999 ◽  
Vol 4 (S3) ◽  
pp. 6-12
Author(s):  
Donald W. Black
Keyword(s):  
Quality Of Life ◽  
South Africa ◽  
Treatment Response ◽  
Obsessive Compulsive Disorder ◽  
The United States ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
The Impact

AbstractThis manuscript summarizes the presentations of an international panel of experts, representing France, Hungary, India, South Africa, and the United States, on obsessive-compulsive disorder (OCD). OCD is culturally universal but probably heterogeneous. New data presented concern a follow-up study from a joint Yale-Brown clinical project; a prevalence study in Hungary; a molecular genetics study from South Africa; a comorbidity study from India; a clinical study from Paris comparing OCD with subclinical OCD; a discussion of compulsive buying as a cross-cultural phenomenon; and survey results showing the impact of OCD on quality of life and economic variables. A roundtable discussion led to a consensus that researchers must continue to: (1) investigate the prevalence of OCD in non Western samples and in less developed countries; (2) collect clinical data on OCD in child and adolescent samples, as well as in off-spring of adults with OCD; (3) refine the concept of age of onset; (4) study the impact of OCD on quality of life and the economy; (5) investigate the validity of the obsessive-compulsive spectrum in epidemiologic and clinical samples and develop appropriate instruments for its assessment; (6) study personality disorder and how it affects treatment response, and examine its prevalence in epidemiologic samples; (7) explore the concept of OCD heterogeneity, which may reflect differing etiologies but may also suggest differential treatment strategies; (8) conduct follow-up studies, particularly now that effective treatments may alter course of illness; and, finally, (9) investigate treatment response and whether certain subtypes demand unique approaches.

scholarly journals A new paradigm of screening and early diagnosis: assessment of benefits and harms

2020 ◽  
Vol 66 (6) ◽  
pp. 589-602
Author(s):  
Давид Заридзе ◽  
Dmitry Maksimovich ◽  
Ivan Stilidi
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Prostate Cancer ◽  
Clinical Trials ◽  
Early Diagnosis ◽  
The United States ◽  
Diagnostic Methods ◽  
New Paradigm

Abstract The article presents scientific evidence that confirms the new paradigm that  “early” diagnosis is not always beneficial, and that screening and early diagnosis can do more harm than good. As a result, of screening, in a number of cases, lesions are diagnosed that, although have histological patterns of cancer, are often clinically insignificant, indolent i.e. overdiagnosis takes place. Such lesions primarily include latent cancers of the prostate and thyroid gland. An increase in the incidence of certain types of cancers in the United States and other developed countries, as a result, of the introduction of PSA screening, mammography, ultrasound examination of the neck and other highly sensitive diagnostic methods, with stable or decreasing mortality, is a sign of overdiagnosis. In Russia, there is also a marked increase in the incidence of cancer of the prostate, breast, thyroid, kidney and melanoma, while mortality from these forms of cancer is stable or decreasing. The increase in the incidence of all malignant formations in Russian, as in American men, is determined by the increase in the incidence of prostate cancer. In randomized clinical trials of the efficacy of screening for prostate and breast cancer, an excess of the detected cases of cancer in the screening group compared with the control group indicates overdiagnosis. With an increase in follow-up (10-15 years), the number of excess cases in the screening group decreases. However, in some studies even after 10-15 years of follow-up, the excess of cancer cases in the screening group persisted, i.e. overdiagnosis was confirmed. Thus, the problem of overdiagnosis is also relevant to controlled clinical trials, despite a well-verified protocol and strict adherence to it. The danger of overdiagnosis in real life, daily practice, and especially with opportunistic screening, which, by definition, is carried out without quality control, is much higher. Overdiagnosis often leads to unnecessary, sometimes excessive treatment and a deterioration in the quality of life of patients who are not cancer patients. Refusal of aggressive therapy and active follow-up should be the method of choice for the management of patients with asymptomatic neoplasms identified at the screening. Such tactics will avoid unnecessary and excessive interventions, which, in turn, will prevent a deterioration in the quality of life of patients and, in addition, will reduce the cost of treatment. Key words: overdiagnosis, screening, early diagnosis, trends in incidence and mortality, prostate cancer, breast cancer, thyroid cancer

A PROSPECTIVE OBSERVATIONAL STUDY TO DETERMINE RESPONSE AND QUALITY OF LIFE IN ADVANCED HEAD&NECK CANCERS FOLLOWING HYPOFRACTIONATED PALLIATIVE EXTERNAL BEAM RADIOTHERAPY.

2021 ◽  
pp. 77-79
Author(s):  
Roopesh Reddy Yotham ◽  
Tamohan Chaudhuri ◽  
Gautam Bhattacharjee
Keyword(s):  
Quality Of Life ◽  
Head And Neck ◽  
Cell Cancer ◽  
The United States ◽  
Head And Neck Cancers ◽  
External Beam ◽  
Radio Therapy ◽  
Fractionation Schedule

Introduction: Squamous cell cancer of the head and neck (HNSCC) represents the sixth most common malignancy, with 6,50,000 new cases and 3,00,000 HNSCC related deaths reported annually worldwide. HNSCC constitutes approximately 90 percent of all head and neck cancers, and accounted for approximately 3 percent (about 50,000) of all new cancer cases and 2 percent (approximately 12,000) of all cancer deaths in 2010 in the United States. Overall, 57.5% of global head and neck cancers occur in Asia. Aims And Objectives: To Determine Local Control And Quality Of Life in stage III & IV Advanced HNSCC Following Hypo Fractionated Palliative Radiotherapy. To study the response with hypo fractionated external beam radio therapy treatment using RECISTcriteria (version 1.1). Materials And Methods: At the completion of treatment both the primary and the node Response was assessed as per the RECIST 1.1 Response Criteria and Quality of life with QLQ H&N 35 module. Results And Conclusion: At the completion of RT, 32.1% had CR, 50% had PR,14.3% had SD and 3.6% had PD. At 4 weeks of follow-up, 28.6% had CR, 53.6% had PR,14.3% had SD and 3.6% had PD. At 3 months of follow up 17.9% had CR, 60.7% had PR,10.7% had SD and 10.7% had PD. There is a statistically signicant improvement in distressing symptoms like pain, swallowing difculty, opening mouth difculty. This fractionation schedule allowed treatment to be completed in a short overall period with good tolerance and clinically acceptable toxicities

scholarly journals Emergency-Department Initiated Buprenorphine: Impact on Quality of Life Factors

2021 ◽  
Author(s):  
Caleb Carroll ◽  
Delissa Hand ◽  
Whitney Covington ◽  
Joel Rodgers ◽  
Lauren A. Walter
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Opioid Use Disorder ◽  
Treatment Programs ◽  
Opioid Use ◽  
Employment Rates ◽  
The Government ◽  
Retention In Treatment

Abstract Background: Emergency department (ED)-initiated medications for opioid use disorder (MOUD) have emerged as an effective strategy against the opioid epidemic. Opioid use disorder (OUD) patients engaged in ED-initiated MOUD programs have higher retention in treatment programs and improved outcomes with regard to overdose rates and mortality. It is unclear however, how engagement in ED-initiated MOUD programs might affect quality of life (QoL). We sought to describe demographic characteristics and QoL factors reported by patients engaged in ED-initiated MOUD and referral services. Methods: An ED MOUD-initiation program was launched in July 2019, with subsequent referral to definitive services. Enrolled patients were interviewed at intake, 3-months, and 6-months to ascertain QoL indices via the Government Performance and Results Act (GPRA) measures. Descriptive statistics and Fisher’s Exact were utilized to assess the data. Results: Through 12/2020, 89 participants were enrolled. The majority were white (85.4%), male (61.8%), and between the ages of 25-44 (75.3%). To-date, 31 participants (43.7% eligible) have completed 3-month follow-up and 28 (45.2% eligible) have competed 6-month follow-up. With regards to assessed QoL factors, over half demonstrated significant improvement, including 5 of 7 psychosocial factors, to include satisfaction with personal relationships, QoL self-rating, satisfaction with personal health, energy for everyday life, and satisfaction with self (p <.05). Financial needs met was the only objective QoL factor to demonstrate significant improvement during the follow-up time period. While not significant, homelessness also decreased, specifically 14 (15.7%) identified as homeless at intake as compared to one (3.7%) at 6-month follow-up. Additional trends toward decreased violence exposure and increased employment rates were also noted.Conclusions: In addition to decreasing illicit opioid drug use, maintenance of ED-initiated MOUD may positively impact broad QoL measures.

scholarly journals Comparison of LORETA Z Score Neurofeedback and Cognitive Rehabilitation in Terms of Their Effectiveness in Reducing Craving in Opioid Addicts

2021 ◽  
Author(s):  
Alireza Faridi ◽  
◽  
Farhad Taremian ◽  
Robert W Thatcher ◽  
Mohsen Dadashi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Attentional Bias ◽  
Cognitive Rehabilitation ◽  
Opioid Use Disorder ◽  
Z Score ◽  
Opioid Use ◽  
Cognitive Rehabilitation Therapy ◽  
Post Test

Background: Previous studies have shown that conventional neurofeedback and cognitive modification treatments have led to numerous psychological improvements in patients suffering from substance use disorders. However, effectiveness of LORETA (Low-Resolution Brain Electromagnetic Tomography) Z score neurofeedback (LZNFB) and Cognitive rehabilitation therapy on reducing of opium craving has yet to be investigated. Thus, aim of the present study was to compare effectiveness of LZNFB and Cognitive rehabilitation therapy with methadone maintenance treatment (MMT) in reduction of opium craving in patients with opioid use disorder. Methods: Thirty patients with opioid use disorder undergoing MMT were randomly assigned into three groups: LZNFB with MMT, Cognitive rehabilitation with MMT (as experimental groups), and MMT alone Control group. The LZNFB and Cognitive rehabilitation groups received 20 and 15 sessions of treatment, respectively. The three groups were assessed using a number of questionnaires as well as Dot-Probe Task at pre-test, post-test, and one-month follow-up. Results: The results showed that both experimental groups accomplished significantly greater reduction in opium craving than MMT alone group at post-test and follow up (P<0.05). The LZNFB with MMT group showed higher decrease in opioid craving than the Cognitive rehabilitation with MMT group. In addition, Cognitive rehabilitation group experienced greater improvement on attentional bias towards craving cues than LZNFB with MMT group at post-test and follow up. Finally, LZNFB with MMT group and Cognitive rehabilitation with MMT group got higher scores on the recovery assessment scale than MMT alone group at post-test and follow up. According to results of this study, LZNFB training is more effective than Cognitive Rehabilitation in decreasing of craving and improving quality of life in addiction to opioids. Conclusion: The findings of the current study provided preliminary support for the effectiveness of LZNFB and Cognitive rehabilitation on reduction of opium craving, improvement of attentional bias towards craving cues and quality of life among Iranian opioids use patients.

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