scholarly journals The Associations Between OPRM1 and COMT Genotypes and Postoperative Pain, Opioid Use, and Opioid-Induced Sedation

2012 ◽  
Vol 15 (3) ◽  
pp. 309-317 ◽  
Author(s):  
Richard A. Henker ◽  
Allison Lewis ◽  
Feng Dai ◽  
William R. Lariviere ◽  
Li Meng ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Postanesthesia Care Unit ◽  
Trauma Patients ◽  
Orthopedic Trauma ◽  
Nucleotide Polymorphisms ◽  
Opioid Use ◽  
Acute Postoperative Pain ◽  
Comt Genotype ◽  
Sedation Scores ◽  
Physiologic Responses

Previous studies have associated mu-opioid receptor ( OPRM1) genotype with pain and analgesia responses in postoperative and patient populations. This study investigates the role of catechol-O-methyltransferase ( COMT) and OPRM1 genotypes in acute postoperative pain scores, opioid use, and opioid-induced sedation after surgical procedures for orthopedic trauma in an otherwise healthy patient population. Verbal pain/sedation scores, opioid use, and physiologic responses in the immediate postoperative period were examined for association with genetic variants in Caucasians genotyped for OPRM1 single nucleotide polymorphisms (SNPs) A118G and C17T and COMT SNPs. The OPRM1 A118G genotype was associated with patients’ postoperative Numerical Pain scale (NPS) ratings at 15 min in the postanesthesia care unit (PACU) ( p = .01) and patients' sedation scores at 15 min in the PACU ( p = .02). COMT genotype (rs4818) was associated with opioid consumption in the first 45 min in the PACU ( p = .04). NPS ratings at 45 min were also higher in the group of patients with A/A genotype of rs4680 than in patients with the other two genotypes at this SNP ( p = .03). Our haplotype trend analysis identified a COMT haplotype “GCGG” significantly associated with NPS at 15 min ( p = .0013), amount of opioids consumed in the first 45 min ( p = .0024), and heart rate at 45 min in the PACU ( p = .017). The results indicate that genetic variations in COMT contribute to the acute postoperative pain and analgesia responses and physiologic responses in this group of otherwise healthy postoperative orthopedic trauma patients.

scholarly journals Postoperative Pain Control Following Cardiac Implantable Electronic Device Implantation

2021 ◽  
Author(s):  
Peter Magnusson ◽  
Jo Ann LeQuang ◽  
Joseph V. Pergolizzi
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Electronic Device ◽  
Perioperative Period ◽  
Cardiac Implantable Electronic Device ◽  
Opioid Use ◽  
Acute Postoperative Pain ◽  
Device Implantation ◽  
Analgesic Regimen ◽  
Short Course

Postoperative pain following cardiac implantable electronic device (CIED) surgery may not always be adequately treated. The postoperative pain trajectory occurs over several days following the procedure with tenderness and limited arm range of motion lasting for weeks after surgery. Pain control typically commences in the perioperative period while the patient is in the hospital and may continue after discharge; outpatients may be given a prescription and advice for their analgesic regimen. It is not unusual for CIED patients to be discharged a few hours after implantation. While opioids are known as an effective analgesic to manage acute postoperative pain, growing scrutiny on opioid use as well as their side effects and potential risks have limited their use. Opioids may be considered for appropriate patients for a short course of treatment of acute postoperative pain, but other analgesics may likewise be considered.

scholarly journals Percutaneous Peripheral Nerve Stimulation to Control Postoperative Pain, Decrease Opioid Use, and Accelerate Functional Recovery Following Orthopedic Trauma

2019 ◽  
Vol 184 (Supplement_1) ◽  
pp. 557-564 ◽  
Author(s):  
Brian M Ilfeld ◽  
Scott T Ball ◽  
Steven P Cohen ◽  
Steven R Hanling ◽  
Ian M Fowler ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Case Series ◽  
Opioid Therapy ◽  
Peripheral Nerve Stimulation ◽  
Orthopedic Trauma ◽  
Opioid Use ◽  
Postamputation Pain ◽  
Improved Function

Abstract Orthopedic trauma is a significant military problem, causing several of the most disabling conditions with high rates of separation from duty and erosion of military readiness. The objective of this report is to summarize the findings of case series of a non-opioid therapy—percutaneous peripheral nerve stimulation (PNS) – and describe its potential for postoperative analgesia, early opioid cessation, and improved function following orthopedic trauma. Percutaneous PNS has been evaluated for the treatment of multiple types of pain, including two case series on postoperative pain following total knee replacement (n = 10 and 8, respectively) and a case series on postamputation pain (n = 9). The orthopedic trauma induced during TKR is highly representative of multiple types of orthopedic trauma sustained by Service members and frequently produces intense, prolonged postoperative pain and extended opioid use following surgery. Collectively, the results of these three clinical studies demonstrated that percutaneous PNS can provide substantial pain relief, reduce opioid use, and improve function. These outcomes suggest that there is substantial potential for the use of percutaneous PNS following orthopedic trauma.

Psychological Characteristics, Female Sex, and Opioid Use Predict Acute Postoperative Pain in Patients Surgically Treated for Thumb Base Osteoarthritis: A Cohort Study

2020 ◽  
Vol 146 (6) ◽  
pp. 1307-1316
Author(s):  
Robbert M. Wouters ◽  
Jarry T. Porsius ◽  
Mark J. W. van der Oest ◽  
Harm P. Slijper ◽  
J. Sebastiaan Souer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Postoperative Pain ◽  
Psychological Characteristics ◽  
Opioid Use ◽  
Acute Postoperative Pain ◽  
Female Sex

Toxicology Screening in Orthopedic Trauma Patients Predicting Duration of Prescription Opioid Use

2006 ◽  
Vol 24 (4) ◽  
pp. 31-41 ◽  
Author(s):  
Gene M. Massey ◽  
Heather N. Dodds ◽  
Craig S. Roberts ◽  
Timothy J. Servoss ◽  
Richard D. Blondell
Keyword(s):  
Prescription Opioid ◽  
Trauma Patients ◽  
Orthopedic Trauma ◽  
Opioid Use ◽  
Toxicology Screening ◽  
Prescription Opioid Use

scholarly journals Patient and Procedural Determinants of Postoperative Pain Trajectories

2021 ◽  
Vol 134 (3) ◽  
pp. 421-434
Author(s):  
Terrie Vasilopoulos ◽  
Richa Wardhan ◽  
Parisa Rashidi ◽  
Roger B. Fillingim ◽  
Margaret R. Wallace ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Oral Morphine ◽  
Surgical Patient ◽  
Opioid Use ◽  
Acute Postoperative Pain ◽  
Patient Factors ◽  
Pain Group ◽  
Pain Trajectories

Background The primary goal of this study was to evaluate patterns in acute postoperative pain in a mixed surgical patient cohort with the hypothesis that there would be heterogeneity in these patterns. Methods This study included 360 patients from a mixed surgical cohort whose pain was measured across postoperative days 1 through 7. Pain was characterized using the Brief Pain Inventory. Primary analysis used group-based trajectory modeling to estimate trajectories/patterns of postoperative pain. Secondary analysis examined associations between sociodemographic, clinical, and behavioral patient factors and pain trajectories. Results Five distinct postoperative pain trajectories were identified. Many patients (167 of 360, 46%) were in the moderate-to-high pain group, followed by the moderate-to-low (88 of 360, 24%), high (58 of 360, 17%), low (25 of 360, 7%), and decreasing (21 of 360, 6%) pain groups. Lower age (odds ratio, 0.94; 95% CI, 0.91 to 0.99), female sex (odds ratio, 6.5; 95% CI, 1.49 to 15.6), higher anxiety (odds ratio, 1.08; 95% CI, 1.01 to 1.14), and more pain behaviors (odds ratio, 1.10; 95% CI, 1.02 to 1.18) were related to increased likelihood of being in the high pain trajectory in multivariable analysis. Preoperative and intraoperative opioids were not associated with postoperative pain trajectories. Pain trajectory group was, however, associated with postoperative opioid use (P < 0.001), with the high pain group (249.5 oral morphine milligram equivalents) requiring four times more opioids than the low pain group (60.0 oral morphine milligram equivalents). Conclusions There are multiple distinct acute postoperative pain intensity trajectories, with 63% of patients reporting stable and sustained high or moderate-to-high pain over the first 7 days after surgery. These postoperative pain trajectories were predominantly defined by patient factors and not surgical factors. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Perioperative Continuation of Buprenorphine at Low–Moderate Doses Was Associated with Lower Postoperative Pain Scores and Decreased Outpatient Opioid Dispensing Compared with Buprenorphine Discontinuation

Pain Medicine ◽  
2020 ◽  
Vol 21 (9) ◽  
pp. 1955-1960 ◽  
Author(s):  
Aurora Quaye ◽  
Kevin Potter ◽  
Sarah Roth ◽  
Gregory Acampora ◽  
Jianren Mao ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Opioid Use Disorder ◽  
Postanesthesia Care Unit ◽  
Opioid Use ◽  
Opioid Agonist ◽  
Medication Assisted Treatment ◽  
Pain Scores ◽  
Surgical Subspecialty ◽  
Number Of Individuals ◽  
Buprenorphine Treatment

Abstract Objective An increasing number of individuals are prescribed buprenorphine as medication-assisted treatment for opioid use disorder. Our institution developed guidelines for perioperative buprenorphine continuation with an algorithm for dose reduction based upon the surgical procedure and patient's maintenance dose. The objective of this study was to compare the effects of buprenorphine continuation with those of discontinuation on postoperative pain scores and outpatient opioid dispensing. Design Retrospective observational study. Subjects Surgical patients on buprenorphine from March 2018 to October 2018. Patients on buprenorphine for chronic pain and those with minor procedures were excluded from analysis. Methods We compared postoperative outpatient opioid dispensing and postanesthesia care unit (PACU) pain scores in patients where buprenorphine was continued compared with held perioperatively, collecting single surgical subspecialty prescriber data on outpatient full mu-opioid agonist prescriptions dispensed, converted into mean morphine equivalents. Buprenorphine formulations were not included in our morphine milligram equivalents (MME) total. Results There were 55 patients total (38 cont. vs 17 held). There was no difference in postoperative buprenorphine treatment adherence (91% cont. vs 88% held, P = 0.324). The number of opioid prescriptions dispensed was significantly higher with buprenorphine discontinuation (53% cont. vs 82% held, P = 0.011), as was MME dispensed (mean of 229 cont. vs mean of 521 held, P = 0.033). PACU pain scores were higher with buprenorphine discontinuation (mean 2.9 cont. vs mean 7.6 held, P < 0.001). Conclusions There was a significant reduction in opioid prescriptions filled, MME dispensed, and PACU pain scores in patients where buprenorphine was continued vs held perioperatively. We provide evidence to support that buprenorphine can be continued perioperatively and that continuation is associated with decreased postoperative pain and decreased outpatient opioid dispensing. These results contribute to the existing literature supporting the perioperative continuation of buprenorphine.

scholarly journals The effect of a Life Care Specialist on pain management and opioid-related outcomes among patients with orthopedic trauma: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Nicholas A. Giordano ◽  
Jesse Seilern und Aspang ◽  
J‘Lynn Baker ◽  
Cammie Wolf Rice ◽  
Bailey Barrell ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Substance Use ◽  
Pain Management ◽  
Controlled Trial ◽  
Trauma Patients ◽  
Orthopedic Trauma ◽  
Life Care ◽  
Opioid Use ◽  
Randomized Controlled ◽  
Care Specialist

Abstract Background Orthopedic trauma patients face complex pain management needs and are frequently prescribed opioids, leaving them at-risk for prolonged opioid use. To date, post-trauma pain management research has placed little emphasis on individualized risk assessments for misuse and systematically implementing non-pharmacologic pain management strategies. Therefore, a community-academic partnership was formed to design a novel position in the healthcare field (Life Care Specialist (LCS)), who will educate patients on the risks of opioids, tapering usage, safe disposal practices, and harm reduction strategies. In addition, the LCS teaches patients behavior-based strategies for pain management, utilizing well-described techniques for coping and resilience. This study aims to determine the effects of LCS intervention on opioid utilization, pain control, and patient satisfaction in the aftermath of orthopedic trauma. Methods In total, 200 orthopedic trauma patients will be randomized to receive an intervention (LCS) or a standard-of-care control at an urban level 1 trauma center. All patients will be assessed with comprehensive social determinants of health and substance use surveys immediately after surgery (baseline). Follow-up assessments will be performed at 2, 6, and 12 weeks postoperatively, and will include pain medication utilization (morphine milligram equivalents), pain scores, and other substance use. In addition, overall patient wellness will be evaluated with objective actigraphy measures and patient-reported outcomes. Finally, a survey of patient understanding of risks of opioid use and misuse will be collected, to assess the influence of LCS opioid education. Discussion There is limited data on the role of individualized, multimodal, non-pharmacologic, behavioral-based pain management intervention in opioid-related risk-mitigation in high-risk populations, including the orthopedic trauma patients. The findings from this randomized controlled trial will provide scientific and clinical evidence on the efficacy and feasibility of the LCS intervention. Moreover, the final aim will provide early evidence into which patients benefit most from LCS intervention. Trial registration ClinicalTrials.govNCT04154384. Registered on 11/6/2019 (last updated on 6/10/2021).

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