Polypharmacy, Opioid Use, and Fibromyalgia

2016 ◽  
Vol 19 (1) ◽  
pp. 97-105 ◽  
Author(s):  
Victoria Menzies ◽  
Leroy R. Thacker ◽  
Sallie D. Mayer ◽  
Anna M. Young ◽  
Shelby Evans ◽  
...  
Keyword(s):  
Symptom Management ◽  
Patient Population ◽  
Adverse Drug Events ◽  
Predictor Variable ◽  
Chronic Widespread Pain ◽  
Pain Severity ◽  
Pain Interference ◽  
Widespread Pain ◽  
Opioid Use ◽  
The Impact

The major therapeutic approach for treating fibromyalgia (FM), a chronic widespread pain syndrome, is pharmacotherapy-centered symptom management. Complexity of treatment often leads to multiple medication prescriptions. While there is no current alternative to the probable need for polypharmacy in this patient population, there remains concern related to potential side effects and adverse drug events. In this secondary analysis of data on medications taken collected from two parent studies, all medications were broken down into the following categories: opioid, nonopioid, antidepressant, anticonvulsant, muscle relaxant, and benzodiazepine. The impact on pain severity and pain interference of these medication categories as well as perceived stress, fatigue, and depression scores was assessed. Baseline pain severity ( p = .0106) and pain interference ( p = .0002) were significantly correlated with opioid use as compared to nonopioid use. A multivariate regression with backward elimination resulted in a model for pain severity with one significant predictor variable, fatigue ( p < .0001); pain interference had three significant predictor variables: opioid use ( p = .04), fatigue ( p < .0001), and depression ( p = .04). While future studies should further address the utility of opioids and examine the role of polypharmacy as part of symptom management strategies for individuals with FM, study findings suggest that, for those who suffer chronic widespread pain as the predominant symptom experience, a challenge equally as perplexing for nurses and nursing research alike as managing the pain lies in addressing the fatigue and depression in this patient population.

scholarly journals 309. The Impact of Addiction Medicine Consultation on Discharges Against Medical Advice in Patients with Opioid Use Disorder and Staphylococcus Aureus Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S152-S152
Author(s):  
Stephanie Spivack ◽  
Daniel Mueller ◽  
Peter Axelrod ◽  
Joseph D’Orazio
Keyword(s):  
Staphylococcus Aureus ◽  
Patient Population ◽  
Medical Advice ◽  
Index Admission ◽  
Opioid Use ◽  
Urban Hospital ◽  
Addiction Medicine ◽  
Against Medical Advice ◽  
Number Of Patients ◽  
The Impact

Abstract Background People who inject drugs (PWID) are at risk for infectious complications of their injection practices, including Staphylococcus aureus (SA) bacteremia. Prolonged hospitalization is sometimes required; however, rates of discharges against medical advice (AMA) are elevated in this patient population. Inadequate control of pain and opioid withdrawal are commonly cited. Our aim was to assess the effectiveness of addiction medicine consultation for preventing AMA discharges. Methods We performed a retrospective chart review of adult PWID admitted to an urban hospital with SA bacteremia between August 2016 and May 2018. Demographics, HIV and HCV status, and presence or absence of addiction medicine consultation were recorded. We assessed whether discharges were planned or AMA; the number of hospitalizations at 30 days, 90 days, and 1 year from index admission; and death within one year. EpiInfo6 was used for data analysis. Results A total of 360 patients with SA bacteremia were reviewed. Of these, 101 reported intravenous opioid use at admission. Average age was 37 years, and 64% were male. HIV and HCV were present in 13% and 82% of patients, respectively. Addiction medicine was consulted on 29 patients. Of these, 4/29 (13.8%) left AMA, compared to 27/72 (37.5%) of patients without an addiction consult (RR = 0.3678 [95% CI = 0.1412 - 0.9583], p = 0.02). Patients receiving addiction medicine consultation averaged 0.17 readmissions within 30 days of their index admission, compared to 0.39 readmissions in the group without addiction medicine consult (p = 0.27). Readmissions at 90 days and 1 year were also lower but not statistically significant. At 1 year, 6 deaths were observed; 2 who had addiction medicine consultation and 4 who did not. Conclusion Consultation with an addiction medicine specialist significantly reduced the number of patients discharged AMA in a high-risk cohort of PWID presenting with SA bacteremia. Numerically fewer readmissions occurred after consultation, though this difference was not statistically significant. Mortality in both groups was low. There were high rates of HIV and HCV in this patient population, suggesting a particularly vulnerable patient population, which warrants further study. Disclosures All Authors: No reported disclosures

scholarly journals Central Sensitization in Neurological, Psychiatric, and Pain Disorders: A Multicenter Case-Controlled Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Keisuke Suzuki ◽  
Yasuo Haruyama ◽  
Gen Kobashi ◽  
Toshimi Sairenchi ◽  
Koji Uchiyama ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Central Sensitization ◽  
Pain Severity ◽  
Pain Interference ◽  
Daily Activities ◽  
Effect Sizes ◽  
Medium Effect ◽  
Controlled Study ◽  
Severity Scores ◽  
The Impact

Background. The role of central sensitization in refractory pain-related diseases has not yet been clarified. Methods. We performed a multicenter case-controlled study including 551 patients with various neurological, psychological, and pain disorders and 5,188 healthy controls to investigate the impact of central sensitization in these patients. Symptoms related to central sensitization syndrome (CSS) were assessed by the Central Sensitization Inventory (CSI) parts A and B. Patients were categorized into 5 groups based on CSI-A scores from subclinical to extreme. The Brief Pain Inventory (BPI), addressing pain severity and pain interference with daily activities, and the Patient Health Questionnaire (PHQ)-9, assessing depressive symptoms, were also administered. Results. CSI-A scores and CSI-B disease numbers were significantly greater in patients than in controls ( p < 0.001 ). Medium effect sizes (r = 0.37) for CSI-A scores and large effect sizes (r = 0.64) for CSI-B disease numbers were found between patients and control groups. Compared with the CSI-A subclinical group, the CSI-A mild, moderate, severe, and extreme groups had significantly higher BPI pain interference and severity scores, PHQ-9 scores, and CSS-related disease numbers based on ANCOVA. Greater CSI-B numbers resulted in higher CSI-A scores ( p < 0.001 ) and a higher odds ratio ( p for trend <0.001). CSS-related symptoms were associated with pain severity, pain interference with daily activities, and depressive symptoms in various pain-related diseases. Conclusions. Our findings suggest that CSS may participate in these conditions as common pathophysiology.

scholarly journals THE OPIOID EPIDEMIC IN LONG-TERM CARE: A STAFF PERSPECTIVE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S709-S709
Author(s):  
Rachael Hemmert ◽  
Gabriella E Dull ◽  
Linda S Edelman
Keyword(s):  
Pain Management ◽  
Long Term Care ◽  
Adverse Drug Events ◽  
Well Being ◽  
Educational Needs ◽  
Opioid Use ◽  
Term Care ◽  
Opioid Prescription ◽  
The Impact

Abstract Opioid-based analgesic therapy is a common treatment for moderate to severe pain among long term care (LTC) residents. It has been estimated that 60% of LTC residents have an opioid prescription. Of these, 14% use opioids as part of a long term pain management strategy. LTC residents are particularly vulnerable to opioid misuse, exhibiting higher rates of adverse drug events. However, addressing pain, polypharmacological needs and resident well-being in the LTC setting is challenging. More research and education regarding opioid use in LTC is needed. The Utah Geriatric Education Consortium conducted interprofessional focus groups with LTC partners to 1) determine educational needs of staff regarding opioid use, and 2) gather qualitative data about the pain management experiences of staff when working with residents and families. Staff identified the following training needs: pain manifestation and assessment; certified nurse assistant education on opioid use; non-pharmacological options for pain management. Review of staff’s perception of the intersection of opioids, family and staff in a LTC setting revealed that 1) family is concerned about opioid use; 2) conversely, staff may not see opioid use as a problem; and 3) non-pharmacological options for pain management are often costly and unavailable to those in LTC. Identifying educational needs of LTC staff will help guide the development of educational materials and provide baseline data for future assessments of the impact of opioid education on long-term care patient outcomes.

scholarly journals Persistent Post-Mastectomy Pain: The Impact of Regional Anesthesia Among Patients with High vs Low Baseline Catastrophizing

Pain Medicine ◽  
2021 ◽  
Author(s):  
Nantthasorn Zinboonyahgoon ◽  
Megan E Patton ◽  
Yun-Yun K Chen ◽  
Rob R Edwards ◽  
Kristin L Schreiber
Keyword(s):  
Regional Anesthesia ◽  
Severity Index ◽  
Estimating Equation ◽  
Pain Severity ◽  
Psychosocial Assessment ◽  
Emotional Impact ◽  
Opioid Use ◽  
Variable Success ◽  
Long Term Impact ◽  
The Impact

Abstract Background Persistent post-mastectomy pain (PPMP) varies both in its severity and impact, with psychosocial factors such as catastrophizing conferring greater risk. Preoperative regional anesthesia (RA) is an important nonopioid therapy, but with variable success at preventing PPMP in previous reports. We previously reported that RA was associated with lower acute post-mastectomy pain and opioid use, but more prominently among patients with higher baseline catastrophizing. The current longitudinal investigation at 3, 6, and 12 months postop aimed to detect differential long-term impact of RA on PPMP among patients with high vs low catastrophizing. Methods In this prospective observational study, patients (n = 123) completed preoperative psychosocial assessment and underwent mastectomy either with (n = 56) or without (n = 67) preoperative RA. Generalized estimating equation (GEE) regression analysis assessed impact of baseline catastrophizing, RA, and their interaction, on the primary outcome of pain severity index, as well as secondary outcomes including cognitive and emotional impact of pain, and persistent opioid use. Results We observed a significant interaction between the effect of catastrophizing and RA on PPMP. Specifically, RA was associated with reduced pain severity and pain impact 3, 6, and 12 months postoperatively, but only among those with high baseline catastrophizing scores. In addition, both RA and lower catastrophizing scores were associated with lower incidence of persistent opioid use. Conclusions The efficacy of therapies to prevent PPMP may be importantly influenced by pain-modulatory psychosocial characteristics. These findings underscore the importance of considering individual patient factors when applying preventive treatments, and of including their assessment in future trials.

scholarly journals Identifying a Need for Mental Health Services Posthospitalization in Adolescent Trauma Patients

2020 ◽  
Vol 3 ◽  
Author(s):  
Alexandra Hochstetler ◽  
Ashley Vetor ◽  
Jodi Raymond ◽  
Hannah Bozell ◽  
Teresa Bell
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Alcohol Use ◽  
Mental Health Disorders ◽  
Pain Severity ◽  
Pain Interference ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Health Disorders ◽  
Prescription Opioid Use

Background: Nearly 150,000 children were hospitalized due to an injury in 2018. Hospitalized patients are often prescribed opioids and as a result, one in eight adolescents will continue using opioids twelve months after hospitalization. Predictors of sustained opioid use and future misuse posthospitalization have yet to be studied in adolescents. One of these predictors may be mental health disorders following hospitalization. It is known mental health disorders can lead to substance use disorders if not addressed properly. In this study we examined the associations between injury severity, mental health, and substance use among adolescents.     Methods: Patients between 12 to 18 years old admitted for trauma were surveyed upon enrollment, and subsequently at 1, 3, 6, and 12 months posthospitalization. These surveys measured anxiety, depression, posttraumatic stress, prescription and non-prescription drug use, pain severity and pain interference.   Results: At enrollment and one-month posthospitalization, higher pain interference was associated with anxiety (p=.003), depression (p<.001), and PTSD (p=.004). Increased pain severity was also associated with higher PTSD (p=.003) However, at three months, pain severity and interference were only associated with PTSD (p=.005, p=.009). Frequent alcohol use and higher PTSD were found to be statistically significant at six and twelve months (p=.02). Regular prescription opioid use was related to higher anxiety (p=.048) and depression (p=.048) only at enrollment and higher PTSD only at one month (p=.034). Prescription opioid use was not associated with pain severity and interference at enrollment but was found significant at one month (p=.016, p=.36).    Conclusion: Adolescents who reported higher pain severity and interference also more commonly had mental health disorders such as PTSD, anxiety, and depression. Higher PTSD scores and frequent alcohol use were also related post-injury. Screening for mental health after hospitalization should be further investigated in identifying adolescents who may be at risk for future opioid use disorders. 

Acceptance: a factor to consider in persistent pain after neck trauma

2019 ◽  
Vol 19 (4) ◽  
pp. 733-741 ◽  
Author(s):  
Sophia Åkerblom ◽  
Johan Larsson ◽  
Eva-Maj Malmström ◽  
Elisabeth Persson ◽  
Hans Westergren
Keyword(s):  
Sex Education ◽  
Psychological Factors ◽  
Enhanced Recovery ◽  
Treatment Strategies ◽  
Persistent Pain ◽  
Pain Severity ◽  
Pain Interference ◽  
Widespread Pain ◽  
Neck Trauma ◽  
Pain Distribution

AbstractBackground and aimsStudies on the interaction between acceptance and pain-related processes after neck trauma are to our knowledge sparse and such treatment strategies are rarely incorporated in management and treatment of posttraumatic neck pain. Thus, the aim of the present study is to investigate how acceptance relates to persistent pain in patients after neck trauma, when controlling for the influence of other psychological factors, trauma characteristics and demographic variables.MethodsConsecutive patients with persistent pain and disability after neck trauma (n = 565) were assessed by a multi-professional team at a specialized pain rehabilitation clinic. Separate regression analyses were conducted with three outcomes: pain distribution, pain interference, and pain severity. Predictors were age, sex, education, time since trauma, type of trauma, anxiety, depression, and acceptance.ResultsAcceptance was the only factor associated with all outcomes, and patients with lower acceptance displayed more widespread pain and greater interference and severity of pain. The results also showed that higher depression was associated with worse pain interference and severity, whilst anxiety only mattered significantly for pain severity and not for pain interference. Female sex was related to more widespread pain and greater pain interference.ConclusionsOverall acceptance stood out as the most important factor for the different outcomes and lower acceptance was associated with more widespread pain distribution and greater pain interference and severity.ImplicationsThe findings of this study add to a growing body of literature confirming that the development of chronicity after neck trauma should be understood as a multidimensional process, best described by a biopsychosocial model. The results also suggest that psychological factors and especially acceptance might be important processes with implications for enhanced recovery after neck trauma.

scholarly journals CHRONIC PAIN, FEAR OF FALLING, AND RESTRICTED ACTIVITY DAYS IN AN OLDER POPULATION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S18-S18
Author(s):  
Suzanne Leveille
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Fall Risk ◽  
Fear Of Falling ◽  
Pain Severity ◽  
Pain Interference ◽  
Multisite Pain ◽  
Restricted Activity ◽  
Pain Characteristics ◽  
The Impact

Abstract Both chronic pain and fear of falling can lead to activity restriction and increased fall risk among vulnerable elders. Little is known about pain characteristics that may be associated with fear of falling, contributing to restricted activity. We studied 765 adults aged ≥65y (mean=78.9y) in the MOBILIZE Boston Study, to evaluate the cross-sectional relationship between pain characteristics and fear of falling measured using the Falls Efficacy Scale (FES). In addition, we examined the impact of pain and fear of falling on restricted activity. We measured 3 domains of global pain: pain distribution (none, single site or multisite pain), and Brief Pain Inventory subscales of pain severity and pain interference. Restricted activity days (RADs) refer to the count of self-reported days of reduced activity due to illness or injury in the previous 12 months. We performed multivariable logistic regressions predicting fear of falling (FES&lt;90/100) adjusted for sociodemographics, fall history and fall risk factors. Participants with multisite pain or moderate-to-high pain interference ratings were more likely to have fear of falling (adj.OR 1.97, 95%CI 1.05-3.67; adj.OR 4.02, 95%CI 2.0-8.06, respectively). Pain severity was not associated with FES. Older adults with multisite pain and fear of falling reported significantly more RADs than those with multisite pain without fear of falling (79±135 and 26±74 RADs, respectively; test for pain x FES interaction, p=0.01). Older adults with chronic pain have greater fear of falling which may contribute to restricted activity. Efforts are needed to increase activity and falls efficacy among older adults with chronic pain.

(433) Polypharmacy, opioid use, and chronic widespread pain: a secondary analysis of clinical trial data

2015 ◽  
Vol 16 (4) ◽  
pp. S84
Author(s):  
V. Menzies ◽  
A. Young ◽  
L. Thacker ◽  
S. Mayer ◽  
L. Barstow ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Secondary Analysis ◽  
Clinical Trial Data ◽  
Chronic Widespread Pain ◽  
Trial Data ◽  
Widespread Pain ◽  
Opioid Use

scholarly journals The Effect of Obesity on Pain Severity and Pain Interference

2020 ◽  
Author(s):  
Jade Basem ◽  
Robert S. White ◽  
Stephanie A. Chen ◽  
Elizabeth Mauer ◽  
Michele L. Steinkamp ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Severity ◽  
Pain Interference ◽  
Pain Clinic ◽  
Opioid Prescription ◽  
The Past ◽  
Total Pain ◽  
Severity Scores ◽  
The Impact ◽  
Interference Score

ABSTRACTBackground and objectivesObesity is one of the most prevalent comorbidities associated with chronic pain, the experience of which can severely interfere with activities of daily living and increase the utilization of clinical resources. Obesity is also a risk factor for increased pain severity (pain intensity) and pain interference (pain related disability). We hypothesize that a higher level of obesity, as measured by body mass index (BMI), would be associated with increased levels of pain severity and interference in a population of chronic pain clinic patients.MethodsParticipant data was pulled from a multi-site chronic pain outpatient database from 7/8/2011 to 10/17/2016. The Brief Pain Inventory (BPI), opioid prescriptions, and basic demographic information were queried and we categorized participants into three different ordinal categories based on recorded BMI levels (underweight, normal and overweight, obese). Bivariate analyses were performed to compare pain outcomes by BMI and by other demographic/clinical patient characteristics. Multivariable linear regressions were constructed to model each of four pain severity scores in addition to total pain interference score. All models examined BMI as the primary predictor, controlling for age, receipt of a pain procedure within 45 days prior to the pain clinic encounter, opioid prescription within 45 days prior to the encounter, and diagnosis. The total pain interference model additionally included pain severity (as measured by worst pain in the past 24 hours) as a covariate.Results2509 patients were included in the study. The median BMI was 27 and the median age was 59 years. 77% of patients were diagnosed with musculoskeletal pain conditions. Bivariate tests revealed significant differences between BMI groups for all pain severity scores and for total pain interference score. On multivariable modelling controlling for age, pain procedure within 45 days prior to pain clinic encounter, opioid prescription with 45 days prior, and diagnosis, obese patients had significantly higher pain severity (as measured by worst, least, average, and current pain in the past 24 hours) as well as higher pain interference (as measured by the overall pain interference score) than normal weight and overweight patients.ConclusionIn our study of pain clinic patients, obesity was found to be associated with increased pain severity and pain interference. We believe that this relationship is multifactorial and bidirectional. Pain phyisicans should consider the impact of obesity when addressing pain management for patients.

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