scholarly journals Tramadol prescribed use in general and chronic noncancer pain: a nationwide register-based cohort study of all patients above 16 years

2019 ◽  
Vol 20 (1) ◽  
pp. 109-124 ◽  
Author(s):  
Carrinna Aviaja Hansen ◽  
Martin T. Ernst ◽  
Maria Stougaard ◽  
Bo Abrahamsen
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Western World ◽  
Opioid Use ◽  
Chronic Noncancer Pain ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Noncancer Pain ◽  
Weak Opioid

AbstractBackground and aimsIn the Western world, it has become clear that we are facing a crisis of overuse, abuse and improperly prescribed use of opioids. As part of the ongoing discussion on opioid use, the use and prescription of tramadol have been addressed in recent years. A significant portion of this discussion should adequately address the risk factors for the use of weak opioid products such as tramadol. The risk factors which characterise the long-term tramadol use are still incompletely understood. Thus, we aimed to describe the characteristics of Danish patients using tramadol in more detail, under different scenarios and determinants of subsequent usage patterns.MethodsWe conducted a nationwide cohort study to identify individuals purchasing tramadol from 01/01/2004 to 31/12/2015 who are age 16 +  years old by using data from The Danish National Databases; these databases consist of unique information for all citizens in Denmark. Logistic regression analyses were used to assess the potential risk factors for repeated tramadol use.ResultsThe final cancer-free cohort consisted of N = 941,839 tramadol users: 54.4% women, with a mean age of 53.2 years. The number of chronic noncancer pain (CNCP) was 430,641 individuals, and 56% of the total third who repeated the use of tramadol with two +  purchased prescriptions were CNCP patients. The increased risk of repeated use for CNCP was, among others, associated with: male sex (HR 1.21), age 69–110 (HR 1.72), back/spine pain men (HR 1.47), women (HR 1.46), spondylopathies (HR 1.24), male osteoporosis (HR 1.22), multimorbid ulcer/skin (HR 1.28), region of municipality Northern Jutland (HR 1.74), Central Jutland (HR 1.75), number of co-medication 4–9 (HR 1.33), dementia (HR 1.27). Factors associated with decreased risk: co-medication ischemic heart disease (HR 0.85), diagnosis headache (HR 0.70), household income highest tertile (HR 0.81), unknown (HR 0.70), single women (HR 0.96).ConclusionsThis study proved a widespread prescribed use of tramadol in Denmark, and, as know from the literature, weak opioid use may lead to long-term use of high potent opioids, this usage is inappropriate, in general, but especially for the treatment of CNCP.ImplicationsWhen striving to reduce the overuse of opioids, focus on the extensive use of tramadol may be essential. The current study indicates an excessive and not appropriately prescribed use of tramadol among Danish CNCP patients. In addition to being inappropriate, such use may also have an impact on the growing problem of an illicit Internet market for this drug. Thus, the situation must be taken seriously. The current study confirms the recent clinical guideline and the National Recommendations in Denmark, which emphasises the risks of problematic use of tramadol. The research may also be relevant in other comparable countries. Caution must especially be taken with CNCP patients with comorbidities like diabetes, lung disease, dementia, and osteoporosis.

Long-term opioid users with chronic noncancer pain: Assessment of opioid abuse risk and relationship with healthcare resource use

2018 ◽  
Vol 14 (2) ◽  
pp. 131 ◽  
Author(s):  
Anna D. Coutinho, BPharm, PhD ◽  
Kavita Gandhi, BPharm, MS ◽  
Rupali M. Fuldeore, BAMS, MS ◽  
Pamela B. Landsman-Blumberg, MPH, DrPH ◽  
Sanjay Gandhi, PhD
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Opioid Abuse ◽  
Low Risk ◽  
Chronic Noncancer Pain ◽  
Cart Analysis ◽  
Risk Patients ◽  
Noncancer Pain ◽  
Abuse Risk

Objective: Identify opioid abuse risk factors among chronic noncancer pain (CNCP) patients receiving long-term opioid therapy and assess healthcare resource use (HRU) among patients at elevated abuse risk.Design: Data were obtained from an integrated administrative claims database. Classification and Regression Tree (CART) analysis identified risk factors potentially predictive of opioid abuse, which were used to classify the overall population into cohorts defined by levels of abuse risk. Multivariable logistic regression compared HRU across risk cohorts.Setting: Retrospective cohort study.Patients, participants: 21,072 patients aged ≥18 years diagnosed with ≥1 of 5 types of CNCP and a prescription for Schedule II or III/IV opioid medication used long-term (≥90 days).Main outcome measures: (1) Opioid abuse risk factors; (2) HRU differences between risk cohorts.Results: CART analysis identified four groups at elevated opioid abuse risk defined by three factors (age, daily opioid dose, and total days’ supply of opioids); sensitivity: 70.3 percent, specificity: 74.1 percent, and positive predictive value: 5.6 percent. The analysis results were used to classify patients into low-risk (72.5 percent), at-risk (25.4 percent), and opioid-abuser (2.2 percent) cohorts. In multivariable analysis, emergency department (ED) use was higher among at-risk vs low-risk patients (odds ratio [OR]: 1.14; p < 0.05); hospitalization and ED visits were higher for opioid-abusers vs low-risk patients (OR: 2.33 and 2.14, respectively; p < 0.05).Conclusions: This study identifies a subpopulation of CNCP patients at risk of opioid abuse. However, limited sensitivity and specificity of criteria defining this subpopulation reinforce the importance of physician discretion in patient-level treatment decisions.

scholarly journals Risk factors for anterior bone loss in cervical disc arthroplasty

2018 ◽  
Vol 29 (2) ◽  
pp. 123-129 ◽  
Author(s):  
David Christopher Kieser ◽  
Derek Thomas Cawley ◽  
Takashi Fujishiro ◽  
Simon Mazas ◽  
Louis Boissière ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Loss ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Range Of Movement ◽  
Disc Arthroplasty ◽  
Increased Risk ◽  
Significant Difference ◽  
Potential Risk Factors

OBJECTIVEThe objective of this study was to identify the risk factors of anterior bone loss (ABL) in cervical disc arthroplasty (CDA) and the subsequent effect of this phenomenon.METHODSThe authors performed a retrospective radiological review of 185 patients with a minimum 5-year follow-up after CDA (using Bryan, Discocerv, Mobi-C, or Baguera C). Postoperative radiographs were examined and compared to the initial postoperative films to determine the percentage of ABL. The relationship of ABL to potential risk factors was analyzed.RESULTSComplete radiological assessment was available in 145 patients with 193 CDRs and 383 endplates (average age 45 years, range 25–65 years, 54% women). ABL was identified in 63.7% of CDRs (48.7% mild, 11.9% moderate, 3.1% severe). Age (p = 0.770), sex (p = 0.200), postoperative alignment (p = 0.330), midflexion point (p = 0.509), maximal flexion (p = 0.080), and extension (p = 0.717) did not relate to ABL. There was no significant difference in the rate of severe ABL between implants. Multilevel surgery conferred an increased risk of any and severe ABL (p = 0.013 for both). The upper endplate, defined as superior to the CDA, was more commonly involved (p = 0.008), but there was no significant difference whether the endplate was between or not between implants (p = 0.226). The development of ABL did not affect the long-term range of movement (ROM) of the CDA, but did increase the overall risk of autofusion. ABL was not associated with pain or functional deficits. No patients required a reoperation or revision of their implant during the course of this study, and there were no cases of progressive ABL beyond the first year.CONCLUSIONSABL is common in all implant types assessed, although most is mild. Age, sex, postoperative alignment, ROM, and midflexion point do not relate to this phenomenon. However, the greater the number of levels operated, the higher the risk of developing ABL. The development of ABL has no long-term effect on the mechanical functioning of the disc or necessity for revision surgery, although it may increase the rate of autofusion.

A Two-Year Prospective Multicenter Study of Opioid Therapy for Chronic Noncancer Pain: Prescription Trends and Predictors

Pain Medicine ◽  
2018 ◽  
Vol 20 (11) ◽  
pp. 2166-2178 ◽  
Author(s):  
Dalila R Veiga ◽  
Liliane Mendonça ◽  
Rute Sampaio ◽  
José M Castro-Lopes ◽  
Luís F Azevedo
Keyword(s):  
Chronic Pain ◽  
Clinical Outcomes ◽  
Opioid Therapy ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain ◽  
Opioid Users

Abstract Objectives Opioid use in chronic pain has increased worldwide in recent years. The aims of this study were to describe the trends and patterns of opioid therapy over two years of follow-up in a cohort of chronic noncancer pain (CNCP) patients and to assess predictors of long-term opioid use and clinical outcomes. Methods A prospective cohort study with two years of follow-up was undertaken in four multidisciplinary chronic pain clinics. Demographic data, pain characteristics, and opioid prescriptions were recorded at baseline, three, six, 12, and 24 months. Results Six hundred seventy-four CNCP patients were recruited. The prevalence of opioid prescriptions at baseline was 59.6% (N = 402), and 13% (N = 86) were strong opioid prescriptions. At 24 months, opioid prescription prevalence was as high as 74.3% (N = 501), and strong opioid prescription was 31% (N = 207). Most opioid users (71%, N = 479) maintained their prescription during the two years of follow-up. Our opioid discontinuation was very low (1%, N = 5). Opioid users reported higher severity and interference pain scores, both at baseline and after two years of follow-up. Opioid use was independently associated with continuous pain, pain location in the lower limbs, and higher pain interference scores. Conclusions This study describes a pattern of increasing opioid prescription in chronic pain patients. Despite the limited improvement of clinical outcomes, most patients keep their long-term opioid prescriptions. Our results underscore the need for changes in clinical practice and further research into the effectiveness and safety of chronic opioid therapy for CNPC.

scholarly journals Incidence, Risk Factors, and Outcomes of Neonatal Renal Vein Thrombosis in Ontario: Population-Based Cohort Study

Kidney360 ◽  
2020 ◽  
Vol 1 (7) ◽  
pp. 640-647 ◽  
Author(s):  
Allison C. Ouellette ◽  
Elizabeth K. Darling ◽  
Branavan Sivapathasundaram ◽  
Glenda Babe ◽  
Richard Perez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Renal Vein Thrombosis ◽  
Population Based ◽  
Long Term Outcomes ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Neonatal Renal Vein Thrombosis

BackgroundThere are limited data at a population level on the burden, risk factors, and long-term outcomes of neonatal renal vein thrombosis (nRVT). We conducted a population-based cohort study to understand the epidemiology and outcomes of nRVT over a 25-year period in Ontario.MethodsUsing linked administrative health databases, all hospitalized neonates ≤28 days born in Ontario between 1992 and 2016 with nRVT were identified. The primary outcome was to calculate the incidence of nRVT and trend over time in Ontario. We also determined the risk factors associated with nRVT as well as the risk of long-term outcomes after nRVT, including CKD, ESKD, all-cause mortality, and hypertension (HTN) compared with the healthy neonatal population without nRVT.ResultsThe annual incidence rate of nRVT was 2.6 per 100,000 live births (n=85). Presence of respiratory distress syndrome (OR, 8.01; 95% CI, 4.90 to 13.1), congenital heart disease (OR, 9.1; 95% CI, 5.05 to 16.4), central venous catheterization (OR, 3.9; 95% CI, 1.89 to 7.93), maternal preeclampsia (OR, 2.8; 95% CI, 1.6 to 4.79), and maternal diabetes (OR, 2.36; 95% CI, 1.36 to 4.07) conferred the highest risk for nRVT. Over a median follow-up of 15 years and after adjusting for confounders, neonates with nRVT versus the comparator cohort had a 15.5-fold risk of CKD, HTN, or death (n=49 [58%] versus n=90,050 [3%]; 95% CI, 11.7 to 20.6); 12.3-fold increased risk of CKD or death (n=39 [46%] versus n=32,016 [1%]; 95% CI, 8.9 to 16.8); and a 15.7-fold increased risk of HTN (n=33 [39%] versus n=64,458 [2%]; 95% CI, 11.1 to 21.1). None of the nRVT cohort developed ESKD. The median time to composite outcome of CKD, HTN, or death was 11.1 years.ConclusionsPatients with a history of nRVT remain at higher risk than the general population for long-term morbidity or mortality, indicating the need for long-term follow-up.

Morbidity and mortality in adult-onset IgA vasculitis: a long-term population-based cohort study

Rheumatology ◽  
2021 ◽  
Author(s):  
Johannes Nossent ◽  
Warren Raymond ◽  
Helen Isobel Keen ◽  
David Preen ◽  
Charles Inderjeeth
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Premature Death ◽  
Population Based ◽  
Increased Risk ◽  
Serious Infections ◽  
Comorbidity Index ◽  
Independent Risk Factors

Abstract Objectives With sparse data available, we investigated mortality and risk factors in adults with IgAV. Methods Observational population-based cohort study using state-wide linked longitudinal health data for hospitalised adults with IgAV (n = 267) and matched comparators (n = 1080) between 1980-2015. Charlson comorbidity index (CCI) and serious infections (SI) were recorded over an extensive lookback period prior to diagnosis. Date and causes of death were extracted from WA Death Registry. Mortality rate (deaths/1000 person-years) ratios (MRR) and hazard ratio (HR) for survival were assessed. Results During 9.9 (±9.8) years lookback patients with IgAV accrued higher CCI scores (2.60 vs1.50 p &lt; 0.001) and had higher risk of SI (OR 8.4, p &lt; 0.001), not fully explained by CCI scores. During 19 years follow-up, the rate of death in Patients with IgAV (n = 137) was higher than in comparators (n = 397) (MRR 2.06, CI 1.70-2.50, p &lt; 0.01) and the general population (SMRR 5.64, CI 4.25, 7.53, p &lt; 0.001). Survival in IgAV was reduced at five (72.7 vs. 89.7%) and twenty years (45.2% vs. 65.6%) (both p &lt; 0.05). CCI (HR1.88, CI:1.25 - 2.73, p = 0.001), renal failure (HR 1.48, CI: 1.04 - 2.22, p = 0.03) and prior SI (HR 1.48, CI:1.01 – 2.16, p = 0.04) were independent risk factors. Death from infections (5.8 vs 1.8%, p = 0.02) was significantly more frequent in patients with IgAV. Conclusions Premorbid comorbidity accrual appears increased in hospitalized patients with IgAV and predicts premature death. As comorbidity does not fully explain the increased risk of premorbid infections or the increased mortality due to infections in IgAV, prospective studies are needed.

Clinical significance of positive cranial bone flap cultures and associated risk of surgical site infection after craniotomies or craniectomies

2011 ◽  
Vol 114 (6) ◽  
pp. 1746-1754 ◽  
Author(s):  
Hsiu-yin Chiang ◽  
Victoria M. Steelman ◽  
Jean M. Pottinger ◽  
Annette J. Schlueter ◽  
Daniel J. Diekema ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Surgical Site Infection ◽  
Potential Risk ◽  
Retrospective Review ◽  
Common Source ◽  
Site Infection ◽  
Increased Risk ◽  
Skin Flora ◽  
Potential Risk Factors

Object The risk of surgical site infection (SSI) after craniotomies or craniectomies in patients in whom contaminated bone flaps have been reimplanted has not been determined. The objectives of this study were to identify the prevalence of bone flaps with positive cultures—especially those contaminated with Propionibacterium acnes—to assess the risk of SSI after reimplanting (either during the initial operation or subsequently) bone flaps with positive cultures, and to identify risk factors for SSI following the initial craniotomies or craniectomies. Methods The authors conducted a retrospective review of cases in which patients underwent craniotomy/craniectomy procedures between January and October 2007 in the neurosurgery department at the University of Iowa Hospitals and Clinics. They also reviewed processes and procedures and did pulsed field gel electrophoresis of P. acnes isolates to look for a common source of contamination. They then conducted a prospective cohort study that included all patients who underwent craniotomy/craniectomy procedures between November 2007 and November 2008 and met the study criteria. For the cohort study, the authors obtained cultures from each patient's bone flap during the craniotomy/craniectomy procedures. Data about potential risk factors were collected by circulating nurses during the procedures or by a research assistant who reviewed medical records after the procedures. An infection preventionist independently identified SSIs through routine surveillance using the Centers for Disease Control and Prevention's definitions. Univariate and bivariate analyses were performed to determine the association between SSI and potential risk factors. Results The retrospective review did not identify specific breaks in aseptic technique or a common source of P. acnes. Three hundred seventy-three patients underwent 393 craniotomy/craniectomy procedures during the cohort study period, of which 377 procedures met the study criteria. Fifty percent of the bone flaps were contaminated by microorganisms, primarily skin flora such as P. acnes, coagulase-negative staphylococci, and Staphylococcus aureus. Reimplanting bone flaps that had positive culture results did not increase the risk of infection after the initial craniotomy/craniectomy procedures and the subsequent cranioplasty procedures (p = 0.80). Allowing the skin antiseptic to dry before the procedures (p = 0.04, OR 0.26) was associated with lower risk of SSIs. Female sex (p = 0.02, OR = 3.49) was associated with an increased risk of SSIs; Gliadel wafer implants (p = 0.001, OR = 8.38) were associated with an increased risk of SSIs after procedures to treat tumors. Conclusions Operative factors such as the way the skin is prepared before the incision rather than the skin flora contaminants on the bone flaps may play an important role in the pathogenesis of SSIs after craniotomy/craniectomy. Gliadel wafers significantly increased the risk of SSI after procedures to treat tumors.

scholarly journals A Typology of Predictive Risk Factors for NonAdherent Medication-Related Behaviors among Chronic Non-Cancer Pain Patients Prescribed Opioids: A Cohort Study

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. E421-E434
Author(s):  
Amy Peacock
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cohort Study ◽  
Cancer Pain ◽  
Physical Functioning ◽  
Prospective Cohort ◽  
Opioid Use ◽  
Risk Profiles ◽  
Key Words Pain ◽  
Increased Risk

Background: There has been no previous prospective examination of the homogeneity of chronic non-cancer pain (CNCP) patients in risk factors for non-adherent opioid use. Objectives: To identify whether latent risk classes exist among people with CNCP that predict non-adherence with prescribed opioids. Study Design: Prospective cohort study. Methods: The Pain and Opioids IN Treatment prospective cohort comprises 1,514 people in Australia prescribed pharmaceutical opioids for CNCP interviewed 3 months apart. Risk factors were assessed in wave 1, and non-adherent behaviors in the 3 months prior to wave 1 and wave 2. Latent class analysis was used to examine groups with differing risk profiles. Logistic regression was used to examine predictors of non-adherence. Results: A 4-class model was selected with classes described as: 1) Poor Physical Functioning group (27%); 2) Poor Coping/Physical Functioning group (35%); 3) Substance Use Problems group (14%); and 4) Multiple Comorbid Problems group (25%). The latter 2 groups had an increased risk of requesting increased opioid doses, early script renewals, using diverted medication, dose stock-piling, and unsanctioned dose alteration at wave 2. Limitations: Risk factor onset prior to non-adherent behavior cannot be determined. Conclusions: Clusters of CNCP patients with distinct risk profiles for non-adherence exist. Each group was identified by at least one risk factor but the likelihood of non-adherent opioid use was higher in groups with particular clusters of multiple risk factors. Not all those with risk factors display non-adherence, emphasising the need for strategies to reduce risk for those patients displaying particular clusters of risks. Key words: Pain, pharmaceutical opioids, non-adherence, injecting drug use, opioid dependence, chronic non-cancer pain, non-adherence, diversion

scholarly journals The Long-Term Safety and Efficacy of Opioids: A Survey of 84 Selected Patients with Intractable Chronic Noncancer Pain

2010 ◽  
Vol 15 (4) ◽  
pp. 213-217 ◽  
Author(s):  
C Peter N Watson ◽  
Judy Watt-Watson ◽  
Mary Chipman
Keyword(s):  
Adverse Effects ◽  
Efficacy And Safety ◽  
Health Related Quality ◽  
Opioid Use ◽  
Chronic Noncancer Pain ◽  
Related Quality ◽  
Health Related ◽  
Noncancer Pain

BACKGROUND: The use of opioids for chronic noncancer pain (CNCP) remains controversial. Despite a number of randomized controlled trials showing efficacy and safety in the short term, long-term data are limited.OBJECTIVE: To survey a selected cohort of patients with intractable CNCP with regard to long-term efficacy and safety of opioids.METHODS: The present study reports long-term results from a survey of 84 patients with CNCP. The majority of patients had neuropathic pain, were treated with opioids and were followed every three months for a median of 8.4 years. Outcomes examined were pain severity, adverse effects, pain relief, satisfaction, mood, problematic opioid use, tolerance, physical dependency, functional status, health-related quality of life, immune status, sexual function, morbidity and mortality. Measures included a numerical rating scale, the Hospital Anxiety and Depression Scale, Brief Pain Inventory interference scale, Pain Disability Index and Short-Form Health Survey 12, version 2.RESULTS AND CONCLUSIONS: Both long- and short-acting opioids were reported to be effective, with few significant long-term adverse effects in many subjects in the present selected cohort. The majority of patients reported at least 50% or greater pain relief and a moderate improvement in disability. Functional status and health-related quality of life scores were not severely affected. Problematic opioid use, tolerance and serious adverse effects, including constipation, were not major issues. The authors emphasize that the results obtained in the present selected group may not be generalizable to all CNCP patients in whom opioids are being initiated.

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