scholarly journals Long-Term Opioid Therapy in Spine Center Outpatients: Protocol for the Spinal Pain Opioid Cohort (SPOC) Study (Preprint)

2020 ◽  
Author(s):  
Claus Manniche ◽  
Lonny Stokholm ◽  
Sophie L Ravn ◽  
Tonny E Andersen ◽  
Lars PA Brandt ◽  
...  
Keyword(s):  
Spinal Pain ◽  
Opioid Therapy ◽  
Opioid Addiction ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Clinical Registry ◽  
Pain Episode ◽  
Wide Range

BACKGROUND Spinal pain is the leading cause of patient-years lived with chronic pain and disability worldwide. Although opioids are well documented as an effective short-term pain-relieving medication, more than a few weeks of treatment may result in a diminishing clinical effect as well as the development of addictive behavior. Despite recognition of opioid addiction in pain patients as a major problem commonly experienced in the clinic, no reference material exists on the scope of long-term problems in novel opioid users and the link to clinical outcomes. OBJECTIVE The main aims of this study are to describe baseline and follow-up characteristics of the Spinal Pain Opioid Cohort (SPOC), to evaluate the general use of opioids in spinal pain when an acute pain episode occurs, and to demonstrate the prevalence of long-term opioid therapy (LTOT). METHODS Prospective clinical registry data were collected from an outpatient spine center setting during 2012-2013 including patients with a new spinal pain episode lasting for more than 2 months, aged between 18 and 65 years who had their first outpatient visit in the center. Variables include demographics, clinical data collected in SpineData, the Danish National Patient Register, and The Danish National Prescription Registry. The primary outcome parameter is long-term prescription opioid use registered from 4 years before the first spine center visit to 5 years after. RESULTS This is an ongoing survey. It is estimated that more than 8000 patients fulfill the SPOC inclusion criteria. In 2019, we began the intellectual process of identifying the most relevant supplementary data available from the wide range of existing national registries available in Denmark. We have now begun merging SpineData with relevant opioid data from Danish national registers and will continue to extract data up to 2021-2022. We will also be looking at data regarding somatic or psychiatric hospitalization patterns, patient usage of health care resources, as well as their working status and disability pensions. CONCLUSIONS To our knowledge, this survey will be the first to document the scope of long-term problems regarding LTOT and opioid addiction following new spinal pain episodes and comparing descriptive follow-up data between substance users and nonusers. CLINICALTRIAL ISRCTN Registry ISRCTN69685117; http://www.isrctn.com/ISRCTN69685117 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/21380

scholarly journals Long-Term Opioid Therapy in Spine Center Outpatients: Protocol for the Spinal Pain Opioid Cohort (SPOC) Study

10.2196/21380 ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. e21380
Author(s):  
Claus Manniche ◽  
Lonny Stokholm ◽  
Sophie L Ravn ◽  
Tonny E Andersen ◽  
Lars PA Brandt ◽  
...  
Keyword(s):  
Spinal Pain ◽  
Opioid Therapy ◽  
Opioid Addiction ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Clinical Registry ◽  
Pain Episode ◽  
Wide Range

Background Spinal pain is the leading cause of patient-years lived with chronic pain and disability worldwide. Although opioids are well documented as an effective short-term pain-relieving medication, more than a few weeks of treatment may result in a diminishing clinical effect as well as the development of addictive behavior. Despite recognition of opioid addiction in pain patients as a major problem commonly experienced in the clinic, no reference material exists on the scope of long-term problems in novel opioid users and the link to clinical outcomes. Objective The main aims of this study are to describe baseline and follow-up characteristics of the Spinal Pain Opioid Cohort (SPOC), to evaluate the general use of opioids in spinal pain when an acute pain episode occurs, and to demonstrate the prevalence of long-term opioid therapy (LTOT). Methods Prospective clinical registry data were collected from an outpatient spine center setting during 2012-2013 including patients with a new spinal pain episode lasting for more than 2 months, aged between 18 and 65 years who had their first outpatient visit in the center. Variables include demographics, clinical data collected in SpineData, the Danish National Patient Register, and The Danish National Prescription Registry. The primary outcome parameter is long-term prescription opioid use registered from 4 years before the first spine center visit to 5 years after. Results This is an ongoing survey. It is estimated that more than 8000 patients fulfill the SPOC inclusion criteria. In 2019, we began the intellectual process of identifying the most relevant supplementary data available from the wide range of existing national registries available in Denmark. We have now begun merging SpineData with relevant opioid data from Danish national registers and will continue to extract data up to 2021-2022. We will also be looking at data regarding somatic or psychiatric hospitalization patterns, patient usage of health care resources, as well as their working status and disability pensions. Conclusions To our knowledge, this survey will be the first to document the scope of long-term problems regarding LTOT and opioid addiction following new spinal pain episodes and comparing descriptive follow-up data between substance users and nonusers. Trial Registration ISRCTN Registry ISRCTN69685117; http://www.isrctn.com/ISRCTN69685117 International Registered Report Identifier (IRRID) DERR1-10.2196/21380

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.

Review article. Opioid analgesics: Does potency matter?

2014 ◽  
Vol 10 (4) ◽  
pp. 263 ◽  
Author(s):  
Steven D. Passik, PhD ◽  
Lynn Webster, MD
Keyword(s):  
Chronic Pain ◽  
Opioid Analgesics ◽  
Patient Characteristics ◽  
Immediate Release ◽  
Opioid Therapy ◽  
Abuse Liability ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Wide Range ◽  
Effective Analgesia

Prescription opioid analgesics with a wide range of potencies are currently used for the treatment of chronic pain. Yet understanding the clinical relevance and therapeutic consequences of opioid potency remains ill defined. Both patients and clinicians alike have misperceptions about opioid potency, expecting that lesspotent opioids will be less effective or fearing that more-potent opioids are more dangerous or more likely to be abused. In this review, common myths about the potency of opioid analgesics will be discussed. Clinicians should understand that pharmacologic potency per se does not necessarily imply more effective analgesia or higher abuse liability. Published dose conversion tables may not accurately calculate the dose for effective and safe rotation from one opioid to another in patients receiving long-term opioid therapy because they are based on limited data that may not apply to chronic pain. Differences in pharmacologic potency are largely accounted for by the actual doses prescribed, according to individualized patient need. Factors for achieving effective analgesia and reducing the risks involved with opioid use include careful medication selection based on patient characteristics, appropriate dosing titration and opioid rotation practices, knowledge of product formulation characteristics (eg, extended release, immediate release, and tamper-resistant features), and an awareness of differences in opioid pharmacokinetics and metabolism. Clinicians should remain vigilant in monitoring patients on any opioid medication, regardless of classification along the opioid potency continuum.

Long-term naturalistic follow-up of chronic pain in adults with prescription opioid use disorder

2019 ◽  
Vol 205 ◽  
pp. 107675 ◽  
Author(s):  
Katherine A. McDermott ◽  
Margaret L. Griffin ◽  
R. Kathryn McHugh ◽  
Garrett M. Fitzmaurice ◽  
Robert N. Jamison ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Prescription Opioid Use

Prevalence of long-term opioid therapy in spine center outpatients the spinal pain opioid cohort (SPOC)

2021 ◽  
Author(s):  
Claus Manniche ◽  
Lonny Stokholm ◽  
Sophie L. Ravn ◽  
Tonny A. Andersen ◽  
Lars Brandt ◽  
...  
Keyword(s):  
Spinal Pain ◽  
Opioid Therapy

Patterns of opioid use in patients with trigeminal neuralgia undergoing neurosurgery

2019 ◽  
Vol 131 (6) ◽  
pp. 1805-1811
Author(s):  
Andrew I. Yang ◽  
Brendan J. McShane ◽  
Frederick L. Hitti ◽  
Sukhmeet K. Sandhu ◽  
H. Isaac Chen ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Opioid Use ◽  
Exact Test ◽  
Fisher's Exact Test ◽  
Fisher’S Exact Test ◽  
Long Term Follow Up ◽  
Neurosurgical Intervention

OBJECTIVEFirst-line treatment for trigeminal neuralgia (TN) is pharmacological management using antiepileptic drugs (AEDs), e.g., carbamazepine (CBZ) and oxcarbazepine (OCBZ). Surgical intervention has been shown to be an effective and durable treatment for TN that is refractory to medical therapy. Despite the lack of evidence for efficacy in patients with TN, the authors hypothesized that patients with neuropathic facial pain are prescribed opioids at high rates, and that neurosurgical intervention may lead to a reduction in opioid use.METHODSThis is a retrospective study of patients with facial pain seen by a single neurosurgeon. All patients completed a survey on pain medications, medical comorbidities, prior interventions for facial pain, and a validated pain outcome tool (the Penn Facial Pain Scale). Patients subsequently undergoing neurosurgical intervention completed a survey at the 1-month follow-up in the office, in addition to telephone interviews using a standardized script between 1 and 6 years after intervention. Univariate and multivariate logistic regression were used to predict opioid use.RESULTSThe study cohort consisted of 309 patients (70% Burchiel type 1 TN [TN1], 18% Burchiel type 2 [TN2], 6% atypical facial pain [AFP], and 6% TN secondary to multiple sclerosis [TN-MS]). At initial presentation, 20% of patients were taking opioids. Of these patients, 55% were receiving concurrent opioid therapy with CBZ/OCBZ, and 84% were receiving concurrent therapy with at least one type of AED. Facial pain diagnosis (for diagnoses other than TN1, odds ratio [OR] 2.5, p = 0.01) and facial pain intensity at its worst (for each unit increase, OR 1.4, p = 0.005) were predictors of opioid use at baseline. Neurosurgical intervention led to a reduction in opioid use to 8% at long-term follow-up (p < 0.01, Fisher’s exact test; n = 154). Diagnosis (for diagnoses other than TN1, OR 4.7, p = 0.002) and postintervention reduction in pain at its worst (for each unit reduction, OR 0.8, p < 10−3) were predictors of opioid use at long-term follow-up. On subgroup analysis, patients with TN1 demonstrated a decrease in opioid use to 5% at long-term follow-up (p < 0.05, Fisher’s exact test), whereas patients with non-TN1 facial pain did not. In the nonsurgical group, there was no statistically significant decrease in opioid use at long-term follow-up (n = 81).CONCLUSIONSIn spite of its high potential for abuse, opioid use, mostly as an adjunct to AEDs, is prevalent in patients with facial pain. Opportunities to curb opioid use in TN1 include earlier neurosurgical intervention.

scholarly journals Patterns of Long-Term Prescription Opioid Use Among Older Adults in the United States: A Study of Medicare Administrative Claims Data

2020 ◽  
Vol 1;24 (1;1) ◽  
pp. 31-40
Keyword(s):  
Older Adults ◽  
Claims Data ◽  
The United States ◽  
Prescription Opioid ◽  
Administrative Claims ◽  
Medicare Beneficiaries ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Administrative Claims Data

BACKGROUND: Long-term opioid therapy was prescribed with increasing frequency over the past decade. However, factors surrounding long-term use of opioids in older adults remains poorly understood, probably because older people are not at the center stage of the national opioid crisis. OBJECTIVES: To estimate the annual utilization and trends in long-term opioid use among older adults in the United States. STUDY DESIGN: Retrospective cohort study. SETTING: Data from Medicare-enrolled older adults. METHODS: This study utilized a nationally representative sample of Medicare administrative claims data from the years 2012 to 2016 containing records of health care services for more than 2.3 million Medicare beneficiaries each year. Medicare beneficiaries who were 65 years of age or older and who were enrolled in Medicare Parts A, B, and D, but not Part C, for at least 10 months in a year were included in the study. We measured annual utilization and trends in new long-term opioid use episodes over 4 years (2013–2016). We examined claims records for the demographic characteristics of the eligible individuals and for the presence of chronic non-cancer pain (CNCP), cancer, and other comorbidities. RESULTS: From 2013 to 2016, administrative claims of approximately 2.3 million elderly Medicare beneficiaries were analyzed in each year with a majority of them being women (~56%) and white (~82%) with a mean age of approximately 75 years. The proportion of all eligible beneficiaries with at least one new opioid prescription increased from 6.64% in 2013, peaked at 10.32% in 2015, and then decreased to 8.14% in 2016. The proportion of individuals with long-term opioid use among those with a new opioid prescription was 12.40% in 2013 and 10.20% in 2016. Among new long-term opioid users, the proportion of beneficiaries with a cancer diagnosis during the study years increased from 13.30% in 2013 to 15.67% in 2016, and the proportion with CNCP decreased from 30.25% in 2013 to 27.36% in 2016. Across all years, long-term opioid use was consistently high in the Southern states followed by the Midwest region. LIMITATIONS: This study used Medicare fee-for-service administrative claims data to capture prescription fill patterns, which do not allow for the capture of individuals enrolled in Medicare Advantage plans, cash prescriptions, or for the evaluation of appropriateness of prescribing, or the actual use of medication. This study only examined long-term use episodes among patients who were defined as opioid-naive. Finally, estimates captured for 2016 could only utilize data from 9 months of the year to capture 90-day long-term-use episodes. CONCLUSIONS: Using a national sample of elderly Medicare beneficiaries, we observed that from 2013 to 2016 the use of new prescription opioids increased from 2013 to 2014 and peaked in 2015. The use of new long-term prescription opioids peaked in 2014 and started to decrease from 2015 and 2016. Future research needs to evaluate the impact of the changes in new and long-term prescription opioid use on population health outcomes. KEY WORDS: Long-term, opioids, older adults, trends, Medicare, chronic non-cancer pain, cancer, cohort study

Serving Students With Acquired Brain Injury: Understanding Long-Term Need and Outcomes After the BrainSTEPS Program

2021 ◽  
pp. 1-14
Author(s):  
Jessica Salley Riccardi ◽  
Libby Crook ◽  
Brenda Eagan-Johnson ◽  
Monica Vaccaro ◽  
Angela H. Ciccia
Keyword(s):  
Brain Injury ◽  
Regular Education ◽  
Acquired Brain Injury ◽  
Transition Services ◽  
Student Outcome ◽  
Severe Injuries ◽  
School Based ◽  
Wide Range

Purpose: The purpose of this study was to inform school-based services for children with acquired brain injury (ABI) by describing and analyzing functional student-outcome data from a state-wide, school-based, school re-entry consultation program, BrainSTEPS (Strategies Teaching Educators, Parents, and Students), in Pennsylvania. Method: A nonexperimental, retrospective analysis was conducted with data collected during a pilot follow-up survey for BrainSTEPS. Caregivers reported on 337 students with ABI participating in BrainSTEPS. Results: Most students post-ABI who were participating in BrainSTEPS were enrolled in regular education and reported no ongoing symptoms, as well as no parent perception of need for additional BrainSTEPS consultation during the time period of the follow-up survey. Current receipt of therapy was significantly associated with injury type, χ 2 (1, n = 329) = 16.72, p < .001. A multiple logistic regression was significant ( p < .001) in predicting the need for additional BrainSTEPS consultation. More severe injuries, educational placement postinjury of regular education with a 504 plan (compared to regular education), and current receipt of therapy significantly increased the odds of need for consultation. Conclusions: Due to the wide range of experiences of students in this sample, hospital-to-school transition services, educational supports and services, and long-term follow-up must be individualized for children with ABI. Speech-language pathologists are critical members of the school-based academic team for students with ABI to decrease long-term unmet needs.

Sign in / Sign up

Export Citation Format

Share Document