scholarly journals Evaluating the 0–10 Point Pain Scale on Adolescent Opioid Use in US Emergency Departments

2021 ◽  
Vol 11 (1) ◽  
pp. 38
Author(s):  
Michael T. Phan ◽  
Daniel M. Tomaszewski ◽  
Cody Arbuckle ◽  
Sun Yang ◽  
Brooke Jenkins ◽  
...  
Keyword(s):  
Pain Score ◽  
Adult Population ◽  
Pain Scale ◽  
Opioid Use ◽  
Cross Sectional ◽  
Weighted Estimates ◽  
Pain Scores ◽  
Care Survey ◽  
Population Counts ◽  
To Receive

Objective: To evaluate trends in national emergency department (ED) adolescent opioid use in relation to reported pain scores. Methods: A retrospective, cross-sectional analysis on National Hospital Ambulatory Medical Care Survey (NHAMCS) data was conducted on ED visits involving patients aged 11–21 from 2008–2017. Crude observational counts were extrapolated to weighted estimates matching total population counts. Multivariate models were used to evaluate the role of a pain score in the reported use of opioids. Anchors for pain scores were 0 (no pain) and 10 (worst pain imaginable). Results: 31,355 observations were captured, which were extrapolated by the NHAMCS to represent 162,515,943 visits nationwide. Overall, patients with a score of 10 were 1.35 times more likely to receive an opioid than patients scoring a 9, 41.7% (CI95 39.7–43.8%) and 31.0% (CI95 28.8–33.3%), respectively. Opioid use was significantly different between traditional pain score cutoffs of mild (1–3) and moderate pain (4–6), where scores of 4 were 1.76 times more likely to receive an opioid than scores of 3, 15.5% (CI95 13.7–17.3%) and 8.8% (CI95 7.1–10.6%), respectively. Scores of 7 were 1.33 times more likely to receive opioids than scores of 6, 24.7% (CI95 23.0–26.3%) and 18.5% (CI95 16.9–20.0%), respectively. Fractures had the highest likelihood of receiving an opioid, as 49.2% of adolescents with a fracture received an opioid (CI95 46.4–51.9%). Within this subgroup, only adolescents reporting a fracture pain score of 10 had significantly higher opioid use than adjacent pain scores, where fracture patients scoring a 10 were 1.4 times more likely to use opioids than those scoring 9, 82.2% (CI95 76.1–88.4%) and 59.8% (CI95 49.0–70.5%), respectively. Conclusions: While some guidelines in the adult population have revised cut-offs and groupings of the traditional tiers on a 0–10 point pain scale, the adolescent population may also require further examination to potentially warrant a similar adjustment.

Buprenorphine for Cancer Pain in Patients With Nonmedical Opioid Use: A Retrospective Study at a Comprehensive Cancer Center

2019 ◽  
Vol 37 (5) ◽  
pp. 350-353
Author(s):  
Eric Hansen ◽  
Chitra Nadagoundla ◽  
Chong Wang ◽  
Austin Miller ◽  
Amy Allen Case
Keyword(s):  
Cancer Pain ◽  
Pain Score ◽  
Pain Scale ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Opioid Use ◽  
Existential Suffering ◽  
Pain Scores ◽  
The Mean

Background: Outpatients with cancer commonly have nonmedical opioid use (NMOU) behaviors and use opioids to dull emotional and existential suffering. Buprenorphine is often used for cancer pain due to less reported euphoria when compared to other opioids. Methods: A retrospective review was done in patients who were prescribed buprenorphine for cancer pain. Pain scores were reported on a Likert pain scale of 1 to 10. Nonmedical opioid use was defined as patients taking opioids for emotional pain at or above the maximum prescribed amount. Results: For 16 patients, the mean pain score prior to buprenorphine (pain pre) was 8.3 (Standard deviation (Std) 1.6), and the mean pain score on follow-up post-buprenorphine (pain post) was 6.1 (Std 2.3) with a reduction in mean pain score (pain change) of −2.0 (Std 2.9, P = .059). Those patients without NMOU had a pain prescore of 9.5 (Std 1.0) and pain post of 4.3 (Std 2.5) with a mean pain change of −5.0 (Std 1.7, P = .20). The mean pain change in those with chemical coping (−1.3/Std 2.7), illicit drug use (−2.8/Std 1.0), or psychiatric comorbidity (−2.4/Std 2.7) were reduced after buprenorphine, however, not statistically significant. Outpatient rotation to buprenorphine was well tolerated. Conclusions: The pain score in those patients without NMOU was significantly lower after rotation to buprenorphine than those with NMOU. We deduce that in those with NMOU, it is more challenging to achieve pain relief with buprenorphine. Overall, for all patients, rotation to buprenorphine resulted in a marginally significantly reduced pain score.

Does meloxicam provide adequate pain management as a post-operative analgesic in canine ovariohysterectomy patients?

2020 ◽  
Vol 11 (4) ◽  
pp. 192-197
Author(s):  
Gavin Goldsbrough ◽  
Helen Reynolds
Keyword(s):  
Pain Management ◽  
Pain Score ◽  
Pain Scale ◽  
Short Term ◽  
Post Surgery ◽  
Pain Scores ◽  
Significant Difference ◽  
Time Frames ◽  
Adequate Pain Management

Background: Meloxicam is an analgesic agent with anti-inflammatory properties, commonly used in veterinary practices to treat a variety of different long-term medical conditions and is also used as a short-term pain relief following particularly traumatic surgeries. Aims: An observational study was conducted to determine whether meloxicam provides adequate pain management as a post-operative analgesic for canine ovariohysterectomies. Methods: 13 canines were admitted for ovariohysterectomy. Each patient was assessed using the Glasgow composite pain scale (CMPS) prior to surgery during the admission procedure, 15 minutes post-operatively, at discharge and at their post-operative check (POC) 3–5 days after surgery. Results: Data were statistically analysed to determine the overall effectiveness of meloxicam in reducing pain following canine ovariohysterectomy. The results showed a statistically significant difference (Kruskal-Wallis test: H3 =12.98, p=0.005) in pain scores between admission, 15 minutes post operatively, discharge and 3–5 days POC. The greatest decrease in pain score was between 15 minutes post-operatively and POC (Mann-Whitney U test: W=236, n=13, 13, p=0.0014) and between discharge and POC (Mann-Whitney U test: W=227, n=13, 13, p=0.0060). Overall, this demonstrated that there was an improvement in pain suggesting meloxicam is effective between these time frames. In addition, 69.2% (n=9) of patients in the study showed a pain score of 0, indicating an absence of pain, on their final POC. Statistical analysis was also used to determine if there was any difference in pain score between the 3, 4 or 5 day POC pain score. The results show there was no significant difference (Kruskal-Wallis test: H2 =0.090, p=0.638) suggesting that meloxicam's effectiveness was similar across this range of time post surgery. Conclusion: The results from the study indicate that meloxicam is an effective post-operative analgesic for canine patients undergoing an ovariohysterectomy.

scholarly journals The WOMAC Pain Scale and Crosstalk From Co-occurring Pain Sites in People With Knee Pain: A Causal Modeling Study

2020 ◽  
Vol 100 (10) ◽  
pp. 1872-1881
Author(s):  
Daniel L Riddle ◽  
Robert A Perera
Keyword(s):  
Knee Pain ◽  
Pain Scale ◽  
Causal Modeling ◽  
The Body ◽  
Test Theory ◽  
Coefficient Of Determination ◽  
Womac Pain ◽  
Cross Sectional ◽  
Pain Scores ◽  
Body Regions

Abstract Objective The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain scale quantifies knee pain severity with activities of daily living, but the potential impact of pain in other body regions on WOMAC pain scores has not been explored using a causal modeling approach. The purpose of this study was to determine if pain in other areas of the body impact WOMAC pain scores, a phenomenon referred to as “crosstalk.” Methods Cross-sectional datasets were built from public use data available from the Osteoarthritis Initiative (OAI) and the Multicenter Osteoarthritis Study (MOST). The WOMAC Pain Scale and generic hip, knee, ankle, foot and back pain measures were included. Three nested regression models grounded in causally based classical test theory determined the extent of crosstalk. Improvements in the coefficient of determination across the 3 models were used to determine the presence of crosstalk. Results Causal modeling provided evidence of crosstalk in both OAI and MOST datasets. For example, in OAI, multiple statistical models demonstrated significant increases in coefficient of determination values (P < .0001) as additional pain areas were added to the models. Conclusions Crosstalk appears to be a clinically important source of error in the WOMAC Pain Scale, particularly for patients with a larger number of painful body regions and when contralateral knee joint pain is more severe. Impact Statement This study has important implications for arthritis research. It also should raise clinician awareness of the threat to score interpretation and the need to consider the extent of pain in other body regions when interpreting WOMAC pain scores.

scholarly journals Comparison of Two Anesthetic Methods for Intravitreal Ozurdex Injection

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
V. Levent Karabaş ◽  
Berna Özkan ◽  
Çiğdem Akdağ Koçer ◽  
Özgül Altıntaş ◽  
Dilara Pirhan ◽  
...  
Keyword(s):  
Pain Relief ◽  
Pain Score ◽  
Branch Retinal Vein Occlusion ◽  
Subconjunctival Hemorrhage ◽  
Vein Occlusion ◽  
Pain Scores ◽  
Lidocaine Injection ◽  
Group 2 ◽  
To Receive ◽  
Group 1

Purpose. To determine whether subconjunctival lidocaine injection maintains additional anesthetic effect during intravitreal Ozurdex injection.Methods. 63 patients who were diagnosed as central or branch retinal vein occlusion and planned to receive Ozurdex injection for macular edema were prospectively included in the study. The patients were randomized into one of the two anesthetic groups. The first group received topical proparacaine drop and lidocaine applied pledget. The second group received subconjunctival lidocaine injection in addition to the anesthetics in group 1.Results. Mean pain score was1.90±2.39in group 1 and 1.71 ± 2.09 in group 2 (p=0.746). Mean subconjunctival hemorrhage grade was1.67±0.17in group 1 and0.90±0.14in group 2 (p=0.001). There was no relationship between the amount of subconjunctival hemorrhage and pain score of the patients.Conclusions. There was no difference in pain scores between the two anesthetic methods. The addition of subconjunctival lidocaine injection offered no advantage in pain relief compared to lidocaine-applied pledgets.

Patient health literacy and the receipt of opioids in the emergency department

2019 ◽  
Vol 15 (4) ◽  
pp. 267-270
Author(s):  
Joseph A. Dayaa, MS ◽  
Montika Bush, PhD, MS ◽  
Natalie L. Richmond, BA ◽  
Lewis S. Nelson, MD ◽  
Timothy F. Platts-Mills, MD, MSc
Keyword(s):  
Emergency Department ◽  
Health Literacy ◽  
Formal Education ◽  
Opioid Use ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
Low Health Literacy ◽  
Percent Difference ◽  
Patient Health ◽  
To Receive

Objective: Assess relationships between patient health literacy and formal education and use of opioids during and following an emergency department (ED) visit.Design: Prospective, cross-sectional study.Setting: Academic ED.Participants: Adults aged ≥ 60 years presenting to the ED with musculoskeletal pain.Main outcome measures: Opioid use during and after an ED visit.Results: In a sample of 136 patients, patients with low health literacy were more likely to receive an opioid in the ED than patients with high health literacy (70 percent vs 52 percent; 18 percent difference, 95% confidence interval [CI]: –1 percent, 35 percent), receive an opioid prescription (63 percent vs 44 percent; 19 percent difference, 95% CI: 1 percent, 37 percent), and take opioids during the week following the ED visit (48 percent vs 29 percent; 18 percent difference, 95% CI: 0 percent, 36 percent).Conclusions: A greater proportion of older adults receiving ED care for musculoskeletal pain with low health literacy receive and use opioids during and following an ED visit.

scholarly journals Do Primary Care Clinicians Incorporate Comorbidities and Concurrent Medications When Prescribing Opioids for Low Back Pain? A Retrospective Cross-Sectional Analysis

2020 ◽  
Author(s):  
Michelle Sophie Keller ◽  
Lyna Truong ◽  
Allison Moser Mays ◽  
Jack Needleman ◽  
MarySue V. Heilemann ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Kidney Disease ◽  
Gastrointestinal Diseases ◽  
Low Back ◽  
Opioid Use ◽  
Cross Sectional ◽  
Opioid Prescription ◽  
To Receive

Abstract Background Given the risks of opioid therapy, clinicians are under growing pressure to treat pain with non-opioid medications. Yet non-opioid analgesics such as non-steroidal anti-inflammatory drugs have their own risks; patients with kidney disease or gastrointestinal diseases can experience serious adverse events. We examined how primary care clinicians balance patient comorbidities and concurrent medications when prescribing opioids. Methods We used a retrospective cross-sectional study design and data from one health system. We identified office visits for low back pain from 2012-2017 and sampled the first visit per patient per year (N= 24,543 visits). We created indicators reflecting contraindications for NSAIDs (kidney, liver, cardiovascular/cerebrovascular, and gastrointestinal diseases; concurrent use of anticoagulants/antiplatelets) and opioids (depression, anxiety, substance use and bipolar disorders, chronic corticosteroid use, and concurrent benzodiazepines) and estimated four logistic regression models, with the first model including all patient visits and then stratifying for previous opioid use. Results Patients received an opioid prescription at 4% of visits. Among all patients, kidney disease (marginal effect [ME]: 3%; 95%CI: 1%-4%) or chronic/concurrent anticoagulant/antiplatelet prescriptions (ME: 2%, 95%CI: 1%-3%) were associated with a higher probability of receiving an opioid prescription. Concurrent benzodiazepines (ME: 7%, 95%CI: 5%-9%) and substance use diagnoses (ME: 1%, 95%CI: 0%-3%) were also associated with a higher probability of opioid prescription receipt. Among patients with long-term opioid use, contraindications for NSAIDs were not associated with a higher probability of opioid prescription receipt, while the probability of opioid receipt among those with concurrent benzodiazepines was substantially higher (ME: 10%, 95%CI: 14%-53%).Conclusions Among our entire sample, patients with kidney disease were 75% more likely to receive an opioid prescription for low back pain. Among patients with long-term opioid use, we did not find the same association. Patients with long-term use were likely started on opioids when opioid prescribing was more liberal; discussions regarding non-opioid options would be worthwhile for this population. Patients with concurrent benzodiazepines were 175% more likely to receive an opioid prescription; among patients with long-term opioid use, they were 250% more likely to receive opioids. These findings are troubling, as this combination is dangerous and can lead to overdose.

Topical Anesthesia in 27-Gauge Pars Plana Vitrectomy

2018 ◽  
Vol 2 (2) ◽  
pp. 100-103
Author(s):  
Abdallah M. Jeroudi ◽  
Wen-Shi Shieh ◽  
Yicheng Chen ◽  
Daniel B. Connors ◽  
Kevin J. Blinder ◽  
...  
Keyword(s):  
Pain Score ◽  
Pars Plana Vitrectomy ◽  
Case Series ◽  
Pain Scale ◽  
Topical Anesthesia ◽  
Pain Scores ◽  
Lidocaine Gel ◽  
Pars Plana ◽  
Intraoperative Pain ◽  
The Mean

Purpose: To explore the safety, comfort, and feasibility of topical anesthesia in 27-gauge pars plana vitrectomy surgery. Methods: A prospective, observational case series of 37 nonconsecutive patients undergoing 3-port, 27-gauge pars plana vitrectomy under topical anesthesia with lid block from July 2016 to March 2017 with a single surgeon was performed. Topical anesthesia was achieved with proparacaine 0.5% drops and 2% lidocaine gel. Surgery was performed for select indications with carefully selected patients amenable to topical anesthesia. Patients were queried and observed to identify the most painful steps of the case and to rate their intraoperative and postoperative pain scores on a 1- to 10-point pain scale. Results: The mean intraoperative pain score was 2.1 with the most painful steps rated as scleral depression (37.8%), trocar/cannula insertion (24.3%), and conjunctival coaptation (24.3%). When correlating the overall intraoperative pain score with the self-identified most painful step, the mean pain scores were highest for endolaser (2.6), scleral depression (2.1), conjunctival coaptation (2.1), and trocar/cannula insertion (1.6). Supplemental intravenous anesthesia was requested once by the surgeon in 54% of the cases. No rescue with local infiltrative anesthesia was required. The mean pain scores were 0.7 and 0 at postoperative day 1 and week 1. No intraoperative or postoperative complications were encountered. Conclusions: Topical anesthesia for 27-gauge pars plana vitrectomy is a safe and feasible anesthesia option for carefully selected patients for certain surgical indications.

scholarly journals Pericapsular nerve group block for hip fracture is safe and effective in the emergency department: a prospective observational study comparing pericapsular nerve group block to fascia iliaca compartment block and femoral nerve block

2021 ◽  
Author(s):  
Alan Fahey ◽  
Elinor Cripps ◽  
Aloysius Ng ◽  
Amy Sweeny ◽  
Peter J. Snelling
Keyword(s):  
Emergency Department ◽  
Hip Fracture ◽  
Pain Score ◽  
Regional Anaesthesia ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Emergency Physicians ◽  
Opioid Use ◽  
Pain Scores ◽  
Fascia Iliaca Compartment Block

ABSTRACTBackgroundThe pericapsular nerve group (PENG) block was first described for the treatment of hip fracture, including neck of femur, in 2018. We hypothesise that the PENG block is safe and effective for patients with hip fracture when provided by emergency physicians and trainees in the emergency department (ED), for which it may be superior to fascia iliaca compartment block (FICB) and femoral nerve block (FNB).MethodsFrom October 2019 to July 2020, consecutive patients receiving regional anaesthesia for hip fracture in the ED of a single large regional hospital were prospectively enrolled. Pain scores were assessed prior to regional anaesthesia then at 15, 30 and 60 minutes after regional anaesthesia. Maximal reduction in pain scores within 60 minutes were assessed using the Visual Analogue Scale (at rest and on movement) or the Pain Assessment IN Advanced Dementia tool (at rest). Patients were followed for opioid use for 12 hours after regional anaesthesia and adverse events over the duration of their admission.ResultsThere were 67 eligible patients during the enrolment period, with 52 (78%) prospectively enrolled. Thirty-three received femoral blocks (19 FICB, 14 FNB) and 19 received a PENG block. There was no difference in maximum pain score reduction between the groups whether measured at rest or on movement. Clinicians providing the PENG block were less experienced in the technique than those providing FICB or FNB. There was no difference in adverse effects between groups. Although opioid use was similar between the groups, more patients were opioid free after a PENG block.ConclusionsAlthough there was no difference in maximal pain score reduction, this study demonstrated that the PENG block was feasible and could be provided safely and effectively to patients with hip fracture in the ED. On this basis, a larger randomised controlled study should now be designed.Key MessagesWhat is already known on this subject□There is a solid neuroanatomical rationale to suggest the PENG block may provide superior anaesthesia of hip fractures than FNB or FICB.□The technique utilises bony sonographic and tactile landmarks which make it an ideal block for emergency physicians to safely and effectively perform.□What this study adds□This is the first comparative study of the PENG block to FNB or FICB in patients with hip fracture in ED, which will provide a scaffold for future research.□This pragmatic observation of evolving practice showed that emergency physicians and trainees inexperienced in the technique could provide it safely and effectively in the ED

scholarly journals Prescription of analgesia in emergency medicine (POEM) secondary analysis: an observational multicentre comparison of pain relief provided to adults and children with an isolated limb fracture and/or dislocation

2021 ◽  
pp. emermed-2020-209835
Author(s):  
Sarah Wilson ◽  
Jane Quinlan ◽  
Sally Beer ◽  
Melanie Darwent ◽  
Jack R. Dainty ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Pain Management ◽  
Pain Score ◽  
Best Practice ◽  
Secondary Analysis ◽  
Fracture Dislocation ◽  
Long Bone ◽  
Cross Sectional ◽  
Limb Fracture ◽  
To Receive

BackgroundAcute pain is a common reason for emergency department (ED) attendance. Royal College of Emergency Medicine (RCEM) pain management audits have shown national variation and room for improvement. Previous evidence suggests that children receive less satisfactory pain management than adults.MethodsPrescription of analgesia in emergency medicine is a cross-sectional observational study of consecutive patients presenting to 12 National Health Service EDs with an isolated long bone fracture and/or dislocation, and was carried out between 2015 and 2017. Using the recommendations in the RCEM Best Practice Guidelines, pain management in ED was assessed for differences of age (adults vs children) and hospital type (children’s vs all patients).ResultsFrom the total 8346 patients, 38% were children (median age 8 years). There was better adherence to the RCEM guidance for children than adults (24% (766/3196) vs 11% (579/5123)) for the combined outcome of timely assessment, pain score and appropriate analgesia. In addition, children were significantly more likely than adults to receive analgesia appropriate to the pain score (of those with a recorded pain score 67% (1168/1744) vs 52% (1238/2361)). Children’s hospitals performed much better across all reported outcomes compared with general hospitals.ConclusionsIn contrast to previous studies, children with a limb fracture/dislocation are more likely than adults to have a pain score documented and to receive appropriate analgesia. Unexpectedly, children’s EDs performed better than general EDs in relation to timely and appropriate analgesia but the reasons for this are not apparent from the present study.

PAIIN (Precise Analgesic Instructions Improve Narcotic Usage): A Randomized Trial

2022 ◽  
Author(s):  
Logan Erz ◽  
Brandon Larson ◽  
Shayda Mirhaidari ◽  
Chad Cook ◽  
Doug Wagner
Keyword(s):  
Pain Management ◽  
The United States ◽  
Pain Scale ◽  
Opioid Use ◽  
Breast Reduction Surgery ◽  
Pain Scores ◽  
Subjective Pain ◽  
Group A ◽  
Group B ◽  
New Strategies

Abstract Background Given the ongoing battle with opioid abuse and over-use in the United States new strategies are consistently being implemented in an attempt to reduce opioid use and over prescribing. Objectives The purpose of this study was to determine if a more regulated explicit pain management instruction plan could reduce the number of opioids taken. Methods Blinded randomized prospective study comparing a total of 110 (Group A=55, Group B=55) women undergoing elective outpatient bilateral breast reduction surgery by two different plastic surgeons. Patients were randomly divided into either Group A (control) that received general pain management instructions or Group B (experimental) that received explicit pain management instructions from the surgeons and nurses. Participants were asked to record the number of times they treated their pain with each separate modality. They were also asked to record their average daily pain scale for the days that they were treating their pain. Results Patients in group B took on average 1.5 oxycodone while patients in group A took on average 5.7 oxycodone (p<0.01). Thirty-four patients in group B took no oxycodone. Patients in group B also had statistically significant lower subjective pain scores. Conclusions Based on these results it appears that standardizing how patients are instructed to treat their pain post-operatively may reduce the number of narcotics needed, thus reducing the number of narcotics prescribed without compromising pain control.

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