scholarly journals Chronic Smoking is Not Associated with Increased Postoperative Opioid Use in Patients with Lung Cancer or Esophageal Cancer

2018 ◽  
Vol 1 (21;1) ◽  
pp. E49-E55 ◽  
Author(s):  
Tak Kyu Oh
Keyword(s):  
Lung Cancer ◽  
Esophageal Cancer ◽  
Postoperative Pain ◽  
Cigarette Smoking ◽  
Final Analysis ◽  
Cancer Center ◽  
Opioid Use ◽  
Opioid Dose ◽  
Cancer Types ◽  
Chronic Smoking

Background: Chronic smokers show differences in pain sensitivity compared to healthy non-smokers. Yet, no study to date has examined whether smoker status has an effect on postoperative pain. Objective: We aim to examine a possible correlation between preoperative smoking and postoperative opioid dose based on the hypothesis that smokers would use higher doses of opioids to manage increased postoperative pain. Study Design: A retrospective observational cohort study. Setting: The National Cancer Center in Korea. Methods: We examined medical record data for patients who had undergone curative resection for either lung or esophageal cancer (lobectomy or bilobectomy for lung cancer or an Ivor Lewis operation for esophageal cancer) between January 1, 2006 and December 31, 2010. We examined the correlation between the total preoperative average number of packs per day multiplied by years of cigarette smoking (pack-years) and morphine equivalent daily doses administered to patients after surgery, considering each type of cancer both individually and together. Partial correlation and regression analyses were performed to determine the causality of a possible relationship between pack-years of cigarette smoking and postoperative opioid dose. Results: A total of 1,129 patients (871 patients with lung cancer and 258 patients with esophageal cancer) were included in the final analysis. There was no significant correlation between total pack-years of cigarette smoking and postoperative opioid dose for lung cancer, esophageal cancer, or both cancer types combined (r = 0.042, -0.012, and 0.037, respectively). In the analysis of both cancer types combined, video-assisted thoracic surgery (VATS) was associated with an 11.1% decrease in opioid dose (β = -0.111, P = 0.003) and epidural analgesia was associated with a 7.2% increase in opioid dose (β = 0.072, P = 0.042). Limitations: The retrospective design of this study is a limitation. Conclusion: Our study did not observe a correlation between preoperative smoking and postoperative opioid dose in patients with lung or esophageal cancer. Key words: Smoking, postoperative pain, opioid, lung cancer, esophageal cancer, analgesia

scholarly journals Acute Pain Burden and Opioid Dose Requirements after Cesarean Delivery in Parturients with Preexisting Chronic Back Pain and Migraine

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Ryu Komatsu ◽  
Michael G. Nash ◽  
Kenneth C. Ruth ◽  
William Harbour ◽  
Taylor M. Ziga ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Back Pain ◽  
Postoperative Pain ◽  
Pain Score ◽  
Cesarean Delivery ◽  
Chronic Back Pain ◽  
Weighted Average ◽  
Opioid Use ◽  
Opioid Dose ◽  
Chronic Pain Conditions

Introduction. Preexisting chronic pain has been reported to be a consistent risk factor for severe acute postoperative pain. However, each specific chronic pain condition has unique pathophysiology, and it is possible that the effect of each condition on postoperative pain is different. Methods. This is a retrospective cohort study of pregnant women with preexisting chronic pain conditions (i.e., migraine, chronic back pain, and the combination of migraine + chronic back pain), who underwent cesarean delivery. The effects of the three chronic pain conditions on time-weighted average (TWA) pain score (primary outcome) and opioid dose requirements in morphine milligram equivalents (MME) during postoperative 48 hours were compared. Results. The TWA pain score was similar in preexisting migraine and chronic back pain. Chronic back pain was associated with significantly greater opioid dose requirements than migraine (12.92 MME, 95% CI: 0.41 to 25.43, P = 0.041 ). Preoperative opioid use ( P < 0.001 ) was associated with a greater TWA pain score. Preoperative opioid use ( P < 0.001 ), smoking ( P = 0.004 ), and lower postoperative ibuprofen dose ( P = 0.002 ) were associated with greater opioid dose requirements. Conclusions. Findings suggest women with chronic back pain and migraine do not report different postpartum pain intensities; however, women with preexisting chronic back pain required 13 MME greater opioid dose than those with migraine during 48 hours after cesarean delivery.

Investigation into Cigarette Smoking and Atmospheric Pollution in the Aetiology of Lung Cancer

1963 ◽  
Vol 2 (01) ◽  
pp. 13-19 ◽  
Author(s):  
R. Doll
Keyword(s):  
Lung Cancer ◽  
Cigarette Smoking ◽  
Atmospheric Pollution ◽  
Direct Evidence ◽  
Retrospective Studies ◽  
Common Factor ◽  
Animal Experiments ◽  
Smoking Habits ◽  
Careful Examination ◽  
Ancillary Data

The evidence that cigarette smoking and atmospheric pcllution are causes of lung cancer is largely statistical. The first evidence was indirect; that is, i1. was noticed that in many countries the incidence of lung cancer had increased and that the increase could be correlated with changes in the prevalence of cigarette smoking and of certain types of atmospheric pollution.Since then much direct evidence has been obtained. The relationship between cigarette smoking and lung cancer has been demonstrated retrospectively by comparing the smoking habits of patients with and without lung cancer and prospectively by observing the mortality from lung cancer in groups of persons of known smoking habits. Conclusions can be drawn from these studies only after careful examination of the results. In particular it is important in retrospective studies to test a) the reproducibility of the data, b) the representativeness of the data, and c) the comparability of the special series and their controls. The resul1.s of retrospective studies are all similar and all show a close relationship between cigarette smoking and the disease.The results have been confirmed by pro~pective studies which are lesF. open to bias. The results can be explained if cigarette smoking causes lung cancer or if both are related to some third common factor. Ancillary data (pathological changes in the bronchial mucosa, animal experiments, etc.) support the causal hypothesis.The evidence relating to atmospheric pollution is less definite and it is difficult to get direct evidence of a relationship in the individual. It is clear that pollution has little effect in the absence of smoking, but the mortality associated with a given amount of smoking is generally greater in large towns than in the countryside and among men who have emigrated from Britain than among men who have lived all their lives in less polluted countries.

scholarly journals Cigarette Smoking and Risk of Lung Cancer in Korean Men: The Seoul Male Cancer Cohort Study

2007 ◽  
Vol 22 (3) ◽  
pp. 508 ◽  
Author(s):  
Jong-Myon Bae ◽  
Moo-Song Lee ◽  
Myung-Hee Shin ◽  
Dong-Hyun Kim ◽  
Zhong-Min Li ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cohort Study ◽  
Cigarette Smoking

scholarly journals Participants with mild, moderate, or severe pain following total hip arthroplasty. A sub-study of the PANSAID trial on paracetamol and ibuprofen for postoperative pain treatment

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Luma Mahmoud Issa ◽  
Kasper Højgaard Thybo ◽  
Daniel Hägi-Pedersen ◽  
Jørn Wetterslev ◽  
Janus Christian Jakobsen ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Severe Pain ◽  
Pain Treatment ◽  
Opioid Analgesic ◽  
Opioid Use ◽  
Mild Pain ◽  
Total Hip ◽  
Pain Scores

AbstractObjectivesIn this sub-study of the ‘Paracetamol and Ibuprofen in Combination’ (PANSAID) trial, in which participants were randomised to one of four different non-opioids analgesic regimen consisting of paracetamol, ibuprofen, or a combination of the two after planned primary total hip arthroplasty, our aims were to investigate the distribution of participants’ pain (mild, moderate or severe), integrate opioid use and pain to a single score (Silverman Integrated Approach (SIA)-score), and identify preoperative risk factors for severe pain.MethodsWe calculated the proportions of participants with mild (VAS 0–30 mm), moderate (VAS 31–60 mm) or severe (VAS 61–100 mm) pain and the SIA-scores (a sum of rank-based percentage differences from the mean rank in pain scores and opioid use, ranging from −200 to 200%). Using logistic regression with backwards elimination, we investigated the association between severe pain and easily obtainable preoperative patient characteristics.ResultsAmong 556 participants from the modified intention-to-treat population, 33% (95% CI: 26–42) (Group Paracetamol + Ibuprofen (PCM + IBU)), 28% (95% CI: 21–37) (Group Paracetamol (PCM)), 23% (95% CI: 17–31) (Group Ibuprofen (IBU)), and 19% (95% CI: 13–27) (Group Half Strength-Paracetamol + Ibuprofen (HS-PCM + IBU)) experienced mild pain 6 h postoperatively during mobilisation. Median SIA-scores during mobilisation were: Group PCM + IBU: −48% (IQR: −112 to 31), Group PCM: 40% (IQR: −31 to 97), Group IBU: −5% (IQR: −57 to 67), and Group HS-PCM + IBU: 6% (IQR: −70 to 74) (overall difference: p=0.0001). Use of analgesics before surgery was the only covariate associated with severe pain (non-opioid: OR 0.50, 95% CI: 0.29–0.82, weak opioid 0.56, 95% CI: 0.28–1.16, reference no analgesics before surgery, p=0.02).ConclusionsOnly one third of participants using paracetamol and ibuprofen experienced mild pain after total hip arthroplasty and even fewer experienced mild pain using each drug alone as basic non-opioid analgesic treatment. We were not able, in any clinically relevant way, to predict severe postoperative pain. A more extensive postoperative pain regimen than paracetamol, ibuprofen and opioids may be needed for a large proportion of patients having total hip arthroplasty. SIA-scores integrate pain scores and opioid use for the individual patient and may add valuable information in acute pain research.

scholarly journals Epigenome-wide association study of whole blood gene expression in Framingham Heart Study participants provides molecular insight into the potential role of CHRNA5 in cigarette smoking-related lung diseases

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Chen Yao ◽  
Roby Joehanes ◽  
Rory Wilson ◽  
Toshiko Tanaka ◽  
Luigi Ferrucci ◽  
...  
Keyword(s):  
Gene Expression ◽  
Lung Cancer ◽  
Dna Methylation ◽  
Cigarette Smoking ◽  
Association Study ◽  
Whole Blood ◽  
Lung Diseases ◽  
Epigenetic Modification ◽  
Blood Gene Expression ◽  
Increased Risk

Abstract Background DNA methylation is a key epigenetic modification that can directly affect gene regulation. DNA methylation is highly influenced by environmental factors such as cigarette smoking, which is causally related to chronic obstructive pulmonary disease (COPD) and lung cancer. To date, there have been few large-scale, combined analyses of DNA methylation and gene expression and their interrelations with lung diseases. Results We performed an epigenome-wide association study of whole blood gene expression in ~ 6000 individuals from four cohorts. We discovered and replicated numerous CpGs associated with the expression of cis genes within 500 kb of each CpG, with 148 to 1,741 cis CpG-transcript pairs identified across cohorts. We found that the closer a CpG resided to a transcription start site, the larger its effect size, and that 36% of cis CpG-transcript pairs share the same causal genetic variant. Mendelian randomization analyses revealed that hypomethylation and lower expression of CHRNA5, which encodes a smoking-related nicotinic receptor, are causally linked to increased risk of COPD and lung cancer. This putatively causal relationship was further validated in lung tissue data. Conclusions Our results provide a large and comprehensive association study of whole blood DNA methylation with gene expression. Expression platform differences rather than population differences are critical to the replication of cis CpG-transcript pairs. The low reproducibility of trans CpG-transcript pairs suggests that DNA methylation regulates nearby rather than remote gene expression. The putatively causal roles of methylation and expression of CHRNA5 in relation to COPD and lung cancer provide evidence for a mechanistic link between patterns of smoking-related epigenetic variation and lung diseases, and highlight potential therapeutic targets for lung diseases and smoking cessation.

scholarly journals Opioid-sparing effects of medical cannabis or cannabinoids for chronic pain: a systematic review and meta-analysis of randomised and observational studies

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047717
Author(s):  
Atefeh Noori ◽  
Anna Miroshnychenko ◽  
Yaadwinder Shergill ◽  
Vahid Ashoorion ◽  
Yasir Rehman ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Sleep Disturbance ◽  
Observational Studies ◽  
Prescription Opioids ◽  
Randomised Trials ◽  
Medical Cannabis ◽  
Opioid Use ◽  
Opioid Dose ◽  
Chronic Cancer Pain ◽  
Pain Patients

ObjectiveTo assess the efficacy and harms of adding medical cannabis to prescription opioids among people living with chronic pain.DesignSystematic review.Data sourcesCENTRAL, EMBASE and MEDLINE.Main outcomes and measuresOpioid dose reduction, pain relief, sleep disturbance, physical and emotional functioning and adverse events.Study selection criteria and methodsWe included studies that enrolled patients with chronic pain receiving prescription opioids and explored the impact of adding medical cannabis. We used Grading of Recommendations Assessment, Development and Evaluation to assess the certainty of evidence for each outcome.ResultsEligible studies included five randomised trials (all enrolling chronic cancer-pain patients) and 12 observational studies. All randomised trials instructed participants to maintain their opioid dose, which resulted in a very low certainty evidence that adding cannabis has little or no impact on opioid use (weighted mean difference (WMD) −3.4 milligram morphine equivalent (MME); 95% CI (CI) −12.7 to 5.8). Randomised trials provided high certainty evidence that cannabis addition had little or no effect on pain relief (WMD −0.18 cm; 95% CI −0.38 to 0.02; on a 10 cm Visual Analogue Scale (VAS) for pain) or sleep disturbance (WMD −0.22 cm; 95% CI −0.4 to −0.06; on a 10 cm VAS for sleep disturbance; minimally important difference is 1 cm) among chronic cancer pain patients. Addition of cannabis likely increases nausea (relative risk (RR) 1.43; 95% CI 1.04 to 1.96; risk difference (RD) 4%, 95% CI 0% to 7%) and vomiting (RR 1.5; 95% CI 1.01 to 2.24; RD 3%; 95% CI 0% to 6%) (both moderate certainty) and may have no effect on constipation (RR 0.85; 95% CI 0.54 to 1.35; RD −1%; 95% CI −4% to 2%) (low certainty). Eight observational studies provided very low certainty evidence that adding cannabis reduced opioid use (WMD −22.5 MME; 95% CI −43.06 to −1.97).ConclusionOpioid-sparing effects of medical cannabis for chronic pain remain uncertain due to very low certainty evidence.PROSPERO registration numberCRD42018091098.

scholarly journals Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients

2017 ◽  
Vol 127 (4) ◽  
pp. 633-644 ◽  
Author(s):  
Keyword(s):  
Postoperative Pain ◽  
Postoperative Delirium ◽  
Intervention Group ◽  
Group Versus ◽  
Length Of Hospital Stay ◽  
Treated Group ◽  
Assessment Method ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Opioid Use

Abstract Background Postoperative pain and opioid use are associated with postoperative delirium. We designed a single-center, randomized, placebo-controlled, parallel-arm, double-blinded trial to determine whether perioperative administration of gabapentin reduced postoperative delirium after noncardiac surgery. Methods Patients were randomly assigned to receive placebo (N = 347) or gabapentin 900 mg (N = 350) administered preoperatively and for the first 3 postoperative days. The primary outcome was postoperative delirium as measured by the Confusion Assessment Method. Secondary outcomes were postoperative pain, opioid use, and length of hospital stay. Results Data for 697 patients were included, with a mean ± SD age of 72 ± 6 yr. The overall incidence of postoperative delirium in any of the first 3 days was 22.4% (24.0% in the gabapentin and 20.8% in the placebo groups; the difference was 3.20%; 95% CI, 3.22% to 9.72%; P = 0.30). The incidence of delirium did not differ between the two groups when stratified by surgery type, anesthesia type, or preoperative risk status. Gabapentin was shown to be opioid sparing, with lower doses for the intervention group versus the control group. For example, the morphine equivalents for the gabapentin-treated group, median 6.7 mg (25th, 75th quartiles: 1.3, 20.0 mg), versus control group, median 6.7 mg (25th, 75th quartiles: 2.7, 24.8 mg), differed on the first postoperative day (P = 0.04). Conclusions Although postoperative opioid use was reduced, perioperative administration of gabapentin did not result in a reduction of postoperative delirium or hospital length of stay.

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