Clinical solutions to chronic pain and the opiate epidemic

Murray, Matthew; Stone, Alexander B.; Pearson, Virginia; Treisman, Glenn J.

doi:10.1016/j.ypmed.2018.10.004

Cited by 15 publications

(10 citation statements)

References 25 publications

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“…There is great potential to replicate this intervention across the country as part of a comprehensive response to the opioid epidemic 27 . Doing so would help decrease opioid use on a large scale in little time and would provide a model for reducing unnecessary opioid use in other medical settings.…”

Section: Discussionmentioning

confidence: 99%

Alternatives to opioid protocols in Colorado emergency departments reduce opioid use without changing reported pain

Stader

Wald

MacKay³

et al. 2020

JACEP Open

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Objective: The objective of this study was to determine whether instituting an alternative to opioids (ALTO) protocol significantly reduced opioid use in emergency departments (EDs). The secondary objective was to determine whether patient-reported pain and satisfaction were affected. Methods: Electronic health records for 10 EDs in Colorado were retrospectively examined for the 6 months before the intervention and for the same 6 months the following year after the intervention, which consisted of systemic and educational initiatives in line with the Colorado American College of Emergency Physicians 2017 Opioid Prescribing and Treatment Guidelines. Results: Of the total preintervention and postintervention unique patient visits, 47.2% received 1 of the drugs of interest, an opioid or ALTO, while in the ED. In aggregate, the EDs decreased opioid usage, measured in morphine equivalent units per 1000 ED visits, by 37.4% (95% confidence interval, 33.6%-76.2%; P < 0.0001) after the intervention. Statistically significant decreases were seen in every type of opioid. Statistically significant increases in ALTO usage were also noted across all study hospitals. There were no significant changes observed in Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction scores before and after the intervention in the hospitals with Hospital Consumer Assessment of Healthcare Providers and Systems data (preintervention mean, 3.74; postintervention mean, 3.74; P = 0.637), and there was a small but statistically significant improvement in pain scores (preintervention mean, 3.62; postintervention mean, 3.66; P = 0.002). In a subgroup analysis of patients presenting with chief complaints of long bone fractures and malignant neoplasms, there were no significant reductions in opioid use. Conclusions: This study demonstrated the feasibility and effectiveness of implementing ALTO protocols to reduce opioid use in the ED setting without an overall reduction in patient perception of pain or satisfaction with care.

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Section: Discussionmentioning

confidence: 99%

Alternatives to opioid protocols in Colorado emergency departments reduce opioid use without changing reported pain

Stader

Wald

MacKay³

et al. 2020

JACEP Open

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“…Activation of the stress axis and the sympathetic nervous system as well as mood disorders, such as depression and anxiety, are linked with chronic pain. Several mechanisms are involved in amplification and chronification of pain, including peripheral sensitization, neuropathic pain, deafferentation pain, sympathetically maintained pain, and central sensitization 57 . Furthermore, a variety of inflammatory and immune transmitters enhance pain signaling.…”

Section: Biomarkers Mediators and Pharmacology Of Painmentioning

confidence: 99%

Pancreatic Pain—Knowledge Gaps and Research Opportunities in Children and Adults

et al. 2021

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A workshop was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases to focus on research gaps and opportunities in pancreatic pain. The event was held on July 21, 2021, and structured into 4 sessions: (1) pathophysiology; (2) biomarkers, mediators, and pharmacology of pain; (3) pain assessment; and (4) pain treatment challenges and opportunities. The current state of knowledge was reviewed; many knowledge gaps and research needs were identified that require further investigation. Common themes included the need to better understand the underlying mechanisms of pain in pancreatic diseases, the relationship of visceral neural pathways and central pain centers, the role of behavioral factors and disorders on the perception of pain, and differences in pain perception and processes in children when compared with adults. In addition, the role of genetic risk factors for pain and the mechanisms and role of placebos in pain treatment were discussed. Methods of pain assessment including quantitative sensory testing were examined, as well as the process of central sensitization of pain. Finally, newer approaches to pain management including cognitive behavioral therapy, nerve stimulation, experimental (nonopioid) drugs, and cannabinoid compounds were covered.

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“…Numerous approaches are available for the management of specific pain syndromes. These approaches may include nerve blocks, trigger-point injections, Botox injections, and local anesthesia to encourage rehabilitation (52). Additional alternatives to opioids include nonsteroidal analgesics, although these have their own potential adverse effects.…”

Section: What Clinicians Can Domentioning

confidence: 99%

Clinical Perspective on Opioids in the Context of Suicide Risk

Nestadt

Bohnert

2020

FOC

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Psychiatrists are on the front lines of two simultaneous public health crises: the increasing rates of suicide and opioid-related deaths. In this review, the authors discuss ways in which these two classes of preventable deaths may be linked, with an emphasis on identifying and preventing both outcomes through increased understanding of their shared risk factors. As clinicians, it is crucial to maintain awareness of the ways in which opioid use may contribute to depression and suicidality, as well as how mood disorders may complicate opioid use. In light of this interplay, interventions which target risk factors for both suicide and overdose are key. Interventions include early treatment of substance dependence and depression, as well as harm reduction measures, such as provision of naloxone, medication-assisted treatments for dependency, and multidisciplinary approaches to chronic pain that do not rely solely on escalating opioid doses. It is also important to address social determinants of health, which may increase risk for both accidental and intentional overdose. The roads to overdose and suicide overlap considerably and cannot be considered separately.

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Clinical solutions to chronic pain and the opiate epidemic

Cited by 15 publications

References 25 publications

Alternatives to opioid protocols in Colorado emergency departments reduce opioid use without changing reported pain

Alternatives to opioid protocols in Colorado emergency departments reduce opioid use without changing reported pain

Pancreatic Pain—Knowledge Gaps and Research Opportunities in Children and Adults

Clinical Perspective on Opioids in the Context of Suicide Risk

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