Pain in systemic connective tissue diseases

Franco, Manuela Di; Bazzichi, Laura; Casale, Roberto; Sarzi-Puttini, Piercarlo; Atzeni, Fabiola

doi:10.1016/j.berh.2015.05.006

Cited by 16 publications

(12 citation statements)

References 57 publications

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“…In this study, persistent users disproportionately utilized the ED compared to limited users, and mostly for non‐lupus–related pain reasons. Chronic pain, a symptom frequently experienced by patients with SLE , was a major cause of ED utilization and ED‐initiated admissions among patients with SLE who persistently frequented the ED. These patients were more likely to be noncritically ill, as evidenced by frequent discharge from the ED and PASS admissions.…”

Section: Discussionmentioning

confidence: 99%

Persistently Frequent Emergency Department Utilization Among Persons With Systemic Lupus Erythematosus

Lee

Lin

Suter

et al. 2019

Arthritis Care & Research

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Objective. In order to identify opportunities to improve outpatient care, we evaluated patients with systemic lupus erythematosus (SLE) who persistently frequent the emergency department (ED).Methods. We conducted a retrospective study of patients with SLE who frequented the ED for ≥3 visits in a calendar year, from 2013 to 2016. Persistent users were those who met criteria for persistent use for at least 2 of the 4 years, and limited users for 1 of the 4 years. Each ED encounter was categorized as SLE-related, infection-related, pain-related, or other. We compared ED use between persistent and limited users, and analyzed factors associated with pain-related encounters among persistent users through multivariate logistic regression.Results. We identified 77 participants who had 1,143 encounters as persistent users, and 52 participants who had 335 encounters as limited users. Persistent users accounted for 77% of ED use by patients with SLE who frequented the ED. Pain-related ED visits were more common among persistent users (32%) than limited users (18%). Among persistent users, most pain-related encounters were discharged from the ED (69%) or within 48 hours of admission (20%). Persistent users with pain-related encounters accounting for >10% of ED use were more likely to be obese, have fewer comorbid conditions, and be on long-term opioid therapy.Conclusion. Pain is a major cause of ED use. Patients with SLE who persistently utilize the ED for pain are likely to be noncritically ill, as evidenced by frequent discharges from the ED and short-stay admissions. Patients with SLE who persistently frequent the ED for pain represent a viable target for interventions to improve outpatient quality of care.

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Section: Discussionmentioning

confidence: 99%

Persistently Frequent Emergency Department Utilization Among Persons With Systemic Lupus Erythematosus

Lee

Lin

Suter

et al. 2019

Arthritis Care & Research

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“…[1][2][3][4] SLE can also be a painful disease, with pain ranging from musculoskeletal (affecting bone, muscles, joints) to centralised (related to fibromyalgia and the central nervous system) systems. [5][6][7][8] There is currently no cure for SLE, standard of care has relied on a combination of antimalarials, corticosteroids and/or immunosuppressants depending on disease severity. 9 Biological therapy was introduced for SLE almost a decade ago with belimumab, a B-lymphocyte stimulator cell-targeting therapy; however, treatment pattern studies have shown a relatively low uptake of this biologic in SLE.…”

Section: Introductionmentioning

confidence: 99%

Corticosteroid dosing and opioid use are high in patients with SLE and remain elevated after belimumab initiation: a retrospective claims database analysis

Birt

Griffing

et al. 2020

Lupus Sci Med

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ObjectivesTo investigate corticosteroid and opioid use among patients with SLE and to examine the impact of belimumab initiation on the use of other SLE therapies.MethodsWe identified adult patients with SLE (International Classification of Diseases, 9th Revision/10th Revision 710.0 and M32) between 1 January 2012 and 31 May 2018 (earliest SLE diagnosis=index date) within MarketScan administrative claims data. Patients were followed from index date for a minimum of 12 months and until the earlier of disenrolment in their health plan or study end (31 May 2018). Corticosteroid utilisation, corticosteroid dose (in prednisone equivalents) and opioid utilisation (overall, by strength (weak, strong) and by duration (chronic use defined as >90 days of cumulative drug supply)) were measured during follow-up. Oral corticosteroid and opioid use were compared in the 6 months before and after initiation of belimumab.ResultsThere were 49 413 patients with SLE eligible for analysis (mean (SD) age: 50.1 (14.0) years, 90.2% female). Of these, 68.5% received corticosteroids, and the average number of prescriptions was 4.59 (4.11) over the first 12 months of follow-up. Among patients with oral corticosteroids, average daily dose was 19.4 (14.2) mg and 59.6% had an average daily dose of ≥15 mg. Half (52.6%) had at least one opioid prescription and of these, 34.6% had chronic use over the first 12 months of follow-up. Among patients initiating belimumab during follow-up (n=1710), oral corticosteroid use decreased by 9.1% (p=0.001), and average daily dose decreased from 14.5 (18.4) mg to 11.9 (18.0) mg (p<0.001) in the 6 months after initiation compared with the 6 months prior. Initiation of belimumab had no impact on prevalence of opioid use.ConclusionsA high proportion of patients with SLE are treated with corticosteroids to control SLE and opioid therapy to manage chronic pain. While there was no change in opioid use, oral corticosteroid use and dose intensity decreased following initiation of belimumab.

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“…However, effective pain management has not been investigated in detail in patients with SSc and the experience in DUs is further limited, particularly regarding opioids such as oxycodone. 11 , 12 Due to the lack of best practice consensus, analgesic strategies are not standardized and are mainly guided by a physician’s experience.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of oxycodone/naloxone in the management of chronic pain in patients with systemic sclerosis with recurrent digital ulcers: two case reports

Ughi¹,

Crotti²,

Ingegnoli³

2016

CIA

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Digital ulcers (DUs) are a severe and frequent clinical feature of patients with systemic sclerosis (SSc). The presence of DUs may cause severe pain and often lead to impairment of patient’s functional activities and health-related quality of life. Moreover, poor patient cooperation during the wound care procedure due to pain may be associated with a negative outcome of DU healing. Therefore, pain management has a key role in patients with SSc. These two case reports describe the effectiveness and safety of oxycodone/naloxone in patients with SSc complicated by painful chronic DUs. Such a therapy has provided pain relief and consequently an increased compliance during redressing wounds.

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Pain in systemic connective tissue diseases

Cited by 16 publications

References 57 publications

Persistently Frequent Emergency Department Utilization Among Persons With Systemic Lupus Erythematosus

Persistently Frequent Emergency Department Utilization Among Persons With Systemic Lupus Erythematosus

Corticosteroid dosing and opioid use are high in patients with SLE and remain elevated after belimumab initiation: a retrospective claims database analysis

Effectiveness and safety of oxycodone/naloxone in the management of chronic pain in patients with systemic sclerosis with recurrent digital ulcers: two case reports

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