Time trends in use of non-steroidal anti-inflammatory drugs and opioids one year after total hip arthroplasty due to osteoarthritis during 1996–2018: a population-based cohort study of 103,209 patients

Klenø, André N; Sørensen, Henrik Toft; Pedersen, Alma B

doi:10.1016/j.joca.2022.07.006

Cited by 7 publications

(5 citation statements)

References 29 publications

(31 reference statements)

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“…Our result showing no association between SES and immediate opioid within 1 month after THA aligns with our recent findings of a substantial increase since 1995 in opioid use in the acute postsurgical phase, and now applies to the majority of patients after THA as a common element of post-surgical treatment [17]. More aggressive early and timely pain treatment with opioids in all patients is highly relevant to promoting rehabilitation and does not seem to affect continued opioid use [17]. However, our study was conducted on Danish patients, and it is important to note that other studies have found higher doses of acute postoperative opioid use to be associated with prolonged opioid use [18,19].…”

Section: Discussionsupporting

confidence: 91%

Do sex, age, and comorbidities modify the association of socioeconomic status and opioid use after total hip arthroplasty?: a population-based study from the Danish Hip Arthroplasty Register

Klenø,

Mechlenburg,

Gademan

et al. 2024

ActaO

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Background and purpose: We aimed to examine the association between socioeconomic status (SES) markers and opioid use after primary total hip arthroplasty (THA) due to osteoarthritis, and whether sex, age, or comorbidities modify any association.Methods: Using Danish databases, we included 80,038 patients undergoing primary THA (2001–2018). We calculated prevalences and prevalence ratios (PRs with 95% confidence intervals [CIs]) of immediate post-THA opioid use (≥ 1 prescription within 1 month) and continued opioid use (≥ 1 prescription in 1–12 months) among immediate opioid users. Exposures were individual-based education, cohabitation, and wealth.Results: The prevalence of immediate opioid use was ~45% in preoperative non-users and ~60% in preoperative users (≥ 1 opioid 0–6 months before THA). Among non-users, the prevalences and PRs of continued opioid use were: 28% for low vs. 21% for high education (PR 1.28, CI 1.20–1.37), 27% for living alone vs. 23% for cohabiting (PR 1.09, CI 1.04–1.15), and 30% for low vs. 20% for high wealth (PR 1.43, CI 1.35–1.51). Among users, prevalences were 67% for low vs. 55% for high education (1.22, CI 1.17–1.27), 68% for living alone vs. 60% for cohabiting (PR 1.10, CI 1.07–1.12), and 73% for low wealth vs. 54% for high wealth (PR 1.32, CI 1.28–1.36). Based on testing for interaction, sex, age, and comorbidity did not statistically significant modify the associations. Nevertheless, associations were stronger in younger patients for all SES markers (mainly for non-users).Conclusion: Markers of low SES were associated with a higher prevalence of continued post-THA opioid use. Age modified the magnitude of the associations, but it was not statistically significant.

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Section: Discussionsupporting

confidence: 91%

Do sex, age, and comorbidities modify the association of socioeconomic status and opioid use after total hip arthroplasty?: a population-based study from the Danish Hip Arthroplasty Register

Klenø,

Mechlenburg,

Gademan

et al. 2024

ActaO

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“…Nonsteroidal anti-inflammatory drugs have a peripheral analgesic effect by inhibiting the activity of epoxidase in the human body, thereby inhibiting the release of inflammatory mediators such as prostaglandins. When the pain cannot be relieved satisfactorily at the maximum dose of NSAIDs, opioids can be used 31–33 . Opioids can achieve analgesia by promoting enkephalin release from endo-opioid peptide neurons, stimulating opioid receptors, inhibiting anterior membrane calcium channels, reducing Ca 2+ influx, stimulating opioid receptors, opening potassium channels, promoting K + outflow, and hyperpolarizing nerve cell membranes to prevent the transmission of pain impulses.…”

Section: Discussionmentioning

confidence: 99%

“…When the pain cannot be relieved satisfactorily at the maximum dose of NSAIDs, opioids can be used. [31][32][33] Opioids can achieve analgesia by promoting enkephalin release from endo-opioid peptide neurons, stimulating opioid receptors, inhibiting anterior membrane calcium channels, reducing Ca 2+ influx, stimulating opioid receptors, opening potassium channels, promoting K + outflow, and hyperpolarizing nerve cell membranes to prevent the transmission of pain impulses. It has a strong analgesic effect and is mainly used for severe pain such as advanced stage of cancer pain.…”

Section: Advantages and Disadvantage Of Tanezumab Treatmentmentioning

confidence: 99%

Different Dosage Regimens of Tanezumab for the Treatment of Chronic Low Back Pain: A Meta-analysis of Randomized Controlled Trials

Lian

Wang

et al. 2022

Clin Neuropharm

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ObjectiveThe aim of this study was to assess the efficacy of different dosage regimens of tanezumab among individuals living with chronic low back pain (CLBP).MethodsPubMed, Embase, The Cochrane Library, and other databases were searched from inception until August 2021. Randomized controlled trials investigating the efficacy and safety of tanezumab in individuals with CLBP were included. Data were extracted independently by 2 investigators and assessed the study quality by the Cochrane risk-of-bias tool. The measurements include low back pain intensity and Roland-Morris Disability Questionnaire. The incidence of adverse events and serious adverse events was set to assess the safety of tanezumab for CLBP.Results and DiscussionThree high-quality randomized controlled trials with 3414 patients were finally included in our analysis. Tanezumab, respectively, led to a notable decrease compared with placebo in low back pain intensity (mean difference, −0.62; 95% confidence interval [CI], −0.77 to −0.46; P < 0.01) and Roland-Morris Disability Questionnaire (mean difference, −0.64; 95% CI, −0.80 to −0.47; P = 0.01). In addition, no significant difference existed between tanezumab and placebo groups (risk ratio, 1.10; 95% CI, 0.81–1.49; P = 0.55) in the adverse events and (risk ratio, 1.06; 95% CI, 0.34–3.27; P = 0.93) serious adverse events.ConclusionsIntravenous and subcutaneous tanezumab injections as treatment for improving CLBP have promising clinical application as its great improvement on all efficacy and its controllable safety issues. Furthermore, intravenous and subcutaneous tanezumab injections were proved to achieve excellent and long-term curative effect on CLBP through our subgroup analysis and comparison.

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“…3 NSAIDs are available in prescription and over-the-counter (OTC) strengths, a variety of different formulations, and oral (most common), intravenous, injectable and topical forms. The use of NSAIDs has risen globally throughout the last 20 years, [4][5][6][7][8] in part due to increasing rates of chronic and persistent pain and an increasing ageing population.…”

Section: Introductionmentioning

confidence: 99%

Scoping review of interventions to de-implement potentially harmful non-steroidal anti-inflammatory drugs (NSAIDs) in healthcare settings

Rockwell,

Oyese,

Singh

et al. 2024

BMJ Open

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ObjectivesPotentially harmful non-steroidal anti-inflammatory drugs (NSAIDs) utilisation persists at undesirable rates worldwide. The purpose of this paper is to review the literature on interventions to de-implement potentially harmful NSAIDs in healthcare settings and to suggest directions for future research.DesignScoping review.Data sourcesPubMed, CINAHL, Embase, Cochrane Central and Google Scholar (1 January 2000 to 31 May 2022).Study selectionStudies reporting on the effectiveness of interventions to systematically reduce potentially harmful NSAID utilisation in healthcare settings.Data extractionUsing Covidence systematic review software, we extracted study and intervention characteristics, including the effectiveness of interventions in reducing NSAID utilisation.ResultsFrom 7818 articles initially identified, 68 were included in the review. Most studies took place in European countries (45.6%) or the USA (35.3%), with randomised controlled trial as the most common design (55.9%). Interventions were largely clinician-facing (76.2%) and delivered in primary care (60.2%) but were rarely (14.9%) guided by an implementation model, framework or theory. Academic detailing, clinical decision support or electronic medical record interventions, performance reports and pharmacist review were frequent approaches employed. NSAID use was most commonly classified as potentially harmful based on patients’ age (55.8%), history of gastrointestinal disorders (47.1%), or history of kidney disease (38.2%). Only 7.4% of interventions focused on over-the-counter (OTC) NSAIDs in addition to prescription. The majority of studies (76.2%) reported a reduction in the utilisation of potentially harmful NSAIDs. Few studies (5.9%) evaluated pain or quality of life following NSAIDs discontinuation.ConclusionMany varied interventions to de-implement potentially harmful NSAIDs have been applied in healthcare settings worldwide. Based on these findings and identified knowledge gaps, further efforts to comprehensively evaluate the effectiveness of interventions and the combination of intervention characteristics associated with effective de-implementation are needed. In addition, future work should be guided by de-implementation theory, focus on OTC NSAIDs and incorporate patient-focused strategies and outcomes, including the evaluation of unintended consequences of the intervention.

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Time trends in use of non-steroidal anti-inflammatory drugs and opioids one year after total hip arthroplasty due to osteoarthritis during 1996–2018: a population-based cohort study of 103,209 patients

Cited by 7 publications

References 29 publications

Do sex, age, and comorbidities modify the association of socioeconomic status and opioid use after total hip arthroplasty?: a population-based study from the Danish Hip Arthroplasty Register

Do sex, age, and comorbidities modify the association of socioeconomic status and opioid use after total hip arthroplasty?: a population-based study from the Danish Hip Arthroplasty Register

Different Dosage Regimens of Tanezumab for the Treatment of Chronic Low Back Pain: A Meta-analysis of Randomized Controlled Trials

Scoping review of interventions to de-implement potentially harmful non-steroidal anti-inflammatory drugs (NSAIDs) in healthcare settings

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