Effect of a structured stretching exercise program on resolution of myofascial pain and opioid usage in "legacy pain" patients: A retrospective cohort study.

Objective: The aim of this study was to determine whether the implementation of a structured exercise stretching routine targeted at resolving myofascial pain is effective in improving outcomes of "legacy pain" patients.

Design: Retrospective cohort study.

Setting: Private community-based interventional pain management practice.

Randomized clinical trial comparing buprenorphine/naloxone and methadone for the treatment of patients with failed back surgery syndrome and opioid addiction.

Opioid analgesic consumption has led to an unprecedented epidemic of overdose death and opioid addiction in the US history. The treatment of chronic pain in patients with opioid addiction who receive prescriptions for opioid medications presents a clinical dilemma. Continuing opioid medication could result in hyperalgesia rendering opioids ineffective and results in iatrogenic therapeutic damage as evidenced by the worsening of addiction.

A retrospective analysis of treatment and retention outcomes of pregnant and/or parenting women with opioid use disorder.

Aim: To determine factors associated with positive outcomes of buprenorphine maintenance treatment for opioid use disorder among pregnant women and women with children under the age of five years.

Methods: This retrospective, de-identified electronic health record review of a cohort of 108 female patients at a suburban primary care outpatient clinic followed patients for one year of treatment at the clinic. Positive outcomes were defined as 1) treatment retention and 2) urine toxicology at 12 months free of all substances other than buprenorphine.

A parenting education program for women in treatment for opioid-use disorder at an outpatient medical practice.

Opioid use during pregnancy poses serious risks for the mother and the unborn child. Opioid-use disorder may be managed with medication-assisted treatment (MAT) in an outpatient setting, but few MAT practices specifically address the challenges faced by pregnant women. This article describes a medical office-based educational support group for women in MAT for opioid-use disorder who were pregnant and/or parenting young children.

Parenting and concerns of pregnant women in buprenorphine treatment.

Purpose: Opioid-dependent pregnant women are characterized by drug use during pregnancy and deficits in knowledge of newborn care and feeding, and of child development. We assessed parenting skills and concerns among pregnant women in buprenorphine treatment for prescription opioid dependence.

Study Design And Methods: We interviewed 32 pregnant women who received buprenorphine treatment for prescription opioid dependence in a primary care setting and administered questionnaires, including the Adult-Adolescent Parenting Inventory version 2 (AAPI-2) and Childhood Experience of Care and Abuse Questionnaire.

Pharmacologic therapy for acute pain.

The approach to patients with acute pain begins by identifying the underlying cause and a disease-specific treatment. The first-line pharmacologic agent for the symptomatic treatment of mild to moderate pain is acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). The choice between these two medications depends on the type of pain and patient risk factors for NSAID-related adverse effects (e.

Primary care patient characteristics associated with completion of 6-month buprenorphine treatment.

Background: Opioid addiction is prevalent in the United States. Detoxification followed by behavioral counseling (abstinence-only approach) leads to relapse to opioids in most patients. An alternative approach is substitution therapy with the partial opioid receptor agonist buprenorphine, which is used for opioid maintenance in the primary care setting.

Reimbursement and practice policies among providers of buprenorphine-naloxone treatment.

Unlabelled: ABSTRACT Background: Physician acceptance of cash payment and low adherence to practice guidelines may contribute to buprenorphine-naloxone diversion. The purpose of this study was to investigate the clinical practice policies of physicians who provide office-based treatment for opioid dependence with buprenorphine-naloxone.

Methods: Data were obtained from 31 of 71 practices surveyed (response rate 43.

A preliminary study comparing methadone and buprenorphine in patients with chronic pain and coexistent opioid addiction.

Patients with opioid addiction who receive prescription opioids for treatment of nonmalignant chronic pain present a therapeutic challenge. Fifty-four participants with chronic pain and opioid addiction were randomized to receive methadone or buprenorphine/naloxone. At the 6-month follow-up examination, 26 (48.

Practices, perceptions, and concerns of primary care physicians about opioid dependence associated with the treatment of chronic pain.

When prescribing opioids to treat chronic pain, physicians face the dilemma of balancing effective pain management while avoiding iatrogenic opioid addiction. Through mailed surveys, the current study assessed concerns, perceptions, and practices of primary care physicians related to this dilemma. Of the 35 (43%) physicians that replied, 32 (91.

Parental prescription opioid abuse and the impact on children.

Objective: The purpose of this study was to identify which characteristics of opioid-abusing parents were associated with greater global impairment of their children.

Methods: Data regarding participant demographics, drug use, and child demographics were collected from 14 patients in a chemical dependency unit who had at least one child between the ages of 4 and 17, inclusive. Child global impairment was measured by the parents' report using the Brief Impairment Scale (BIS).

Specialized training on addictions for physicians in the United States.

In the United States accredited residency programs in addiction exist only for psychiatrists specializing in addiction psychiatry (ADP); nonpsychiatrists seeking training in addiction medicine (ADM) can train in nonaccredited "fellowships," or can receive training in some ADP programs, only to not be granted a certificate of completion of accredited training. Information about ADP residency programs has been tabulated, but it is not available for ADM fellowships. The authors conducted a national survey to compile information about the location, structure, curriculum, and other characteristics of active ADM fellowships.

A randomized trial of two behavioral interventions to improve outcomes following inpatient detoxification for alcohol dependence.

Participants (n=150), undergoing inpatient alcohol detoxification, were randomized into 3 groups: treatment as usual (TAU), motivation enhancement therapy (MET), or peer-delivered 12-step facilitation (P-TSF). The main outcome was the initiation of any type of subsequent rehabilitation service (i.e.

A Clinical Trial Comparing Tapering Doses of Buprenorphine with Steady Doses for Chronic Pain and Co-existent Opioid Addiction.

Objectives: Effective strategies are needed to manage individuals with chronic non-cancer pain and coexistent opioid addiction. This study compared opioid discontinuation and opioid replacement protocols.

Methods: We planned to enroll 60 individuals into an open-label trial who had been treated with opioids for chronic non-cancer pain, and who also had opioid addiction.

Differences between adolescents who complete and fail to complete residential substance abuse treatment.

This study examined the admission characteristics associated with failure to complete residential substance abuse treatment among male adolescents. Of 160 admissions, 48 (30%) completed treatment. Having commercial health insurance (P= .

Prescription opioid use among patients seeking treatment for opioid dependence.

Objective: This study was designed to assess non-medical prescription opioid use among a sample of opioid dependent participants.

Methods: A cross-sectional survey was conducted with a convenience sample of patients hospitalized for medical management of opioid withdrawal. We collected data related to participant demographics, socio-economic characteristics, the age of first opioid use, types of opioids preferred, and routes of administration.

Self-help program components and linkage to aftercare following inpatient detoxification.

Many patients fail to initiate aftercare for addictive disease rehabilitation following detoxification. This study of 136 inpatients compared characteristics of those who initiated aftercare (behavior therapy or self-help programs) during the week following discharge with those who did not. Among this group of patients, 77% (91/119) linked to aftercare.

Integrating screening and interventions for unhealthy behaviors into primary care practices.

Background: Four unhealthy behaviors (tobacco use, unhealthy diet, physical inactivity, and risky alcohol use) contribute to almost 37% of deaths in the U.S. However, routine screening and interventions targeting these behaviors are not consistently provided in primary care practices.

A randomized trial of extended buprenorphine detoxification for opioid dependency.

Objective: : The objective of this study was to determine whether additional "take-home" medication after inpatient opioid detoxification would lead to improved rates of subsequent treatment initiation and abstinence.

Methods: : We randomly assigned 60 inpatients to a 7-day or 37-day extension of sublingual buprenorphine/naloxone after hospitalization. Follow-up telephone interviews were conducted approximately 5 weeks after discharge.

The epidemiologic association between opioid prescribing, non-medical use, and emergency department visits.

Introduction: Since the 1990s prescriptions for and the non-medical use of opioids have increased. This study examines associations between opioid prescribing, non-medical use, and emergency department (ED) visits.

Methods: Data were abstracted from four federally sponsored, nationally representative, annual surveys (National Hospital Ambulatory Medical Care Survey, National Ambulatory Medical Care Survey, National Survey on Drug Use and Health, and Drug Abuse Warning Network).

Linkage to primary medical care following inpatient detoxification.

It is important to address the medical problems of individuals admitted for detoxification by arranging for follow-up with primary care physicians after discharge. This was a prospective cohort study of 119 patients admitted for detoxification. Follow-up data were collected over the telephone one week following discharge.

Buprenorphine and methadone: a comparison of patient completion rates during inpatient detoxification.

Buprenorphine and methadone are both effective for the control of the acute signs and symptoms of opiate withdrawal, but it is not known if there are differences between these two medications for other important clinical outcomes. This observational, non-randomized study evaluated completion rates of patients over a 13-month period when buprenorphine replaced methadone as the medication used for short-term inpatient opiate detoxification. Of the 644 patients in the study, the 303 treated with buprenorphine were more likely to complete detoxification than the 341 treated with methadone (89% vs.

Initiation of outpatient treatment after inpatient detoxification.

Additional treatment after inpatient detoxification is recommended; however, many patients fail to initiate aftercare. The purpose of this observational study was to determine which patients hospitalized for alcohol or drug withdrawal subsequently fail to initiate recommended outpatient aftercare treatment by using existing data from medical records. Of 406 patients, 180 (44.