Low back pain is a leading cause of disability globally. It is a common reason for presentation to the emergency department where opioids are commonly prescribed. This is a retrospective cohort study of opioid-naive adults with low back pain presenting to 1 of 4 emergency departments in Nova Scotia. We use routinely collected administrative clinical and drug-use data (July 2010-November 2017) to investigate the prevalence of prolonged opioid use and associated individual and prescription characteristics. In total, 23,559 eligible individuals presented with nonspecific low back pain, with 84.4% being opioid-naive. Our study population included 4023 opioid-naive individuals who filled a new opioid prescription within 7 days after their index emergency department visit (24.4%). The prevalence of prolonged opioid use after a new opioid prescription for low back pain (filling an opioid prescription 8-90 days after the emergency department visit and filling a subsequent prescription ±30 days of 6 months) was 4.6% (185 individuals). Older age and female sex were associated with clinically important increased odds of prolonged opioid use. First prescription average >90 morphine milligram equivalents/day (odds ratio 1.6, 95% confidence interval 1.0-2.6) and greater than 7-day supply (1.9, 1.1-3.1) were associated with prolonged opioid use in adjusted models. We found evidence of declining opioid prescriptions over the study period, but that 24.3% of first opioid prescriptions in 2016 would not have aligned with current guideline recommendations. Our study provides evidence to support a cautious approach to prescribing in opioid-naive populations.
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http://dx.doi.org/10.1097/j.pain.0000000000002075 | DOI Listing |
Sci Rep
December 2024
Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Drug addiction is a multifactorial syndrome in which genetic predispositions and exposure to environmental stressors constitute major risk factors for the early onset, escalation, and relapse of addictive behaviors. While it is well known that stress plays a key role in drug addiction, the genetic factors that make certain individuals particularly sensitive to stress and, thereby, more vulnerable to becoming addicted are unknown. In an effort to test a complex set of gene x environment interactions-specifically gene x chronic stress-here we leveraged a systems genetics resource: BXD recombinant inbred mice (BXD5, BXD8, BXD14, BXD22, BXD29, and BXD32) and their parental mouse lines, C57BL/6J and DBA/2J.
View Article and Find Full Text PDFAnesthesiology
December 2024
In Residence, Department of Anesthesiology, University of California San Diego, La Jolla, CA, USA.
Background: Traumatic rib fractures are associated with pain lasting weeks to months and a decreased ability to inspire deeply or cough to clear secretions. Ultrasound-guided percutaneous cryoneurolysis involves reversibly ablating peripheral nerve(s) using exceptionally low temperature with a transdermal probe, resulting in a prolonged nerve block with a duration measured in months. We hypothesized that cryoneurolysis would improve analgesia and inspired volume following rib fracture.
View Article and Find Full Text PDFReg Anesth Pain Med
December 2024
Anesthesia and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada
Background: The addition of intravenous dexamethasone can significantly prolong analgesia and reduce opioid-related side effects after brachial plexus blockade, but the most effective administration time is yet unknown. The objective of this study is to determine if the timing of administration of dexamethasone affects the duration of analgesia after supraclavicular brachial plexus block.
Methods: This is a double-blind, placebo-controlled, randomized trial performed at a single-center, tertiary academic health sciences center.
Heliyon
December 2024
Department of Biomedical Sciences, Pak Austria Fachhochschule: Institute of Applied Sciences and Technology, Haripur, Khyber Pakhtunkhwa, Pakistan.
Morphine belongs to the class of opioids and is known for its potential to cause dependence and addiction, particularly with prolonged use. Due to the associated risks, caution must be taken when prescribing and limiting its clinical use. Overexpression of N-methyl-D-aspartate (NMDA) receptors, nitric oxide and cGMP pathway has been implicated in exacerbate the development of morphine dependence and withdrawal.
View Article and Find Full Text PDFCureus
November 2024
Anesthesiology, Hospital Clínica Bíblica, San José, CRI.
Pain is a prevalent issue among patients, requiring effective management to prevent the transition of acute pain into chronic pain and to mitigate significant clinical and socioeconomic impacts, such as increased morbidity, mortality, prolonged recovery, unplanned readmissions, and diminished quality of life. Despite advancements in pain management guidelines, achieving consistent pain relief remains challenging due to individual differences in pain thresholds, the nature of surgical procedures, patient age, and existing comorbidities. Tapentadol, an opioid that acts as both a μ-opioid receptor agonist and a noradrenaline reuptake inhibitor, presents a promising option for pain management.
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