Pain
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To develop a simple, valid model to identify patients at high risk of opioid overdose-related hospitalization and mortality, Oregon prescription drug monitoring program, Vital Records, and Hospital Discharge data were linked to estimate 2 logistic models; a first model that included a broad range of risk factors from the literature and a second simplified model. Receiver operating characteristic curves, sensitivity, and specificity of the models were analyzed. Variables retained in the final model were categories such as older than 35 years, number of prescribers, number of pharmacies, and prescriptions for long-acting opioids, benzodiazepines or sedatives, or carisoprodol. ⋯ The positive predictive value of the model was low. Computationally simple models can identify high-risk patients based on prescription history alone, but improvement of the predictive value of models may require information from outside the prescription drug monitoring program. Patient or prescription features that predict opioid overdose may differ from those that predict diversion.
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Chronic pain is common and creates a significant burden to the individual and society. Emerging research has shown the influence of the family environment on pain outcomes. However, it is not clear what shared factors between family members associate with chronic pain. ⋯ There was an increase in odds of chronic pain if exposure family member had chronic pain (odds ratio [OR]: 1.30, 95% confidence interval [CI]: 1.02-1.65), if both were women (OR: 1.39, 95% CI: 0.99-1.94), if both were older in age (OR: 1.80, 95% CI: 1.31-2.48), and if both had low household income (OR: 3.27, 95% CI: 1.72-6.21). These findings show that most explanation for chronic pain is still at the individual level. However, some significant shared effects between family members associate with chronic pain, and this highlights the influence of the family context.
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We studied children enrolled within 90 days of juvenile idiopathic arthritis diagnosis in the Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) prospective inception cohort to identify longitudinal trajectories of pain severity and features that may predict pain trajectory at diagnosis. A total of 1062 participants were followed a median of 24.3 months (interquartile range = 16.0-37.1 months). Latent trajectory analysis of pain severity, measured in a 100-mm visual analogue scale, identified 5 distinct trajectories: (1) mild-decreasing pain (56.2% of the cohort); (2) moderate-decreasing pain (28.6%); (3) chronically moderate pain (7.4%); (4) minimal pain (4.0%); and (5) mild-increasing pain (3.7%). ⋯ Although most children with juvenile idiopathic arthritis in this cohort had mild or moderate initial levels of pain that decreased quickly, about 1 in 10 children had concerning pain trajectories (chronically moderate pain and mild-increasing pain). Systematic periodic assessment of pain severity in the months after diagnosis may help identify these concerning pain trajectories early and lay out appropriate pain management plans. Focused research into the factors leading to these concerning trajectories may help prevent them.