Pain medicine : the official journal of the American Academy of Pain Medicine
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Randomized Controlled Trial
No Effect of Acupuncture as Adjunctive Therapy for Patients with Total Knee Replacement: A Randomized Controlled Trial.
Acupuncture is a low risk option in pain management following total knee replacement as an alternative to opioid analgesics. Therefore, the benefit of acupuncture as adjunct to an exercise program was investigated. Furthermore, the modifying effect of previous benefit from acupuncture was explored. ⋯ Our results do not support the addition of acupuncture to routine rehabilitation. Previous benefit from acupuncture was not able to identify those likely to respond to acupuncture. Future studies to investigate whether subgroups of patients would benefit from acupuncture are needed.
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To determine 1) the feasibility of implementing an e-learning module on chronic low back pain (CLBP) in an older adult into an existing internal medicine residency curriculum and 2) the impact of this module on resident attitudes, confidence, knowledge, and clinical skills relating to CLBP. ⋯ An online module on CLBP in the older adult was a feasible addition to an existing curriculum for internal medicine residents. The module positively and substantively impacted resident clinical behaviors, as evidenced by enhanced sophistication in physical exam documentation; it also was associated with improved confidence in certain aspects of chronic pain management.
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Observational Study
Prescription Opioid Access Patterns and Factors Associated with Increasing Number of Prescribers, Pharmacies, and Dispensings: An Observational Study Using Pharmaceutical Claims.
To examine associations between patient factors and increasing opioid access measured by three metrics: number of unique prescribers, pharmacies, and dispensings in 12 months. ⋯ Delineating legitimate from extramedical opioid use based on pharmaceutical claims is imprecise. We demonstrated that "high" levels of access, defined in previous research, may reflect routine care for complex patients. Pharmaceutical claims have utility in examining population norms of prescription drug use and access patterns, and flagging persons at the extreme end of access, for at least one measure, who may warrant further investigation.