The journal of pain : official journal of the American Pain Society
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Prescription opioid misuse is a serious public health concern, yet antecedent factors are poorly described. Using data from the National Longitudinal Study of Adolescent to Adult Health (N = 14,784), we examined the longitudinal relationship between a history of adolescent chronic pain and the odds of misusing prescription opioids in adulthood. The primary predictor variable was chronic pain status during adolescence. ⋯ Longitudinal associations between adolescent chronic pain and subsequent adult prescription opioid misuse highlight the need for early targeted screening and prevention efforts that may reduce later opioid misuse. Perspective: Using a large, nationally representative sample, we found that chronic pain during adolescence was an independent risk factor for opioid misuse in adulthood, over and above other known risk factors. Furthermore, among those individuals with adolescent chronic pain, substance use, exposure to trauma, and race were associated with opioid misuse.
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Review Meta Analysis
Combination Drug Therapy for the Management of Low Back Pain and Sciatica: Systematic Review and Meta-Analysis.
Combining medicines may give greater pain relief and/or improved tolerability. We conducted a systematic review to investigate the effects of combination drug therapy in patients with low back pain and/or sciatica on pain, disability, and adverse events. Databases and trial registers were searched from inception to July 27, 2017, for randomized trials of (sub)acute or chronic back pain or sciatica participants that were administered combination drug therapy compared with monotherapy or placebo. ⋯ There is no clear evidence to support any combination drug therapy for the management of low back pain and sciatica due to the limited number of studies and overall low quality of evidence. Perspective: Combining medicines may give greater pain relief and/or improved tolerability compared with single-ingredient medicines. However, the lack of studies and overall low quality of evidence limit the recommendation of combination drug therapy for the management of low back pain and sciatica.
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Traumatic brain injury (TBI) may be a predisposing factor to pain syndromes other than headache. We conducted a longitudinal cohort study among veterans evaluated for TBI in the US Department of Veterans Affairs (VA). Among 36,880 veterans at baseline, 55% reported back pain. ⋯ Deployment-related moderate to severe TBI was significantly associated with self-reported back pain in cross-sectional (aOR = 1.74, 95% CI = 1.58-1.91), and longitudinal analyses (aHR = 1.20, 95% CI = 1.05-1.38; P = .01). These findings indicate that deployment-related moderate to severe TBI confers increased back pain risk, but do not support a causal effect of deployment-related mild TBI on back pain. PERSPECTIVE: Findings from this longitudinal study of veterans indicate that deployment-related moderate to severe TBI confers increased back pain risk, but do not support a causal effect of deployment-related mild TBI on back pain.
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We assessed the effects of opioid dose and risk reduction initiatives on opioid overdose rates among patients on chronic opioid therapy (COT). Using an interrupted time series design, we compared trends in overdose rates. We compared patients on COT in settings that implemented a COT dose reduction initiative and then a COT risk stratification/monitoring initiative to similar patients on COT from control settings. ⋯ PERSPECTIVE: Risk stratification/monitoring interventions among patients on COT did not decrease opioid overdose rates. The effects of COT dose reduction on opioid overdose rates were inconsistent. Greater decreases in COT dose, a larger control group, or both may have been needed to identify conclusive reductions in opioid overdose rates.
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Randomized Controlled Trial
Cost-effectiveness and cost-utility of internet-delivered exposure therapy for fibromyalgia: results from a randomized controlled trial.
Fibromyalgia (FM) is a prevalent and debilitating chronic pain disorder associated with a substantial economic burden. Although there are several studies investigating the effectiveness of psychological treatments such as cognitive-behavioral therapy for FM, studies on cost-effectiveness are scarce. The aim of the present study was to investigate the cost-effectiveness of Internet-delivered exposure therapy (iExp) for FM. ⋯ PERSPECTIVE: Health-economic evaluations of psychological interventions for FM are scarce. This study is a cost-effectiveness analysis of Internet-delivered exposure therapy for patients with FM. Results showed that iExp was highly cost-effective compared with no treatment, where each successfully treated case generated a substantial societal cost saving.