Journal of pain & palliative care pharmacotherapy
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J Pain Palliat Care Pharmacother · Aug 2013
Characterization of patients undergoing total hip arthroplasty in a real-world setting and pain-related medication prescriptions for management of postoperative pain.
This observational study characterized medication use in the immediate postoperative period among patients undergoing total hip arthroplasty (THA) at an academic medical center, and evaluated pain (0-10 numerical pain rating scale [NPRS]; 0 = no pain, 10 = worst pain that the patient can imagine), function (Harris Hip Score [HSS]and Lower Extremity Function Scale [LEFS]), and health-related quality of life (SF-36). Study patients (N = 115; 59% female; average age 61.3 ± 12.0 years; mean BMI of 29.9 ± 6.9 kg/m2) who underwent THA between September 1, 2008, and November 30, 2010, and met study inclusion criteria were drawn from the University of Utah Orthopedic Clinic database. The most common comorbidities in these patients were osteoarthritis, hypertension, and chronic back pain. ⋯ Opioids and celecoxib continued to be commonly prescribed at discharge. Pain was improved at a 6-week follow-up (mean change −3.3 ± 3.3 points), as were HSS and LEFS, with mean changes of 19.9 ± 24.2 and 8.7 ± 16.9 points (P < .01 for both), respectively. Although SF-36 scores were also improved, these scores were significantly lower relative to normative values for the US general population as well as relative to individuals having both osteoarthritis and hypertension.
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J Pain Palliat Care Pharmacother · Aug 2013
Opioid use in end-of-life care in patients with interstitial pneumonia associated with respiratory worsening.
The authors investigated the treatment outcome of patients with severe interstitial pneumonia (IP) who received opioids during end-of-life care. Twenty-two consecutive patients were retrospectively evaluated before and after continuous administration of opioids for 24 hours. All subjects died within 21 days; the mean survival period after opioid administration was 5.6 days. ⋯ The other 16 patients showed both positive and negative effects as expected. Clinicians should assess dyspnea prior to opioid administration, since the purpose of the opioid administration is to relieve dyspnea. Dyspnea should be monitored and recorded in routine clinical practice, at least after hospitalization.
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J Pain Palliat Care Pharmacother · Aug 2013
Estimates of charges associated with emergency department and hospital inpatient care for opioid abuse-related events.
The economic burden of prescription opioid abuse is substantial; however, no study has estimated the monetary burden of hospital services (emergency department [ED] and inpatient) using a single, nationally representative database. We sought to estimate total and average (adjusted for demographic and clinical factors) charges billed for opioid abuse-related events, and magnitude of difference in charges between ED visits resulting in inpatient admission to the same hospital and treat-and-release ED visits in the United States. We used the 2006, 2007, and 2008 files of the Healthcare Cost and Utilization Project's Nationwide Emergency Departments Sample (HCUP-NEDS) to identify events and charges assigned opioid abuse, dependence, or poisoning ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) diagnosis codes (304.0X, 304.7X, 305.5X, 965.00, 965.02, 965.09). ⋯ Compared with events covered by private insurance, mean charges for Medicare- and Medicaid-covered events were higher (t = 28.14, P < .001; t = 6.42, P < .001, respectively), whereas self-paid events had significantly lower charges (t = -11.14, P < .001). ED visits resulting in subsequent inpatient admission had approximately 6 times higher charges than treat-and-release visits. This study provides estimates of differences in hospital costs of opioid abuse by insurance status, resulting in a better understanding of the economic burden of opioid abuse on the health care system.
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Chronic pelvic pain is a common, multifactorial complaint that affects both women and men, causing disability and frustration for patients. The exact aetiology remains unknown, although several theories have been proposed. Assessment should be undertaken with care and compassion, while considering the sensitive nature of the area. ⋯ Novel treatment approaches have been investigated for specific clinical scenarios. The more severe CPP cases are best managed using a multidisciplinary approach. Management requires good integration and knowledge of all pelvic organ systems and including musculoskeletal, neurologic and psychological mechanisms.
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J Pain Palliat Care Pharmacother · Aug 2013
Case ReportsManaging musculoskeletal pain in an elderly woman.
Musculoskeletal conditions are common and a major cause of chronic pain; more than nine million people in the UK are affected by arthritis alone. Successful treatment of pain can lead to increased physical activity with consequent improvement of muscle tone around the affected joints. In older patients with multiple comorbidities, fewer therapeutic approaches or surgical interventions tend to be indicated. Where opioid therapy is unsuccessful, possible strategies include opioid rotation and/or changing route of administration.