Suchergebnisse

OBJECTIVES: Due to their potentially deleterious effects, minimizing the use of opioids for musculoskeletal pain is a priority for healthcare systems. The objective of this study was to examine the risk of future opioid prescription use based on prior opioid use within a non-surgical cohort with musculoskeletal knee pain. We also examined the risk of pre-existing comorbidities on future opioid use, and the risk of prior opioid use on future comorbidities (sleep, mental health, cardiometabolic disorders). METHODS: Data came from the Military Health System Data Repository for 80 290 consecutive beneficiaries with an initial episode of care for patellofemoral pain from January 1, 2010 through December 31, 2011. Risk was calculated using 2 × 2 tables based on pre- and post-opioid utilization and comorbid diagnosis. Risk ratios, relative and absolute risk increases, and numbers needed to harm were calculated, all with 95% confidence intervals. RESULTS: Prior opioid use resulted in a risk ratio of 18.0 (95 CI 17.1, 19.0) and an absolute risk increase of 61.6% for future opioid use (numbers needed to harm = 2). The presence of all comorbidities (except cardiometabolic syndrome) were associated with a significant relative risk for future opioid use (RR range 1.2-1.5), but the absolute risk increase was trivial (range 0.7%-2.2%). The relative risk for a chronic pain diagnosis, traumatic brain injury/concussion, insomnia, depression, and PTSD were all significantly higher in those with prior opioid use (1.3-1.6), but absolute risk increase was minimal (1.1%-6.5%). DISCUSSION: Prior opioid use was a strong risk factor for future opioid use in non-surgical patients with knee pain. These findings show that history of prior opioid use is important when assessing the risk of future opioid use, whereas prior comorbidities may not be as important. Opioid history assessment should be standard practice for all patients with patellofemoral pain in whom an opioid prescription is considered.

Background: There is a relationship between sleep, pain, and chronic opioid utilization. This has been poorly explored in general, and especially in patients undergoing orthopaedic surgery. Fewer studies have investigated this relationship based on a sleep diagnosis present both before and after surgery. OBJECTIVES:To identify the association between insomnia and sleep apnea and downstream opioid use and medical utilization (visits and cost) in the 2 years following arthroscopic hip surgery. Study Design: A retrospective cohort. Setting: The US Military Health System. Methods: This was a consecutive cohort of individuals undergoing hip arthroscopy in the Military Health System (MHS). Medical utilization data were abstracted from the MHS Data Repository between 2003 and 2015, representing 1 year prior and 2 years after surgery for every individual. Sleep disorder diagnoses (insomnia and sleep apnea) were identified using International Classification of Disease codes, and opioid utilization was determined from pharmacy data based on American Hospital Formulary Service codes 280808 and 280812. Sleep disorders present before surgery were used as predictors in multivariate logistic regression, and sleep disorders present after surgery were examined for associations with the outcomes using the Chi-square tests. The dependent variables in both cases were downstream medical utilization (costs, visits, and opioid use). RESULTS: Of 1870 eligible patients (mean age 32.3 years; 44.5% women), 165 (8.8%) had a diagnosis of insomnia before surgery and 333 (17.8%) after surgery; whereas 93 (5.0%) had a diagnosis of apnea before surgery and 268 (14.3%) after surgery. A diagnosis of insomnia before surgery predicted having at least 3+ opioids prescriptions after surgery (adjusted odds ratio, 1.97 [95% confidence interval, 1.39, 2.79]) and greater downstream total medical visits and costs in the 2 years after surgery. However, the number of individuals with a diagnosis of insomnia or apnea after surgery more than doubled, and was significantly associated with chronic opioid use, all-cause medical and all hip-related medical downstream visits and costs in the 2 years after surgery. Limitation: The use of observational data and claims data are only as good as how it was entered. CONCLUSIONS:Sleep disorders prior to surgery predicted chronic opioid use and medical utilization after surgery. However, a much higher rate of individuals had sleep apnea and insomnia present after surgery, which were significantly associated with chronic opioid use and greater total and hip-related medical utilization (visits and costs). Screening for sleep disorders prior to surgery may be important, but an even higher rate of sleep disorders may be developed after surgery, and continued screening after surgery may have greater clinical merit. Assessing quality of sleep during perioperative management may provide a unique opportunity to decrease pain and chronic opioid use after surgery.

Purpose Determine the association between incremental increases in the number of social risk factors and the prevalence of any disability and disability type. Design The cross-sectional analysis was conducted using 2017 Behavioral Risk Factor Surveillance System data from states whose surveys included items about social risk factors. Setting Respondents from 17 US states. Subjects Respondents included 136 432 adults. Measures Dichotomized social risk factors included food, housing, and financial insecurity, unsafe neighborhood, and healthcare access hardship. Analysis Weighted χ2 and logistic regression analyses adjusted for demographic characteristics, measures of socioeconomic position, and comorbid health conditions were used to examine differences in the prevalence of disability by social risk factor and via a social risk index created by summing the social risk factors. Results Compared to those reporting 0 social risk factors, respondents reporting ≥4 had more than thrice the odds of reporting a cognition ((adjusted odds ratio [AOR]=3.37; 95%CI [2.75-4.13]), independent living (AOR=3.24 [2.52-4.15]), self-care (AOR=3.33 [2.55-4.34]), or any disability (AOR=3.90 [3.24-4.70]); more than twice the odds of reporting a vision (AOR=2.61 [1.93-3.52]) or mobility (AOR=2.72 [2.16-3.41]) disability; and more than 1.5 times the odds of reporting a hearing disability (AOR=1.59 [1.22-2.07]). Conclusions Incremental increases in the number of social risk factors were independently associated with higher odds of disability. Intervention efforts should address the social context of US adults with disabilities to improve health outcomes.

BACKGROUND: Recent clinical practice guidelines have suggested conservative treatment approaches, including physical therapy, are indicated as first-line treatment for patients with low back pain (LBP); however, LBP continues to be managed with opioids, despite decreases in function, morbidity, and insignificant improvements in pain. OBJECTIVE: The primary purpose was to compare characteristics and downstream medication use between patients with LBP with prior opioid exposure vs. those who were opioid-naïve. The secondary purpose was to explore the role of prior opioid use by LBP disability. METHODS: Seven hundred and nine participants in a LBP self-management class were evaluated utilizing self-report data at baseline and longitudinal claims data from the Military Health System Data Repository. Participants were dichotomized into opioid-naïve and prior opioid use groups and then further divided into low and high disability groups based on Oswestry Disability Index (ODI) scores. Patient characteristics, comorbidities, and medication use were compared between groups. RESULTS: Prior opioid users had significantly higher baseline ODI and Fear Avoidance Beliefs Questionnaire physical activity subscale and work subscale scores as well as pre-index instances of mental health disorders, chronic pain, and insomnia than opioid-naïve individuals. Prior opioid users filled significantly more pain medication prescriptions in the year after the index date than did opioid-naïve individuals. Prior opioid users were significantly more likely to be taking opioids at 1 year after the index date, regardless of disability level. CONCLUSION: In patients presenting with LBP, prior opioid exposure appears to be related to increased analgesic use (opioid and non-opioid) and longitudinal analgesic utilization at 1 year after the index date.