scholarly journals Medical Cannabis Certification Is Associated With Decreased Opiate Use in Patients With Chronic Pain: A Retrospective Cohort Study in Delaware

Cureus ◽  
2021 ◽  
Author(s):  
Alan Balu ◽  
Divya Mishra ◽  
Jahan Marcu ◽  
Ganesh Balu
Keyword(s):  
Chronic Pain ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Medical Cannabis ◽  
Opiate Use

Mexiletine Usage in a Chronic Pain Clinic: Indications, Tolerability, and Side Effects

2018 ◽  
Vol 1 (21;1) ◽  
pp. E573-E579 ◽  
Author(s):  
Adam Romman
Keyword(s):  
Chronic Pain ◽  
Neuropathic Pain ◽  
Cohort Study ◽  
Pain Management ◽  
Side Effects ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Diagnosis ◽  
Pain Clinic ◽  
Chronic Pain Management

Background: Background: Intravenous lidocaine has multiple applications in the management of acute and chronic pain. Mexiletine, an oral lidocaine analogue, has been used in a number of chronic pain conditions although its use is not well characterized. Objectives: To report our experience using mexiletine in a chronic pain population, specifically looking at tolerability, side effects, and EKG changes. Study Design: Retrospective, cohort study. Setting: Multiple pain clinic locations in an integrated multispecialty health system. Methods: All patients who had a mexiletine prescription between August 2015 and August 2016 were queried via the electronic medical record. Each chart was examined for demographics, QTc changes on EKG, length of use, and reasons for stoppage. Results:There were 74 total patients identified in the chronic pain management clinics as receiving at least 1 mexiletine prescription over the 1-year time period. Twice as many women as men received mexiletine prescriptions. Neuropathic pain was the most common primary diagnosis (64%) which included diabetic neuropathy, radiculopathy, and others. Fibromyalgia was the next most common primary diagnosis (28%). A QTc change on the EKG showed a mean decrease of 0.1 ms and median increase of 1.5 ms. At 6 months (180 days), approximately 30% of the patients remained on mexiletine therapy, and 28% remained on the therapy at 1 year (360 days). Median duration of use was 60 days and the mean was 288 days. Neurologic and gastrointestinal side effects were the most commons reason for stoppage. All side effects were mild and resolved with stoppage. After side effects, lack of response, or loss of efficacy, were the next most common reasons for stoppage. Limitations: Pain relief and outcomes were not specifically examined due to confounding factors including interventional treatments and multiple treatment modalities. This was a retrospective, cohort study limited to our specific clinic population with a relatively high loss to follow-up rate. Conclusion:Mexiletine is rarely a first line option for chronic pain management and is often used when multiple other modalities have failed. By reporting our experience, we hope other clinicians may have more familiarity with the drug’s use in a chronic pain practice. It appears reasonably tolerable, may not require frequent EKG monitoring, and can be an appropriate adjunct in the chronic pain population. More research is needed regarding efficacy and dose titration for mexiletine in chronic pain. Key Words: Chronic pain, mexiletine, IV lidocaine, pain, neuropathic pain, neuropathy, fibromyalgia, QTc, tolerability

scholarly journals 40. The Impact of Medically Assisted Therapy for Opiate Use Disorder in staphylococcus Aureus Bacteremia Patients Within a Large Hospital System - A Retrospective Cohort Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S21-S22
Author(s):  
Brooks A Keene ◽  
Shadi Saboori ◽  
Jacqueline Meredith ◽  
Deanna King ◽  
Christopher Polk ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Treatment Guidelines ◽  
Spinal Epidural Abscess ◽  
Hospital System ◽  
Clinical Endpoints ◽  
Opiate Use ◽  
Opiate Use Disorder ◽  
The Impact

Abstract Background Intravenous drug use (IVDU) is a risk factor for development of S. aureus bacteremia (SAB) and prevalent in opiate use disorder (OUD). While the standard of care involves treating the underlying OUD with medically assisted therapy (MAT), it is unknown how much impact this has on clinical endpoints. Methods We conducted a retrospective cohort study of patients with IVDU with hospitalizations for SAB during a 28-month period from 9/2016 through 12/2018 in 10 urban and rural North Carolina hospitals in a single large health system. We compared outcomes for patients receiving prescription for MAT at discharge versus no MAT at discharge. MAT was defined as receiving methadone, buprenorphine, or naltrexone. Patients who expired inpatient were excluded from analysis. Clinical endpoints were 30- and 90-day mortality and 30-day SAB-related readmissions. Results Of the 174 patients, 28% received a prescription for MAT at discharge. The majority of the patients were Caucasian (88%), female (57%), with mean age of 37 years. Factors that significantly increased likelihood of MAT at discharge were female gender (34% vs 20%, p=0.04), having a complicated SAB (33% vs 28%, p=0.01), presence of a spinal/epidural abscess (57% vs 43%, p=0.002), and increased length of stay (LOS) (37 days vs 24 days, p=< 0.001). No difference in 30- and 90-day mortality was observed; only one patient in each group died within 90 days. Prescription for any MAT at discharge was associated with a significant decrease in the risk of SAB-related 30-day readmission (0% vs 17%, p=0.002). Table 1: Baseline Characteristics Table 2: MAT & Clinical Outcomes in S. aureus Bacteremia Figure 1: Medically Assisted Therapy Prescribed at Discharge Conclusion Gender, more complicated infections, and prolonged LOS may increase the likelihood of receiving a prescription for MAT at discharge. MAT prescription at discharge may decrease the risk of 30-day SAB related readmission (NNT 5.9). The results suggest that provision of MAT to patients with SAB and history of IVDU should be incorporated into standardized treatment guidelines. Disclosures All Authors: No reported disclosures

scholarly journals TEP versus Lichtenstein, which one to choose? A retrospective cohort study

2019 ◽  
Vol 65 (9) ◽  
pp. 1201-1207 ◽  
Author(s):  
Murat Urkan ◽  
Yasar Subutay Peker
Keyword(s):  
Chronic Pain ◽  
Cohort Study ◽  
Postoperative Complications ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Visual Analog Scale Score ◽  
Inguinal Hernioplasty ◽  
Analog Scale ◽  
Early Postoperative Complications ◽  
Laparoscopic Hernioplasty

SUMMARY OBJECTIVES Inguinal hernioplasty techniques have been improved since the first hernioplasty. Tension-free techniques that apply synthetic mesh materials, as in the Lichtenstein approach, are the gold standard. Laparoscopic hernioplasty is the strongest alternative to Lichtenstein. The superiority of laparoscopic hernioplasty over Lichtenstein is a major topic of debate. In this study, we aimed to find a conclusion to this debate by comparing our totally extraperitoneal (TEP) experiences with Lichtenstein experiences. METHODS Patients who underwent inguinal hernioplasty at the Gulhane Training and Research Hospital from 2013 to 2018 were included in this retrospective cohort study. The sample included 96 TEP and 90 Lichtenstein patients for a total of 186 patients. The variables assessed were hospitalization duration, postoperative early visual analog scale score, chronic pain, paresthesia, recurrence, and early postoperative complications. Data were collected from patient records and via telephone questionnaire if needed. Data analysis was done by SPSS v20, using chi-square, Fisher’s exact, and Mann-Whitney U tests. RESULTS Male/female ratios were similar between the TEP and Lichtenstein groups. There was no difference in mean age between groups (p=0.1). The hospital stay was shorter (p=0.0001), and early postoperative visual analog scale score was lower in the TEP group (p=0.003). Chronic pain, paresthesia, recurrence, and early postoperative complications (hematoma, seroma, wound infection) were similar. CONCLUSIONS TEP is superior to Lichtenstein with shorter hospitalization duration and lower rates of early postoperative pain. No difference between the two techniques was found for chronic pain. We believe that laparoscopic hernioplasty approach may be the best alternative technique for inguinal hernia repair.

scholarly journals Non-Cancer Chronic Pain Conditions and Risk for Incident Alzheimer’s Disease and Related Dementias in Community-Dwelling Older Adults: A Population-Based Retrospective Cohort Study of United States Medicare Beneficiaries, 2001–2013

2020 ◽  
Vol 17 (15) ◽  
pp. 5454
Author(s):  
Sumaira Khalid ◽  
Usha Sambamoorthi ◽  
Kim E. Innes
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Chronic Pain ◽  
Cohort Study ◽  
Sleep Disorders ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Community Dwelling ◽  
Chronic Pain Conditions

Accumulating evidence suggests that certain chronic pain conditions may increase risk for incident Alzheimer’s disease and related dementias (ADRD). Rigorous longitudinal research remains relatively sparse, and the relation of overall chronic pain condition burden to ADRD risk remains little studied, as has the potential mediating role of sleep and mood disorders. In this retrospective cohort study, we investigated the association of common non-cancer chronic pain conditions (NCPC) at baseline to subsequent risk for incident ADRD, and assessed the potential mediating effects of mood and sleep disorders, using baseline and 2-year follow-up data using 11 pooled cohorts (2001–2013) drawn from the U.S. Medicare Current Beneficiaries Survey (MCBS). The study sample comprised 16,934 community-dwelling adults aged ≥65 and ADRD-free at baseline. NCPC included: headache, osteoarthritis, joint pain, back or neck pain, and neuropathic pain, ascertained using claims data; incident ADRD (N = 1149) was identified using claims and survey data. NCPC at baseline remained associated with incident ADRD after adjustment for sociodemographics, lifestyle characteristics, medical history, medications, and other factors (adjusted odds ratio (AOR) for any vs. no NCPC = 1.21, 95% confidence interval (CI) = 1.04–1.40; p = 0.003); the strength and magnitude of this association rose significantly with increasing number of diagnosed NCPCs (AOR for 4+ vs. 0 conditions = 1.91, CI = 1.31–2.80, p-trend < 0.00001). Inclusion of sleep disorders and/or depression/anxiety modestly reduced these risk estimates. Sensitivity analyses yielded similar findings. NCPC was significantly and positively associated with incident ADRD; this association may be partially mediated by mood and sleep disorders. Additional prospective studies with longer-term follow-up are warranted to confirm and extend our findings.

scholarly journals Associations between chronic pain, analgesic use and physical therapy among adults living with HIV in Atlanta, Georgia: a retrospective cohort study

AIDS Care ◽  
2019 ◽  
Vol 32 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Sara D. Pullen ◽  
Carlos del Rio ◽  
Daniel Brandon ◽  
Ann Colonna ◽  
Meredith Denton ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cohort Study ◽  
Physical Therapy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Living With Hiv ◽  
Analgesic Use
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