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Morphine milligram equivalents

Matthew Daubresse, G Caleb Alexander, Deidra C Crews, Dorry L Segev, Mara A McAdams-DeMarco
BACKGROUND: Hemodialysis (HD) patients frequently experience pain. Previous studies of HD patients suggest increased opioid prescribing through 2010. It remains unclear if this trend continued after 2010 or declined with national trends. METHODS: Longitudinal cohort study of 484,745 HD patients in the United States Renal Data System/Medicare data. We used Poisson/negative binomial regression to estimate annual incidence rates of opioid prescribing between 2007 and 2014...
December 13, 2018: American Journal of Nephrology
David J DiBenedetto, Kelly M Wawrzyniak, Michael E Schatman, Ronald J Kulich, Matthew Finkelman
Objective: To evaluate clinical outcomes and health care utilization at 12 months post spinal cord stimulator (SCS) implantation compared with baseline and a matched sample of patients receiving conventional medical management (CMM) for the treatment of low back and lower extremity pain. Patients: A retrospective study of patients with at least 24 months of active treatment at an interdisciplinary community pain center between December 1, 2014 and December 31, 2017...
2018: Journal of Pain Research
Charles A Riley, Matthew Kim, Anthony P Sclafani, Aron Kallush, Klaus Kjaer, Ashutosh S Kacker, Abtin Tabaee
BACKGROUND: Opioid-based analgesics are routinely prescribed after elective rhinologic surgery. Balancing appropriate pain management while avoiding overprescription necessitates an evidence-based approach. METHODS: Patients undergoing elective rhinologic surgery, including endoscopic sinus surgery (ESS), septoplasty, or ESS with septoplasty, were prospectively enrolled. Patients completed demographic and psychometric questionnaires assessing attitudes toward pain, baseline anxiety, and depression before surgery...
December 3, 2018: International Forum of Allergy & Rhinology
Sriram Yennurajalingam, Zhanni Lu, Suresh K Reddy, EdenMae C Rodriguez, Kristy Nguyen, Marie J Waletich-Flemming, Kyu-Hyoung Lim, Aksha Memon, Nhu-Nhu Nguyen, Kristy W Rofheart, Guoqin Wang, Srikanth Reddy Barla, Jimin Wu, Janet L Williams, Eduardo Bruera
PURPOSE: An understanding of opioid prescription and cost patterns is important to optimize pain management for patients with advanced cancer. This study aimed to determine opioid prescription and cost patterns and to identify opioid prescription predictors in patients with advanced cancer who received inpatient palliative care (IPC). MATERIALS AND METHODS: We reviewed data from 807 consecutive patients with cancer who received IPC in each October from 2008 through 2014...
November 29, 2018: Journal of Oncology Practice
Willem K Scholten, Ann-Eva Christensen, Anne Estrup Olesen, Asbjørn Mohr Drewes
Opioid analgesics are the mainstay for treatment of moderate and severe pain but, in many countries, the consumption of these medicines is inadequate. Over time, various groups have published opioid analgesic metrics, including authors from the World Health Organization. They linked consumption to a level considered adequate based on the actual consumption in developed countries. In this study, we present our current results on the adequacy of opioid analgesic consumption. We included statistics for 18 controlled opioid medicines that are primarily used as analgesics, and we developed the Adequacy of Opioid Consumption (AOC) Index...
November 29, 2018: American Journal of Public Health
Udai S Sibia, Abigail E Mandelblatt, G Caleb Alexander, Paul J King, James H MacDonald
Prescription opioids are commonly prescribed for pain relief after total joint arthroplasty (TJA), yet little is known about the quantity of opioids prescribed after surgery. This study retrospectively reviewed a consecutive series of 1000 TJAs from April 2014 through September 2015. Postoperative opioid prescriptions were quantified using standardized morphine milligram equivalents (MME). Eighty-four percent of total knee arthroplasty (TKA) and 77% of total hip arthroplasty (THA) patients were opioid naïve...
December 0: Journal of Surgical Orthopaedic Advances
Rachel Wong, William Carroll, Astha Muttreja, Victor Garcia, Erin Taub, Alice Fernan
Objective: Chronic pain and opioid management are challenging in primary care, especially for trainees with discontinuous ambulatory schedules and less practice experience. The study objective was to improve adherence to quality metrics and office visit utilization in a resident clinic. Design: Before-after quality improvement intervention over two Plan-Do-Study-Act cycles. Setting. Suburban, university-affiliated Internal Medicine resident clinic. Methods: During the 2015-2017 academic years, two sequential interventions were implemented: 1) use of electronic pain and opioid management templates and workflow redesign routing opioid renewals through a registered nurse (RN); 2) RN previsit planning and daily nurse-physician huddles before patient visits...
November 23, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Andrea Jakubowski, Alexander Pappas, Lee Isaacsohn, Felipe Castillo, Mariya Masyukova, Richard Silvera, Louisa Holaday, Evan Rausch, Sameen Farooq, Keith T Veltri, Chinazo O Cunningham, Marcus A Bachhuber
BACKGROUND: Overdose education and naloxone distribution (OEND) to people at risk of witnessing or experiencing an opioid overdose has traditionally been provided through harm reduction agencies. Expanding OEND to inpatient general medical settings may reach at-risk individuals who do not access harm reduction services and have not been trained. An OEND program targeting inpatients was developed, piloted, and evaluated on 2 general medicine floors at Montefiore Medical Center, a large urban academic medical center in Bronx, New York...
November 26, 2018: Substance Abuse
Ilsley B Colton, Mayo H Fujii, Thomas P Ahern, Charles D MacLean, Julie E Lahiri, Matthew Alef, Andrew C Stanley, Georg Steinthorsson, Daniel J Bertges
The aim of this study was to assess postoperative opioid prescribing patterns, usage, and pain control after common vascular surgery procedures in order to develop patient centered best-practice guidelines. We performed a prospective review of opioid prescribing after seven common vascular surgeries at a rural, academic medical center from December 2016 to July 2017. A standardized telephone questionnaire was prospectively administered to patients ( n = 110) about opioid use and pain management perceptions...
November 18, 2018: Vascular Medicine
Roy Hwang, Nicholas Field, Vignessh Kumar, Steven Paniccioli, Rachel Grey, Michael Briotte, Vishad Sukul, Julie G Pilitsis
INTRODUCTION: Placement of spinal cord stimulation (SCS) paddles under general anesthesia using intraoperative neuromonitoring (IONM) has been shown to be associated with equivocal or superior clinical outcomes in comparative studies. The value of IONM in percutaneous permanent SCS placement has not been demonstrated. METHODS: Outcomes for patients under percutaneous SCS placement performed with IONM were prospectively collected. Descriptive outcomes included numerical rating scale (NRS), the Oswestry disability index (ODI), McGill pain questionnaire, pain catastrophizing scale score (PCS), and Beck Depression Inventory...
November 16, 2018: Neuromodulation: Journal of the International Neuromodulation Society
Charles D MacLean, Mayo Fujii, Thomas P Ahern, Peter Holoch, Ruby Russell, Ashley Hodges, Jesse Moore
Objective: To assess postoperative opioid prescribing in response to state and organizational policy changes. Methods: We used an observational study design at an academic medical center in the Northeast United States over a time during which there were two important influences: 1) implementation of state rules regarding opioid prescribing and 2) changes in organization policies reflecting evolving standards of care. Results were summarized at the surgical specialty and procedure level and compared between baseline (July-December 2016) and postrule (July-December 2017) periods...
November 8, 2018: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Yuyan Shi, Di Liang, Yuhua Bao, Ruopeng An, Mark S Wallace, Igor Grant
OBJECTIVES: Medical marijuana use may substitute prescription opioid use, whereas nonmedical marijuana use may be a risk factor of prescription opioid misuse. This study examined the associations between recreational marijuana legalization and prescription opioids received by Medicaid enrollees. METHODS: State-level quarterly prescription drug utilization records for Medicaid enrollees during 2010-2017 were obtained from Medicaid State Drug Utilization Data. The primary outcome, opioid prescriptions received, was measured in three population-adjusted variables: number of opioid prescriptions, total doses of opioid prescriptions in morphine milligram equivalents, and related Medicaid spending, per quarter per 100 enrollees...
October 25, 2018: Drug and Alcohol Dependence
Joanna G Katzman, Clifford R Qualls, William A Satterfield, Martin Kistin, Keith Hofmann, Nina Greenberg, Robin Swift, George D Comerci, Rebecca Fowler, Sanjeev Arora
BACKGROUND: Opioid overdose deaths occur in civilian and military populations and are the leading cause of accidental death in the USA. OBJECTIVE: To determine whether ECHO Pain telementoring regarding best practices in pain management and safe opioid prescribing yielded significant declines in opioid prescribing. DESIGN: A 4-year observational cohort study at military medical treatment facilities worldwide. PARTICIPANTS: Patients included 54...
October 31, 2018: Journal of General Internal Medicine
Andres Rodriguez-Buitrago, Basem Attum, Nichelle Enata, Adam Evans, William Obremskey, Manish Sethi, Alex Jahangir
The purpose of our study was to identify the opioid-prescribing practices after operative treatment of isolated pilon fractures at a level 1 trauma center. Patients ≥ 18 years of age with an operatively treated isolated pilon fracture between 2005 and 2015 were identified. Total morphine milligram equivalents (MMEs) were then calculated. Mean and standard deviations were calculated for patients without a history of opiate use and for patients with a history of opiate use within 1 year prior to injury. Data were obtained from the State Controlled Substance Monitoring Database...
November 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Patrick J Van Winkle, Ali Ghobadi, Qiaoling Chen, Michael Menchine, Adam L Sharp
OBJECTIVES: Adolescents and young adults are at high risk for opioid misuse and abuse. The emergency department (ED) plays a key role in treatment of acute and chronic pain and is a primary place that this patient population is exposed to prescription opioids. We evaluate the effect of patient age on use of opioids for adolescents and young adults in community EDs. METHODS: Retrospective cohort study of adolescent and young adult encounters in 14 community EDs from 2013 to 2014...
October 16, 2018: American Journal of Emergency Medicine
Zlatan Cizmic, Emmanuel Edusei, Afshin A Anoushiravani, Joseph Zuckerman, Ronald Ruden, Ran Schwarzkopf
Poor outcomes associated with increased perioperative opioid use have led investigators to seek alternative pain management modalities after total joint arthroplasty. Nonpharmacological approaches, such as electroceuticals, have shown promise. The purpose of this study was to evaluate the effects of "havening," a specific form of psychosensory therapy, on postoperative pain scores and narcotic consumption. In this prospective, randomized controlled trial, the authors compared 19 patients who underwent psychosensory therapy with 22 patients who served as the control group...
November 1, 2018: Orthopedics
Pietro Bortoletto, Malavika Prabhu, Elizabeth M Garry, Krista F Huybrechts, Raymond M Anchan, Brian T Bateman
OBJECTIVE: To study opioid dispensing patterns following oocyte retrieval. DESIGN: Retrospective cohort. SETTING: Not applicable. PATIENT(S): Women undergoing oocyte retrieval with a maximum of 1 opioid prescription in the 12 weeks prior to the procedure, without an opioid use or other substance use disorder. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): We measured the frequency of opioids dispensed within 3 days of oocyte retrieval, most common opioids dispensed; and quantity dispensed, in median (interquartile range [IQR] and 10th-90th percentile ranges) oral morphine milligram equivalents (MME)...
October 2018: Fertility and Sterility
Melissa Henry, Ali Alias, Saul Frenkiel, Keith Richardson, Michael Hier, Anthony Zeitouni, Karen Kost, Alex Mlynarek, Martin Black, Christina MacDonald, Gabrielle Chartier, Zeev Rosberger
PURPOSE: The purpose of this study was to determine, within the first-year post-head and neck cancer (HNC) diagnosis, the contribution of past and upon HNC psychiatric diagnoses (ie, substance use disorder, major depressive disorder, and anxiety disorder) to the extent (ie, cumulated dose) of opioid prescription. METHODS: Prospective longitudinal study of 223 consecutive adults (on 313 approached; 72% participation) newly diagnosed (<2 weeks) with a first occurrence of primary HNC, including Structured Clinical Interviews for DSM-IV disorders, validated psychometric measures, and medical chart reviews...
October 11, 2018: Psycho-oncology
David R Rosen, Rachel C Wolfe, Aneel Damle, Chady Atallah, William C Chapman, Joel M Vetter, Matthew G Mutch, Steven R Hunt, Sean C Glasgow, Paul E Wise, Radhika K Smith, Matthew L Silviera
BACKGROUND: Thoracic epidural analgesia has been shown to be an effective method of pain control. The utility of epidural analgesia as part of an enhanced recovery after surgery protocol is debatable. OBJECTIVE: This study aimed to determine if the use of thoracic epidural analgesia in an enhanced recovery after surgery protocol decreases hospital length of stay or inpatient opioid consumption after elective colorectal resection. DESIGN: This is a single-institution retrospective cohort study...
December 2018: Diseases of the Colon and Rectum
Ron Carico, Xinhua Zhao, Carolyn T Thorpe, Joshua M Thorpe, Florentina E Sileanu, John P Cashy, Jennifer A Hale, Maria K Mor, Thomas R Radomski, Leslie R M Hausmann, Julie M Donohue, Katie J Suda, Kevin Stroupe, Joseph T Hanlon, Chester B Good, Michael J Fine, Walid F Gellad
Background: Overlapping use of opioids and benzodiazepines is associated with increased risk for overdose. Veterans receiving medications concurrently from the U.S. Department of Veterans Affairs (VA) and Medicare may be at higher risk for such overlap. Objective: To assess the association between dual use of VA and Medicare drug benefits and receipt of overlapping opioid and benzodiazepine prescriptions. Design: Cross-sectional. Setting: VA and Medicare...
November 6, 2018: Annals of Internal Medicine
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