Do opioids work in chronic pain?

Slides:

Advertisements

Similar presentations

By Victor Chalwe, MD, MSC. ICIUM, Turkey.  The home management of malaria strategy is a WHO tool that identifies high risks groups such as children and.

Advertisements

Update on the 2015 Agency Medical Directors’ Group’s (AMDG’s) Interagency Guideline on Prescribing Opioids for Pain.

1 Journal Club Alcohol, Other Drugs, and Health: Current Evidence July–August 2011.

Journal Club Alcohol, Other Drugs, and Health: Current Evidence March–April 2010.

Dr.Zhila Abedi Asl MD.Fellowship of lnfertility Tehran medical university.

A raised thyroid stimulating hormone result is associated with an increased rate of cardiovascular events and would benefit from treatment Gibbons V, Conaglen.

Diagnostic Indicators of Anxiety and Depression in Older Dizzy Patients in Primary Care J Geriatr Psychiatry Neurol 2011;24(2) Maarsingh OR, 1 Dros.

® Introduction Back Pain Flare Ups, Physical Function, and Opioid Use Adriana Gonzalez, Darryl White MD, Sandra Burge PhD The University of Texas Health.

Characteristics of Patients Using Extreme Opioid Dosages in the Treatment of Chronic Low Back Pain In this sample of 204 participants, 70% were female,

Opioid Use: What are the technological, clinical, ethical, and regulatory issues? Michael Von Korff Group Health Research Institute.

® Introduction Changes in Opioid Use for Chronic Low Back Pain: One-Year Followup Roy X. Luo, Tamara Armstrong, PsyD, Sandra K. Burge, PhD The University.

[this box will not print/ display] Please note: NIHR Brand Guidance requires you to use their logo as follows: Slides that are:  Introductory should use.

Development and preliminary validation of a dynamic, patient-tailored method to detect abnormal laboratory test results PhD Student: Paolo Fraccaro MEng.

FDA Anesthetic & Life Support Drugs Advisory Committee Sept. 10, 2003 Art Van Zee,MD St. Charles Clinic St. Charles, Va.

Chronic pelvic pain Journal Club 17 th June 2011 Dr Claire Hoxley (GPST1) Dr Harpreet Rayar (GPST2)

Post-It Notes to Improve Questionnaire Response Rates in RCTs Findings from a Randomised Sub-Study Ada Keding 1, Helen Lewis 2, Kate Bosanquet 2, Simon.

Correlates of the use of urgent care (UC) and quality of life in patients with 4 long-term physical conditions (CHD, asthma, diabetes and/or COPD). Authors:

Forced Sexual Violence and HIV Infection among MSM in Tamil Nadu Presented by Santosh Kumar Sharma On behalf of Rakesh Kumar Singh Ph.D Research Scholar.

Contact: Patrick Phillips,

Prevalence of Chronic Bronchitis in First Nations People Punam Pahwa,1, 2,* Chandima P. Karunanayake,1 Donna Rennie, 1 Kathleen McMullin,1 Josh Lawson,1.

Caroline Clements Project lead, Professor Nav Kapur

Trial Sequential Analysis (TSA)

Physical Activity in Adults with Arthritis and Its Contribution to Health Outcomes Samannaaz S. Khoja1, Gustavo J. Almeida1, Mary Chester Wasko2, Sara.

Paid employment and Common Mental Disorders (CMD) in the UK

Participation in Community Assets and Health-Related Quality of Life and Health Care Utilisation Amongst Older People Luke Munford.

1University of Kentucky, Lexington, Kentucky

Maria Cabrera Escobar Nkosinathi Ngcobo & Timothy Quinlan

The Association of Exposure to Adverse

Opioids for the management chronic non-cancer pain in Primary Care:

Opioids Aware A resource for patients and healthcare professionals to support prescribing of opioid medicines for pain.

John Weeks1, MD Candidate 2017, Justin Hickman1, MD Candidate 2017

Ageing firefighters may impair the quality of emergency responses.

Diagnostic characteristics and prognoses of primary-care patients referred for clinical exercise testing: a prospective observational study Nilsson G1,

Multinutrient fortification of human breast milk for preterm infants following hospital discharge: systematic review Lauren Young1, Felicia M McCormick2,

The use of regular text messaging over one year to collect primary outcome data in an RCT Reuben Ogollah1,2, Martyn Lewis1,2, Kika Konstantinou1 Sarah.

Patterns of psychiatric hospital admission for schizophrenia and related psychosis in England: A retrospective cross-sectional survey Thompson A. D.¹,

Alessandro Andreucci, Paul Campbell, Kate Dunn

Prognostic factors for musculoskeletal injury identified through medical screening and training load monitoring in professional football (soccer): a systematic.

Training package is appropriate

Use of exercise tests in primary care: importance for referral decisions and possible bias in the decision process; a prospective observational study Gunnar.

Conclusions Context Long-Term Conditions Questionnaire Results

Steve Tomlin Consultant Pharmacist – Children’s Services

Delivering High Quality Care for Older People History taking

University of Witwatersrand, Johannesburg, South Africa

Cognitive Impacts of Ambient Air Pollution in the National Social Health and Aging Project (NSHAP) Cohort Lindsay A. Tallon MSPH1, Vivian C. Pun PhD1,

Sensory stimulation of the foot and ankle early post-stroke:

Ageing with ideal cardiovascular risk factors

Critical Reading of Clinical Study Results

Oxford Niacin Trial.

EMPHASIS-HF Extended Follow-up

School for Primary Care Research

The landscape of prescription drug misuse in the UK

Interim findings from Severe Obesity Study

The efficacy of using CAD for detection of

A presentation to: Meeting name Date

School for Primary Care Research

Long-Term Opioid Therapy for Chronic Noncancer Pain: A Systematic Review and Meta-Analysis of Efficacy and Safety Meredith Noble, MS, Stephen J. Tregear,

Does an Increase in Opioid Dose lead to an Increase in Depression?

School for Primary Care Research

Quantifying the magnitude and the overlap between frailty, multimorbidity and disability in the very old – results from the Newcastle 85+ Study Michael.

Social prescribing: Less rhetoric and more reality

A presentation to: Meeting name Date

Michael Putman, MD Rheumatology Fellow RWCS 2019

More Than One-Third of Women in the U. S. Skip Care Because of Cost vs

Opioid prescribing workflow in the electronic medical record.

This study/project is funded by/ supported by the National Institute for Health Research (NIHR) [name of NIHR programme (Grant Reference Number XXX)/name.

Metabolic syndrome and risk of incident psoriasis: prospective data from the HUNT Study, Norway Ingrid Snekvik1,2, Tom I L Nilsen1, 3, Pål R Romundstad1,

This study/project is funded by/ supported by the National Institute for Health Research (NIHR) [name of NIHR programme (Grant Reference Number XXX)/name.

This study/project is funded by/ supported by the National Institute for Health Research (NIHR) [name of NIHR programme (Grant Reference Number XXX)/name.

Long-Term Opioid Therapy for Chronic Noncancer Pain: A Systematic Review and Meta-Analysis of Efficacy and Safety Meredith Noble, MS, Stephen J. Tregear,

Presentation transcript:

Do opioids work in chronic pain? Opioids and female sexual dysfunction: a cross-sectional study Richardson, E., Bedson, J., Chen, Y., Lacey, RJ.,Dunn, KM. Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK OPIOIDS Do opioids work in chronic pain? Cochrane reviews unable to identify strong evidence for opioid effectiveness (1,2) Opioids can be effective as part of a structured care programme with monitoring (3) Are opioids safe? Cochrane review significant risk of adverse events (long-term opioids vs placebo) (4) Number needed to harm 4.2 (3.1-6.4) (5) Previous work Systematic Review – 3 papers including low libido (6) Cohort Study – <1% of women had low libido No significant results in either Sexual Dysfunction? Sexual dysfunction seen in men with opioids Sparse evidence in women Needs further investigation Aim – To investigate associations between opioid use in women with musculoskeletal conditions and Female Sexual Dysfunction (FSD) Cross-Sectional Study Methods Cross-sectional study 18-45 year old women Musculoskeletal condition and prescribed opioid (past 6 months) 30 general practices 1020 postal questionnaires Total daily morphine equivalent dose calculated for each participant Groups - 0mg/day, <20mg/day and ≥20mg/day FSD assessed with STEFFI-5 (7) Logistic regression for FSD Female Sexual Dysfunction Sensitivity analysis OR for ≥20mg opioids = 2.39 (1.01 – 5.67) (using STEFFI-2 to identify FSD) Bivariate adjustment for pain grade, Age, BMI, PHQ-2. Direction of relationship remained consistent. Opioid Category No Opioid <20mg ≥20mg FSD 13 (31.7%) 16 (35.8%) 24 (50.0%) Unadjusted OR (95% CI) 1.00 (reference) 1.28 (0.51 – 3.20) 2.29 (0.94 – 5.55) Results 15% (153/1000) response rate Responders vs. non-responders: older (38 (31-42) vs. 35 (29-41) p=0.03) and less deprived (p=0.02) Conclusion There appears to be a dose related response between opioid use and FSD. Increasing OR with increasing dose. Low response rate Unable to adjust statistical analysis Decreased power Increased risk of non-response bias FSD should be considered when prescribing and reviewing opioids Further work with larger numbers required to investigate further Opioid Category P* No Opioid <20mg ≥20mg N 41 (28.1%) 46 (31.5%) 48 (32.9%) BMI 24.4 (21.4-29.6) 28.9 (24.6 – 35.4) 32.7 (26.6 – 37.3) 0.00 PHQ2 (+ve) 14 (34.1%) 27 (58.7%) 38 (79.2%) Pain grade 4 13 (31.7%) 14 (30.4%) 30 (62.5%) 0.01 Medication 2 (1-3) 4 (3-5) 5 (4-8.5) * one-way ANOVA for any difference Acknowledgements. This is a summary of independent research funded by the National Institute for Health Research (NIHR)’s In Practice Fellowship Programme. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Many Thanks to West Midlands Clinical Research Network for their support with this study. References: (1) Noble, M., Treadwell, J.R., Tregear, S.J., Coates, V.H., Wiffen, P.J., Akafomo, C., Schoelles, K.M. (2010). Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev CD006605. (2) Els, C., Jackson, T., Hagtvedt, R., Kunyk, D., Sonnenberg, B., Lappi, V., Straube, S. (2017a). High-dose opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database Syst Rev 1–15. (3) O’Brien, T., Christrup, L.L., Drewes, A.M., Fallon, M.T., Kress, H.G., McQuay, H.J., Mikus, G., Morlion, B.J., Perez-Cajaraville, J., Pogatzki-Zahn, E., Varrassi, G., Wells, J.C.D. (2017). European Pain Federation position paper on appropriate opioid use in chronic pain management. Eur J Pain (United Kingdom) 21, 3–19. (4) Els, C., Jackson, T., Kunyk, D., Lappi, V., Sonnenberg, B., Hagtvedt, R., Sharma, S., Kolahdooz, F., Straube, S. (2017b). Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database Syst Rev. (5) Kalso, E., Edwards, J.E., Moore, R.A., McQuay, H.J. (2004). Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain 112, 372–380. (6) Wersocki, E., Bedson, J., Chen, Y., LeResche, L., Dunn, K. (2017). Comprehensive Systematic Review of long-term opioids in women with chronic non cancer pain and associated reproductive dysfunction (hypothalamic-pituitary-gonadal axis disruption). Pain 158, 8–16. (7) Kriston, L., Günzler, C., Rohde, A., Berner, M.M. (2010). Is One question enough to detect female sexual dysfunctions? a diagnostic accuracy study in 6,194 Women. J Sex Med 7, 1831–1841.