Browsing by Subject "Pain Management"
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Item Additional Validation of the Pain Medication Questionnaire in a Sample of Patients with Chronic Pain(2009-09-04) Buelow, Amanda; Silver, Cheryl H.The present study represents an initial stage in the formal attempt to aid in developing a psychometrically sound, self-report screen tool used for assessing potential pain medication misuse risk. This study follows previous studies of Adams and colleagues (2004) and Holmes and colleagues (2006). The Pain Medication Questionnaire (PMQ), initially a 26-item instrument, was studied as a 23-item questionnaire designed to measure risk for opioid misuse. This revised PMQ showed good reliability and validity. This study also examined the ability of the revised PMQ to predict pain medication misuse in a heterogeneous sample of chronic pain patients. The PMQ was administered to 1,540 patients at a pain center that provided interdisciplinary pain management, including medication, psychological, and physical therapy disciplines. The risk of a patient's pain medication misuse, as predicted by the PMQ, was found to significantly decrease following interdisciplinary intervention. Cut-off scores were created from the distributed PMQ scores by assessing a frequency scatter plot and determined that those participants with scores below a 21 on the PMQ made up the lowest (L-PMQ) group, scores including and between 21 to 30 on the PMQ made up the middle (M-PMQ) group, and scores above 30 made up the highest (H-PMQ) group. A comparison using the H-PMQ and L-PMQ groups revealed that those participants in the H-PMQ group, after completing an interdisciplinary treatment program, had significantly decreased PMQ scores at post-treatment. In addition, the H-PMQ group was significantly associated with greater levels of non-compliance or drop out from treatment, early pain medication refill requests, and endorsement of having a history of alcohol abuse or history of rehab for alcohol or drugs. Finally, the present study also examined the relationship of total PMQ score with measures of physical impairment and perceived pain. Findings suggest that higher scores on the PMQ are minimally associated with higher levels of impairment of physical functioning and perceived pain.Item Assess Effectiveness of Opioid Prescription Policies for Acute Pain Management(2022-05-01T05:00:00.000Z) Machchhar, Arti; Reed, W. Gary; Phelps, Eleanor; Kandil, EnasBACKGROUND: In 2017, the Department of Health and Human Services (HHS) declared the Opioid Crisis a public health emergency. Regulatory agencies and institutions have adopted several guidelines to ensure opioids are prescribed appropriately. In October 2014, the DEA changed the schedule of hydrocodone combination products (HCPs) from schedule III to schedule II narcotics. This led to a substantial rise in Tylenol 3 prescriptions at the University of Texas at Southwestern Medical Center (UTSW) due to the institutional guideline that prevents residents from prescribing schedule II narcotics without documented approval from an attending physician. OBJECTIVE: We sought to evaluate whether the UTSW guideline preventing residents from prescribing schedule II narcotics serves to improve patient safety and pain management. METHODS: Prescription data and associated patient demographic data was pulled directly from the UTSW electronic medical record (EMR) for one year prior to and following the rescheduling of HCPs. Additional data was pulled for the 2019 and 2020 calendar years. The proportion of T3 and schedule II narcotic prescriptions was calculated for all time periods and stratified for age, race, provider type, and department. RESULTS: One year before the rescheduling of hydrocodone, the vast majority of prescriptions were schedule II narcotics at 98.92% and T3 was very rarely prescribed at 1.08%. In 2014 - 2015 following the rescheduling of HCPs, there was an overall decrease in opioid prescriptions and the proportion of T3 prescriptions rose to 49.94%. In 2019 and 2020, the overall number of opioid prescriptions increased to 17,297 in 2019 and 15,395 in 2020 and the proportion of T3 prescriptions decreased to 37.12% and 33.89% respectively. CONCLUSION: The rescheduling of HCPs led to the dramatic shift in Tylenol 3 prescriptions, indicating that regulatory agencies and institutional guidelines are driving prescribing habits. Tylenol 3 is being prescribed at a significant rate however, information regarding its addictive potential, metabolic effects, and potential adverse effects remains relatively unknown. The drug policies and institutional guidelines discussed disproportionately affect people of color and lower socioeconomic class.Item Association Between Health-Related Perceptions and Treatment Outcomes in an Interdisciplinary Pain Management Program(2014-12-22) Mader, Megan Denise; Gatchel, Robert J.; Robinson, Richard C.; Noe, CarlBACKGROUND: Adherence to treatment recommendations, specifically chronic pain treatment, is a particular area of importance in the elderly. It has been suggested that patient beliefs/perceptions play a role in treatment outcome, and the current study seeks to further explore this relationship in order to determine the extent to which health-related beliefs and perceptions effect treatment outcome. SUBJECTS: The study consisted of a total of 103 patients, ages 20-82, who were treated at the Eugene McDermott Center for Pain Management at University of Texas Southwestern Medical Center over the past two years. METHOD: Initial and discharge responses to Computerized Adaptive Testing (CAT) items were collected. Select measures, such as the PMQ (Pain Medication Questionnaire), BIPQ (Brief Illness Perception Questionnaire), PROMIS Global Health, Composite Pain Rating, and other PROMIS measures were analyzed via SPSS. RESULTS: Strong correlations were found between Global Health and outcomes, specifically initial Global Health and initial outcome responses. Strong correlations were also found between initial BIPQ and initial outcome measure scores. DISCUSSION: The results supported the hypotheses and showed that as health-related perceptions change, outcome measures can also change accordingly with the progression of treatment.Item Comparative Ability of the Pain Disability Questionnaire in Predicting Health Outcomes and Healthcare Costs(2013-07-03) Lippe, Ben Jonathan; Gatchel, Robert J.; Noe, Carl; Kennard, Beth D.; Deschner, Martin; Whitfill, TravisGiven the tremendous personal and societal costs of chronic pain, efforts at improving pain conceptualization via the Biopsychosocial Model have become critical in addressing pain-related health outcomes and healthcare costs. The current study consisted of 254 (Average age= 49.72, SD= 14.55) adult chronic pain patients seeking treatment through an interdisciplinary chronic pain management clinic. Participants were administered a battery of assessments including the Pain Disability Questionnaire and other established measures of health and pain-related outcomes (e.g., SF-36, PROMIS pain-related measures) at baseline and post-treatment time points. Convergent validity was observed between the Pain Disability Questionnaire and other study measures. Hierarchical regression analyses demonstrated significant associations between pain-related disability as measured by the Pain Disability Questionnaire and a range of health and psychosocial outcomes. Pain Disability Questionnaire scores, as placed in categorical severity levels, demonstrated good discriminative abilities in terms of predicting health outcomes profiles. Further, logistic regression models established that the Pain Disability Questionnaire provided good predictive validity in terms of healthcare cost categorization at three month follow-up. These findings support the clinical use of the Pain Disability Questionnaire as an equivalent, and in some cases superior, empirically supported predictor of health-related outcomes as compared with other established measures of pain and health outcomes. Additionally, initial evaluation of the Pain Disability Questionnaire’s predictive utility in terms of pain-related healthcare costs displayed significant predictive abilities. Overall, these findings suggest that the Pain Disability Questionnaire is a valuable tool in efforts to understand and manage chronic pain as well as predict associated healthcare costs for chronic pain patients.Item Decision Fatigue in Primary Care Opioid Prescribing(2020-05-01T05:00:00.000Z) Hughes, Jordan Gregory; Kandil, Enas; Reed, W. Gary; Greilich, PhilipBACKGROUND: Decision fatigue -- a psychological phenomenon describing the depletion of mental resources as one makes a series of decisions -- affects primary care physicians as they treat patients and prescribe medications throughout the course of the clinical day. This results in more inappropriate treatments being ordered as the day goes on. Because the United States faces an unprecedented epidemic of opioid abuse, we must understand the extent to which decision fatigue affects opioid prescribing, as the prescription of these drugs has been associated with both long-term use and overdose deaths. Additionally, we are unaware of the effect various national interventions to stem the tide of the opioid epidemic have had on decision fatigue in opioid prescribing. LOCAL PROBLEM: We are unaware of whether decision fatigue is playing a role in opioid prescribing, and if it is, how great the variation in prescription likelihood is throughout the clinical day in UT Southwestern's primary care clinics. The aim of this study is to measure PCPs' varying likelihoods of prescribing opioids throughout the clinical day, before and after major interventions were implemented to combat the epidemic, as this can serve as an indication of both the presence of decision fatigue and the impact of concerted interventions. METHODS: We used the years 2014 and 2017 to represent the pre- and post-intervention periods for study, as many major interventions to combat the opioid epidemic took place in 2016. Next, we analyzed the percentage of appointments in which opioids were prescribed in each hour of physicians' clinical days, at three exclusively primary care clinics at UT Southwestern. Scheduled appointment times were used as substitutes for visit times. We then excluded patients with cancer and those who had surgery within six weeks of an appointment, in order to minimize the number of appointments in which opioids may be prescribed by clear clinical indication. Finally, we employed logistic regression analysis to determine the predictive relationship between appointment time and opioid prescriptions, using physicians' prescription rates in their first clinic hour as the reference for calculating hourly odds ratios in each year. INTERVENTIONS: New legislation, updated healthcare guidelines, and national media coverage in 2016, including: the CDC's "Guideline for Prescribing Opioids for Chronic Pain—United States", the FDA's "General Principles for Evaluating the Abuse Deterrence of Generic Solid Oral Opioid Drug Products: Guidance for Industry, 2016", the Comprehensive Addiction and Recovery Act of 2016, the Surgeon General's call to providers to end the opioid crisis, and the opioid crisis becoming top health news story of 2016. RESULTS: 34,972 clinic visits in 2014 and 42,313 clinic visits in 2017 met our inclusion criteria. In 2014, patients were prescribed an opioid at 5.34% of all primary care appointments, while in 2017, they were prescribed at a rate of 4.34% (2014 vs 2017 OR=1.290; 95% CI, 1.217-1.367). While the overall rates of opioids decreased from 2014 to 2017, the hourly likelihoods of patients being prescribed opioids steadily increased throughout the clinical day in both years (p<0.01 in 2014 and 2017). In fact, each year had hours in which physicians' opioid prescription odds ratio was over 1.6, when compared to their first clinical hour. DISCUSSION: While there was a significant decrease in the overall likelihood of being prescribed opioids in 2017 compared to 2014, the variation in hourly prescription likelihoods is similar in both years. The results show that while interventions to combat the opioid epidemic were successful in reducing the overall amount of opioids prescribed, they had minimal impact on the effect of decision fatigue. Clinical decision support tools, integrated into the electronic medical record, have been proven to reduce the clinical variation that indicates the presence of decision fatigue. In light of this, this project should be continued, and decision fatigue measured, after implementation of such tools.Item Development and Implementation of a Brief Video-Based Mindful Movement Intervention Prior to Pelvic Exams to Reduce Pain Intensity and State Anxiety(August 2021) Collins, Marielle Heather; Greer, Tracy L.; Evans, Harry M.; Kho, Kimberly A.; Trombello, Joseph M.; Carmody, ThomasMindfulness interventions have demonstrated efficacy for numerous health related outcomes, and been implemented in medical settings to reduce pain and anxiety prior to exams, surgeries, or procedures. This broad investigation begins with a theoretical review exploring a proposed mechanism of mindfulness, improved attention. It presents a theory of mindful movement as a type of mindfulness potentially more efficacious for individuals who struggle with mind-wandering, such as those with depression and anxiety. Mind-wandering and rumination are barriers to mindfulness, and movement has been shown to engage finite executive resources also utilized for mind-wandering. Mindfulness interventions with movement, may promote greater engagement for individuals with attentional challenges, compared to focused attention meditation. Mindful movement may provide a more accessible form of mindfulness for brief interventions, implemented in settings with a wide range of participants. The current study tests the efficacy of a 5-minute mindful movement video prior to pelvic examination in a sample of 99 women at an outpatient gynecology clinic, with the aim of reducing anxiety and pain. Participants were randomized into Treatment (5-minute mindful movement video; n=49) and Control (educative materials about mindfulness benefits; n=50). Upon arrival, women completed a PHQ-9, and baseline measurements of anxiety and pain using a visual analogue scale. They then completed the group specific activity and rated anxiety prior to examination. After examination participants rated exam pain, post-exam anxiety, and completed questionnaires assessing exam satisfaction and intervention acceptability. Physicians (n=2) rated ease of performing pelvic examination and ability to obtain clinical information. Results demonstrated clinically anxious individuals who completed the intervention reported significantly lower anxiety before pelvic examination (p=.000, partial η2=.262) and after (p= .010, partial η2=.126) compared to control group. No significant differences in pain, patient exam satisfaction, or physician perception of the exam were noted between groups. Acceptability and interest in the intervention was also high. This study demonstrates the ability to implement a brief mindful movement video into the flow of a medical clinic and reduce pelvic exam anxiety. In general, this broad investigation supports ongoing research exploring mindful movement from a mechanistic perspective, and the implementation of brief mindful movement interventions in medical settings.Item The Development and Preliminary Evaluation of MOTIVATE: Moving to Improve Chronic Back Pain and Depression in Older Adults(2021-03-10) Yang, Ailing Eileen; Makris, Una; Roche, Vivyenne; Saxon, LadonnaBACKGROUND: Chronic low back pain (cLBP) is the 2nd most common reason for physician visits; annual related costs exceed USD 100 billion and are expected to rise with the aging population. cLBP and depression often coexist, and current non-pharmacologic interventions have not focused on older adults with these challenging comorbidities. A feasible, effective non-pharmacologic intervention targeting cLBP and comorbid depressive symptoms in older adults is needed. MOTIVATE (Moving to Improve Chronic Back Pain and Depression in Older Adults) is a novel 8-session, 12-week, telephonic behavioral intervention targeting older adults with cLBP and comorbid depressive symptoms. A health coach utilizes motivational interviewing and value-concordant goal setting to capture individual motivations to increase physical activity. The ultimate goal is to improve back pain-related pain interference, disability, and depressive symptoms. OBJECTIVE: To develop a unique telephone-delivered behavioral intervention that is feasible, increases physical activity, and ultimately improves pain, function, and depressive symptoms among older Veterans. METHODS: In Phase 1, Dr. Makris' research team developed a telephone-delivered multicomponent behavioral intervention that targets older Veterans (>65 years old) with cLBP and comorbid depressive symptoms. Input from stakeholder groups [experts in pain, geriatrics, geriatric psychology, primary care, behavioral interventions, among others (n=8), patients (n=5), and key clinical leaders (n=6)] was used to inform and refine content for this unique population. In Phase 2, we conducted a single-arm rollout of MOTIVATE in older Veterans with cLBP and depressive symptoms to further refine future intervention content, procedures, and delivery based on stakeholder feedback. For qualitative interviews, the Promoting Action on Research Implementation in Health Services (PARIHS) framework was used to develop the discussion guide and facilitate individual interviews with the following key stakeholder groups: Veteran participants (n=4) over the age of 65 with comorbid cLBP and depressive symptoms who received MOTIVATE, primary care providers (PCP) (n=4), clinic director (n=1), and health coach (n=1). RESULTS: Informed by interviews with 14 experts and 5 Veterans, we developed and iteratively refined the MOTIVATE manual and study procedures for Phase 1. In the single-arm MOTIVATE rollout (Phase 2), we enrolled 7 Veterans, with a mean age of 69 years who were predominately white (71%), male (86%), married (57%), and had some education beyond high school (71%). The eligibility mean pain intensity score was 7.3/10; baseline cLBP Pain, Enjoyment of Life, and General (PEG-3) Activity Scale was 7.14/10, back pain-specific Roland Morris Disability Questionnaire (RMDQ) Scale was 16.5/24; and depression PHQ-9 score was 16.7/27, with higher scores indicating greater impairment. Two case studies are provided for additional context and to more fully articulate important MOTIVATE intervention concepts. Upon completion of the intervention, semi-structured interviews with Veterans and other stakeholders provided valuable feedback on how to modify MOTIVATE moving forward. Briefly, Veterans who completed MOTIVATE engaged well with the health coach, were motivated to walk with a pedometer, and felt that being more active reduced pain and depressive symptoms. Of the four PCPs interviewed, all attributed the success of the intervention to the skills and engagement of the health coach; we also learned about the variability in how PCPs would like results relating to patient-identified values and goals to be communicated with them. The health coach noted that Veterans were able to identify value-concordant goals and easily link these to physical activities. All stakeholders stated that the individual health coach plays a critical role in activating and motivating older Veterans with complex medical and psychiatric conditions. CONCLUSION: MOTIVATE content and procedures were developed in Phase 1. The Phase 2 rollout showed that we were able to effectively recruit older Veterans with cLBP and depressive symptoms and deliver MOTIVATE via telephone. Feedback from key stakeholders regarding the iterative refinement of recruitment, study procedures, and content will aid the future evaluation and implementation of MOTIVATE in a pilot randomized controlled trial.Item Effectiveness of Interdisciplinary Pain Management Programs in Elderly Populations(2016-07-25) Huber, Elizabeth Gray; Robinson, Richard C.; Gatchel, Robert J.; Noe, Carl; Deschner, Martin; Minhajuddin, AbuBACKGROUND: Chronic pain is a debilitating disease that affects millions of adults in the United States. In recent years, there has been a steady increase in the use of interdisciplinary interventions to treat chronic pain. While the effectiveness of such programs is well-documented in adult populations, little is known about the efficacy of such methods for elderly populations. OBJECTIVE: This study assessed the effectiveness of an interdisciplinary pain management program in addressing chronic pain and associated disability (e.g., loss of functioning, poor mood) in the elderly. Study aims also included a comparison of outcomes between elderly and non-elderly participants in an interdisciplinary pain management program, as well as an examination of which variables may serve as predictors for completion of such programs. METHOD: Participants included one hundred and thirteen chronic pain patients receiving treatment in an interdisciplinary program at the Eugene McDermott Center for Pain Management. Participants completed multiple measures pertaining to pain and associated conditions at baseline, mid-way through the program (2 weeks post-enrollment) and upon completion of the program (4 weeks post-enrollment). ANALYSIS: Repeated measures ANOVA analyses examined changes in participants’ scores over time on various self-report measures that assessed pain rating, functionality and mood. Separate analyses were conducted to evaluate results from elderly participants only, and then to compare results between elderly and non-elderly participants. A binomial logistic regression was performed to determine the effects of age and mood on the likelihood that participants in an interdisciplinary pain management program would complete treatment in the program. RESULTS: Although elderly participants’ mean scores across a variety of measures showed signs of improvement, these changes did not meet statistical significance. However, when examining elderly and non-elderly participants together, both groups demonstrated significant improvement across all outcomes with the exception of depression. There were group differences on a select number of outcomes, including those that assessed pain disability, anxiety and depression levels; on these measures, the mean scores for non-elderly participants were higher as compared to elderly participants. There were no interactions between the two groups for any of the variables assessed. The logistic regression model that examined the effects of age and mood on the likelihood that participants would complete treatment in the current study was not significant. DISCUSSION: The current study demonstrates that non-elderly participants experience benefit from participation in interdisciplinary pain management programs. Further research is warranted with a larger elderly population to assess how treatment may need to be tailored to the unique needs of the elderly.Item Evaluating Differences in Patient Perception of Effectiveness of Oral Versus Parenteral Non-Steroidal Anti-Inflammatory Drugs(2015-01-26) Semeiks, Jeremy; Neuwelt, Simone; Nasr, Alexander; Tran, Thong; Velez, Larissa; Roppolo, LynnBACKGROUND: Pain is a very common reason for emergency department (ED) visits. Providing safe, effective analgesia is not only central to providing good health care, but also to overall patient satisfaction. Prior work has shown that although parenteral administration of NSAIDs is more expensive and has greater risk of adverse effects than oral administration, there are no significant differences between the two routes in amount or efficiency of pain relief. However, some clinicians believe that patients presenting with pain to the ED prefer parenteral over oral NSAIDs, due to an assumed patient perception that shots are more effective than pills. Additionally, prior studies in this area have not examined patient ethnicity as a factor in administration preference. OBJECTIVE: To determine the extent to which patient preference for oral versus parenteral methods of NSAID administration can be influenced by education. METHODS: All patients who presented to a county hospital ED with a chief complaint of pain and were subsequently prescribed any type of NSAID were included. After obtaining consent, a survey was given in English or Spanish to obtain demographic data and question the patient on three items: (1) Which NSAID form (pill or shot) is better at taking away pain (2) Which NSAID form is faster at taking away pain (3) Which NSAID form is preferred to take away pain. This preference survey was repeated after educating the patient that the shot and the pill are equally effective but the shot costs more and causes pain. Statistical analysis was performed using standard methods. RESULTS: N=270 patients were surveyed, with mean age 42; 49% female; and 37% African American, 37% Hispanic, and 23% Caucasian. Before education, overall subjects were equally likely to prefer the pill versus the shot but believed the shot to be faster (82%) than the pill (17%). Patient education on NSAIDs significantly influenced patient beliefs on all three items: 73% found the pill to be as effective as the shot, 55% found the pill to be as fast as the shot, and 75% preferred the pill (p<0.001 in all three cases). There were no statistically significant differences in any of these beliefs across patient ethnicity, education, or narcotic preference. CONCLUSION: Despite clinician assumptions, most patients have favorable attitudes toward NSAID pill versus shot effectiveness and overall preference, and can be easily influenced by briefly educating these patients in the ED. This suggests brief patient education is effective to reduce cost of treating minor pain in the ED. Future work should compare effectiveness of various education methods.Item An Evaluation of the Predictive Validity of the Pain Medication Questionnaire With a Heterogeneous Group of Chronic Pain Patients(2006-08-11) Dowling, Leah Suzanne; Stowell, Anna W.The Pain Medication Questionnaire (PMQ) was initially developed by Adams and colleagues (2004) as a 26-item self-report assessment to screen for opioid medication misuse. The PMQ has demonstrated good reliability and validity, and was predictive of early termination from treatment and identified patients who demonstrated maximal benefit from interdisciplinary treatment (Holmes et al., 2006). This current study explored whether or not the initial PMQ score would accurately predict the development of aberrant opioid medication use behaviors relative to specific behavioral indices (i.e., request for early refills, use of a medication agreement) and a physician rating of medication misuse behaviors. Patients fell into two groups according to their initial score on the PMQ based on the median score of 25. Patients with higher PMQ (H-PMQ) scores reported greater levels of perceived disability and decreased physical and mental functioning. Total scores from the PMQ were moderately correlated with initial measures of physical and psychosocial functioning, and observed problematic medication use behaviors observed by physicians during evaluation. However, higher PMQ scores did not significantly predict the use of a medication agreement or requests for early refills. Five patients were identified from the H-PMQ group that demonstrated problematic opioid medication use that fell outside of the realm of early refill requests. These included utilizing leftover pain medications, taking narcotic medication prescribed to a family member, prescription forgery, and referral for detoxification. Although these patients varied on demographic variables, they each had a PMQ total score greater than 30. Indicating that although a PMQ total score ≥ 25 is indicative of problematic use, a score ≥ 30 suggests that a patient should be closely monitored when prescribed and opioid medication. Overall, this study demonstrated that a patient's self-report is significantly correlated with problematic behaviors observed by physicians. Therefore, when utilized in a busy clinic setting, the PMQ will aide in the identification of specific problematic behaviors and beliefs at the outset of treatment that may hinder successful treatment of a patient's pain condition.Item Ice-POP: Ice Application for Post-Operative Pain: A Randomized Controlled Trial(2021-05-01T05:00:00.000Z) Kenyon, Laura Elizabeth; Kho, Kimberly A.; Shields, Jessica; Weix, PatrickBACKGROUND: The Opioid Crisis is directly linked to over-prescription of opioids by physicians. Non-opioid and non-pharmacologic forms of post-operative pain management need to be explored. Cryotherapy, accomplished with the use of ice, is a non-pharmacologic form of pain relief. There is limited data regarding cryotherapy and its application in abdominal surgery. OBJECTIVE: To investigate the effectiveness of cryotherapy as an additional form of pain control in women undergoing total laparoscopic hysterectomy (TLH) for benign gynecologic conditions through a randomized trial. METHODS: 52 patients were randomized evenly to receive standardized post-operative pain management with or without cryotherapy (abdominal ice packs applied directly following surgery). VAS pain scores and narcotic usage were collected at the patient's pre-op appointment, before surgery, at discharge, during a 1-day post-op phone interview, and at a 2-week post-op appointment. Questions about the patient's perception of pain were asked during the postoperative day 1 phone call. Quality of recovery scales were collected at enrollment and the 2-week post-op appointment. Demographic data, VAS pain scores, and narcotic usage were analyzed for significance via the student's t-test. RESULTS: There was no statistically significant difference (p < 0.05) between the patient group receiving ice and no ice based on demographics, VAS pain score, narcotic usage, quality of recovery, and perception of pain control. However, for patients using ice, VAS pain scores were lower on postoperative day 1 and narcotic usage was lower in the post-anesthesia care unit (PACU). Patient perception of ice was largely positive with 87% of patients reporting they would use ice again while 83% would recommend ice to family/friends. Of note, less than half (38%) of opioids prescribed were used within 2 weeks post-op. CONCLUSION: Based on the minimal risks of ice, low cost, and perceived benefit by patients including the opportunity for patient autonomy, we would recommend using ice immediately following surgery. Ice is a reasonable alternative to decrease the number of opiates prescribed.Item Investigating Resource Utilization in Elective Spine Patients with Affective Disorders: A Retrospective Analysis of a Cohort of 1199 Elective Spine Patients(2021-05-01T05:00:00.000Z) Christian, Zachary Kemon; Bagley, Carlos; Aoun, Salah; Dodds, JeffreyBACKGROUND: In elective spine surgery patients, affective disorders (ADs) are associated with increased preoperative opioid use to control pain, longer length of hospital stays, and increased postoperative readmission rates. When assessing healthcare resource utilization, how ADs influence perioperative electronic patient portal (EPP) communication with care providers has not been explored. It is also unclear how ADs influence in-patient and postoperative opioid consumption. OBJECTIVE: To investigate the resource utilization of patients with ADs in our population by analyzing the relationship between AD and both perioperative EPP communication, opioid use, and surgical outcomes. METHODS: The records of 1199 consecutive adult patients who underwent elective spinal surgery between January 2010 and August 2017 at a single institution were retrospectively reviewed for analysis. Primary outcomes included the number of perioperative EPP messages sent, perioperative narcotic use, rates of peri-operative complications, hospital length of stays, Emergency Department visits within 6 weeks, and readmissions within 30 after surgery. In the subanalysis, patients with patient-reported outcome measures for pain, anxiety, and depression within 30 days prior to surgery were used to assess whether preoperative narcotic use correlated with reported preoperative pain levels. RESULTS: Patients with an AD were more likely to take narcotics before surgery and to have active EPP accounts compared to controls. They were also more likely to send postoperative messages, and tended to send more messages. The AD group had higher rates of postoperative complications, ED visits, and readmissions postoperatively. The AD group also requirement more opioid in the inpatient setting and were more likely to refill prescriptions for opioid medications 3- and 12-months after surgery. In the subanalysis, the average rating of pain intensity was notably higher in the AD group; however, there was no statistically significant difference in rates of narcotic use between low- and high-pain cohorts. This was not the case for the control group. CONCLUSION: AD patients have increased EPP communication, perioperative opioid use, and postoperative complications. Addressing these concerns early and advocating for resources for this population may prevent more serious morbidity, reduce costs, address the opioid crisis, and improve patient care.Item Management of low back pain in older adults: changing our approach(2015-05-08) Makris, UnaItem Memo to editors and news directors(1972) Fenley, Bob; Weeks, JohnItem [News](1982-01-29) Harrell, AnnItem [News](1973) Fenley, BobItem [News](1984-10-25) Rutherford, SusanItem Pain Scores with Atypical Pain Regimens in Severe Burn(2015-01-26) Jang, Eunjin; Saeman, Melody R.; Banon, Shawn; Burris, Agnes; Wolf, Steven E.INTRODUCTION: Severely burned patients receive a variety of medications to alleviate their pain. We wondered if there are differences in reported pain scores and acceptable levels of pain in patients who receive only opioid analgesics versus patients who receive atypical pain medications in addition to opioids. METHODS: The regional burn center's database was queried for subjects with greater than 20% TBSA (total body surface area) burn admitted from January 2011 to March 2014. Subjects who received only opioid medications were categorized into the "opioid" group, and those who received any combination of atypical non-opioid pain medications in addition to opioids were in the "non-opioid" group. Non-opioid medications included typical and atypical antipsychotics, benzodiazepines, SSRIs, and heterocyclic antidepressants. The non-opioid subjects were matched for TBSA burn, age, and gender with opioid subjects. Pain scores and reported acceptable levels of pain were collected from review of the electronic medical record. Scores were averaged from the first five days of hospitalization and compared to scores from the last five days of hospitalization to evaluate for differences. Statistical analysis was performed with SigmaPlot using t-test, Mann-Whitney, chi-square, and Wilcoxon signed rank test where appropriate. RESULTS: Twenty-eight subjects were identified in each cohort. The median TBSA burn was 25% (21, 31[IQR]) in non-opioid subjects and 28% (24, 32 [IQR]) in opioid subjects. The median length of stay was 31 days and the mean age was 42 years for both groups. There was no statistical difference in TBSA burn, gender, age, or length of stay between groups. We found no differences in pain scores or acceptable pain levels between groups at either time points. Paired t-test demonstrated no statistical change in pain scores over hospitalization in the opioid group. However, those who received non-opioid pain medications had a statistical improvement (p = 0.018) in pain scores over their hospitalization from 2.5 (1.6, 3.9 [IQR]) to 1.8 (1.2, 2.5 [IQR]) at the end. There was no statistical difference in the acceptable level of pain over hospitalization in either group. CONCLUSIONS: Our results suggest improved pain scores with atypical pain regimens compared to opioid-only treatments.Item Predictors of Attrition in an Interdisciplinary Pain Management Program(2019-07-08) Chong, Jeanette Lee; Robinson, Richard C.; Jarrett, Robin B.; Hynan, Linda S.; Noe, Carl; Zafereo, JasonBACKGROUND: Chronic pain is a debilitating condition that affects millions of adults in the United States. In recent years, particularly with the growing concerns about opioid use, there has been a steady increase in the use of interdisciplinary pain programs (IPP) to treat chronic pain. The effectiveness of such programs has been well-documented; however, attrition has also been identified as a neglected topic in outcome studies. OBJECTIVE: This study aimed to investigate the extent to which demographic/clinical characteristics predict attrition in an IPP. Study aims also included examining longitudinal changes in score for the completion group for a variety of clinical measures, and an exploratory analysis comparing changes between non/completion groups. METHOD: Participants included one hundred and seventy-eight patients receiving treatment for chronic pain conditions in an IPP at the Eugene McDermott Center for Pain Management at UT Southwestern Medical Center. Participants completed measures related to pain and psychosocial functioning at baseline, mid-intervention (2 weeks post-enrollment), and post-intervention (4 weeks post-enrollment). ANALYSIS: This study used logistic regression analyses to identify variables most predictive of attrition in five domains: 1) selected demographic variables, 2) number of medical diagnoses [psychiatric and non-psychiatric], 3) opioid use/risk of misuse, 4) pain-related cognition and behavior, and 5) physical, social, and mental well-being. Mixed models analyses were also conducted to examine longitudinal changes in score on a variety of clinical measures for the completion group. RESULTS: Participants who were of younger age, unemployed, and not on opioids pre-intervention had higher odds of dropping out. The completion group demonstrated improvement pre- to post-intervention on each of the measures assessed in the 1) pain-related cognition and behavior domain and 2) physical, social, and mental well-being domain, except for one measure. DISCUSSION: Mean age of non-completers was 48.72 years (SD = 13.44); these patients may have had difficulty with program compliance due to more outside stressors (e.g., younger children, demanding jobs). Participants may have been unemployed due to a number of potential contributing factors (e.g., lack of transportation, lower motivation, physical mobility), which would create barriers to program completion. Previous findings suggest opioid dependency contributes to higher odds of dropout; however, results from the current study suggest pre-intervention opioid use--not dependency--does not contribute to higher odds of attrition.Item Prevalence of Prescription Medication Misuse in Patients Presenting to the Emergency Department(2015-01-26) Davis, Jennifer; Schaeffer, Thomas; Kleinschmidt, Kurt; Wax, Paul; Young, Amy; Drake, Kelsey; Furmaga, JakubIn the early 1990s multiple studies displayed the inadequate treatment of acute pain for patients presenting to Emergency Departments across the U.S. As a result, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) modified the standard of care in regards to acute pain management, which required more consistent assessments and diligent treatments. Subsequently, the average number of prescribed opioid analgesics in the U.S. increased from 96 mg of morphine equivalents per person in 1997 to approximately 700 mg per person in 2007. Furthermore, the number of unintentional opioid drug overdose deaths increased from 3,000 to 12,000 per year. Clinicians and policy makers are now working to reduce the effects of this new prescription drug epidemic. Data for this study was collected from patients presenting to the ED of Parkland Memorial Hospital (PMH) with a chief complaint of 'back pain' or 'back injury' via a confidential, self-reporting survey designed to obtain demographic information, a brief medical history, and pain and anxiety medication use habits. Statistical analysis of 132 patients revealed that 71 (53.8%) patients have used prescription pain or anxiety drugs in the past 3 months, with 30 (22.7%) utilizing them on a daily or near daily basis. Although only 6 (4.6%) patients admitted to struggling with pain or anxiety medication misuse and 0 (0%) admitted to utilizing current prescription medications for recreational purposes, 12 (9.1%) reported personal troubles, 12 (9.1%) reported a failure to do what was normally expected of them at some point in the past 3 months, and 9 (6.8%) reported a friend or relative expressing concern about substance use. 24 patients reported having a current prescription for pain or anxiety medication. Of these, 17 (70.8%) were obtained from either ED or primary care physicians. A number of relationships were also analyzed in order to determine at-risk individuals. Education level showed a statistically significant association with pain or anxiety medication use in the past 3 months (p=0.003), while a history of chemical dependence therapy was correlated with the expression of concern from friends or family in regard to substance use (p=0.02). This data may be used to determine the prevalence and cause of prescription drug misuse among patients presenting to EDs, providing clinicians with promising areas of intervention. Understanding the scope of the issue, coupled with the ability to prevent habitual drug misuse prior to its initiation, may serve to alleviate some of the negative effects associated with this new epidemic.