Correlates of Pain in an in-Treatment Sample of Opioid-Dependent People.

Correlates of pain in an in-treatment sample of opioid-dependent people.

Drug Alcohol Rev. 2013 Apr 17;
Nielsen S, Larance B, Lintzeris N, Black E, Bruno R, Murnion B, Dunlop A, Degenhardt L

INTRODUCTION AND AIMS: The limited literature on pain in opioid-treatment samples indicates that it is highly prevalent. Understanding the implications of pain on treatment outcomes is important, particularly in light of ageing opioid-treatment cohorts. This study explores correlates of pain, including aberrant behaviours related to prescribed opioids. Our hypothesis is that pain may increase aberrant opioid-related behaviours, including illicit substance use, among opioid-dependent people. DESIGN AND METHODS: We examined pain in methadone or buprenorphine patients (n?=?141) from three treatment services. Measures included basic demographics, Brief Pain Inventory, general mental health, physical health and quality of life measures, pain history and treatments, and an aberrant opioid-related behaviour scale. Univariate and multivariate analyses were used to examine correlates of pain. RESULTS: Forty percent reported current pain, measured with the first question of the Brief Pain Inventory. Correlates of pain were depression ratings [adjusted odds ratio (OR) 2.24, 95% confidence interval (CI) 1.04, 4.83], anxiety ratings (adjusted OR 4.29, 95% CI 1.88, 9.80) and self-reported health ratings (adjusted OR 0.35, 95% CI 0.16, 0.76). Contrary to our hypothesis, pain was not associated with greater use of illicit opioids, nor any aberrant opioid-related behaviours. Pain was comparable among methadone and buprenorphine patients. DISCUSSION AND CONCLUSIONS: The lack of association with pain and aberrant behaviours suggest that it should not be assumed that those in opioid treatment misuse medications in response to pain. The high prevalence of depression/anxiety symptoms indicates a need for further work with larger samples to explore pain and co-morbidity among opioid-dependent people. [Nielsen S, Larance B, Lintzeris N, Black E, Bruno R, Murnion B, Dunlop A, Degenhardt L. Correlates of pain in an in-treatment sample of opioid-dependent people. Drug Alcohol Rev 2013]. HubMed – addiction


Prescription Opioid Abuse in the United Kingdom.

Br J Clin Pharmacol. 2013 Apr 18;
Giraudon I, Lowitz K, Dargan PI, Wood DM, Dart RC

The United States (US) is considered the center of prescription drug abuse. Since drug abuse is a worldwide phenomenon, it would be valuable to determine if the trend of increasing prescription opioid misuse and abuse seen in the US is developing in the United Kingdom (UK). To compare trends in deaths associated with prescription opioid drugs, mortality data was obtained online for England, Wales, and Scotland from the Office for National Statistics and the General Register Office and for the US from The National Vital Statistics System (NVSS). Mortality trends in the US show a relentless increase of deaths from unintentional drug poisoning with opioid analgesics in the last decade. In 2010, the number of deaths related to opioid analgesics was over 16,500, more than double the number of 2002 and more than twice the number of deaths from heroin and cocaine deaths combined [1]. Although the number of deaths related to drug poisoning reviewed from England and Wales is not as high as the US, the overall trends are remarkably similar (Figure 1). The prominent role of methadone in UK opioid deaths also is striking. In Scotland, methadone-related deaths increased from 71 in 2001 to 275 in 2011 [2] and they currently represent over half of all reported opioid deaths. However, this should be viewed in the context of a considerable increase in the availability of opioid substitution treatment in the UK [3]. In the US, most cases relate to opioid analgesics, and the number of oxycodone deaths slightly exceeds the number of methadone deaths. Tramadol presents interesting data in the UK: in 1996, England and Wales reported one death with the drug mentioned, but by 2011 there were 154 deaths [4]. In Scotland, tramadol-related deaths increased from 8 in 2001 to 34 deaths in 2011 [2]. The increase in tramadol-related deaths may reflect a rise in tramadol prescriptions, therefore availability, but also points to the need to monitor closely any increase in deaths caused by opioid analgesics as it may signal an emerging problem in the UK similar to the issue that is now well-established in the US. HubMed – addiction


Reducing the Barriers to Pain Management in Albania: Results from an Educational Seminar with Family Doctors.

J Palliat Med. 2013 Apr 17;
Xhixha A, Rama R, Radbruch L

Abstract Palliative care (PC) services are a very limited service in Albania and are provided mainly from the nonprofit sector (nongovernmental organizations [NGOs]) that cover about 30% of the demand. There are very few doctors and nurses qualified in PC and pain management. Training and education programs on opioid treatment do not exist and patients cannot access opioids easily. This study evaluated the attitudes of family doctors on pain assessment, management, and opioid usage before and after seminars on opioid pain management. The Barriers Questionnaire II (BQ-II) was used to evaluate attitudes towards pain management in 227 family doctors (general practitioners) working in the state primary health care system in both urban and rural areas. Data was collected before and after one-day seminars on opioids conducted in six cities located in all the major regions of the country. The response rate was 83.3%. Barriers were measured to be high in the participating physicians, with mean scores of 3 out of 5 or above for 10 of 27 items. The danger of addiction to pain medicines as well as the fear that many people with cancer would get addicted to pain medicine received the highest scores. At the end of the seminar barriers were significantly lower, with the total mean scores (with standard deviation) reduced from 2.4±0.6 to 1.6±0.7. High barriers to the use of opioids in family physicians in Albania were reduced significantly following a one-day training, demonstrating the effectiveness of the intervention. However, more research on the sustainability of the training effect is needed. HubMed – addiction



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