Pain Medicine

Cohort Study: Prenatal opioid exposure linked to modest increase in neuropsychiatric disorders – The BMJ

25 May, 2024 | 19:50h | UTC

This nationwide birth cohort study from South Korea investigated the impact of prenatal opioid exposure on the risk of neuropsychiatric disorders among children. The study followed 3,128,571 infants born between 2010 and 2017 until the end of 2020. Researchers found that infants exposed to opioids prenatally showed a slightly increased risk of developing neuropsychiatric disorders, including mood disorders, attention deficit hyperactivity disorder, and intellectual disability. The increased risk was more pronounced with higher opioid doses, longer duration of use, and exposure during the first trimester of pregnancy. However, this association was not significant in sibling comparison cohorts, indicating a modest overall clinical impact. The study emphasizes the need for cautious interpretation due to its observational design and the specific conditions under which risk increases.

Reference (link to free full-text):

Jiseung Kang et al. (2024). Prenatal opioid exposure and subsequent risk of neuropsychiatric disorders in children: nationwide birth cohort study in South Korea. BMJ, 385, e077664. DOI: https://doi.org/10.1136/bmj-2023-077664

RCT: Triple combination of paracetamol, ibuprofen, and dexamethasone reduces morphine use post-hip arthroplasty – Lancet Rheumatol

11 May, 2024 | 14:18h | UTC

Study Design and Population: The RECIPE trial was a randomized, blinded, placebo-controlled multicenter study conducted across nine Danish hospitals to evaluate the effectiveness of non-opioid analgesic combinations in managing postoperative pain following total hip arthroplasty. A total of 1,060 adults scheduled for surgery were enrolled and randomly assigned to one of four treatment groups, receiving combinations of paracetamol, ibuprofen, and dexamethasone. The study’s primary endpoint was the 24-hour intravenous morphine consumption, with a predefined minimal important difference set at 8 mg.

Main Findings: The trial results indicated significant reductions in 24-hour morphine consumption in the group receiving paracetamol, ibuprofen, and dexamethasone combined, compared to other groups, though none reached the minimal important difference. Specifically, this group consumed a median of 15 mg morphine, which was less than the other groups ranging from 16 mg to 24 mg. However, the differences did not meet the study’s threshold for a clinically important effect. Adverse events were lowest in the combined treatment group, suggesting a better safety profile primarily characterized by fewer incidents of nausea, vomiting, and dizziness.

Implications for Practice: The findings support the use of a combined regimen of paracetamol, ibuprofen, and dexamethasone for reducing morphine consumption post-total hip arthroplasty, which could be significant in clinical settings aiming to minimize opioid use. The improved safety profile also highlights the potential benefits of multimodal analgesia. Further research may explore the optimization of dosing schedules and long-term outcomes to enhance patient recovery and satisfaction.

Reference (link to abstract – $ for full-text):

Steiness J et al. (2024). Non-opioid analgesic combinations following total hip arthroplasty (RECIPE): a randomised, placebo-controlled, blinded, multicentre trial. The Lancet Rheumatology, 6(4), e205-e215. DOI: 10.1016/S2665-9913(24)00020-1

RCT: Serratus anterior plane block reduces pain and opioid use in rib fracture patients – JAMA Surgery

2 May, 2024 | 23:20h | UTC

Study Design and Population:
This study was a multicenter, open-label, pragmatic randomized clinical trial conducted across eight emergency departments in New South Wales, Australia. The trial included 210 patients aged 16 years or older who had clinically suspected or radiologically confirmed rib fractures. Patients intubated, transferred for urgent surgical intervention, or with major concomitant nonthoracic injuries were excluded.

Main Findings:
In the trial, patients were randomized to receive either a serratus anterior plane block (SAPB) along with standard rib fracture management or standard care alone. The primary outcome was a composite pain score measured 4 hours post-enrollment. The SAPB group showed a significant increase in patients achieving the desired pain score reduction (41% in SAPB group vs. 19.6% in control; RR 0.73, 95% CI 0.60-0.89, P = 0.001). Additionally, SAPB recipients had significantly lower opioid consumption at 24 hours compared to the control group.

Implications for Practice:

The trial’s results support the addition of a serratus anterior plane block (SAPB) to standard rib fracture management for providing effective early pain relief and reducing opioid use. However, it’s important to note that this study did not include a sham group, and patients were aware of whether they received the intervention. This lack of blinding could influence patient-reported outcomes due to placebo effects. Despite this limitation, the reduction in pain and opioid consumption suggests that SAPB is a beneficial component of care for patients with rib fractures.

Reference (link to abstract – $ for full-text):

Reference: Partyka, C. et al. (2024). Serratus Anterior Plane Blocks for Early Rib Fracture Pain Management The SABRE Randomized Clinical Trial. JAMA Surg. Published online May 1, 2024. DOI: 10.1001/jamasurg.2024.0969

Cohort Study: No increased risk of autism, ADHD, or intellectual disability from acetaminophen use in pregnancy

29 Apr, 2024 | 12:34h | UTC

This cohort study investigated the association between acetaminophen use during pregnancy and the risk of autism, ADHD, and intellectual disability in children. The study utilized a population-based sample of nearly 2.5 million Swedish children born between 1995 and 2019, with data analyzed up to 2021. Initial findings without sibling controls suggested a marginal increase in the risks of autism and ADHD. However, sibling control analyses, which help adjust for familial confounding, showed no significant associations (HR for autism and ADHD at 0.98, and intellectual disability at 1.01). These results imply that earlier observed risks might be due to unaccounted familial factors, not acetaminophen exposure.

Reference (link to abstract – $ for full-text):

Viktor H. Ahlqvist et al. (2024). Acetaminophen Use During Pregnancy and Children’s Risk of Autism, ADHD, and Intellectual Disability. JAMA, 331(14), 1205-1214. DOI: 10.1001/jama.2024.3172

Phase 2 Trials | Selective NaV1.8 inhibitor, VX-548, shows potential in acute postoperative pain management

7 Aug, 2023 | 14:51h | UTC

Selective Inhibition of NaV1.8 with VX-548 for Acute Pain – New England Journal of Medicine (link to abstract – $ for full-text)

Video Summary: Selective Inhibition of NaV1.8 for Acute Pain | NEJM

Commentaries:

High-Dose VX-548 Reduces Acute Pain Post-Surgery – HCP Live

High-Dose VX-548 Reduces Acute Pain Over 48 Hours – HealthDay

Commentary on Twitter

Original Article: Selective Inhibition of NaV1.8 with VX-548 for Acute Pain https://t.co/ogmEx6FNKo #surgery pic.twitter.com/0FpipA1xey

— NEJM (@NEJM) August 5, 2023

RCT | Opioids not more effective than placebo for acute low back and neck pain

Deprescribing considerations for older people in general practice – Australian Journal of General Practice

Deprescribing Strategies for Opioids and Benzodiazepines with Emphasis on Concurrent Use: A Scoping Review – Journal of Clinical Medicine

An Overview of Systematic Reviews and Meta-Analyses on the Effect of Medication Interventions Targeting Polypharmacy for Frail Older Adults – Journal of Clinical Medicine

Physician-led medication reviews in polypharmacy patients treated with at least 12 medications in a type 2 diabetes outpatient clinic: a randomised trial – Diabetic Medicine

RCT | A deprescribing intervention reduced medication burden among older adults in post-acute care

Achieving sustainable healthcare through deprescribing of unnecessary medications: making sense of the evidence – Cochrane Library

Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis – Health Technology Assessment

Barriers and facilitators to deprescribing of cardiovascular medications: a systematic review – BMJ Open

A National Modified Delphi Consensus Process to Prioritize Experiences and Interventions for Antipsychotic Medication Deprescribing Among Adult Patients With Critical Illness – Critical Care Explorations

Deprescribing proton pump inhibitors – Australian Journal of General Practice

Medication reviews and deprescribing as a single intervention in falls prevention: a systematic review and meta-analysis – Age and Ageing

Optimizing Medication Use in Older Adults With Rheumatic Musculoskeletal Diseases: Deprescribing as an Approach When Less May Be More – ACP Open Rheumatology

Facing the challenge of polypharmacy when prescribing for older people with cardiovascular disease. A review by the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy – European Heart Journal – Cardiovascular Pharmacotherapy

Deprescribing in Older Adults with Cardiovascular Disease – Journal of the American College of Cardiology

Multimorbidity in Older Adults with Cardiovascular Disease – American College of Cardiology, Latest in Cardiology

Antihypertensive Deprescribing in Older Adults: a Practical Guide – Current Hypertension Reports

How-to guide for medication reviews in older adults with cancer: A Young International Society of Geriatric Oncology and Nursing & Allied Health Interest Group initiative – Journal of Geriatric Oncology

Deprescribing in Palliative Cancer Care – Life

Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review – Kidney360

Process evaluation of implementation strategies to reduce potentially inappropriate medication prescribing in older population: A scoping review – Research in Social and Administrative Pharmacy

AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review – Gastroenterology

Development of a Metric to Detect and Decrease Low-Value Prescribing in Older Adults – JAMA Network Open

The MedSafer Study—Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial – JAMA Internal Medicine

Quantifying Anticholinergic Burden and Sedative Load in Older Adults with Polypharmacy: A Systematic Review of Risk Scales and Models – Drugs & Aging

Deprescribing in palliative patients with cancer: a concise review of tools and guidelines – Supportive Care in Cancer

Prescribing practices, patterns, and potential harms in patients receiving palliative care: A systematic scoping review – Exploratory Research in Clinical and Social Pharmacy

A narrative review of evidence to guide deprescribing among older adults – Journal of General and Family Medicine

Polypharmacy, inappropriate prescribing, and deprescribing in older people: through a sex and gender lens – The Lancet Health Longevity

Polypharmacy Management in Older Patients – Mayo Clinic Proceedings

Psychopharmacological Treatment in Older People: Avoiding Drug Interactions and Polypharmacy – Deutsches Ärzteblatt international

Eliminating Medication Overload: A National Action Plan – Lown Institute

International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): Position Statement and 10 Recommendations for Action – Drugs & Aging

Common ED Medication Errors: Polypharmacy – emDocs

Current and future perspectives on the management of polypharmacy – BMC Family Practice

Routine deprescribing of chronic medications to combat polypharmacy – Therapeutic Advances in Drug Safety

Polypharmacy—an Upward Trend with Unpredictable Effects – Deutsches Ärzteblatt international

Clinical Consequences of Polypharmacy in Elderly – Expert Opinion on Drug Safety

M-A | The effect of blood pressure lowering medications on the prevention of episodic migraine

12 Jul, 2023 | 13:50h | UTC

The effect of blood pressure lowering medications on the prevention of episodic migraine: A systematic review and meta-analysis – Cephalalgia

News Release: New study shows common blood pressure meds underused for migraine – George Institute for Global Health

RCT | Opioids not more effective than placebo for acute low back and neck pain

5 Jul, 2023 | 01:15h | UTC

Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial – The Lancet (link to abstract – $ for full-text)

News Releases:

Opioids no more effective than placebo for acute back and neck pain – University of Sidney

Opioid pain relievers do not reduce acute lower back and neck pain, study suggests – The Lancet

Commentary from the authors: Opioids don’t relieve acute low back or neck pain – and can result in worse pain, new study finds – The Conversation

M-A | Metoclopramide effective in acute migraine relief, comparable to most active drugs, superior to placebo

30 Jun, 2023 | 14:51h | UTC

The efficacy and safety of metoclopramide in relieving acute migraine attacks compared with other anti-migraine drugs: a systematic review and network meta-analysis of randomized controlled trials – BMC Neurology

RCT | Acupuncture, doxylamine–pyridoxine, and their combination in nausea treatment during pregnancy

29 Jun, 2023 | 13:56h | UTC

Acupuncture and Doxylamine–Pyridoxine for Nausea and Vomiting in Pregnancy: A Randomized, Controlled, 2 × 2 Factorial Trial – Annals of Internal Medicine (link to abstract – $ for full-text)

News Release: Acupuncture and doxylamine-pyridoxine beneficial for moderate to severe nausea and vomiting during pregnancy: Study – American College of Physicians

Commentary: Combo treatment eases nausea and vomiting of pregnancy – MDedge

Part 2: Practice Advisory for Preoperative and Intraoperative Pain Management of Cardiac Surgical Patients – Anesthesia and Analgesia (free for a limited period)

Infographic: Persistent Pain After Thoracic Surgery—What Works, What Doesn’t – Anesthesia and Analgesia (free for a limited period)

Evidence-based clinical practice guideline for deprescribing opioid analgesics

15 Jun, 2023 | 15:08h | UTC

Evidence-based clinical practice guideline for deprescribing opioid analgesics – University of Sidney

RCT | Cannabis-based medicines show no significant relief for moderate-to-severe cancer pain

15 Jun, 2023 | 15:10h | UTC

Cannabis‐based medicines and medical cannabis for adults with cancer pain – Cochrane Library

Summary: Cannabis-based medicines for cancer pain – Cochrane Library

Review | The cervical spine in tension type headache

13 Jun, 2023 | 13:58h | UTC

The cervical spine in tension type headache – Musculoskeletal Science and Practice

Commentary on Twitter

The cervical spine in tension type headache

???https://t.co/EFcxBlDO34 pic.twitter.com/y7SyA3T7qt

— Physio Meets Science (@PhysioMeScience) June 1, 2023

Editorial: Patient Perspectives on the 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis – Arthritis Care & Research

News Release: New Guideline Introduces Recommendations for Integrative Approach to RA Treatment – American College of Rheumatology

Cohort Study: Prenatal opioid exposure linked to modest increase in neuropsychiatric disorders – The BMJ

RCT: Triple combination of paracetamol, ibuprofen, and dexamethasone reduces morphine use post-hip arthroplasty – Lancet Rheumatol

RCT: Serratus anterior plane block reduces pain and opioid use in rib fracture patients – JAMA Surgery

Cohort Study: No increased risk of autism, ADHD, or intellectual disability from acetaminophen use in pregnancy

Phase 2 Trials | Selective NaV1.8 inhibitor, VX-548, shows potential in acute postoperative pain management

RCT | Atogepant outperforms placebo in reducing migraines over 12 weeks

Review | Painful diabetic peripheral neuropathy

Clinical practice guideline for deprescribing opioid analgesics

M-A | The effect of blood pressure lowering medications on the prevention of episodic migraine

RCT | Opioids not more effective than placebo for acute low back and neck pain

M-A | Metoclopramide effective in acute migraine relief, comparable to most active drugs, superior to placebo

RCT | Acupuncture, doxylamine–pyridoxine, and their combination in nausea treatment during pregnancy

Editorial | Who should judge treatment effects as unimportant?

Guidelines for the management of trigeminal neuralgia

Practice advisory for preoperative and intraoperative pain management of thoracic surgical patients

Evidence-based clinical practice guideline for deprescribing opioid analgesics

RCT | Cannabis-based medicines show no significant relief for moderate-to-severe cancer pain

Review | The cervical spine in tension type headache

Systematic Review | Impact of physical therapies on pain, function, and life quality in myofascial pain syndrome

M-A | Efficacy and safety of duloxetine in chronic musculoskeletal pain

ACR Guideline for exercise, rehabilitation, diet, and additional integrative interventions for rheumatoid arthritis

Systematic review | Analgesic use in sports

Review | Medication-assisted recovery for opioid use disorder

Review | Deprescribing interventions for gabapentinoids in adults

Cohort Study | Prevalence and risk factors of significant persistent pain symptoms after critical care illness

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