Traumatic Brain Injury and Receipt of Prescription Opioid Therapy for Chronic Pain in Iraq and Afghanistan Veterans: Do Clinical Practice Guidelines Matter?

Seal, Karen H.; Bertenthal, Daniel; Barnes, Deborah E.; Byers, Amy L.; Gibson, Carolyn J.; Rife, Tessa; Yaffe, Kristine

doi:10.1016/j.jpain.2018.03.005

Cited by 35 publications

(38 citation statements)

References 41 publications

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“…Regarding opioid classes, 3 studies provided a list of specific opioids[41,43,44], 2 studies[42,44] used a standard formula to calculate morphine equivalents to compare opioid doses across classes, and 3 studies[39,43,45] specified opioid replacement therapy for OUD ( i.e ., methadone and buprenorphine) as an exclusion criterion. With regard to opioid intake, 7 studies defined opioid prescription as the outcome variable.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies also controlled for race/ethnicity[36,37,41]. Of these, 2 also controlled for educational level[37,41] and 2 also controlled for marital status[40,45].…”

Section: Resultsmentioning

confidence: 99%

“…In relation to opioid intake, 2 different outcome variables were identified: opioid prescriptions and OUD. Opioid prescriptions were generally assessed according to the medical prescription-dispensing pattern, although this pattern was defined in different ways, such as total number of prescription days[41,42,44,45] and pharmacy records of opioid prescriptions[39,43]. One study[37] only indicated whether or not patients consumed prescribed opioids.…”

Section: Resultsmentioning

confidence: 99%

“…Seal et al[45] found that, after controlling for numerous variables such as antidepressant medication use, alcohol and non-alcohol drug disorders, and self-informed pain disability, a diagnosis of PTSD was significantly associated with opioid therapy, and particularly with a long-term therapy (adjusted RR, 2.32; 95%CI: 2.05–2.63). Similarly, Macey et al[42] found that the proportion of users with PTSD who had been prescribed opioids short- and long-term was higher than those with major depressive disorder and those with nicotine use disorder.…”

Section: Resultsmentioning

confidence: 99%

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Chronic pain, posttraumatic stress disorder, and opioid intake: A systematic review

López‐Martínez¹,

Reyes-Pérez²,

Serrano‐Ibáñez³

et al. 2019

WJCC

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BACKGROUNDThe literature suggests that there is a high degree of co-occurrence between chronic pain and posttraumatic stress disorder (PTSD). An association has been found between PTSD and substance abuse. PTSD is a severe disorder that should be taken into account when opioids are prescribed. It has been found that the prevalence of opioid use disorder (OUD) in chronic pain patients is higher among those with PTSD than those without this disorder.AIMTo perform a systematic review on the association between PTSD, chronic non-cancer pain (CNCP), and opioid intake (i.e., prescription, misuse, and abuse).METHODSWe conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Patient, Intervention, Comparator, and Outcomes (PICOS) criteria were formulated a priori in the protocol of the systematic review. A search was conducted of the PROSPERO database. In March 2019, searches were also conducted of 5 other databases: PubMed, MEDLINE, PsycINFO, Web of Science, and PILOTS. The Scottish Intercollegiate Guidelines Network checklist for cohort studies was used to assess the selected studies for their methodological quality and risk of bias. Each study was evaluated according to its internal validity, participant sampling, confounding variables, and the statistical analysis.RESULTSA total of 151 potentially eligible studies were identified of which 17 were retained for analysis. Only 10 met the selection criteria. All the studies were published between 2008 and 2018 and were conducted in the United States. The eligible studies included a total of 1622785 unique participants. Of these, 196516 had comorbid CNCP and PTSD and were consuming opiates. The participants had a cross-study mean age of 35.2 years. The majority of participants were men (81.6%). The most common chronic pain condition was musculoskeletal pain: back pain (47.14% across studies; range: 16%-60.6%), arthritis and joint pain (31.1%; range: 18%-67.5%), and neck pain (28.7%; range: 3.6%-63%). In total, 42.4% of the participants across studies had a diagnosis of PTSD (range: 4.7%-95%). In relation to opioid intake, we identified 2 different outcomes: opioid prescription and OUD. All the studies reported evidence of a greater prevalence of PTSD in CNCP patients who were receiving prescribed opioids and that PTSD was associated with OUD in CNCP patients.CONCLUSIONOpioid analgesic prescription as the treatment of choice for CNCP patients should include screening for baseline PTSD to ensure that these drugs are safely consumed.

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Section: Resultsmentioning

confidence: 99%

“…Three studies also controlled for race/ethnicity[36,37,41]. Of these, 2 also controlled for educational level[37,41] and 2 also controlled for marital status[40,45].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Chronic pain, posttraumatic stress disorder, and opioid intake: A systematic review

López‐Martínez¹,

Reyes-Pérez²,

Serrano‐Ibáñez³

et al. 2019

WJCC

View full text Add to dashboard Cite

show abstract

“…One multi-center study found that over 70% of people receiving acute rehabilitation after TBI were prescribed opioids during their hospital stay (Hammond et al, 2015). Persons with persistent post-concussive symptoms after TBI are also more likely to be prescribed opioids (Mehalick & Glueck, 2018;Seal et al, 2018). In addition to the known addictive properties of long-term opioid therapy (Chou et al, 2015;Dowell, Haegerich, & Chou, 2016), individuals with TBI may be more susceptible to OUD compared to those without a history of brain injury.…”

mentioning

confidence: 99%

The intersection of lifetime history of traumatic brain injury and the opioid epidemic

Corrigan

Adams

2019

Addictive Behaviors

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Outpatient prescription medications during the first year following combat‐related amputations and traumatic brain injury: A retrospective study

Melcer,

Perez,

Zouris

et al. 2024

PM&R

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BackgroundPrescription medications are an essential element of military amputation care programs.ObjectivesTo analyze (1) outpatient prescription medications following combat‐related amputations, (2) longitudinal changes in prescription activity during the first year postinjury, and (3) patient characteristics associated with prescription medications.DesignRetrospective study of military casualty records and outpatient prescription medications. Clinicians identified 13 medication categories based on American Hospital Formulary Service classifications.SettingMilitary amputation rehabilitation program.Patients1651 service members who sustained major limb amputations during 2001–2017.Main Outcomes MeasuresPrescription medication category, days' supply, opioid dosage.ResultsDuring the first year postinjury, patients averaged 65 outpatient prescriptions (new or refills, SD = 43.3) and 8 (SD = 1.9) of 13 medication categories. Nearly all patients (99%) had opioid prescriptions averaging high dosages with variation by patient characteristics and postinjury time. At least 84% of patients had prescriptions for one or more central nervous system, gastrointestinal, psychotherapeutic, immune/anti‐infective and/or nonopioid analgesic medications. Prescriptions declined from the first (92%) to fourth (73%) quarter postinjury. Many patients had prescription opioids (51%), central nervous system medications (43%), or psychotherapeutic medications (32%) during the fourth quarter. In regression models, multiple factors including White race/ethnicity (relative risk [RR] = 1.16; 95% confidence interval [CI]: [1.06–1.28], p = .001), injury severity, traumatic brain injury, upper limb amputation (RR = 0.90; CI: [0.83–0.99], p = .020), multiple amputation (RR = 1.12 CI: [1.03–1.22], p = .008), phantom limb syndrome, chronic pain, and posttraumatic stress disorder were significantly associated with prescriptions (p's < .05).ConclusionsAmputation care providers manage a high volume and wide range of prescription medications including multiple central nervous system drugs. The results show significant variation in prescription practices by patient characteristics and time postinjury. These findings can help optimize the benefits and reduce the risks of prescription medications and indicate areas for future research.

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Traumatic Brain Injury and Receipt of Prescription Opioid Therapy for Chronic Pain in Iraq and Afghanistan Veterans: Do Clinical Practice Guidelines Matter?

Cited by 35 publications

References 41 publications

Chronic pain, posttraumatic stress disorder, and opioid intake: A systematic review

Chronic pain, posttraumatic stress disorder, and opioid intake: A systematic review

The intersection of lifetime history of traumatic brain injury and the opioid epidemic

Outpatient prescription medications during the first year following combat‐related amputations and traumatic brain injury: A retrospective study

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