Anti-MME monoclonal antibody, clone SN5c [FITC]

Objectives: To determine the association of preinjury opioid use on incidence of fasciotomy after lower extremity trauma. Design: Retrospective case-control study. Setting: Level 1 trauma center. Patients/Participants: We identified 245 consecutive patients treated with fasciotomy for compartment syndrome of the lower extremity from 2011 to 2016. Of these, 115 were excluded for isolated vascular injury without fracture, age younger than 18 years, out-of-state residence, nontraumatic etiology, and/or incomplete opioid records. Three hundred ninety age- and sex-matched patients with tibial fractures not requiring fasciotomy were selected for comparison. Intervention: Review of demographics, injury characteristics, and opioid prescriptions. Main Outcome Measurements: Rate of preinjury narcotic use. Results: There was no significant difference in chronic opioid use between patients requiring fasciotomy and those who did not (odds ratio = 0.80, 95% confidence interval: 0.43-1.50, P = 0.49). There was no significant difference in average morphine milligram equivalents (MME)/day (66.6 vs. 77.4, P = 0.68). There was no significant difference in active opioid use (odds ratio = 0.76, 95% confidence interval: 0.45-1.29, P = 0.30). There was no significant difference in average MME/day (69.3 vs. 75.6, P = 0.80) for active narcotic users. Conclusion: There were no differences in the rate or average MME/day of preinjury opioid use between patients with a tibia fracture treated with or without fasciotomy for compartment syndrome. These results indicate that pre-existing opioid use does not interfere with the accurate diagnosis of compartment syndrome in trauma patients. The diagnosis and treatment of compartment syndrome is not affected by preinjury narcotic use and potential associations with opiate-induced hyperalgesia.

People living with HIV (PLH) may be at increased risk of experiencing both chronic pain and opioid dependence. Physical therapy (PT) has been shown to be effective as a nonpharmacological strategy for mitigating chronic pain in the general population, however, there is gap in research investigating PT to reduce chronic pain and opioid use among PLH. This case series describes the feasibility of an innovative PT intervention to decrease chronic pain and opioid use at a multidisciplinary human immunodeficiency virus (HIV) clinic. Participants (n = 4) were evaluated and given an individualized PT "package" consisting of manual therapy, exercise prescription, Transcutaneous Electrical Nerve Stimulation, and pain coping strategies. Pre- and postintervention outcomes were measured for pain reports, opioid use, and quality-of-life measures. After the intervention, all participants reported decrease or total elimination of both pain measured on the 0-10 numerical rating scale and opioid use measured in morphine milligram equivalents (MME). A paired t-test showed a significant difference (<.05) in the preintervention and postintervention pain scores and MME values. Results of this case series suggest in this sample that the described PT intervention is a feasible approach to mitigating chronic pain and opioid use among PLH and should be implemented on a larger scale for maximal effect.