Opioid Prescribing Trends and Geographic Variation After Anterior Cruciate Ligament Reconstruction
SPORTS HEALTH-A MULTIDISCIPLINARY APPROACH
Authors: Marrache, Majd; Best, Matthew J.; Raad, Micheal; Mikula, Jacob D.; Amin, Raj M.; Wilckens, John H.
Abstract
Introduction: Opioid prescribing patterns play an important role in the opioid epidemic in the United States. The purpose of this study is to examine the trends and geographic variation in opioid prescribing patterns after anterior cruciate ligament (ACL) reconstruction. Hypothesis: Regional differences in opioid prescribing patterns after ACL reconstruction are present. Study Design: Descriptive epidemiology study. Methods: The Truven Health MarketScan Commercial Claims database was used to analyze all patients with perioperative private insurance coverage who underwent ACL reconstruction from January 1, 2010, to November 31, 2017. Total number and morphine milligram equivalents per day (MMED) of opioid prescriptions were examined, and regional and statewide variation was assessed. Results: A total of 90,068 ACL reconstruction patients who underwent surgery between 2010 and 2017 were included in the study. Overall, 67% received an opioid prescription within 30 days of surgery and 17% received an opioid prescription >= 90 MMED. The West (20%) had the highest proportion of patients with an opioid prescription >= 90 MMED and the Northeast had the lowest (12%),P< 0.001. The number of opioid prescriptions as well as proportion of opioid prescriptions >= 90 MMED varied significantly by state,P< 0.001. There was a significant increase in number of opioid prescriptions from 2010 to 2017 (62% in 2010 and 83% in 2017;P< 0.001). A significant change in the proportion of patients being prescribed >= 90 MMED was also present (P= 0.04; 15% in 2010, 17% in 2011, 17% 2012, 17% in 2013, 15% in 2014, 20% in 2015, 18% in 2016, and 15% in 2017). Conclusion: This study shows a trend of increasing opioid prescriptions and geographic variations in the amount and MMED of opioid prescriptions for patients undergoing ACL reconstruction. These data highlight several areas of improvement that state officials and national entities can use to help curb the opioid epidemic and underscore the importance of national guidelines for opioid prescribing. Clinical Relevance: Knowledge of prescribing patterns after specific procedures may help provide more direct insight and guidance to surgeons and patients regarding postoperative pain management.
Antinociceptive and neurochemical effects of a single dose of IB-MECA in chronic pain rat models
PURINERGIC SIGNALLING
Authors: Cioato, Stefania Giotti; Medeiros, Liciane Fernandes; Lopes, Bettega Costa; de Souza, Andressa; Medeiros, Helouise Richardt; Assumpcao, Jose Antonio Fagundes; Caumo, Wolnei; Roesler, Rafael; Torres, Iraci L. S.
Abstract
This study aimed to evaluate the effect of a single administration of IB-MECA, an A3 adenosine receptor agonist, upon the nociceptive response and central biomarkers of rats submitted to chronic pain models. A total of 136 adult male Wistar rats were divided into two protocols: (1) chronic inflammatory pain (CIP) using complete Freund's adjuvant and (2) neuropathic pain (NP) by chronic constriction injury of the sciatic nerve. Thermal and mechanical hyperalgesia was measured using von Frey (VF), Randal-Selitto (RS), and hot plate (HP) tests. Rats were treated with a single dose of IB-MECA (0.5 mu mol/kg i.p.), a vehicle (dimethyl sulfoxide-DMSO), or positive control (morphine, 5 mg/kg i.p.). Interleukin 1 beta (IL-1 beta), brain-derived neurotrophic factor (BDNF), and nerve growth factor (NGF) levels were measured in the brainstem and spinal cord using enzyme-linked immunosorbent assay (ELISA). The establishment of the chronic pain (CIP or NP) model was observed 14 days after induction by a decreased nociceptive threshold in all three tests (GEE, P < 0.05). The antinociceptive effect of a single dose of IB-MECA was observed in both chronic pain models, but this was more effective in NP model. There was an increase in IL-1 beta levels promoted by CIP. NP model promoted increase in the brainstem BDNF levels, which was reversed by IB-MECA