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1.
BMJ ; 372: n102, 2021 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568363

RESUMO

OBJECTIVE: To evaluate the risk of first trimester exposure to prescription opioids for major congenital malformations, previously reported to be associated with such exposure. DESIGN: Population based cohort study. SETTING: Nationwide sample of publicly and commercially insured pregnant women linked to their liveborn infants, nested in the Medicaid Analytic eXtract (MAX, 2000-14) and the MarketScan Research Database (MarketScan, 2003-15). PARTICIPANTS: 1 602 580 publicly insured (MAX) and 1 177 676 commercially insured (MarketScan) pregnant women with eligibility from at least three months before pregnancy to one month after delivery; infants with eligibility for at least three months after birth. INTERVENTIONS: Use of prescription opioids was ascertained by requiring two or more dispensations of any opioid during the first trimester. MAIN OUTCOMES MEASURES: Major malformations overall, cardiac malformations overall, ventricular septal defect, secundum atrial septal defect/patent foramen ovale, neural tube defect, clubfoot, and oral cleft, defined based on validated algorithms. Propensity score stratification was used to adjust for potential confounders and/or proxies for confounders. Estimates from each database were combined using meta-analysis. RESULTS: 70 447 (4.4%) of 1 602 580 publicly insured and 12 454 (1.1%) of 1 177 676 commercially insured pregnant women had two or more dispensations of an opioid during the first trimester. Absolute risk of malformations overall was 41.0 (95% confidence interval 39.5 to 42.5) per 1000 pregnancies exposed to opioids versus 32.0 (31.7 to 32.3) per 1000 unexposed pregnancies in the MAX cohort, and 42.6 (39.0 to 46.1) and 37.3 (37.0 to 37.7) per 1000, respectively, in the MarketScan cohort. Pooled unadjusted relative risk estimates were raised for all outcomes but shifted substantially toward the null after adjustment; for malformations overall (relative risk 1.06, 95% confidence interval 1.02 to 1.10), cardiovascular malformations (1.09, 1.00 to 1.18), ventricular septal defect (1.07, 0.95 to 1.21), atrial septal defect/patent foramen ovale (1.04, 0.88 to 1.24), neural tube defect (0.82, 0.53 to 1.27), and clubfoot (1.06, 0.88 to 1.28). The relative risk for oral clefts remained raised after adjustment (1.21, 0.98 to 1.50), with a higher risk of cleft palate (1.62, 1.23 to 2.14). CONCLUSIONS: Prescription opioids used in early pregnancy are not associated with a substantial increase in risk for most of the malformation types considered, although a small increase in the risk of oral clefts associated with their use is possible.


Assuntos
Anormalidades Induzidas por Medicamentos/epidemiologia , Analgésicos Opioides/efeitos adversos , Complicações na Gravidez/tratamento farmacológico , Anormalidades Induzidas por Medicamentos/etiologia , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Recém-Nascido , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Gravidez , Complicações na Gravidez/epidemiologia , Primeiro Trimestre da Gravidez , Risco
2.
Medicine (Baltimore) ; 100(3): e23978, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545983

RESUMO

BACKGROUND AND PURPOSE: Medial compartment femoro-tibial osteoarthritis (OA) is a common disease and opening-wedge high tibial osteotomy (OWHTO) is the common surgical procedure carried out for these patients. While most researchers are focusing on the surgical techniques during operation, the aim of this study is to evaluate the pain control effect of femoral nerve block (FNB) for OWHTO patients. METHODS: In this prospective, single-center, randomized controlled trial (RCT) study, 41 patients were operated on by OWHTO for OA during 2017 to 2018. Twenty of them (group A) accepted epidural anesthesia with FNB and 21 patients (group B) only had their single epidural anesthesia. All blocks were successful and all the 41 patients recruited were included in the analysis and there was no loss to follow-up or withdrawal. Systematic records of visual analog scores (VAS), quadriceps strength, mean number of times of patient-controlled intravenous analgesia (PCIA), using of additional opioids or nonsteroidal anti-inflammatory drugs (NSAIDs), and complications were done after hospitalization. The Student t test and Chi-Squared test was used and all P values ≤.05 were considered statistically significant. RESULTS: VAS scores at rest (3.48 ±â€Š1.0 vs 4.68 ±â€Š1.1) and on movemment (4.51 ±â€Š0.6 vs 4.97 ±â€Š0.8) decreased more in group A than group B with significance at follow-up of 12 hours. The quadriceps strength, consumption of additional opioids or NSAID injections and mean number of times that the patients pushed the PCIA button didnot differ significantly within each group. CONCLUSION: This RCT study shows that FNB in patients undergoing OWHTO for unicompartmental osteoarthritis of the knee could result in significant reduction in VAS scores at 12 hours postoperatively.Research registry, Researchregistry4792. Registered April 7, 2019 - Retrospectively registered, http://www.researchregistry.com.


Assuntos
Nervo Femoral/efeitos dos fármacos , Bloqueio Nervoso/normas , Manejo da Dor/normas , Tíbia/cirurgia , Feminino , Nervo Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Bloqueio Nervoso/estatística & dados numéricos , Osteotomia/efeitos adversos , Osteotomia/métodos , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Estudos Prospectivos , Tíbia/efeitos dos fármacos
3.
Medicine (Baltimore) ; 99(46): e22540, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181643

RESUMO

BACKGROUND: Wound infiltration analgesia provides effective postoperative pain control in patients undergoing laparoscopic cholecystectomy (LC). However, the efficacy and safety of wound infiltration with different doses of ropivacaine is not well defined. This study investigated the analgesic effects and pharmacokinetic profile of varying concentrations of ropivacaine at port sites under laparoscopy assistance. METHODS: In this randomized, double-blinded study, 132 patients were assigned to 4 groups: Group H: in which patients were infiltrated with 0.75% ropivacaine; Group M: 0.5% ropivacaine; Group L: 0.2% ropivacaine; and Group C: 0.9% normal saline only. The primary outcome was pain intensity estimated using numeric rating scale (NRS) at discharging from PACU and at 4 hours, 6 hours, 8 hours, and 24 hours after infiltration. Secondary outcomes included plasma concentrations of ropivacaine at 30 minutes after wound infiltration, rescue analgesia requirements after surgery, perioperative vital signs changes, and side effects. RESULTS: The NRS in Group C was significantly higher at rest, and when coughing upon leaving PACU and at 4 hours, 6 hours, 8 hours, and 24 hours after infiltration (P < .05) and rescue analgesic consumption was significantly higher. Notably, these parameters were not significantly different between Groups H, Group M and Group L (P > .05). Intra-operative consumption of sevoflurane and remifentanil, HR at skin incision and MAP at skin incision, as well as 5 minutes after skin incision were significantly higher in Group C than in the other 3 groups (P < .01). In contrast, these parameters were not significantly different between Groups H, Group M and Group L (P > .05). The concentration of ropivacaine at 30 minutes after infiltration in Group H was significantly higher than that of Group L and Group M (P < .05). No significant differences were observed in the occurrence of side effects among the 4 groups (P > .05). CONCLUSIONS: Laparoscopy-assisted wound infiltration with ropivacaine successfully decreases pain intensity in patients undergoing LC regardless of the doses used. Infiltration with higher doses results in higher plasma concentrations, but below the systematic toxicity threshold.


Assuntos
Anestesia Local/normas , Manejo da Dor/normas , Ropivacaina/administração & dosagem , Adulto , Análise de Variância , Anestesia Local/métodos , Anestesia Local/estatística & dados numéricos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Distribuição de Qui-Quadrado , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/estatística & dados numéricos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Medição da Dor/métodos , Estudos Prospectivos , Ropivacaina/uso terapêutico
4.
Medicine (Baltimore) ; 99(46): e23279, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181719

RESUMO

BACKGROUND: Magnesium sulfate (MgSO4) is widely used in analgesia for different conditions. Recent randomized controlled trials (RCTs) have evaluated the effects of MgSO4 on renal colic; however, this new evidence has not been synthesized. Thus, we conducted a systematic review and meta-analysis to assess the efficacy and safety of MgSO4 in comparison with control for renal colic. METHODS: PubMed, EMBASE, and Scopus databases were searched from inception to February 2020. We included RCTs that evaluated MgSO4 vs control for patients with renal colic. Data were independently extracted by 2 reviewers and synthesized using a random-effects model. RESULTS: Four studies with a total of 373 patients were analyzed. Intravenous MgSO4 15 to 50 mg/kg did not significantly reduce renal colic pain severity at 15 minutes (mean difference [MD] = 0.35, 95% confidence interval [CI] -0.51 to 1.21; 2 RCTs), 30 minutes (MD = 0.19, 95% CI -0.74 to 1.13; 4 RCTs), and 60 minutes (MD = -0.28, 95% CI -0.72 to 0.16; 3 RCTs) in comparison with controls. In patients who failed to respond to initial analgesics, intravenous MgSO4 15 mg/kg or 2 ml of 50% solution provided similar pain relief to ketorolac or morphine at 30 minutes (P = .90) and 60 minutes (P = .57). No significant hemodynamic changes were observed with short-term use of MgSO4 in these studies. CONCLUSION: MgSO4 provides no superior therapeutic benefits in comparison with control treatments. MgSO4 may be used as a rescue medication in patients not responding to initial analgesics. The short-term use of MgSO4 did not affect hemodynamic values.


Assuntos
Sulfato de Magnésio/normas , Manejo da Dor/normas , Cólica Renal/tratamento farmacológico , Analgésicos/farmacologia , Analgésicos/normas , Analgésicos/uso terapêutico , Humanos , Sulfato de Magnésio/farmacologia , Sulfato de Magnésio/uso terapêutico , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos
5.
BMC Psychol ; 8(1): 112, 2020 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-33115532

RESUMO

BACKGROUND: Being bullied and socially excluded interferes with the fundamental need for humans to belong to a social group, which is necessary for well-being. This might underpin pain and the use of non-prescription analgesics. AIM: The aim of the study was to gain insight into how social exclusion and bullying affect well-being in adolescents reporting frequent pain and high use of non-prescription analgesics. METHODS: A phenomenological hermeneutical method based on in-depth interviews was used. Nineteen teenagers, 14-16 years of age voluntarily participated in the study. Those included had frequent pain and used non-prescription analgesics daily or several times a week. RESULTS: Bullying and social exclusion affects thoughts, feelings and attitudes and thereby the quality of life of the adolescents we interviewed. They described feelings such as sadness, loneliness and depression, and a sense of being an outsider among peers was common. It also appears that bullying has significant potential to spread in a school environment. CONCLUSION: The adolescents were self-aware and well-articulated. They conceptualised their experiences of being socially excluded and bullied. They described being socially excluded and bullied by peers as painful and they used non-prescription analgesics to alleviate pain. Teachers and health professionals should be aware of frequent pain and high use of non-prescribed analgesic medication as signs of psychosocial stress caused by social exclusion and bullying. Social exclusion and bullying should be systematically mapped, and targeted interventions implemented.


Assuntos
Analgésicos/administração & dosagem , Analgésicos/uso terapêutico , Bullying/psicologia , Manejo da Dor/estatística & dados numéricos , Dor , Pesquisa Qualitativa , Adolescente , Feminino , Humanos , Masculino , Qualidade de Vida
6.
N Z Med J ; 133(1522): 96-111, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32994620

RESUMO

AIM: To determine what patients presenting to general practice (GP) understand about the use of cannabis as a medicine, beliefs of how this may impact their medical conditions and interactions with doctors. METHOD: An in-person survey of 134 GP patients from four GP practices throughout the North Island of New Zealand undertaken from November 2018 to October 2019. RESULTS: Fifty-five percent of the sample were female, with 40% of all participants aged 60 years plus. Ninety-one percent of participants indicated they would use a prescribed medicinal cannabis product while 45% reported they believed it may be of some benefit to their medical condition. Of those who believed it beneficial, 71% indicated they thought it useful for pain relief. Participants indicated comfort discussing medicinal cannabis use with GPs and specialists (92% respectively); however, less than 10% had done this. CONCLUSIONS: Just under half of patients surveyed believe that medicinal cannabis products may be helpful to their condition, and while the majority report willingness, few have discussed this with their GP or specialist. There is need for accessible, accurate information regarding the use of cannabis-based medicine for patients and doctors alike to guide the patient-doctor consultation and decrease barriers to open discussion.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Maconha Medicinal/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Medicina Geral , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
7.
Cochrane Database Syst Rev ; 9: CD012780, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32996586

RESUMO

BACKGROUND: Serious illness is often characterised by physical/psychological problems, family support needs, and high healthcare resource use. Hospital-based specialist palliative care (HSPC) has developed to assist in better meeting the needs of patients and their families and potentially reducing hospital care expenditure. There is a need for clarity on the effectiveness and optimal models of HSPC, given that most people still die in hospital and also to allocate scarce resources judiciously. OBJECTIVES: To assess the effectiveness and cost-effectiveness of HSPC compared to usual care for adults with advanced illness (hereafter patients) and their unpaid caregivers/families. SEARCH METHODS: We searched CENTRAL, CDSR, DARE and HTA database via the Cochrane Library; MEDLINE; Embase; CINAHL; PsycINFO; CareSearch; National Health Service Economic Evaluation Database (NHS EED) and two trial registers to August 2019, together with checking of reference lists and relevant systematic reviews, citation searching and contact with experts to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) evaluating the impact of HSPC on outcomes for patients or their unpaid caregivers/families, or both. HSPC was defined as specialist palliative care delivered by a palliative care team that is based in a hospital providing holistic care, co-ordination by a multidisciplinary team, and collaboration between HSPC providers and generalists. HSPC was provided to patients while they were admitted as inpatients to acute care hospitals, outpatients or patients receiving care from hospital outreach teams at home. The comparator was usual care, defined as inpatient or outpatient hospital care without specialist palliative care input at the point of entry into the study, community care or hospice care provided outside of the hospital setting. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We assessed risk of bias and extracted data. To account for use of different scales across studies, we calculated standardised mean differences (SMDs) with 95% confidence intervals (CIs) for continuous data. We used an inverse variance random-effects model. For binary data, we calculated odds ratio (ORs) with 95% CIs. We assessed the evidence using GRADE and created a 'Summary of findings' table. Our primary outcomes were patient health-related quality of life (HRQoL) and symptom burden (a collection of two or more symptoms). Key secondary outcomes were pain, depression, satisfaction with care, achieving preferred place of death, mortality/survival, unpaid caregiver burden, and cost-effectiveness. Qualitative data was analysed where available. MAIN RESULTS: We identified 42 RCTs involving 7779 participants (6678 patients and 1101 caregivers/family members). Twenty-one studies were with cancer populations, 14 were with non-cancer populations (of which six were with heart failure patients), and seven with mixed cancer and non-cancer populations (mixed diagnoses). HSPC was offered in different ways and included the following models: ward-based, inpatient consult, outpatient, hospital-at-home or hospital outreach, and service provision across multiple settings which included hospital. For our main analyses, we pooled data from studies reporting adjusted endpoint values. Forty studies had a high risk of bias in at least one domain. Compared with usual care, HSPC improved patient HRQoL with a small effect size of 0.26 SMD over usual care (95% CI 0.15 to 0.37; I2 = 3%, 10 studies, 1344 participants, low-quality evidence, higher scores indicate better patient HRQoL). HSPC also improved other person-centred outcomes. It reduced patient symptom burden with a small effect size of -0.26 SMD over usual care (95% CI -0.41 to -0.12; I2 = 0%, 6 studies, 761 participants, very low-quality evidence, lower scores indicate lower symptom burden). HSPC improved patient satisfaction with care with a small effect size of 0.36 SMD over usual care (95% CI 0.41 to 0.57; I2 = 0%, 2 studies, 337 participants, low-quality evidence, higher scores indicate better patient satisfaction with care). Using home death as a proxy measure for achieving patient's preferred place of death, patients were more likely to die at home with HSPC compared to usual care (OR 1.63, 95% CI 1.23 to 2.16; I2 = 0%, 7 studies, 861 participants, low-quality evidence). Data on pain (4 studies, 525 participants) showed no evidence of a difference between HSPC and usual care (SMD -0.16, 95% CI -0.33 to 0.01; I2 = 0%, very low-quality evidence). Eight studies (N = 1252 participants) reported on adverse events and very low-quality evidence did not demonstrate an effect of HSPC on serious harms. Two studies (170 participants) presented data on caregiver burden and both found no evidence of effect of HSPC (very low-quality evidence). We included 13 economic studies (2103 participants). Overall, the evidence on cost-effectiveness of HSPC compared to usual care was inconsistent among the four full economic studies. Other studies that used only partial economic analysis and those that presented more limited resource use and cost information also had inconsistent results (very low-quality evidence). Quality of the evidence The quality of the evidence assessed using GRADE was very low to low, downgraded due to a high risk of bias, inconsistency and imprecision. AUTHORS' CONCLUSIONS: Very low- to low-quality evidence suggests that when compared to usual care, HSPC may offer small benefits for several person-centred outcomes including patient HRQoL, symptom burden and patient satisfaction with care, while also increasing the chances of patients dying in their preferred place (measured by home death). While we found no evidence that HSPC causes serious harms, the evidence was insufficient to draw strong conclusions. Although these are only small effect sizes, they may be clinically relevant at an advanced stage of disease with limited prognosis, and are person-centred outcomes important to many patients and families. More well conducted studies are needed to study populations with non-malignant diseases and mixed diagnoses, ward-based models of HSPC, 24 hours access (out-of-hours care) as part of HSPC, pain, achieving patient preferred place of care, patient satisfaction with care, caregiver outcomes (satisfaction with care, burden, depression, anxiety, grief, quality of life), and cost-effectiveness of HSPC. In addition, research is needed to provide validated person-centred outcomes to be used across studies and populations.


Assuntos
Cuidadores/estatística & dados numéricos , Serviços Hospitalares de Assistência Domiciliar/economia , Cuidados Paliativos/economia , Cuidados Paliativos/métodos , Assistência Terminal/economia , Assistência Terminal/métodos , Assistência Ambulatorial/economia , Viés , Cuidadores/psicologia , Análise Custo-Benefício , Família , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Hospitalização/economia , Humanos , Neoplasias/mortalidade , Neoplasias/terapia , Manejo da Dor/estatística & dados numéricos , Satisfação do Paciente , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Avaliação de Sintomas/estatística & dados numéricos
8.
PLoS One ; 15(7): e0235192, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32663844

RESUMO

INTRODUCTION: As marijuana use becomes more common, it is essential clinicians understand the relationship between marijuana use and health behaviors. METHODS: Using a retrospective cohort of adolescents and adults with sickle cell disease (SCD) stratified into a young (<25 years) and older cohort (> = 25 years), we conducted multiple linear regression examining relationship of marijuana use (independent variable) on each dependent variable (SCD self-management score and pain management). RESULTS: Among young cohort, 16.9% used marijuana compared to 21.8% of older cohort. The younger cohort reporting marijuana use had lower mean self-care scores (ß = -2.74;p = 0.009) and were more likely to have admissions to the hospital for pain (ß = 0.87;p = 0.047) compared to non-users. In contrast, the older cohort reporting marijuana use had more days treating pain at home (ß = 0.44;p = 0.035). CONCLUSIONS: Only a minority of patients with SCD reported lifetime marijuana use. Among those reporting marijuana use, there were different associations with self-care and health-related behaviors by age. The older cohort who endorsed marijuana use reported more days of treating pain at home, although this did not translate into increased acute care visits for pain crisis. Among youth, endorsing marijuana use was associated with worse SCD self-care.


Assuntos
Anemia Falciforme/terapia , Comportamentos Relacionados com a Saúde , Uso da Maconha/epidemiologia , Manejo da Dor/estatística & dados numéricos , Autocuidado/estatística & dados numéricos , Adulto , Fatores Etários , Anemia Falciforme/complicações , Feminino , Humanos , Masculino , Uso da Maconha/psicologia , Dor/etiologia , Manejo da Dor/métodos , Manejo da Dor/psicologia , Estudos Retrospectivos , Autocuidado/psicologia , Estados Unidos , Adulto Jovem
9.
Clin Interv Aging ; 15: 1003-1012, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32617001

RESUMO

Purpose: To assess comorbidity burden and pain-management patterns among working-aged patients with knee osteoarthritis only (KOA/O) and patients with knee osteoarthritis plus osteoarthritis at another site (KOA/+) in Japan. Patients and Methods: Retrospective claims data analysis was conducted using the Japan Medical Data Center database. Working-aged adults (aged 40 to 71 years) with 5 years of follow-up and diagnosed with knee osteoarthritis (KOA) between January 1, 2011, and December 31, 2012, were evaluated. The first claim with a KOA diagnosis defined the index date. Patients were divided into two mutually exclusive cohorts: KOA/O and KOA/+. Longitudinal pain-management patterns during each year of follow-up were analyzed. Results: A total of 2542 patients met study criteria: 1575 KOA/O and 967 KOA/+. Mean age and number of comorbidities were higher among the KOA/+ versus KOA/O cohort. Pharmaceutical treatment was received by 91.5% of patients in the KOA/+ compared with 85.1% of patients in the KOA/O cohort during the first year of follow-up. The most common pharmacological treatment received during the first year of follow-up was either topical or oral nonsteroidal anti-inflammatory drugs for both cohorts. During each year of follow-up, the KOA/+ cohort had greater proportion of patients with at least one health-care encounter (ie, hospital admissions, outpatient and pharmacy visits) and higher direct medical costs compared with the KOA/O cohort. Conclusion: This study demonstrates that a greater proportion of the working population with KOA/+ received pain-related treatment compared with patients with KOA/O. Further studies are necessary to evaluate appropriate pain management for both KOA only and KOA with other sites.


Assuntos
Osteoartrite do Joelho/terapia , Manejo da Dor/estatística & dados numéricos , Dor/prevenção & controle , Idoso , Estudos de Coortes , Comorbidade , Emprego/estatística & dados numéricos , Feminino , Humanos , Japão , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Medição da Dor/estatística & dados numéricos , Estudos Retrospectivos
10.
PLoS One ; 15(7): e0236360, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32706825

RESUMO

In 2011 Yale New Haven Hospital, in response to high utilization of acute care services and widespread patient and health care personnel dissatisfaction, set out to improve its care of adults living with sickle cell disease. Re-organization components included recruitment of additional personnel; re-locating inpatients to a single nursing unit; reducing the number of involved providers; personalized care plans for pain management; setting limits upon access to parenteral opioids; and an emphasis upon clinic visits focused upon home management of pain as well as specialty and primary care. Outcomes included dramatic reductions in inpatient days (79%), emergency department visits (63%), and hospitalizations (53%); an increase in outpatient visits (31%); and a decrease in costs (49%). Providers and nurses viewed the re-organization and outcomes positively. Most patients reported improvements in pain control and life style; many patients thought the re-organization process was unfair. Their primary complaint was a lack of shared decision-making. We attribute the contrast in these perspectives to the inherent difficulties of managing recurrent acute and chronic pain with opioids, especially within the context of the imbalance in wellness, power, and privilege between persons living with sickle cell disease, predominantly persons of color and poor socio-economic status, and health care organizations and their personnel.


Assuntos
Anemia Falciforme/terapia , Hospitais Universitários , Atenção Primária à Saúde/organização & administração , Adulto , Assistência Ambulatorial/estatística & dados numéricos , Analgésicos Opioides/uso terapêutico , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Enfermeiras e Enfermeiros/estatística & dados numéricos , Manejo da Dor/estatística & dados numéricos , Avaliação de Resultados da Assistência ao Paciente , Médicos/estatística & dados numéricos , Fatores Socioeconômicos
11.
J Surg Res ; 255: 144-151, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32559522

RESUMO

BACKGROUND: In light of current opioid-minimization efforts, we aimed to identify factors that predict postoperative opioid requirement in pediatric appendicitis patients. METHODS: A single-center retrospective cohort study was conducted of children (<18 y) who underwent laparoscopic appendectomy for acute appendicitis between January 1, 2018 and April 30, 2019. Patients who underwent open or interval appendectomies were excluded. The primary outcome was morphine milliequivalents (MMEs) per kilogram administered between 2 and 24 h after surgery. Multivariable analyses were performed to evaluate predictors of postoperative opioid use. Clinically sound covariates were chosen a priori: age, weight, simple versus complicated appendicitis, preoperative opioid administration, and receipt of regional or local anesthesia. RESULTS: Of 546 patients, 153 (28%) received postoperative opioids. Patients who received postoperative opioids had a longer median preadmission symptom duration (48 versus 24 h, P < 0.001) and were more likely to have complicated appendicitis (55% versus 21%, P < 0.001). Patients who received postoperative opioids were more likely to have received preoperative opioids (54% versus 31%, P < 0.001). Regional and local anesthesia use was similar between groups. Nearly all patients (99%) received intraoperative opioids. Each preoperative MME per kilogram that a patient received was associated with receipt of 0.29 additional MMEs per kilogram postoperatively (95% confidence interval, 0.19-0.40). CONCLUSIONS: Preoperative opioid administration was independently associated with increased postoperative opioid use in pediatric appendicitis. These findings suggest that preoperative opioids may potentiate increased postoperative pain. Limiting preoperative opioid exposure, through strategies such as multimodal analgesia, may be an important facet of efforts to reduce postoperative opioid use.


Assuntos
Analgésicos Opioides/administração & dosagem , Apendicectomia/efeitos adversos , Apendicite/terapia , Manejo da Dor/efeitos adversos , Dor Pós-Operatória/diagnóstico , Cuidados Pré-Operatórios/efeitos adversos , Adolescente , Analgesia/métodos , Analgésicos Opioides/efeitos adversos , Apendicite/complicações , Criança , Feminino , Humanos , Masculino , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Medição da Dor/estatística & dados numéricos , Dor Pós-Operatória/etiologia , Período Pós-Operatório , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
12.
J Trauma Acute Care Surg ; 88(6): 816-824, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459447

RESUMO

BACKGROUND: Efforts to reduce opioid use in trauma patients are currently hampered by an incomplete understanding of the baseline opioid exposure and variation in United States. The purpose of this project was to obtain a global estimate of opioid exposure following injury and to quantify the variability of opioid exposure between and within United States trauma centers. STUDY DESIGN: Prospective observational study was performed to calculate opioid exposure by converting all sources of opioids to oral morphine milligram equivalents (MMEs). To estimate variation, an intraclass correlation was calculated from a multilevel generalized linear model adjusting for the a priori selected variables Injury Severity Score and prior opioid use. RESULTS: The centers enrolled 1,731 patients. The median opioid exposure among all sites was 45 MMEs per day, equivalent to 30 mg of oxycodone or 45 mg of hydrocodone per day. Variation in opioid exposure was identified both between and within trauma centers with the vast majority of variation (93%) occurring within trauma centers. Opioid exposure increased with injury severity, in male patients, and patients suffering penetrating trauma. CONCLUSION: The overall median opioid exposure was 45 MMEs per day. Despite significant differences in opioid exposure between trauma centers, the majority of variation was actually within centers. This suggests that efforts to minimize opioid exposure after injury should focus within trauma centers and not on high-level efforts to affect all trauma centers. LEVEL OF EVIDENCE: Epidemiological, level III.


Assuntos
Analgésicos Opioides/uso terapêutico , Uso de Medicamentos/estatística & dados numéricos , Dor/tratamento farmacológico , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/tratamento farmacológico , Adulto , Idoso , Feminino , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Estudos Prospectivos , Fatores Sexuais , Estados Unidos , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico
13.
Medicine (Baltimore) ; 99(14): e19614, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243387

RESUMO

BACKGROUND: Breast cancer is the most commonly diagnosed cancer in women, and more than half of breast surgery patients experience severe acute postoperative pain. This meta-analysis is designed to examine the clinical analgesic efficacy of Pecs block in patients undergoing breast cancer surgery. METHODS: An electronic literature search of the Library of PubMed, EMBASE, Cochrane Library, and Web of Science databases was conducted to collect randomized controlled trials (RCTs) from inception to November 2018. These RCTs compared the effect of Pecs block in combination with general anesthesia (GA) to GA alone in mastectomy surgery. Pain scores, intraoperative and postoperative opioid consumption, time to first request for analgesia, and incidence of postoperative nausea and vomiting were analyzed. RESULTS: Thirteen RCTs with 940 patients were included in our analysis. The use of Pecs block significantly reduced pain scores in the postanesthesia care unit (weighted mean difference [WMD] = -1.90; 95% confidence interval [CI], -2.90 to -0.91; P < .001) and at 24 hours after surgery (WMD = -1.01; 95% CI, -1.64 to -0.38; P < .001). Moreover, Pecs block decreased postoperative opioid consumption in the postanesthesia care unit (WMD = -1.93; 95% CI, -3.51 to -0.34; P = .017) and at 24 hours (WMD = -11.88; 95% CI, -15.50 to -8.26; P < .001). Pecs block also reduced intraoperative opioid consumption (WMD = -85.52; 95% CI, -121.47 to -49.56; P < .001) and prolonged the time to first analgesic request (WMD = 296.69; 95% CI, 139.91-453.48; P < .001). There were no statistically significant differences in postoperative nausea and vomiting and block-related complications. CONCLUSIONS: Adding Pecs block to GA procedure results in lower pain scores, less opioid consumption and longer time to first analgesic request in patients undergoing breast cancer surgery compared to GA procedure alone.


Assuntos
Analgesia/estatística & dados numéricos , Anestesia Geral/efeitos adversos , Neoplasias da Mama/cirurgia , Mastectomia/efeitos adversos , Bloqueio Nervoso/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Analgesia/métodos , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Medição da Dor , Dor Pós-Operatória/etiologia , Nervos Torácicos , Resultado do Tratamento
14.
J Surg Res ; 253: 105-114, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32348919

RESUMO

BACKGROUND: Differences in nociception and use of opioids between sexes are of particular interest, considering higher rates of persistent opioid use among women after surgery. Although enhanced recovery protocols (ERPs) have improved postoperative pain control in colorectal surgery, sex-based comparisons of inpatient opioid use after surgery in an ERP remain understudied. METHODS: This retrospective study analyzed data from adults after colorectal surgery using an ERP at a single hospital between 2015 and 2017. The main outcome was the rate of opioid consumption measured as oral morphine equivalents per inpatient day. Poisson regression determined association between sex and opioid consumption, accounting for early discharge, using inverse probability weighting and adjusting for covariates that retained significance on univariate analysis. Linear regression assessed the association between sex and pain scores on postoperative days 0-5 adjusting for covariates. RESULTS: Of 588 patients included, 43% were men and 57% were women. In the unadjusted model, malignancy, prehospital psychiatric medication and analgesic use, tobacco, ileostomy creation, operative time, and postoperative complications were associated with increased opioid consumption. In multivariate analyses, prehospital opioid and nonopioid analgesic use, operative time, anastomotic leak, and postoperative ileus remained significantly associated with increased inpatient opioid consumption. However, there was no significant association between sex and opioid use in crude or adjusted analysis (incidence rate ratio: 1.09; 95% confidence interval: 0.90, 1.32). Women reported higher average daily pain scores (coefficient: 0.29; 95% confidence interval: 0.04, 0.55) in adjusted analyses. CONCLUSIONS: Among patients undergoing colorectal surgery using an ERP, sex-based differences exist in pain scores but not early postoperative opioid consumption. Identification of intragroup differences in postoperative pain and opioid use among patients managed with an ERP serves as targets for customization and enhancement of current protocols. Furthermore, incongruence between reported pain and analgesic administration may have important implications for sex-related differences in persistent opioid use.


Assuntos
Analgésicos Opioides/uso terapêutico , Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Recuperação Pós-Cirúrgica Melhorada , Dor Pós-Operatória/epidemiologia , Reto/cirurgia , Adulto , Idoso , Analgésicos não Entorpecentes/uso terapêutico , Fístula Anastomótica/epidemiologia , Anestésicos Locais/uso terapêutico , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Humanos , Íleus/complicações , Íleus/epidemiologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Manejo da Dor/estatística & dados numéricos , Medição da Dor/estatística & dados numéricos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
15.
Rev Neurol (Paris) ; 176(5): 325-352, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32276788

RESUMO

Neuropathic pain remains a significant unmet medical need. Several recommendations have recently been proposed concerning pharmacotherapy, neurostimulation techniques and interventional management, but no comprehensive guideline encompassing all these treatments has yet been issued. We performed a systematic review of pharmacotherapy, neurostimulation, surgery, psychotherapies and other types of therapy for peripheral or central neuropathic pain, based on studies published in peer-reviewed journals before January 2018. The main inclusion criteria were chronic neuropathic pain for at least three months, a randomized controlled methodology, at least three weeks of follow-up, at least 10 patients per group, and a double-blind design for drug therapy. Based on the GRADE system, we provide weak-to-strong recommendations for use and proposal as a first-line treatment for SNRIs (duloxetine and venlafaxine), gabapentin and tricyclic antidepressants and, for topical lidocaine and transcutaneous electrical nerve stimulation specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a second-line treatment for pregabalin, tramadol, combination therapy (antidepressant combined with gabapentinoids), and for high-concentration capsaicin patches and botulinum toxin A specifically for peripheral neuropathic pain; a weak recommendation for use and proposal as a third-line treatment for high-frequency rTMS of the motor cortex, spinal cord stimulation (failed back surgery syndrome and painful diabetic polyneuropathy) and strong opioids (in the absence of an alternative). Psychotherapy (cognitive behavioral therapy and mindfulness) is recommended as a second-line therapy, as an add-on to other therapies. An algorithm encompassing all the recommended treatments is proposed.


Assuntos
Neuralgia/tratamento farmacológico , Neuralgia/terapia , Manejo da Dor/métodos , Manejo da Dor/normas , Guias de Prática Clínica como Assunto , Analgésicos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Antidepressivos/uso terapêutico , Terapia Cognitivo-Comportamental , Terapias Complementares/métodos , Terapias Complementares/normas , Terapias Complementares/estatística & dados numéricos , França/epidemiologia , Humanos , Atenção Plena/métodos , Atenção Plena/normas , Neuralgia/epidemiologia , Manejo da Dor/estatística & dados numéricos , Guias de Prática Clínica como Assunto/normas , Estimulação Magnética Transcraniana
16.
J Surg Res ; 252: 169-173, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32278971

RESUMO

BACKGROUND: Initial opioid exposure for most individuals with substance use disorder comes from the healthcare system, and overprescription of opioids in ambulatory operations is common. This report describes an academic medical center's experience implementing opioid-free thyroid and parathyroid operations. MATERIALS AND METHODS: This is a retrospective chart review of patients undergoing a thyroid or parathyroid operation before and after implementation of an opioid-free analgesia protocol. The primary endpoint was new postoperative opioid prescription. Secondary endpoints included prescription characteristics and predictors of new opioid prescription. RESULTS: A total of 515 patients were enrolled in the study: 240 in the control or "pre-intervention" cohort (May through October 2017) and 275 in the intervention or "post" cohort (May through October 2018). Patients in the intervention cohort were significantly less likely to receive an opioid prescription (12.0% versus 59.6%, P < 0.001). When opioids were prescribed, they were used for shorter durations and at lower doses in the intervention cohort. Among the patients prescribed opioids in the intervention cohort (N = 33), the only significant predictor of postoperative opioid use was preoperative opioid use (P = 0.001). CONCLUSIONS: Opioids may not be required after thyroidectomy and parathyroidectomy, especially for opioid-naïve patients. Future research should examine patient satisfaction with opioid-sparing analgesia.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Implementação de Plano de Saúde , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Paratireoidectomia/efeitos adversos , Tireoidectomia/efeitos adversos , Centros Médicos Acadêmicos/normas , Centros Médicos Acadêmicos/estatística & dados numéricos , Acetaminofen/efeitos adversos , Idoso , Analgésicos Opioides/efeitos adversos , Combinação de Medicamentos , Prescrições de Medicamentos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/normas , Uso de Medicamentos/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Hidrocodona/efeitos adversos , Masculino , Pessoa de Meia-Idade , Epidemia de Opioides/prevenção & controle , Manejo da Dor/normas , Manejo da Dor/estatística & dados numéricos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
17.
Balkan Med J ; 37(4): 189-195, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32126746

RESUMO

Background: Moringa peregrina (M. peregrina) is an edible, drought-resistant tree that is native to semi-arid countries. It is used as a painkiller in folk medicine. Aims: To study the antinociceptive effects of the leaf extract of M. peregrina in mice. Study Design: Animal experimentation. Methods: We employed thermal (hot plate and tail-immersion tests) and chemical (writhing and formalin tests) pain models in male BALB/c mice (eight animals per group) to investigate the mechanisms involved in the antinociceptive actions of M. peregrina. Additionally, we identified the chemical constituents present in the extract of M. peregrina by using liquid chromatography-mass spectrometry analysis, and predicted the possible active constituents that interact with the receptor based on molecular docking simulations. Results: In the writhing test, 200 mg/kg of M. peregrina extract restricted abdominal cramps by up to 55.97% (p<0.001). Further, it reduced the time of paw-licking in the early and late phases of formalin test by up to 56.8% and 65.5%, respectively, as compared to the percentage inhibitions of 50.5% and 48.4% produced by 30 mg/kg diclofenac sodium in the early and late phases, respectively (p<0.05). This effect was abrogated by yohimbine (1 mg/kg, intraperitoneally), but not by methysergide (5 mg/kg, intraperitoneally), in the late phase only, which indicates that the action of M. peregrina in formalin test is not mediated by 5-HT2 serotonin receptors, but rather via α2-adrenergic receptors. In the hot plate test, but not on tail-immersion test, the high dose (400 mg/kg) of the extract increased the latency time after 30 minutes of its administration. Yohimbine antagonized the action of M. peregrina in the hot plate test. Based on LC-MS analysis, the major constituents found in M. peregrina methanolic extract were chrysoeriol 7-O-diglucoside, lupeol acetate, quercetin, and rutin. Depending on the molecular docking results, the activity of M. peregrina extract could be due to the binding of chrysoeriol 7-O-diglucoside, quercetin, and rutin to the α2-adrenergic receptor. Conclusion: Interaction with the α2-adrenergic receptor serves as a possible mechanism of the M. peregrina analgesic effect.


Assuntos
Moringa , Dor/tratamento farmacológico , Receptores Adrenérgicos alfa 2/uso terapêutico , Analgésicos/uso terapêutico , Animais , Modelos Animais de Doenças , Camundongos Endogâmicos BALB C , Manejo da Dor/métodos , Manejo da Dor/normas , Manejo da Dor/estatística & dados numéricos , Extratos Vegetais/uso terapêutico
18.
BMJ Open Qual ; 9(1)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32188739

RESUMO

BACKGROUND: Many care home residents cannot self-report their own health status. Previous studies have shown differences between staff and resident ratings. In 2012, we collected 10 168 pairs of health status ratings using the howRu health status measure. This paper examines differences between staff and resident ratings. METHOD: HowRu is a short generic person-reported outcome measure with four items: pain or discomfort (discomfort), feeling low or worried (distress), limited in what you can do (disability) and require help from others (dependence). A summary score (howRu score) is also calculated. Mean scores are shown on a 0-100 scale. High scores are better than low scores. Differences between resident and staff reports (bias) were analysed at the item and summary level by comparing distributions, analysing correlations and a modification of the Bland-Altman method. RESULTS AND CONCLUSIONS: Distributions are similar superficially but differ statistically. Spearman correlations are between 0.55 and 0.67. For items, more than 92.9% of paired responses are within one class; for the howRu summary score, 66% are within one class. Mean differences (resident score minus staff score) on 0-100 scale are pain and discomfort (-1.11), distress (0.67), discomfort (1.56), dependence (3.92) and howRu summary score (1.26). The variation is not the same for different severities. At higher levels of pain and discomfort, staff rated their discomfort and distress as better than residents. On the other hand, staff rated disability and dependence as worse than did residents. This probably reflects differences in perspectives. Red amber green (RAG) thresholds of 10 and 5 points are suggested for monitoring changes in care home mean scores.


Assuntos
Pessoal de Saúde/psicologia , Nível de Saúde , Casas de Saúde/normas , Pacientes/psicologia , Austrália , Pessoal de Saúde/estatística & dados numéricos , Humanos , Satisfação no Emprego , Nova Zelândia , Casas de Saúde/organização & administração , Casas de Saúde/estatística & dados numéricos , Manejo da Dor/normas , Manejo da Dor/estatística & dados numéricos , Satisfação do Paciente , Pacientes/estatística & dados numéricos , Inquéritos e Questionários , Reino Unido
19.
Medicine (Baltimore) ; 99(9): e19306, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118751

RESUMO

The study aimed to explore whether cancer-related pain and opioids use are associated with the survival of cancer patients, and perform a cohort study and a meta-analysis to quantify the magnitude of any association.A retrospective cohort study was performed to analyze the impact of pain level, and opioids use on cancer-specific survival (CSS) in advanced cancer patients. Patients and relevant medical records were selected from the registry of the Radiation and chemotherapy division of Ningbo First Hospital between June 2013 and October 2017. Hazard ratios (HRs) and 95% confidential intervals (CIs) for CSS by opioids use were calculated by univariate and multivariate Cox regression analyses. The systematic review included relevant studies published before October 2018. The combined HRs and 95% CIs for overall survival (OS) and progression-free survival (PFS) were calculated using random-effect models.A total of consecutive 203 cancer patients were included in the cohort study. Kaplan-Meier curves indicate a negative association between CSS and cancer-related pain or opioids requirement, but less evidence of an association with the dose of opioids use. Multivariate models revealed that the pain level and opioids requirement were associated with shorter CSS, after adjusting for significant covariates. The results of the meta-analysis indicated that postoperative opioids use had a poor effect on PFS, and opioids use for cancer-related pain was associated with poor OS in cancer patients, while intraoperative opioids use was not associated with cancer survival.We concluded that cancer-related pain and opioids requirements are associated with poor survival in advanced cancer patients, and postoperative opioids use and opioids use for cancer-related pain may have an adverse effect on the survival of cancer patients.


Assuntos
Analgésicos Opioides/normas , Neoplasias/tratamento farmacológico , Neoplasias/mortalidade , Dor/tratamento farmacológico , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Análise de Variância , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Dor/etiologia , Manejo da Dor/métodos , Manejo da Dor/normas , Manejo da Dor/estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Análise de Sobrevida
20.
Pain Physician ; 23(1): 17-24, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32013275

RESUMO

BACKGROUND: Pain control is strongly correlated with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) quality-of-care domains and overall hospital experience. Prior research implicates several factors in the variability of patients' pain management satisfaction scores, including but not limited to racial diversity, ethnic diversity, gender, socioeconomic status, and other cultural factors. OBJECTIVE: In this study, we examined responses to the HCAHPS survey in order to assess factors associated with patient-reported experiences of pain management. STUDY DESIGN: The study design involved a retrospective analysis of patient survey responses. SETTING: The research took place at a university-affiliated tertiary hospital. METHODS: The study was conducted in a university-affiliated tertiary hospital. Records for adult patients discharged between October 2015 and June 2017 were included. We obtained all patient responses to the HCAHPS pain management questions. We then performed a systematic statistical analysis to evaluate interactions between demographic factor variables and responses to the HCAHPS pain management questions. RESULTS: Between October 2015 and June 2017, 107,287 patients were discharged from the hospital. Of these, 13,026 of the respondents answered at least one of the HCAHPS pain management questions. Among HCAHPS pain-domain respondents, "Hispanic" and "Black or African American" respondents are more likely to report successful Pain Control when compared to "Not Hispanic" and "Caucasian/White," respectively (odds ratios [ORs] 1.60, 1.22). Additionally, among women, "Black or African American" respondents are more likely to report positive Staff Helpfulness than "Caucasian/White" respondents (OR 1.38).However, we also identified corresponding associations among HCAHPS pain-question responding and patient race/ethnicity: "Hispanic" and "Black/African American" patients were each less likely to respond to the HCAHPS pain questions (ORs 2.03, 2.74). LIMITATIONS: The primary limitation to this study was nonresponse bias; nevertheless, this is likely to be similar to bias experienced at other institutions. Additionally, this is a single institution study; however, given that the institution has a very large catchment area, we believe the results could be generalized to other settings. CONCLUSION: Response rates and responses to HCAHPS pain questions vary by race/ethnicity and sex. It appears likely that Hispanic and Black/African American patients underreport negative experiences. As HCAHPS surveys are used to inform decision-making within the US health care system, demographic biases in the survey data could lead to biases in care and resource allocation. KEY WORDS: Pain, HCAHPS, patient reported outcome measures, patient satisfaction, ethnicity, race.


Assuntos
Manejo da Dor/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente/etnologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Satisfação do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Inquéritos e Questionários
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