Browsing by Subject "analgesics"

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    Design, recruitment outcomes, and sample characteristics of the Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial
    (Elsevier, 2017-11) Krebs, Erin E.; Jensen, Agnes C.; Nugent, Sean; DeRonne, Beth; Rutks, Indulis; Leverty, David; Gravely, Amy; Noorbaloochi, Siamak; Bair, Matthew J.; Kroenke, Kurt; Department of Medicine, School of Medicine
    This manuscript describes the study protocol, recruitment outcomes, and baseline participant characteristics for the Strategies for Prescribing Analgesics Comparative Effectiveness (SPACE) trial. SPACE is a pragmatic randomized comparative effectiveness trial conducted in multiple VA primary care clinics within one VA health care system. The objective was to compare benefits and harms of opioid therapy versus non-opioid medication therapy over 12 months among patients with moderate-to-severe chronic back pain or hip/knee osteoarthritis pain despite analgesic therapy; patients already receiving regular opioid therapy were excluded. Key design features include comparing two clinically-relevant medication interventions, pragmatic eligibility criteria, and flexible treat-to-target interventions. Screening, recruitment and study enrollment were conducted over 31 months. A total of 4491 patients were contacted for eligibility screening; 53.1% were ineligible, 41.0% refused, and 5.9% enrolled. The most common reasons for ineligibility were not meeting pain location and severity criteria. The most common study-specific reasons for refusal were preference for no opioid use and preference for no pain medications. Of 265 enrolled patients, 25 withdrew before randomization. Of 240 randomized patients, 87.9% were male, 84.1% were white, and age range was 21–80 years. Past-year mental health diagnoses were 28.3% depression, 17% anxiety, 9.4% PTSD, 7.9% alcohol use disorder, and 2.6% drug use disorder. In conclusion, although recruitment for this trial was challenging, characteristics of enrolled participants suggest we were successful in recruiting patients similar to those prescribed opioid therapy in usual care.
  • Thumbnail Image
    Item
    First Do No Harm - The Indiana Providers Guide to the Safe, Effective Management of Chronic Non-Terminal Pain
    (State of Indiana, 2013) Bell-Sharp, Kim; Gregory, Eigner; Brooks, Tracy L.; Elliott, Alicia; Cragen, Debbie; Ersin, Ozlem H.; Croasdell, Lori; Fernandes, Taya; Duwve, Joan; Fielding, Stephen M.; Gentry, Mark E.; Greene, Marion S.; King, Timothy E.; Kelley, Kristen; Konchalski, Jan; Kuzma, Abigail; LaHood, Amy; MacKie, Palmer J.; McMahan, Deborah; Mowry, James B.; Park, Esther J.; Pontones, Pam; Ring, Barry S.; Robinson, Natalie; Roth, Daniel C.; Rumsey, Todd C.; Schreier, Eric M.; Stone, Cynthia L.; Straub, Tom; Welch, Peggy; Sybesma, J. Michelle; Symmes, Shelly; Whitworth, Michael; Vaught, Cynthia; Weitlauf, Sharon L.; Weaver, Tamara; Zachodni, Carla
    "First Do No Harm: The Indiana Healthcare Providers Guide to the Safe, Effective Management of Chronic Non-Terminal Pain" was developed by the Indiana Prescription Drug Abuse Prevention Task Force’s Education Committee under the leadership of Dr. Deborah McMahan. This provider toolkit, based on expert opinion and recognized standards of care, was developed over many months with the input of healthcare providers representing multiple specialties and all corners of the state. First Do No Harm provides options for the safe and responsible treatment of chronic pain, including prescriptions for opioids when indicated, with the ultimate goals of patient safety and functional improvement. It was developed as an interactive compendium to the new Medical Licensing Board rule addressing Opioid Prescribing for Chronic, Non-terminal Pain to give healthcare providers tools they can use to comply with the rule.
  • Thumbnail Image
    Item
    Opioid Overdose Prevention in Family Medicine Clerkships: A CERA Study
    (STFM, 2018) Gano, Laura; Hernandez, Ruben H.; Renshaw, Scott E.; Cronholm, Peter F.; Family Medicine, School of Medicine
    BACKGROUND AND OBJECTIVES: The national opioid crisis requires medical education to develop a proactive response centering on prevention and treatment. Primary care providers (PCPs)—many of whom are family medicine physicians—commonly treat patients on opiates, and write nearly 50% of opioid prescriptions. Despite linkages between PCP opioid prescribing patterns and the associated potential for overdose, little is known about how family medicine clerkship students are trained to prevent opioid overdose, including training on the use of naloxone. This study describes the presence of opioid overdose education at the national level and barriers to inclusion. It also discusses implementation strategies along with instructional methodology and learner evaluation. METHODS: Data were collected as part of a cross-sectional survey administered electronically by the Council of Academic Family Medicine Educational Research Alliance to 139 family medicine clerkship directors. RESULTS: A total of 99 clerkship directors (71.2% response rate) responded to the survey. A large majority (86.4%) agreed that it is important to offer opioid overdose prevention education in the clerkship, yet only 25.8% include this topic. Of these, only 50.0% address naloxone use. The most common barriers to including opioid overdose prevention education were prioritization of educational topics (82.1%) followed by lack of available faculty with sufficient experience/expertise (67.7%). CONCLUSIONS: Findings point to a disparity between perceived importance of opioid overdose prevention education and inclusion of this topic in family medicine clerkship-level medical education. Innovative use of online education and partnering with community resources may address barriers related to curricular prioritization while supporting interprofessional education principles.
  • Thumbnail Image
    Item
    Risks Associated with Drug Treatments for Kidney Stones
    (Taylor and Francis, 2015-12) York, Nadya; Borofsky, Michael S.; Lingeman, James E.; Department of Urology, IU School of Medicine
    Introduction: Renal stones are one of the most painful medical conditions patients experience. For many they are also a recurrent problem. Fortunately, there are a number of drug therapies available to treat symptoms as well as prevent future stone formation. Areas covered: Herein, we review the most common drugs used in the treatment of renal stones, explaining the mechanism of action and potential side effects. Search of the Medline databases and relevant textbooks was conducted to obtain the relevant information. Further details were sourced from drug prescribing manuals. Recent studies of drug effectiveness are included as appropriate. Expert opinion: Recent controversies include medical expulsive therapy trials and complex role of urinary citrate in stone disease. Future directions in research will involve new medical therapies for stone prevention, for example new drugs for hyperoxaluria.
  • Thumbnail Image
    Item
    Training Indiana's Family Medicine Residents to Address the Problem of Prescription Drug Abuse
    (2013-08-05) Fielding, Stephen M.; Duwve, Joan; Wilson, Gregory; Steele, Gregory
    Prescription drug abuse has been a growing problem in Indiana and around the nation for almost two decades. In recent years, prescription drug overdoses have pushed drug poisonings ahead of motor vehicle crashes as the leading cause of injury death. However, deaths due to overdoses of prescription drugs are only the tip of the iceberg when it comes to the much larger problem of abuse. This study has characterized prescription drug abuse in Indiana and taken an in-depth look at how it is and can be addressed both through organizational policies and state legislation. Opioid painkillers such as hydrocodone, oxycodone, and methadone are the most commonly abused prescription drugs, and most of these prescriptions are written by primary care physicians. Because more than 70% of Indiana’s family medicine residents will remain in the state to practice medicine following the conclusion of their residencies, it is worthwhile to take a look at how these residents are being educated during their training. St. Vincent’s Family Medicine Residency program in Indianapolis is one of several residency programs in Indiana training their residents on best practices of prescribing controlled substances. A review of residents’ prescribing patterns before and after training on the subject went into effect showed significant reductions in the number of opioid painkillers being prescribed, and showed the same reductions for alprazolam, a benzodiazepine anxiolytic.