Sleep and daytime sleepiness problems among patients with chronic noncancerous pain receiving long-term opioid therapy: A cross-sectional study

Objective: Sleep problems are common among patients with chronic pain (CP). Information on sleep problems and associated covariates in opioid-treated patients with CP is limited. The aim of this study was to assess the prevalence, characteristics, and risk factors of sleep and daytime sleepiness problems in this specific population.Design: Cross-sectional.Setting: Primary care outpatient clinics.Participants: Eight hundred and seventy six patients with CP treated with long-term opioids.Main Outcome Measures: Prestudy selected questionnaires: six questions from the Medical Outcomes Study Sleep Scale, Pain Inventory Survey, Pain Patient Profile, Substance Dependence Severity Scale, and medication log.Results: Insomnia-type sleep problems and combined sleep and sleepiness problems were reported by 87 percent and 49 percent of the sample, respectively. Logistic regression analysis showed that depression (adjusted OR, aOR 2.8, 95% CI 2.1-3.7) and pain severity (aOR 1.4, 95% CI 1.1-1.7) were the strongest independent predictors of sleep problems; only depression severity predicted daytime sleepiness (aOR 1.9, 95% CI 1.6-2.2) or combined sleep/sleepiness problems (aOR 2.2, 95% CI 1.8-2.5). Opioid dose was associated with a slight tendency toward unrefreshing sleep (aOR 1.2, 95% CI 1.0-1.4) and worse sleep maintenance (aOR 1.2, 95% CI 1.0-1.4), while use of long-acting opioids was associated with a trend toward increased napping (aOR 1.3, 95% CI 1.0-1.8).Conclusions: Sleep and daytime sleepiness problems are common among opioid-treated primary care patients with CP and seem to be related mainly to depression and pain severity. Physicians caring for opioid-treated patients with CP may want to assess them for sleep disorders as a part of routine CP care.

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Treatment of chronic noncancer pain in patients on opioid therapy in primary care: A retrospective cohort study

Canadian Pharmacists Journal / Revue des Pharmaciens du Canada ◽

10.1177/1715163519887766 ◽

2019 ◽

Vol 153 (1) ◽

pp. 52-58

Author(s):

Arden R. Barry ◽

Chantal E. Chris

Keyword(s):

Primary Care ◽

Cohort Study ◽

Back Pain ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Opioid Therapy ◽

Opioid Agonist ◽

Chronic Noncancer Pain ◽

Opioid Dose ◽

Noncancer Pain

Background: This study sought to characterize the real-world treatment of chronic noncancer pain (CNCP) in patients on opioid therapy in primary care. Methods: A retrospective cohort study from 2014-18 was conducted at a multidisciplinary primary care clinic in Chilliwack, British Columbia. Included were adults on daily opioid therapy for CNCP. Patients receiving palliative care or ≤1 visit were excluded. Outcomes of interest included use of opioid/nonopioid pharmacotherapy, number/frequency of visits and proportion of patients able to reduce/discontinue opioid therapy. Results: Seventy patients (mean age 53 years, 53% male, 51% back pain) were included. Median follow-up was 6 visits over 12 months. Sixty-two patients (89%) reduced their opioid dose, 6 patients had no change and 2 patients required a dose increase. Mean opioid dose was reduced from 183 to 70 mg morphine equivalents daily. Twenty-four patients (34%) discontinued opioid therapy, 6 patients (9%) transitioned to opioid agonist therapy and 6 patients (9%) breached their opioid treatment agreement. Nonopioid pharmacotherapy included nonsteroidal anti-inflammatory drugs (64%), gabapentinoids (63%), tricyclic antidepressants (56%) and nabilone (51%). Discussion: Over half of patients were no longer on opioid therapy by the end of the study. Most patients had a disorder (e.g., back pain) for which opioids are generally not recommended. Overall mean opioid dose was reduced from baseline by approximately 60% over 1 year. Lack of access to specialized pain treatments may have accounted for high nonopioid pharmacotherapy usage. Conclusions: This study demonstrates that treatment of CNCP and opioid tapering can successfully be achieved in a primary care setting. Can Pharm J (Ott) 2020;153:xx-xx.

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Clinical trial: long-term use of proton pump inhibitors in primary care patients - a cross sectional analysis of 901 patients

Alimentary Pharmacology & Therapeutics ◽

10.1111/j.1365-2036.2009.04092.x ◽

2009 ◽

Vol 30 (7) ◽

pp. 725-732 ◽

Cited By ~ 20

Author(s):

C. REIMER ◽

P. BYTZER

Keyword(s):

Primary Care ◽

Clinical Trial ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Primary Care Patients ◽

Sectional Analysis

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Symptoms in long-term breast cancer survivors: A cross-sectional study in primary care

The Breast ◽

10.1016/j.breast.2020.09.013 ◽

2020 ◽

Vol 54 ◽

pp. 133-138 ◽

Cited By ~ 1

Author(s):

S.W.M.C. Maass ◽

L.M. Boerman ◽

D. Brandenbarg ◽

P.F.M. Verhaak ◽

J.H. Maduro ◽

...

Keyword(s):

Breast Cancer ◽

Primary Care ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional

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Is the MDS-UPDRS a Good Screening Tool for Detecting Sleep Problems and Daytime Sleepiness in Parkinson’s Disease?

Parkinson s Disease ◽

10.1155/2014/806169 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

Krisztina Horváth ◽

Zsuzsanna Aschermann ◽

Péter Ács ◽

Edit Bosnyák ◽

Gabriella Deli ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Daytime Sleepiness ◽

Screening Tool ◽

Rating Scale ◽

Sleep Problems ◽

Rank Correlation ◽

Correlation Coefficients ◽

Moderate Correlation ◽

Cross Sectional

Movement Disorder Society-sponsored Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) has separate items for measuring sleep problems (item 1.7) and daytime sleepiness (1.8). The aim of our study was to evaluate the screening sensitivity and specificity of these items to the PD Sleep Scale 2nd version (PDSS-2) and Epworth Sleepiness Scale (ESS). In this nationwide, cross-sectional study 460 PD patients were enrolled. Spearman’s rank correlation coefficients were calculated between the individual items, domains, and the total score of PDSS-2 and item 1.7 of MDS-UPDRS. Similarly, the items and the total score of ESS were contrasted to item 1.8 of MDS-UPDRS. After developing generalized ordinal logistic regression models, the transformed and observed scores were compared by Lin’s Concordance Correlation Coefficient. Only item 3 difficulties staying asleep and the “disturbed sleep” domain of PDSS-2 showed high correlation with “sleep problems” item 1.7 of the MDS-UPDRS. Total score of PDSS-2 had moderate correlation with this MDS-UPRDS item. The total score of ESS showed the strongest, but still moderate, correlation with “daytime sleepiness” item 1.8 of MDS-UPDRS. As intended, the MDS-UPDRS serves as an effective screening tool for both sleep problems and daytime sleepiness and identifies subjects whose disabilities need further investigation.

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M1898 Long-Term Use of Proton Pump Inhibitors in Primary Care Patients. a Cross Sectional Analysis of 499 Patients

Gastroenterology ◽

10.1016/s0016-5085(09)62033-3 ◽

2009 ◽

Vol 136 (5) ◽

pp. A-441

Author(s):

Christina Reimer ◽

Peter Bytzer

Keyword(s):

Primary Care ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Primary Care Patients ◽

Sectional Analysis

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Capsule Commentary on Behar et al., Acceptability of Naloxone Co-Prescription Among Primary Care Providers Treating Patients on Long-Term Opioid Therapy for Pain

Journal of General Internal Medicine ◽

10.1007/s11606-016-3947-0 ◽

2016 ◽

Vol 32 (3) ◽

pp. 313-313

Author(s):

William Cheung

Keyword(s):

Primary Care ◽

Primary Care Providers ◽

Opioid Therapy ◽

Care Providers

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Improving Adherence to Long-term Opioid Therapy Guidelines to Reduce Opioid Misuse in Primary Care

JAMA Internal Medicine ◽

10.1001/jamainternmed.2017.2468 ◽

2017 ◽

Vol 177 (9) ◽

pp. 1265 ◽

Cited By ~ 52

Author(s):

Jane M. Liebschutz ◽

Ziming Xuan ◽

Christopher W. Shanahan ◽

Marc LaRochelle ◽

Julia Keosaian ◽

...

Keyword(s):

Primary Care ◽

Opioid Therapy ◽

Opioid Misuse ◽

Therapy Guidelines

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Evidence of Specific Cognitive Deficits in Patients with Chronic Low Back Pain under Long-Term Substitution Treatment of Opioids

January 2018 - Pain Physician ◽

10.36076/ppj.2014/17/9 ◽

2014 ◽

Vol 17;1 (1;17) ◽

pp. 9-19

Author(s):

Haili Wang

Keyword(s):

Information Processing ◽

Back Pain ◽

Cognitive Functions ◽

Chronic Back Pain ◽

Opioid Therapy ◽

Healthy Controls ◽

Cross Sectional ◽

Time Pattern ◽

Number Of Patients

Background: There is a growing number of patients worldwide being treated with longterm opioids for chronic non-cancer pain, although there is limited evidence for their effectiveness in improving pain and function. Opioid-use related adverse effects, especially in cognitive functioning in these patients, are rarely evaluated. Objectives: The present study investigated the cognitive functions of patients with chronic back pain who underwent long-term opioid treatment in comparison with those patients without opioid usage and healthy controls. Study Design: A prospective, nonrandomized, cross-sectional study. Setting: Multidisciplinary pain management clinic, specialty referral center, University Hospital in Germany. Methods: In a prospective cross-sectional design, 37 patients with chronic back pain who underwent long-term opioid therapy (OP) were compared with 33 patients with chronic back pain without opioid therapy (NO) and 25 healthy controls (HC). Assessment of primary outcome included cognitive function such as information processing speed, choice reaction time, pattern recognition memory, and executive function. Other data included pain, back function, depression and anxiety, use of medication, and education status. The relationship between cognitive functions and anxiety/depression was analysed. Results: Both patient groups needed significantly longer time in information processing when compared to HC (Group 1: 41.87 ± 20.47 Group 2: 38.29 ± 19.99 Group 3: 30.25 ± 14.19). Additionally, OP patients had significantly reduced spatial memory capacity, flexibility for concept change, and impaired performance in working memory assessment compared to NO patients and HC. The impaired cognitive outcomes were significantly associated with pain intensity, depression scores, and medication use. Limitations: Limitations include small number of patients with heterogeneous opioid therapy and the nonrandomized observational nature of the study. Conclusions: Our findings give a differential view into the cognitive changes from chronic back pain with and without long-term opioids treatment. Chronic back pain itself impairs some distinct cognitive functions. Long-term opioid therapy adds further cognitive impairment. Key words: Long-term opioid therapy, chronic back pain, cognitive dysfunction

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The value of a Patient Access Portal in primary care: a cross-sectional survey of 62,486 registered users in the UK

Universal Access in the Information Society ◽

10.1007/s10209-019-00693-8 ◽

2019 ◽

Vol 19 (4) ◽

pp. 855-872 ◽

Cited By ~ 1

Author(s):

Mohammed A. Mohammed ◽

Jane Montague ◽

Muhammad Faisal ◽

Laura Lamming

Keyword(s):

Primary Care ◽

Medical Records ◽

Positive Impact ◽

Patient Access ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Long Term Conditions ◽

Monetary Value ◽

Online Access

Abstract In England, primary care patients have access to Patient Access Portals (PAPs), enabling them to book appointments, request repeat medication prescriptions, send/receive messages and review their medical records. Few studies have elicited user views and value of PAPs, especially in a publicly funded primary care setting. This study aimed to elicit the value users of PAPs place on online access to medical records and linked services. Secondary data analysis of the completed electronic survey (available 2 May 2015–27 June 2015) distributed via the EMIS PAP to all its registered users. EMIS designed the survey; responses were voluntary. There were 62,486 responders (95.7% self-completed). The PAP was mainly used for medication requests (86.3%) and online appointment bookings (78.4%), and, to a lesser extent, medical record viewing (18.3%) and messaging (9.5%). The majority (70%) reported a positive impact from using it. One in five rated it as their favourite online service second only to online banking. Almost three out of four responders stated that availability of online access would influence their move to another practice. Nonetheless, responders were reluctant to award a high monetary value to it. These findings correlated with the number of long-term conditions. The majority of users place a relatively high value, but not monetary value, on the PAP and report a positive impact from using it. The potential for PAPs to enhance patient experience, especially for those with long-term conditions, appears to be largely untapped. Research exploring the reasons for non-use is also required.

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