Journal articles on the topic 'Morpheme interference effect'
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Yablonski, Maya, and Michal Ben-Shachar. "The Morpheme Interference Effect in Hebrew." Linguistic Perspectives on Morphological Processing 11, no. 2 (July 18, 2016): 277–307. http://dx.doi.org/10.1075/ml.11.2.05yab.
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An extensive body of psycholinguistic research suggests that word reading involves morphological decomposition: Individual morphemes are extracted and lexically accessed when skilled readers are presented with multi-morphemic orthographic stimuli. This view is supported by the Morpheme Interference Effect (MIE): Responses to pseudowords that contain real morphemes are slower and less accurate than responses to pseudowords that contain invented morphemes. The MIE was previously demonstrated in several languages with linear morphologies. Here, we examined whether the MIE applies to Hebrew, a language with an interleaved morphology, and whether it generalizes across the nominal and verbal domains. Participants performed a lexical decision task on visually presented Hebrew words and pseudowords derived from real or invented roots. The results showed robust MIEs in both the verbal and nominal domains. Specifically, pseudowords derived from real roots induced significantly lower accuracy and longer response times compared to pseudowords derived from invented roots. Participants’ verbal and nominal MIEs were significantly correlated, suggesting that the MIE captures a general sensitivity to morphological structure.
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DEACON, S. HÉLÈNE, and PETER BRYANT. "The strength of children's knowledge of the role of root morphemes in the spelling of derived words." Journal of Child Language 32, no. 2 (May 2005): 375–89. http://dx.doi.org/10.1017/s0305000904006816.
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The spelling of words in English is governed in part by the morphemes that make them up. This study examines the strength of children's knowledge of the role of root morphemes in spelling, specifically focusing on whether it can withstand interference by phonological changes. A total of 75 children between seven and nine years of age were given the first parts of two-morpheme transparent and opaque derived words (e.g. musical and objection) and one-morpheme control words (e.g. metal and portion). Children used the clues to a significant extent with the two-, but not the one-morpheme words. This effect was consistent across age groups and across both types of derived words. This is evidence that children's understanding of the link between morphemes and spelling is not impeded by changes in the sound of morphemes. These findings have substantial implications for models of spelling development and for educational practice.
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Carden, Julia R., Juan P. Barreyro, Juan Segui, and Virginia Jaichenco. "The fundamental role of position in affix identity." Mental Lexicon 14, no. 3 (December 31, 2019): 357–80. http://dx.doi.org/10.1075/ml.19009.car.
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Abstract Previous research suggests that while free morpheme identification during visual word recognition is position-independent, suffixes are activated only when they occur after the stem. Surprisingly, prefix position coding has not yet been assessed. This point is important given that some experimental studies demonstrated clear processing differences between prefixes and suffixes. In this study we examined whether Spanish suffixes and prefixes are recognized independently of their position by adapting the Crepaldi, Rastle, and Davis’s (2010) experimental paradigm. We observed that morphologically structured nonwords in which the affix occurs in its typical position (e.g., curiosura, disgrave) are rejected more slowly and less accurately than their matched orthographic controls (e.g., curiosula, dusgrave). Crucially, such morpheme interference effect is completely absent when the morphemes are inverted (i.e., uracurios and gravedis are rejected as easily as ulacurios and gravedus). Our data provide strong support to the hypothesis that all affix processing is sensitive to position.
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Gafni, Chen, Maya Yablonski, and Michal Ben-Shachar. "Morphological sensitivity generalizes across modalities." Mental Lexicon 14, no. 1 (November 11, 2019): 37–67. http://dx.doi.org/10.1075/ml.18020.gaf.
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Abstract A growing body of psycholinguistic research suggests that visual and auditory word recognition involve morphological decomposition: Individual morphemes are extracted and lexically accessed when participants are presented with multi-morphemic stimuli. This view is supported by the Morpheme Interference Effect (MIE), where responses to pseudowords that contain real morphemes are slower and less accurate than responses to pseudowords that contain invented morphemes. The MIE was previously demonstrated primarily for visually presented stimuli. Here, we examine whether individuals’ sensitivity to morphological structure generalizes across modalities. Participants performed a lexical decision task on visually and auditorily presented Hebrew stimuli, including pseudowords derived from real or invented roots. The results show robust MIEs in both modalities. We further show that visual MIE is consistently stronger than auditory MIE, both at the group level and at the individual level. Finally, the data show a significant correlation between visual and auditory MIEs at the individual level. These findings suggest that the MIE reflects a general sensitivity to morphological structure, which varies considerably across individuals, but is largely consistent across modalities within individuals. Thus, we propose that the MIE captures an important aspect of language processing, rather than a property specific to visual word recognition.
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Dort-Slijper, Marjolein van, Gert Rijlaarsdam, and Eva Breedveld. "De Verwerving Van Morfologische Regels in Schrift (III)." Toegepaste Taalwetenschap in Artikelen 61 (January 1, 1999): 97–110. http://dx.doi.org/10.1075/ttwia.61.09dor.
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In order to provide textbook authors with empirical data on the acquisition in Dutch of written morphology in nouns, verbs and adjectives, several empirical studies have been undertaken. In this article, the third study reports on the performance of the morpheme -e in a special case of adjectives in Dutch: the adjectives derived from participles. The study tries to determine the possible interference between the morphological rules for verb inflection (past tense) and adjective declension in reading and writing. Five classes of adjectives were distinguished according to order of relative difficulty established a priori. Subjects (n=157, grade 6, 7 and 8 from two schools) individually completed a compre-hension and a production task in which factors were systematically varied. Also a recognition test on the spelling of the past tense of verbs was administered. The results showed an effect of categories of verbal adjectives in the production task, but only for groups 7 and 8; group 6 was not sensitive to the differences between the categories. In the recognition task, no effect of type of adjective (verbal or normal) was found for groups 7 and 8; but for group 6, performance on verbal adjectives was lower for the three most difficult categories of adjectives. In the production task, all three groups performed lower on verbal adjectives than normal adjectives in the two most difficult categories of adjectives. It turned out that groups which acquired spelling rules for the past tense of verbs to a higher level, made more errors in the spelling of verbal adjectives, especially in the two categories of adjectives which related the strongest to the spelling of verbs. It was concluded that indications were found that negative transfer or interference is present. Authors recommend changing the order of phases in which spelling rules are trained: from 'adjective declension-verb inflection (past tense)-verbal adjective declension' to 'adjective declension (including verbal adjective declension)-verb declension (past tense).
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Sugianto, Sugianto, and Kamarudin Kamarudin. "THE INTERFERENCES OF SASAK LANGUAGE ON ENGLISH VOCABULARY MASTERY." Journal of Languages and Language Teaching 9, no. 1 (January 25, 2021): 99. http://dx.doi.org/10.33394/jollt.v9i1.3235.
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The article is aimed at revealing some crucial languags interferences that happened to Sasak students who were learning English. The Sasak itself is a sub-Austronesian language spoken by most citizens who live in Lombok and half of western Sumbawa. These language interferences play very important roles either in helping the students mastering eng English or challenging them. The positive interferences brought easiness to the students of Sasak to master English vocabularies. On the other hand, the negative interferences caused difficulties for students to learn English as their second language.The article say that defining the language interferences between Sasak and English brought some positive effects, particularly it is a real endeavor to help the lecturers, teachers, and instructors of English in conducting the teaching and learning practices. The research was conducted for the sake of findingpieces of evidences of these interferences issues. The interview was conducted by involving Sasak students who were learning English. Moreover, a writing test of vocabulary was also conducted to confirm the existance of language interferences when they are producing English words. Went through the research, it was concluded that some morphemes that exited in the Sasak were a lot similar to morphemes existed in English. Positively, this fact brought good effects on students who were learning English. Unfortunately, the accent in pronouncing those words was completely different, which then challenged the students to master the English vocabularies.
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Dort-Slijper, Marjolein van, Gert Rijlaarsdam, and Maaike Ditzel. "De Verwerving van Morfologische Regels in Schrift." Taal(leer)problemen 60 (January 1, 1998): 87–100. http://dx.doi.org/10.1075/ttwia.60.10dor.
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In order to provide authors of text books with empirical data on the acquisition in Dutch of written morphology in nouns, verbs and adjectives, several empirical studies were undertaken. In this article, the second study is reported on the performance of the morpheme -en in a special case of adjectives in Dutch: material adjectives such as 'gouden' (gold). The study tried to determine factors which affect the performance in reading and writing. Factors involved were two interference factors (plural in adjacent nouns; normal adjectives), cognitive task (comprehension versus writing) and two syntactic factors (grammatical function and position in the sentence of the constituent. Subjects (n=80, grades 6 and 7, from four schools) individually completed a comprehension and a production task in which factors were systematically varied. No effects of cognitive task were observed. Therefore only results for the production task were reported in detail. It turned out that material adjectives were more difficult than normal adjectives, and that within the category of material adjectives two subcategories should be distinguished, the easier one in which the morpheme is preceded by a stressed syllable as in 'gouden', and the more difficult one in which this is not the case, as in 'zilveren'. Of the two syntactic factors, only the grammatical function seems to affect the performance: adjectives in constituents with subject function were more difficult than adjectives with other grammatical functions; interactions between group and category of adjectives were found. Of the two interference factors, both factors seemed to affect performance.
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Wu, Christopher L., Shefali Agarwal, Prabhav K. Tella, Brendan Klick, Michael R. Clark, Jennifer A. Haythornthwaite, Mitchell B. Max, and Srinivasa N. Raja. "Morphine versus Mexiletine for Treatment of Postamputation Pain." Anesthesiology 109, no. 2 (August 1, 2008): 289–96. http://dx.doi.org/10.1097/aln.0b013e31817f4523.
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Background Stump and phantom pains are debilitating sequelae of amputations that are often resistant to treatment. The efficacy of pharmacologic therapies, including opioids and sodium channel blockers, for postamputation pain is uncertain. Methods The authors conducted a double-blind, randomized, placebo-controlled, crossover study in adult patients with postamputation pain of 6 months or longer and greater than 3 on a 0-10 numeric pain rating scale. Each of the three treatment periods (morphine, mexiletine, or placebo) included a 1-week drug-free interval followed by 4-week titration, 2-week maintenance, and 2-week drug-taper phases. The primary outcome measure was change in average pain intensity from the drug-free baseline to the last week of maintenance. Results Sixty amputees were enrolled; data were analyzed from 56 subjects for one drug period, 45 subjects for two drug periods, and 35 subjects who completed all three drug periods. The mean morphine and mexiletine dosages were 112 and 933 mg, respectively. Morphine treatment provided lower pain scores compared with placebo and mexiletine (P = 0.0003). The mean percent pain relief during treatment with placebo, mexiletine, and morphine was 19, 30, and 53%, respectively (P < 0.0001, morphine vs. placebo and mexiletine). The numbers needed to treat to obtain 50% and 33% decreases in pain intensity with morphine were 5.6 and 4.5, respectively. Treatment with morphine was associated with a higher rate of side effects. Conclusions Therapy with morphine, but not mexiletine, resulted in a decrease in intensity of postamputation pain but was associated with a higher rate of side effects and no improvement in self-reported levels of overall functional activity and pain-related interference in daily activities.
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Agrawal, Neeraj K., Uma Gupta, Nitin Kothari, Shruti Chandra, Rashmi Singh, and Shubham Pandey. "Anti-nociceptive effect of seed extract of Acacia tortilis in rodents." International Journal of Basic & Clinical Pharmacology 7, no. 4 (March 23, 2018): 650. http://dx.doi.org/10.18203/2319-2003.ijbcp20181164.
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Background: Management of pain is a primary clinical concern for any pathology in medical field. Addiction liability of opioids and troublesome gastrointestinal side effects of NSAIDs leads to intensive research for compound with lesser side effects.The aim of the study to evaluate the anti-nociceptive activity of Acacia Tortilis Seed Extract (ATE) in experimental animals.Methods: First of all, animals were randomly allocated into four groups of six animals each. In acetic acid induced writhing test model, Group I (NC) served as vehicle control received saline/Tween 80 0.1%, 10ml/kg BW orally, group II (ATE-100) and III (ATE-200) received ATE in dose of 100 and 200mg/kg BW orally respectively and group IV received the standard drug diclofenac sodium in dose of 50 mg/kg BW orally. Group I to IV were same in rest of three experimental models. One additional group of standard drugs (group V) morphine sulfate in dose of 5 mg/kg BW subcutaneously (SC) was allocated for screening method hot plate and tail flick tests. In Formalin induced paw licking test, three additional groups (group V) morphine sulfate in dose of 5mg/kg BW SC, group VI- morphine+naloxone (5mg/kg SC +2mg/kg intra-peritoneally (IP) and group VII - ATE+ naloxone (200mg/kg BW orally +2mg/kg BW IP) were also made.Results: The ATE when administered orally in dose of 100 and 200mg/ kg body weight (BW), produced significant analgesic activity (P <0.01) in acetic acid induced writhing syndrome and late phase of formalin test. In the hot plate test in mice and tail flick test in rats, ATE in same doses also showed significant analgesic activity (P <0.05) which is almost equally efficacious to standard drug diclofenac sodium (50mg/kg BW orally) but far less efficacious than morphine sulfate (5mg/kg BW subcutaneous).ATE (200mg/Kg BW orally) activity did not blocked by naloxone (2mg/kg intra-peritoneal).Conclusions: ATE possesss significant anti-nociceptive activity as evidenced in all the animal models of nociception. It might exert its effect through the peripheral mechanism of analgesic action possibly by interference in biosynthesis, release and/or action of prostaglandins and leukotrienes.
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Musclow, Shirley L., Tabatha Bowers, Hanna Vo, Mark Glube, and Thong Nguyen. "Long-Acting Morphine Following Hip or Knee Replacement: A Randomized, Double-Blind, Placebo-Controlled Trial." Pain Research and Management 17, no. 2 (2012): 83–88. http://dx.doi.org/10.1155/2012/704932.
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BACKGROUND: Patients undergoing total hip or knee replacement surgery experience unmanaged pain during postoperative physiotherapy sessions. It was theorized that a baseline opioid would improve pain management.OBJECTIVES: To examine the effectiveness of adding long-acting oral morphine to a routine postoperative regimen for total hip or knee replacement surgery.METHODS: The present study was a double-blind, randomized, placebo-controlled trial for patients undergoing total hip or knee replacement surgery. All patients received routine postoperative analgesia; in addition, the treatment group received long-acting oral morphine 30 mg orally twice daily for three days, while the control group received placebo capsules. The primary end point was a decrease in pain scores by two points on a 0- to 10-point pain rating scale. Secondary end points included adverse effects, acute confusion, pain-related interferences in function and sleep, length of stay and patient satisfaction.RESULTS: Two hundred patients were enrolled in the present study (March 2004 to March 2006). Although the groups were large enough to yield statistical significance, most pain scores did not reach the predetermined improvement for clinical significance. Additionally, there was an increase in opioid usage (P<0.0001), vomiting (P=0.0148) and oversedation (P=0.08). There were no statistically significant changes in function or sleep. Improved satisfaction with pain management was minimal (P=0.052).DISCUSSION: The present study was undertaken to determine the value of adding a long-acting opioid (morphine) to the usual care of patients undergoing total hip or total knee replacement surgery. The results yielded minimally improved pain scores and additional adverse effects (vomiting and oversedation). Published research in which long-acting opioids (oxycodone) were used for similar postoperative procedures did not robustly report improved pain scores. In addition, patients using a long-acting opioid (oxycodone) during the postoperative period reported somnolence, dizziness and confusion. Statistically, the patients in the present study showed higher confusion scores and no improvement for pain-related interferences with activity or walking. The treatment group did report increased satisfaction; however, the significance was weak.CONCLUSIONS: Thirty milligrams twice per day of long-acting morphine from days 1 to 3 following total hip and total knee replacement surgery provided minimal improvements in pain scores, and more adverse effects in the treatment group. The overall strength of evidence for improved outcomes is minimal and thus not supported.
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Deutsch, Avital, Hadas Velan, and Tamar Michaly. "Decomposition in a non-concatenated morphological structure involves more than just the roots: Evidence from fast priming." Quarterly Journal of Experimental Psychology 71, no. 1 (January 2018): 85–92. http://dx.doi.org/10.1080/17470218.2016.1250788.
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Complex words in Hebrew are composed of two non-concatenated morphemes: a consonantal root embedded in a nominal or verbal word-pattern morpho-phonological unit made up of vowels or vowels and consonants. Research on written-word recognition has revealed a robust effect of the roots and the verbal-patterns, but not of the nominal-patterns, on word recognition. These findings suggest that the Hebrew lexicon is organized and accessed via roots. We explored the hypothesis that the absence of a nominal-pattern effect reflects methodological limitations of the experimental paradigms used in previous studies. Specifically, the potential facilitative effect induced by a shared nominal-pattern was counteracted by an interference effect induced by the competition between the roots of two words derived from different roots but with the same nominal-pattern. In the current study, a fast-priming paradigm for sentence reading and a “delayed-letters” procedure were used to isolate the initial effect of nominal-patterns on lexical access. The results, based on eye-fixation latency, demonstrated a facilitatory effect induced by nominal-pattern primes relative to orthographic control primes when presented for 33 or 42 ms. The results are discussed in relation to the role of the word-pattern as an organizing principle of the Hebrew lexicon, together with the roots.
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Hamidi, Samin. "Simultaneous and Sensitive Determination of Amphetamine, Codeine and Morphine in Exhaled Breath Condensate, Using Capillary Electrophoresis Coupled with On-line and Off-line Enhancing Methods." Current Pharmaceutical Analysis 16, no. 7 (August 17, 2020): 872–79. http://dx.doi.org/10.2174/1573412915666190219143049.
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Background: Abuse of drugs is associated with several medical, forensic, toxicology and social challenges. “Drugs of abuse” testing is therefore an important issue. Objective: We propose a simple CE-based method for the quantification of amphetamine, codeine and morphine after direct injection of Exhaled Breath Condensate (EBC) by the aid of simple stacking mode and an off-line pre-concentration method. Methods: Using graphene oxide adsorbents, amphetamine, codeine and morphine were extracted from EBC in order to eliminate the proteins and other interferences. In addition to off-line method, an online stacking mode was applied to improve the analytical signal obtained from the instrument. Results: The validation parameters were experimented on the developed method based on the FDA guideline over concentration ranges of 12.5-100, 30-500 and 10-1250 ng/mL associated with amphetamine, codeine and morphine, respectively. Small volumes (around 100 μL) of EBC were collected using a lab-made setup and successfully analyzed using the proposed method where precisions and accuracies (within day and between days) were in accordance with the guideline (recommended less than 15 % for biological samples). The recovery tests were used to evaluate the matrix effect and data (94 to 105 %) showed that the proposed method can be applied in different EBC matrix samplings of subjects. Conclusion: The proposed method is superior for simultaneous determination of amphetamine, codeine and morphine over chromatographic analyses because it is fast and consumes fewer chemicals, with no derivatization step.
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Garcia, Laura M., Brandon J. Birckhead, Parthasarathy Krishnamurthy, Josh Sackman, Ian G. Mackey, Robert G. Louis, Vafi Salmasi, Todd Maddox, and Beth D. Darnall. "An 8-Week Self-Administered At-Home Behavioral Skills-Based Virtual Reality Program for Chronic Low Back Pain: Double-Blind, Randomized, Placebo-Controlled Trial Conducted During COVID-19." Journal of Medical Internet Research 23, no. 2 (February 22, 2021): e26292. http://dx.doi.org/10.2196/26292.
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Background Chronic low back pain is the most prevalent chronic pain condition worldwide and access to behavioral pain treatment is limited. Virtual reality (VR) is an immersive technology that may provide effective behavioral therapeutics for chronic pain. Objective We aimed to conduct a double-blind, parallel-arm, single-cohort, remote, randomized placebo-controlled trial for a self-administered behavioral skills-based VR program in community-based individuals with self-reported chronic low back pain during the COVID-19 pandemic. Methods A national online convenience sample of individuals with self-reported nonmalignant low back pain with duration of 6 months or more and with average pain intensity of 4 or more/10 was enrolled and randomized 1:1 to 1 of 2 daily (56-day) VR programs: (1) EaseVRx (immersive pain relief skills VR program); or (2) Sham VR (2D nature content delivered in a VR headset). Objective device use data and self-reported data were collected. The primary outcomes were the between-group effect of EaseVRx versus Sham VR across time points, and the between–within interaction effect representing the change in average pain intensity and pain-related interference with activity, stress, mood, and sleep over time (baseline to end-of-treatment at day 56). Secondary outcomes were global impression of change and change in physical function, sleep disturbance, pain self-efficacy, pain catastrophizing, pain acceptance, pain medication use, and user satisfaction. Analytic methods included intention-to-treat and a mixed-model framework. Results The study sample was 179 adults (female: 76.5%, 137/179; Caucasian: 90.5%, 162/179; at least some college education: 91.1%, 163/179; mean age: 51.5 years [SD 13.1]; average pain intensity: 5/10 [SD 1.2]; back pain duration ≥5 years: 67%, 120/179). No group differences were found for any baseline variable or treatment engagement. User satisfaction ratings were higher for EaseVRx versus Sham VR (P<.001). For the between-groups factor, EaseVRx was superior to Sham VR for all primary outcomes (highest P value=.009), and between-groups Cohen d effect sizes ranged from 0.40 to 0.49, indicating superiority was moderately clinically meaningful. For EaseVRx, large pre–post effect sizes ranged from 1.17 to 1.3 and met moderate to substantial clinical importance for reduced pain intensity and pain-related interference with activity, mood, and stress. Between-group comparisons for Physical Function and Sleep Disturbance showed superiority for the EaseVRx group versus the Sham VR group (P=.022 and .013, respectively). Pain catastrophizing, pain self-efficacy, pain acceptance, prescription opioid use (morphine milligram equivalent) did not reach statistical significance for either group. Use of over-the-counter analgesic use was reduced for EaseVRx (P<.01) but not for Sham VR. Conclusions EaseVRx had high user satisfaction and superior and clinically meaningful symptom reduction for average pain intensity and pain-related interference with activity, mood, and stress compared to sham VR. Additional research is needed to determine durability of treatment effects and to characterize mechanisms of treatment effects. Home-based VR may expand access to effective and on-demand nonpharmacologic treatment for chronic low back pain. Trial Registration ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177 International Registered Report Identifier (IRRID) RR2-10.2196/25291
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Lundorff, MD, Lena, Per Sjøgren, DmSci, MD, Ole Bo Hansen, MD, Torsten Jonsson, MD, Per Rotbøll Nielsen, and Lona Christrup, PhD, MSc(Pharm). "Switching from high doses of pure µ-opioid agonists to transdermal buprenorphine in patients with cancer: A feasibility study." Journal of Opioid Management 9, no. 4 (July 1, 2013): 255–62. http://dx.doi.org/10.5055/jom.2013.0166.
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Background: Several myths on buprenorphine’s pharmacology exist: possible analgesic ceiling effect, feasibility of combination with other opioid agonists, and the reversibility of side effects. Aim to evaluate: 1) if cancer patients receiving high doses of pure agonists could obtain adequate pain relief after switching to transdermal (TD) buprenorphine and 2) whether the numbers of breakthrough pain episodes after switching increased and whether they could be treated with the same doses of pure agonist as before switching.Design: The prospective open multicenter study included outpatients with moderate-to-severe cancer pain satisfactorily controlled.Setting: Patients were switched from the usual pure agonist to TD buprenorphine and were titrated to a stable dose. The assessments were: 1) daily self-assessment of pain intensity, numbers of rescue medications, and pain interference with sleep; 2) brief pain inventory; 3) pain relief and pain intensity; 4) quality of life; and 5) adverse events and symptoms.Results: Eighteen patients receiving 150-516 mg of morphine/day were included. The buprenorphine dose at the end of the study varied between 52.5 and 140 mg/h. No difference in pain before and after switching was shown. The level of rescue doses was maintained. The patches were well tolerated. A significant decrease in fatigue and an increase in global health status were seen after the switch.Conclusion: It is feasible to switch cancer patients from high doses of pure µ- opioid agonists to TD buprenorphine without eliciting any antagonist effects, but the dose conversion factor is individual and the switching process should be tailored for the individual patient.
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Hillman, R. Tyler, Maria D. Iniesta, Qiuling Shi, Tina Suki, Tsun Chen, Katherine Cain, Loretta Williams, et al. "Longitudinal patient-reported outcomes and restrictive opioid prescribing after minimally invasive gynecologic surgery." International Journal of Gynecologic Cancer 31, no. 1 (November 6, 2020): 114–21. http://dx.doi.org/10.1136/ijgc-2020-002103.
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ObjectiveTo determine post-discharge patient-reported symptoms before and after implementation of restrictive opioid prescribing among women undergoing minimally invasive gynecologic surgery.MethodsWe compared clinical outcomes and symptom burden among a cohort of 389 women undergoing minimally invasive gynecologic surgery at a single institution before and after implementation of a restrictive opioid prescribing quality improvement initiative in July 2018. Post-discharge symptom burdens were collected up to 42 days after discharge using the MD Anderson Symptom Inventory and analyzed using linear mixed effects models.ResultsThe majority of women included in this study were white non-smokers and the median age was 55 (range 23–83). Most women underwent hysterectomy (64%), had surgery for malignancy (71%), and were discharged from the hospital on the day of surgery (65%). Women in the restrictive opioid prescribing group had a median reduction in morphine equivalent dose prescribed at discharge of 83%, corresponding to a median reduction in 25 tablets of 5 mg oxycodone per person. There was no difference between opioid prescribing groups in either the rate of refill requests (P=1) or hospital re-admission (P=1) up to 30 days after discharge. After adjustment for co-variates, there was no statistically significant difference in post-discharge symptom burden including patient-reported pain (P=0.08), sleep (P=0.30), walking interference (P=0.64), activity interference (P=0.12), or affective interference (P=0.67). There was a trend toward less reported constiptation in the restrictive opioid prescribing group that did not reach statistical significance (P=0.05).ConclusionWe found that restrictive post-operative opioid prescribing was not associated with differences in longitudinal symptom burden among women undergoing minimally invasive gynecologic surgery. These results provide the most comprehensive picture to date of post-operative symptom recovery under different opioid prescribing approaches, lending additional support for existing recommendations to reduce opioid prescribing following gynecologic surgery.
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Petrie, Gavin N., Kiri L. Wills, Fabiana Piscitelli, Reem Smoum, Cheryl L. Limebeer, Erin M. Rock, Ashlyn E. Humphrey, et al. "Oleoyl glycine: interference with the aversive effects of acute naloxone-precipitated MWD, but not morphine reward, in male Sprague–Dawley rats." Psychopharmacology 236, no. 9 (April 16, 2019): 2623–33. http://dx.doi.org/10.1007/s00213-019-05237-9.
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Arendsen, Jeroen, Andrea J. van Doorn, and Huib de Ridder. "When do people start to recognize signs?" Gesture 9, no. 2 (September 30, 2009): 207–36. http://dx.doi.org/10.1075/gest.9.2.03are.
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The aim of this paper is to examine when signers start to recognize the lexical meaning of a sign. This is studied with movies of 32 mono-morphemic signs of Sign Language of the Netherlands (SLN). Signs were presented in isolation or with preceding fidgets (e.g., rubbing your nose). Signers watched these movies at normal playing speed and had to respond as soon as they recognized a sign, which they were able to do, on average, about 850 ms after the coded beginning of the sign. By subtracting the time participants need to generate a motor response to a visible event, which was 310 ms on average, sign recognition was estimated to occur after around 540 ms. The results were further analyzed in relation to the sign’s movement phases (preparation, nucleus, and recovery) and for effects of participant characteristics, sign characteristics, and embedding conditions. The current findings are compared with earlier work on the time course of lexical sign recognition. Moreover, they are compared with findings from an earlier experiment on detecting the beginning of a sign (Arendsen et al., 2007) to study possible interference of lexical recognition with sign detection by signers.
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Parker, K. P., D. L. Bliwise, J. Dalton, W. Harris, S. Jain, M. Kohles-Baker, M. Ribeiro, C. Vena, and B. Viswanathan. "Polysomnographic measures of sleep moderate the relationship between depression and pain." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 8526. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.8526.
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8526 Background: We explored the effects of polysomnographic measures of nocturnal sleep on depression and pain in advanced cancer patients taking opioids. Methods: The sample included 72 subjects (solid tumor, Stages III/IV) with a mean age of 55.9 (9.1); 39 were male. All were taking opioids. Subjects underwent ambulatory polysomnography for 48 hours in their homes. Nocturnal sleep parameters included total sleep time (minutes); sleep efficiency (SE; %); sleep latency (SL; minutes); rapid-eye-movement sleep latency (REML; minutes); the percentages (%) of non-rapid eye movement (NREM) Stages 1, 2, and slow wave sleep (SWS, 3 & 4), and REM sleep; and the number of awakenings > 60 seconds. Subjects kept an opioid diary, data from which were converted into a mean hourly morphine equivalent dose (HMED). Subjects also completed the Brief Pain Inventory (BPI) and the Beck Depression Inventory (BDI). Descriptive, correlation, and regression procedures were used for data analysis. Results: Subjects had a mean nocturnal sleep period of 400.1 ± 97.4 minutes. The SL was normal at 26.5 ± 42.6 minutes but the SE was low (77.5 ± 13.2%). Most sleep was light NREM Stages 1 and 2 with decreased amounts of deep SWS (0.3 ± 2.7%) and REM sleep (14.4 ± 8.5%). The REML was prolonged at 149.1 ± 105.1 minutes. The mean BPI scores for pain intensity and interference were 4.4 ± 1.4 and 5.0 ± 2.1, respectively. The mean BDI score was 13.7 ± 7.9. The average HMED was .59 ± .1. Controlling for age and gender, regression analyses revealed that SWS and REM sleep moderated the relationship between depression and pain. Those with more SWS had lower depression levels in spite of higher pain intensity (t = -2.8, p = .007) while those with more REM sleep had lower depression levels despite higher pain interference (t = -2.0, p = .045). Controlling for pain intensity and interference, HMED was positively associated with Stage 1 % (r = .36, p = .001) and the number of nocturnal awakenings > 60 seconds (r = .28, p = .019). Conclusions: Opioids may lighten and disrupt sleep altering sleep cycle progression. The resulting decrements in SWS and REM sleep may lead to increased depression and enhanced pain. Consideration of the timing and dosing of opioids in relationship to nocturnal sleep may decrease depression and subsequently optimize pain management. No significant financial relationships to disclose.
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Mercadante, Sebastiano, Augusto Caraceni, Arturo Cuomo, Massimo Mammucari, Paolo Marchetti, Rocco Domenico Mediati, Silvia Natoli, and Giuseppe Tonini. "A Longitudinal Study of Breakthrough Cancer Pain: An Extension of IOPS-MS Study." Journal of Clinical Medicine 10, no. 11 (May 24, 2021): 2273. http://dx.doi.org/10.3390/jcm10112273.
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The aim of this study was to longitudinally assess the characteristics of background pain and breakthrough pain (BTcP), analgesic treatment, and satisfaction with treatment four weeks after the first assessment. Methods: Adult cancer patients with a diagnosis of BTcP were included. At T0, age, gender, visit setting, cancer diagnosis, the extent of the disease, ongoing anticancer treatments, and Karnofsky level were recorded. The background pain intensity in the last 24 h (on a numerical scale 0–10), opioids used for background pain, and their doses, expressed as oral morphine equivalents (OME), as well as other analgesic drugs, were recorded. The number of BTcP episodes, their intensity, predictability and precipitating factors, onset duration of untreated episodes, and interference with daily activities were collected. Analgesics and doses used for BTcP, and the mean time to meaningful pain relief after taking medication, were assessed. The level of satisfaction with BTcP medication was also assessed. Adverse effects to be attributed to these medications were also recorded. At T4, the same data were evaluated. Results: After one-month follow-up, patients had a lower number of BTcP episodes and peak intensity, possibly due to the optimization of background analgesia. The principal characteristics of BTcP did not change significantly. Conclusion: A careful and continuous assessment should be guaranteed to all patients to limit the burden induced by BTcP, other than treating BTcP episodes with short-onset opioids.
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Wangnamthip, Suratsawadee, Skaorat Panchoowong, Carolina Donado, Kimberly Lobo, Pimporn Phankhongsap, Pinyo Sriveerachai, Pramote Euasobhon, et al. "The Effectiveness of Cancer Pain Management in a Tertiary Hospital Outpatient Pain Clinic in Thailand: A Prospective Observational Study." Pain Research and Management 2021 (July 20, 2021): 1–11. http://dx.doi.org/10.1155/2021/5599023.
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Context. In a previous retrospective study, cancer pain management was effective in 47.5% of a cohort assessed after 3 months in a pain clinic at Siriraj Hospital. New guidelines were established, including a multidisciplinary approach, availability of pain interventions, and palliative care referral. Objectives. The objective was to examine the effectiveness of the updated approach. Methods. With IRB approval, outpatients with cancer were enrolled from January to December 2018. Assessments were recorded at baseline and three consecutive visits (BL, FU1, FU2, and FU3), including Numerical Rating Scale (NRS), the Brief Pain Inventory (BPI), the Edmonton Symptom Assessment System (ESAS), side effects, and analgesic use. The primary outcome was a favorable response, defined as an NRS decrease more than 30% or NRS <4. Secondary outcomes included trends over time in BPI, ESAS, side effects, and analgesic use. Pain response predictors at FU3 were analyzed using logistic regression. Results. Among 150 patients, 72 (48%) completed follow-ups. Of these, 61% achieved a favorable response at FU3. Pain interference diminished at all visits relative to baseline ( p < 0.05 ). Median morphine equivalent daily dosage (MEDD) at BL was 20 mg/day, with a statistically significant, but clinically modest increase to 26.4 mg/day at FU3. Radiation therapy during pain care was a predictor of pain responders. Conclusion. The current Siriraj multidisciplinary approach provided effective relief of pain and stabilization of other cancer-related symptoms. Radiation therapy during pain care can be used to predict pain outcomes. Ongoing improvement domains were identified and considered in the context of cultural, economic, and geographic factors.
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Safakish, Ramin, Gordon Ko, Vahid Salimpour, Bryan Hendin, Imrat Sohanpal, Gena Loheswaran, and Sun Young Rosalia Yoon. "Medical Cannabis for the Management of Pain and Quality of Life in Chronic Pain Patients: A Prospective Observational Study." Pain Medicine 21, no. 11 (June 18, 2020): 3073–86. http://dx.doi.org/10.1093/pm/pnaa163.
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Abstract Objective To evaluate the short-term and long-term effects of plant-based medical cannabis in a chronic pain population over the course of one year. Design A longitudinal, prospective, 12-month observational study. Setting Patients were recruited and treated at a clinic specializing in medical cannabis care from October 2015 to March 2019. Subjects A total of 751 chronic pain patients initiating medical cannabis treatment. Methods Study participants completed the Brief Pain Inventory and the 12-item Short Form Survey (SF-12), as well as surveys on opioid medication use and adverse events, at baseline and once a month for 12 months. Results Medical cannabis treatment was associated with improvements in pain severity and interference (P < 0.001) observed at one month and maintained over the 12-month observation period. Significant improvements were also observed in the SF-12 physical and mental health domains (P < 0.002) starting at three months. Significant decreases in headaches, fatigue, anxiety, and nausea were observed after initiation of treatment (P ≤ 0.002). In patients who reported opioid medication use at baseline, there were significant reductions in oral morphine equivalent doses (P < 0.0001), while correlates of pain were significantly improved by the end of the study observation period. Conclusions Taken together, the findings of this study add to the cumulative evidence in support of plant-based medical cannabis as a safe and effective treatment option and potential opioid medication substitute or augmentation therapy for the management of symptoms and quality of life in chronic pain patients.
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Solon, Lorenzo, Cristina DelPrete, David I. Pedowitz, Steven M. Raikin, Brian S. Winters, Joseph N. Daniel, Rachel J. Shakked, and Joseph T. O'Neil. "Prospective Randomized Study Evaluating the Effect of Postoperative Ketorolac on Bone Healing and Opioid Consumption after First Metatarsophalangeal Joint Fusion." Foot & Ankle Orthopaedics 7, no. 4 (October 2022): 2473011421S0094. http://dx.doi.org/10.1177/2473011421s00949.
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Category: Midfoot/Forefoot Introduction/Purpose: Amid the opioid crisis, the use of non-narcotic pain medication post-operatively has garnered increased interest. Nonsteroidal anti-inflammatory drugs (NSAIDs) have the potential to serve as an adjunct treatment to opioid medications in the post-operative period but have been viewed with hesitancy due to associations with delayed bone healing. This prospective randomized study aimed to evaluate the use of ketorolac on postoperative pain, opioid requirements, patient satisfaction, complication/reoperation rates, and delayed and/or nonunion rates in patients undergoing fusion of their first metatarsophalangeal joint (1st MTPJ) for treatment of end-stage arthritis. We hypothesized that the use of postoperative ketorolac would decrease opioid medication use and improve patient satisfaction with regards to their pain control, while having no effect on clinical or radiographic healing. Methods: Eighty-eight patients undergoing 1st MTPJ fusion were randomized before surgery to treatment with or without ketorolac for 5 days after surgery. A once-daily survey was distributed via email on postoperative days (POD) 1-7. Unblinded participants were asked to report opioid consumption, VAS pain level, satisfaction with pain management using a 6-point Likert scale, perceived frequency of pain using a 5-point Likert scale, pain interference with sleep, and side effects using VAS. Clinical healing was assessed by the treating surgeon based on patient's ability to ambulate comfortably at 12 weeks post-operatively. Radiographic healing at 12-weeks was assessed by two fellowship-trained orthopedic foot and ankle surgeons blinded to the patient's name and cohort assignment. Intention-to-treat analysis was performed. Results: Seventy-two patients completed at least 4 out of the 7 postoperative surveys. Average was 60.7 +- 8.39 years with 58.3% female (42/72), and a mean BMI of 28.6 +- 5.77. Between groups, there were no significant differences in age, BMI, sex, smoking status, inflammatory arthritis, or diabetes (p>0.05). Across all POD, there were no significant differences in VAS-pain scores and satisfaction with pain management. Morphine milligram equivalents (MME) consumed (36.2 +- 24.7 vs. 26.2 +- 24.2, p=0.119) and number of opioid pills taken (5.78 +- 2.86 vs. 3.93 +- 2.06, p=0.055) were slightly, but not significantly, lower among patients who received ketorolac on POD 2. There were no differences in MME consumed on the other postoperative days. Overall, 94.4% (68/72) returned for 12-week radiographic evaluation and there were no differences in radiographic healing between the two groups with a Kappa-Fleiss value of 0.559, indicating moderate agreement between reviewers. Conclusion: The use of postoperative ketorolac led to slightly, but not significantly, less opioid consumption in the acute postoperative period following 1st MTPJ fusion, while not causing a negative effect on radiographic healing of the fusion at 12- weeks postoperatively.
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Rogero, Ryan, Elizabeth McDonald, Steven M. Raikin, Daniel Fuchs, Rachel J. Shakked, and Armen Voskeridjian. "Randomized Study of the Effect of Initial Ropivacaine Dosage during Continuous Popliteal Nerve Blocks on Rebound Pain in Foot and Ankle Surgery." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0006. http://dx.doi.org/10.1177/2473011419s00064.
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Category: Basic Sciences/Biologics, Anesthesia/Pain Control Introduction/Purpose: Rebound pain, the quantifiable difference in pain experienced after nerve block resolution, can be a substantial component of postoperative pain, opioid intake, sleep disturbances, and patient satisfaction. A relatively higher concentration initial local anesthetic bolus may contribute to this phenomenon, as the transition from an entirely numb and painless limb to a partially numb limb may lead to greater perceived pain following block resolution. In contrast, patients experiencing some level of background pain immediately following surgery due to a lower concentration initial bolus may have less perceived pain after block resolution. The purpose of this study is to evaluate the influence of the initial local anesthetic concentration in continuous popliteal nerve blocks on rebound pain and other postoperative variables in foot and ankle surgery. Methods: Following IRB approval, patients undergoing outpatient foot and ankle procedures requiring continuous popliteal nerve blocks under the care of a single fellowship-trained foot & ankle surgeon were identified. Subjects were randomized and blinded to either the standard (0.5%) or low-dose (0.2%) initial ropivacaine bolus, both being followed by a continuous 0.2% ropivacaine catheter infusion. From postoperative days 1 to 7, subjects recorded their hourly visual analog scale (VAS) pain level out of 100, perceived pain relief from the block, and satisfaction with pain control, as well as daily narcotic intake and other postoperative side effects, through an electronic survey. Rebound pain was scored according to a published method by subtracting the lowest VAS pain score during the 12 hours prior to the subject’s determination of block resolution from the highest VAS pain score in the 12 hours after resolution. 69 subjects completed the study. Outcomes were compared using Student’s t-tests. Results: Thirty-four subjects received a standard initial 0.5% ropivacaine bolus, while 35 received a 0.2% bolus. Chi-square testing and t-tests revealed no difference in any preoperative patient variables or procedural type/location between groups. Subjects receiving the lower 0.2% ropivacaine bolus had a lower rebound pain score (47.6) than those receiving the standard ropivacaine bolus (51.0), though not significantly (p=.679). The group receiving the lower concentration bolus only reported a higher mean VAS pain at 72 hours following surgery (39.6 vs. 25.7, p=.044) and more pain interference with sleep (p=.015) on postoperative day 5. The groups did not differ significantly (p>.05) on any day in terms of morphine equivalent units (MEUs) consumed, satisfaction with pain control, nausea, constipation, or nerve-related symptoms of tingling, numbness, and hypersensitivity. Conclusion: The utilization of a lower concentration initial local anesthetic bolus in continuous peripheral nerve blocks in foot and ankle surgery did not significantly lower rebound pain, but provided similar postoperative pain control as a standard local anesthestic bolus concentration. Further investigation with larger cohorts is needed to further optimize local anesthetic concentration in continuous nerve blocks in order to limit postoperative pain, side effects, and opioid intake following foot and ankle surgery.
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Lázaro, Miguel, Víctor Illera, Seila García, and José María Ruíz Sánchez de León. "Morphological Processing Of Complex And Simple Pseudo-words In Adults And Older Adults." Language and Cognition, April 11, 2022, 1–16. http://dx.doi.org/10.1017/langcog.2022.6.
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Abstract The role of morphemes in lexical recognition has been extensively explored in recent years, although the evidence from older adults is extremely scarce. In this study, we carry out a lexical decision task to assess the interference generated by morphological composition of pseudo-words (i.e., the longer and more error prone decisions on pseudo-words made up of morphemes in comparison to pseudo-words without morphological appearance) in a group of young and older adults (mean = 74 years). The results show the expected effect on both response latencies and error rates for both groups. The effect of imageability is also significant. The specific results for the older adults show an interaction between the morphological effect and cognitive reserve: older adults with higher levels of cognitive reserve are more sensitive to morphological interference than older adults with lower cognitive reserve. The overall results are interpreted based on current models of morphological processing and aging.
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Joassin, Frédéric, Pierre Maurage, and Salvatore Campanella. "Perceptual complexity of faces and voices modulates cross-modal behavioral facilitation effects." Neuropsychological Trends, no. 3 (April 2008). http://dx.doi.org/10.7358/neur-2008-003-joas.
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Joassin et al. (Neuroscience Letters, 2004, 369, 132-137) observed that the recognition of face-voice associations led to an interference effect, i.e. to decreased performances relative to the recognition of faces presented in isolation. In the present experiment, we tested the hypothesis that this interference effect could be due to the fact that voices were more difficult to recognize than faces. For this purpose, we modified some faces by morphing to make them as difficult to recognize as the voices. Twenty one healthy volunteers performed a recogniton task of previously learned face-voice associations in 5 conditions: voices (A), natural faces (V), morphed faces (V30), voice-natural face associations (AV) and voice-morphed faces associations (AV30). As expected, AV led to interference, as it was less well and slower performed than V. However, when faces were as difficult to recognize as voices, their simultaneous presentation produced a clear facilitation, AV30 being significantly better and faster performed than A and V30. These results demonstrate that matching or not the perceptual complexity of the unimodal stimuli modulates the potential cross-modal gains of the bimodal situations.
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Barzegari, Amir Abbas, and Kamran Shahabi. "Effects of Isoniazid on the Acquisition and Expression of Morphine Dependence in Male Mice." Pharmaceutical and Biomedical Research, May 7, 2022. http://dx.doi.org/10.18502/pbr.v7i4.9377.
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Background:GABAergic drugs have extensive interference with morphine’s pharmacological effects, including dependence.
Objectives:The present study was conducted to evaluate the effects of isoniazid, a GABAergic agent, on the acquisition and expression of morphine-induced dependence in male mice.
Methods: Sixty-four male mice were used. The mice became dependent on morphine by administrating ten doses of morphine in four days. For the precipitation of the morphine withdrawal signs (jumping, diarrhea, and weight loss), two hours after the last dose of morphine, the mice received naloxone (4 mg/kg, IP). In the expression experiment, four groups of mice received saline or isoniazid (25, 50, and 75 mg/kg, IP) one hour before naloxone. In the acquisition experiment, the other four groups, one hour before the first six doses of morphine, received saline or isoniazid (25, 50, and 75 mg/kg, IP).
Results: In the expression experiment, all doses of isoniazid decreased the number of jumping in mice, but only the lowest dose influenced diarrhea (increased weight of diarrheal stool) significantly. The higher doses of isoniazid (50 and 75 mg/kg, IP) caused a significant reduction in the percentage of weight loss, but its lowest dose (25 mg/kg, IP) significantly increased the sign. In the acquisition experiment, isoniazid (25, 50 mg/kg IP) decreased the number of jumping and the percentage of weight loss, but not the weight of diarrheal stool.
Conclusion: Isoniazid may be a good candidate to prevent morphine withdrawal signs.
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Huepenbecker, Sarah, Robert Tyler Hillman, Maria D. Iniesta, Tsun Chen, Katherine Cain, Gabriel Mena, Javier Lasala, et al. "Impact of a tiered discharge opioid algorithm on prescriptions and patient-reported outcomes after open gynecologic surgery." International Journal of Gynecologic Cancer, June 16, 2021, ijgc—2021–002674. http://dx.doi.org/10.1136/ijgc-2021-002674.
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ObjectiveTo compare discharge opioid refills, prescribed morphine equivalent dose and quantity, and longitudinal patient-reported outcomes before and after implementation of a tiered opioid prescribing algorithm among women undergoing open gynecologic surgery within an enhanced recovery after surgery program.MethodsWe compared opioid prescriptions, clinical outcomes, and patient-reported outcomes among 273 women. Post-discharge symptom burden was collected up to 42 days after discharge using the validated 27-item MD Anderson Symptom Inventory and analyzed using linear mixed effects models and Kaplan–Meier curves for symptom recovery.ResultsAmong 113 pre-implementation and 160 post-implementation patients there was no difference in opioid refills (9.7% vs 11.3%, p=0.84). The post-implementation cohort had a significant reduction in median morphine equivalent dose (112.5 mg vs 225 mg, p<0.01), with no difference in median hospital length of stay (3 days vs 3 days, p=1.0) or 30-day readmission rate (9.4% vs 7.1%, p=0.66). There was no difference in patient-reported pain between the pre- and post-implementation cohorts on the day of discharge (severity 4.93 vs 5.14, p=0.53) or in any patient-reported symptoms, interference measures, or composite scores by post-discharge day 7. The median recovery time for most symptoms was 7 days, except for pain (14 days), fatigue (18 days), and physical interference (21 days), with no differences between cohorts.ConclusionsAfter implementation of a tiered opioid prescribing algorithm, the quantity and dose of discharge opioids prescribed decreased with no change in post-operative refills and without negatively impacting patient-reported symptom burden or interference, which can be used to educate and reassure patients and providers.
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White, Samantha, Susan Bondy, Michelle Firestone, and Brian Rush. "Heroin Abuse among IDU and Local PO Dispensing Levels in Ontario Cities." University of Toronto Journal of Public Health 1, no. 1 (March 8, 2020). http://dx.doi.org/10.33137/utjph.v1i1.33831.
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Background: Amid Ontario’s growing opioid crisis, heroin abuse remains widespread in select urban areas and contributes to a large proportion of opioid overdoses provincially. Compared to prescription opioids (POs), heroin is especially hazardous to abuse since it is illicitly manufactured and frequently consumed by injection. PO abuse can also transition to heroin if access to preferred POs is impacted via diversion, dispensing or prescribing. However, the dynamics between preferences for heroin and local PO saturation (in this case, dispensing) are not well understood.
Methods: Heroin abuse data were gathered from PHAC’s I-Track surveillance system while PO dispensing data were from the Ontario Drug Benefit (ODB) claims database. Using an unmatched repeated cross-sectional design, datasets spanning 2003 to 2011 were merged. The hierarchical structure consisted of individual-level I-Track responses nested within year and again within five city-level (Kingston, London, Sudbury, Thunder Bay and Toronto) dispensing rates. Mixed-effects multilevel logistic regressions were used to examine relationships.
Results: Almost one third (30.5%) of I-Track respondents abused heroin in the previous six months with marked variation by city, from roughly half of Toronto participants (51.0%) to about one in twenty (5.2%) in Thunder Bay. The final multivariate model for heroin abuse contained morphine dispensing (OR=1.04, p=0.011), present age (OR=0.99, p=0.045) and age of first injection (OR=0.97, p≤0.001). That is, considering age and age of first injection, heroin abuse was 4.4% more likely among IDU with each increase in annual morphine dispensing rates in their respective cities.
Implications: The connection between heroin abuse and dispensing rates of chemically similar morphine, but not other POs, reflects a substitution effect for specific opioid types regardless of whether illicit or prescription. Precautions should be taken to prevent heroin abuse and establish harm reduction strategies before expected interference to local dispensing levels of any chemically analogous POs (particularly morphine).
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Garner, Jamani B., Laura S. Marshall, Nathaniel M. Boyer, Vinaya Alapatt, and Laurence L. Miller. "Effects of Ketoprofen and Morphine on Pain-Related Depression of Nestlet Shredding in Male and Female Mice." Frontiers in Pain Research 2 (June 8, 2021). http://dx.doi.org/10.3389/fpain.2021.673940.
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A primary goal in pain treatment is restoration of behaviors that are disrupted by pain. Measures of pain interference indicate the degree to which pain interferes with activities in pain patients, and these measures are used to evaluate the effects of analgesic drugs. As a result of the emphasis on the expression and treatment of functional impairment in clinical settings, preclinical pain researchers have attempted to develop procedures for evaluation of pain-related functional impairment in laboratory animals. The goal of the present study was to develop and validate a low cost procedure for the objective evaluation of pain-related depression of home cage behavior in mice. On test days, a 5 × 5 cm Nestlet was weighed prior to being suspended from the wire lid of the home cage of individually housed male and female ICR mice. Over the course of experimental sessions, mice removed pieces of the suspended Nestlet, and began to build a nest with the material they removed. Thus, the weight of the pieces of Nestlet that remained suspended at various time points in the session provided an indicator of the rate of this behavior. The results indicate that Nestlet shredding was stable with repeated testing, and shredding was depressed by intra-peritoneal injection of 0.32% lactic acid. The non-steroidal anti-inflammatory drug ketoprofen blocked 0.32% lactic acid-induced depression of shredding, but did not block depression of shredding by a pharmacological stimulus, the kappa opioid receptor agonist U69,593. The μ-opioid receptor agonist morphine did not block 0.32% lactic acid-induced depression of shredding when tested up to doses that depressed shredding in the absence of lactic acid. When noxious stimulus intensity was reduced by decreasing the lactic acid concentration to 0.18%, morphine was effective at blocking pain-related depression of behavior. In summary, the data from the present study support consideration of the Nestlet shredding procedure for use in studies examining mechanisms, expression, and treatment of pain-related functional impairment.
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McCarthy, Robert J., Ashley Meng Adams, Amanda C. Sremac, Wendy Jo Kreider, Pete L. Pelletier, and Asokumar Buvanendran. "Trajectories of opioid consumption from day of surgery to 28 days postoperatively: a prospective cohort study in patients undergoing abdominal, joint, or spine surgery." Regional Anesthesia & Pain Medicine, September 22, 2021, rapm—2021–102910. http://dx.doi.org/10.1136/rapm-2021-102910.
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IntroductionDescriptions of opioid use trajectories and their association with postsurgical pain and opioid consumption are limited. We hypothesized that trajectories of opioid consumption in the first 28 days following surgery would be associated with unique patterns of pain and duration of opioid use.MethodsA prospective longitudinal cohort of patients undergoing elective inpatient abdominal, joint, or spine surgery between June 2016 and June 2019 was studied. At hospital discharge and every 7 days for 28 days, patients were assessed for pain, analgesic use, pain interference, satisfaction, and side effects. Duration of opioid use was determined for 6 months. The primary analysis used latent class group modeling to identify trajectories of opioid use.ResultsDecreasing, high, and persistent opioid trajectories were identified following joint and spine surgery and a decreasing and persistent trajectory following abdominal surgery. Reported pain was greater in the high and persistent trajectories compared with the decreasing use trajectories. Compared with the decreasing opioid trajectory, the median duration of opioid use was increased by 4.5 (95% CI 1 to 22, p<0.01) weeks in persistent opioid use abdominal and by 6 (95% CI 0 to 6, p<0.01) weeks in the high or persistent use joint and spine groups. The odds (95% CI) of opioid use at 6 months in the high or persistent opioid use trajectory was 24.3 (2.9 to 203.4) for abdominal and 3.7 (1.9 to 7.0) for joint or spine surgery compared with the decreasing use trajectory. Morphine milliequivalent per 24 hours of hospitalization was the primary independent predictor of opioid use trajectories.ConclusionsWe observed distinct opioid use trajectories following abdominal and joint or spine surgery that were associated with different patterns of pain and duration of opioid use postoperatively. Prediction of postoperative opioid use trajectory groups may be clinically important for identifying risk of prolonged opioid use.