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Objective. To evaluate current opioid prescribing patterns nationally and regionally across several northern New England states and compare with prescription data on an institutional level over a twoyear period, between 2013 and 2014. Design, Setting, and Subjects. The IMS Health National Prescription Audit (NPA) database was used to obtain prescription data from US retail pharmacies between 2013 and 2014. Methods. Our study compared noninjectable opioid dispensing between two time periods: January-June 2013 and July-December 2014. Opioid prescription data were obtained nationally and in New Hampshire, Vermont, Maine, and Massachusetts. Institutional prescription data were supplied by Dartmouth Hitchcock Medical Center (DHMC) and University of Vermont Medical Center (UVMC) pharmacies. Results. There was a 3.4% (P50.81) decrease in opioid prescriptions filled nationally. Among New England states, opioid prescribing decreased in Maine (25.20%, P50.72), Massachusetts (24.4%, P50.78), and Vermont (22.2%, P50.89) but increased in New Hampshire by 1.3% (P50.94). Examination of local institutional opioid utilization revealed a 13.6% decline in prescriptions filled at UVMC, and only a 0.4% decrease at DHMC. Conclusions. The review of opioid prescriptions filled in 2013-14 suggests that national opioid utilization may be reaching a plateau. Initiatives such as prescription monitoring programs, prescriber opioid education, addiction treatment programs, public addiction awareness, and availability of medical cannabis may play a role in interstate variability of opioid use. National and regional data served as a benchmark for local institutional comparison, laying groundwork for efforts to explore areas where opioids can be prescribed more judiciously. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether grouping of patients with back pain into similar behavioral patient profiles using SF-36 scores is predictive of outcome following 1-year treatment in a multidisciplinary spine center beginning with referral for epidural steroid injection., Design: A prospective observational study was conducted on 81 consecutive patients selected for epidural steroid injections by independent physicians following common institutional criteria. Each patient completed a baseline SF-36 questionnaire as well as a numerical response pain scale. The initial SF-36 data were used to place each patient into one of three subgroups (Highly Functional, Emotional Adapters, and Dysfunctional). Follow-up SF-36 and numerical response pain scale questionnaires were completed by the patients at 1 month and 12 months following the initial epidural steroid injection., Results: Results revealed significant improvement among all three patient subgroups following multidisciplinary treatment at both 1 month and 12 months. Few differences in outcome occurred among the subgroups., Conclusion: The SF-36-determined subgroups did not predict response to a multidisciplinary pain clinic. All three subgroups showed similar improvement following treatment.