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Background: Overprescribing of opioids to patients following surgery is a public health concern, as unused pills may be diverted and contribute to opioid misuse and dependence. The objectives of this study were to determine current opioid-prescribing patterns for common surgical procedures, factors that affect surgeons' prescribing behaviour and their perceived ability to manage patients with opioid use disorder. Methods: Survey participants included all consultant and trainee surgeons at the University of Toronto. The survey, which was administered electronically, included 52 multiple-choice, rank-order and open-text questions eliciting information on current prescribing patterns, prescribing of adjunct pain medications, and education and other factors related to opioid prescribing. Staff surgeons were also asked about how they manage patients with a suspected opioid issue. Results: Eighty surgical trainees and 40 staff surgeons responded to the survey (response rate 32%). Five staff surgeons (12%) felt adequately educated to prescribe pain medications (including opioids) at discharge. Staff surgeons prescribed Tylenol 3 more frequently than other opioids. Twenty (51%) of 39 staff surgeons reported that they sought further help for their patients when an opioid use disorder was suspected. Conclusion: Our results support existing studies showing a large degree of variability in postoperative opioid prescribing. Institutional guidelines have been shown to be effective in curbing excessive opioid prescribing without increasing unnecessary emergency department visits for uncontrolled pain. Thus, there is an opportunity to develop institutional guidelines to educate surgical teams in the prescribing of opioids and about services available for patients with a substance use disorder. Contexte : La surprescription d'opioides aux patients apres une chirurgie represente un probleme de sante publique car il y a un risque que les comprimes inutilises soient detournes et utilises a mauvais escient, voire qu'ils causent la dependance. Cette etude avait pour objectif d'identifier les modes actuels de prescription des opioides pour les chirurgies courantes, les facteurs qui influent sur les habitudes de prescription des chirurgiens et leur capacite percue a prendre en charge les cas de mesusage des opioides. Methodes : Les participants au sondage etaient tous les chirurgiens en poste et en formation a l'Universite de Toronto. Ce sondage administre par voie electronique comprenait 52 questions (choix multiples, echelles ordinales et ouvertes) qui visaient a recueillir des renseignements sur les modes actuels de prescription, la prescription d'analgesiques d'appoint, l'enseignement au patient et autres elements relatifs a la prescription des opioides. Les chirurgiens en poste ont aussi ete interroges sur leur gestion des cas presumes de mesusage des opioides. Resultats : Quatre-vingt chirurgiens en formation et 40 chirurgiens en poste ont repondu au sondage (taux de reponse, 32 %). Cinq chirurgiens en poste (12 %) se sont estimes adequatement renseignes sur la facon de prescrire les analgesiques, (y compris les opioides) au moment du conge. Les chirurgiens en poste prescrivaient Tylenol 3 fois plus souvent que d'autres opioides. Vingt (51 %) chirurgiens en poste sur 39 ont dit consulter s'ils avaient besoin d'aide pour la prise en charge de patients soupconnes de presenter un probleme de mesusage des opioides. Conclusion : Nos resultats viennent etayer les conclusions d'etudes existantes selon lesquelles les modes de prescription des opioides en postoperatoire varient grandement. Il a ete demontre que l'adoption de lignes directrices institutionnelles permet de limiter efficacement la surprescription des opioides sans accroitre indument le nombre de consultations aux urgences pour douleur non maitrisee. Il y a donc la une possibilite d'adopter a plus grande echelle les lignes directrices institutionnelles pour sensibiliser les equipes chirurgicales a l'utilisation judicieuse des opioides et a l'existence des services a l'intention des patients qui presentent un probleme de mesusage., Recent studies have highlighted the practice of over-prescribing opioids to patients following surgery. (1-3) This topic has received much attention owing to public concern over the opioid epidemic. Overprescribing is [...]

Background/importance Patient selection for spinal cord stimulation (SCS) therapy is crucial and is traditionally performed with clinical selection followed by a screening trial. The factors influencing patient selection and the importance of trialing have not been systematically evaluated. Objective We report a narrative review conducted to synthesize evidence regarding patient selection and the role of SCS trials. Evidence review Medline, EMBASE and Cochrane databases were searched for reports (any design) of SCS in adult patients, from their inception until March 30, 2022. Study selection and data extraction were carried out using DistillerSR. Data were organized into tables and narrative summaries, categorized by study design. Importance of patient variables and trialing was considered by looking at their influence on the long-term therapy success. Findings Among 7321 citations, 201 reports consisting of 60 systematic reviews, 36 randomized controlled trials (RCTs), 41 observational studies (OSs), 51 registrybased reports, and 13 case reports on complications during trialing were included. Based on RCTs and OSs, the median trial success rate was 72% and 82%, and therapy success was 65% and 61% at 12 months, respectively. Although several psychological and nonpsychological determinants have been investigated, studies do not report a consistent approach to patient selection. Among psychological factors, untreated depression was associated with poor long-term outcomes, but the effect of others was inconsistent. Most RCTs except for chronic angina involved trialing and only one RCT compared patient selection with or without trial. The median (range) trial duration was 10 (0–30) and 7 (0–56) days among RCTs and OSs, respectively. Conclusions Due to lack of a consistent approach to identify responders for SCS therapy, trialing complements patient selection to exclude patients who do not find the therapy helpful and/or intolerant of the SCS system. However, more rigorous and large studies are necessary to better evaluate its role. [ABSTRACT FROM AUTHOR]

Introduction Cannabis and cannabinoids continue to gain popularity as adjuncts or alternatives to opioids in pain management, with evolving evidence of effectiveness. The relationship between cannabis and opioid use has previously been investigated in smaller cohorts or ecological samples, but not yet in a nationally representative sample. Methods A cross-sectional analysis of adults in the USA was undertaken using National Health and Nutrition Examination Survey (NHANES) data from 2009 to 2018. The primary exposure was self-reported use of at least one opioid-containing prescription medication in the 30 days prior to survey administration. The outcome of interest was self-reported cannabis use in the same period. Multivariable logistic regression was used to adjust for sociodemographic and health-related covariates, and NHANES survey sample weights were included in modeling. Prescription opioid users were then subclassified as short-term users (<90 days) or chronic users (=90 days) in secondary analysis. Results A total 10,928 survey respondents were included in analyses, representing 110 million adults in the USA aged 18-59. In this weighted cohort, 5.6%±0.4% reported a recent opioid prescription. Among prescription opioid users, 18.4%±3.1% reported recent cannabis use, not significantly different from 17.7%±0.7% among non-users (OR 1.05, 95% CI 0.81 to 1.36, p=0.714). After adjustment for covariates, opioid users were significantly less likely to have recently used cannabis (adjusted OR, aOR 0.70, 95% CI 0.51 to 0.97, p=0.032). When opioid users were subclassified by duration of prescription, there was no detectable difference in recent cannabis use between chronic opioid users and short-term opioid users (aOR 1.11, 95% CI 0.70 to 1.78, p=0.649). Conclusion Recent prescription opioid use was associated with decreased odds of cannabis use in this cross-sectional analysis of a nationally representative cohort. These findings suggest that use of cannabis or prescription opioids may not independently promote use of the other. [ABSTRACT FROM AUTHOR]