AHRQ systematic review

Purpose of Review

To assess the effectiveness and harms of opioid therapy for chronic noncancer pain, alternative opioid dosing strategies, and risk mitigation strategies. 

Key Messages

• Opioids are associated with small improvements versus placebo in pain and function, and increased risk of harms at short-term (1 to <6 months) followup; evidence on long-term effectiveness is very limited, and there is evidence of increased risk of serious harms that appear to be dose dependent.
• At short-term followup, evidence showed no differences between opioids versus nonopioid medications in improvement in pain, function, mental health status, sleep, or depression.
• Evidence on the effectiveness and harms of alternative opioid dosing strategies and the effects of risk mitigation strategies is lacking, although provision of naloxone to patients might reduce the likelihood of opioid-related emergency department visits, a taper support intervention might improve functional outcomes compared to no taper support, and co-prescription of benzodiazepines and gabapentinoids might increase risk of overdose.
• No instrument has been shown to be associated with high accuracy for predicting opioid overdose, addiction, abuse, or misuse.

1. Nonopioid Pharmacologic Treatments for Chronic Pain

AHRQ systematic review  

Purpose of Review

Evaluate the benefits and harms of nonopioid drugs in randomized controlled trials of patients with specific types of chronic pain, considering the effects on pain, function, quality of life, and adverse events.

Key Messages

• In the short term, improvement in pain and function was small with specific anticonvulsants, moderate with specific antidepressants in diabetic peripheral neuropathy/post-herpetic neuralgia and fibromyalgia, and small with nonsteroidal anti-inflammatory drugs (NSAIDs) in osteoarthritis and inflammatory arthritis.
• In the intermediate term, evidence was limited, with evidence of benefit for memantine in fibromyalgia and for serotonin norepinephrine reuptake inhibitor (SNRI) antidepressants in low back pain and fibromyalgia.
• In the long term, evidence was too limited to draw conclusions. In general, evidence on quality of life was limited and no treatment achieved a large improvement in pain or function.
• Small to moderate, dose-dependent increases in withdrawal due to adverse events were found with SNRIs duloxetine and milnacipran, anticonvulsants pregabalin and gabapentin, and NSAIDs. Large increases were seen with oxcarbazepine. NSAIDs have increased risk of serious gastrointestinal, liver dysfunction, and cardiovascular adverse events.

2. Noninvasive Nonpharmacological Treatment for Chronic Pain

A Systematic Review Update

Purpose of Review

To assess noninvasive nonpharmacological treatments for common chronic pain conditions.

Key Messages

• Interventions that improved function and/or pain for ≥1 month:
• Some interventions did not improve function or pain.
• Serious harms were not observed with the interventions.

At the conclusion of the session, the participant will be able to accomplish the following:

• Describe the burden of multidrug-resistant organisms (MDROs).
• Describe challenges to preventing MDRO transmission in nursing homes.
• Define Standard Precautions, Enhanced Barrier Precautions, and Contact Precautions.
• Identify which residents and activities meet criteria for Enhanced Barrier Precautions.
• Discuss best practices for implementing Enhanced Barrier Precautions.

The U.S. Department of Health and Human Services published a new Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics - PDF. Individual patients, as well as the health of the public, benefit when opioids are prescribed only when the benefit of using opioids outweighs the risks.  But once a patient is on opioids for a prolonged duration, any abrupt change in the patient’s regimen may put the patient at risk of harm and should include a thorough, deliberative case review and discussion with the patient. The HHS Guide provides advice to clinicians who are contemplating or initiating a change in opioid dosage.

“Care must be a patient-centered experience. We need to treat people with compassion, and emphasize personalized care tailored to the specific circumstances and unique needs of each patient,” said Adm. Brett P. Giroir, M.D., assistant secretary for health. “This Guide provides more resources for clinicians to best help patients achieve the dual goals of effective pain management and reduction in the risk for addiction.”

Clinicians have a responsibility to coordinate patients’ pain treatment and opioid-related problems. In certain situations, a reduced opioid dosage may be indicated, in joint consultation with the care team and the patient. HHS does not recommend opioids be tapered rapidly or discontinued suddenly due to the significant risks of opioid withdrawal, unless there is a life-threatening issue confronting the individual patient.

Compiled from published guidelines and practices endorsed in the peer-reviewed literature, the Guide covers important issues to consider when changing a patient’s chronic pain therapy. It lists issues to consider prior to making a change, which include shared decision-making with the patient; issues to consider when initiating the change; and issues to consider as a patient’s dosage is being tapered, including the need to treat symptoms of opioid withdrawal and provide behavioral health support. 

EVS personnel play a critical role in preventing the spread of germs and healthcare-associated infections

“EVS and the Battle Against Infection” is an interactive graphic novel illustrating the important role of EVS personnel in the prevention of healthcare-associated infections. The online version of the training tool features real-world infection prevention and control scenarios and allows participants to choose options that affect the outcome of the story. 

Healthcare professionals are the first line of defense against healthcare-associated infections (HAIs) and the spread of germs in healthcare settings. CDC now offers a new online interactive infection control training, “Let’s Talk Patient Safety: Reducing HAI Transmission Risk,” to help healthcare professionals identify infection risks and prevent the spread of HAIs. The training provides free continuing education for healthcare professionals, including nurses, physician assistants, medical assistants, health educators, and other clinicians. (0.1 CEU and 0.6 CNE).

The free online training can be completed anywhere. It has two modules and takes approximately 30 minutes to complete the entire training.

Module 1: “What’s the Risk?” 

This interactive module transports healthcare professionals into a scenario where they must identify infection risks and take action to protect patients, colleagues, and visitors. 

Module 2: “Chain of Infection” 

This story-based interactive module challenges professionals to break the chain of infection in a busy healthcare environment and educates them on the consequences of not following infection prevention and control recommendations.