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  1. Book ; Online ; E-Book: The right to pain relief and other deep roots of the opioid epidemic

    Sullivan, Mark D. / Ballantyne, Jane

    2023  

    Abstract: Containing patient vignettes as well as scientific and policy controversies that have emerged as the opioid epidemic has evolved, 'The Right to Pain Relief and Other Deep Roots of the Opioid Epidemic' examines the ethical and scientific concepts about ... ...

    Author's details Mark D. Sullivan and Jane C. Ballantyne
    Abstract Containing patient vignettes as well as scientific and policy controversies that have emerged as the opioid epidemic has evolved, 'The Right to Pain Relief and Other Deep Roots of the Opioid Epidemic' examines the ethical and scientific concepts about pain that made the opioid epidemic possible and offers a new lens through which to view the opioid epidemic as a consequence of serious misunderstandings of both opioids and pain.
    Keywords Chronic pain/Treatment ; Drugs/Side effects ; Opioid abuse ; Health and Wellbeing ; Clinical & internal medicine
    Subject code 616.0472
    Language English
    Size 1 online resource (230 pages) :, illustrations
    Publisher Oxford University Press
    Publishing place New York, NY
    Document type Book ; Online ; E-Book
    Note Also issued in print: 2023.
    Remark Zugriff für angemeldete ZB MED-Nutzerinnen und -Nutzer
    ISBN 0-19-761575-9 ; 0-19-761573-2 ; 0-19-761574-0 ; 9780197615720 ; 978-0-19-761575-1 ; 978-0-19-761573-7 ; 978-0-19-761574-4 ; 0197615724
    DOI 10.1093/med/9780197615720.001.0001
    Database ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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  2. Article ; Online: Randomised trial reveals opioids relieve acute back pain no better than placebo.

    Sullivan, Mark D / Ballantyne, Jane C

    Lancet (London, England)

    2023  Volume 402, Issue 10398, Page(s) 267–269

    MeSH term(s) Humans ; Analgesics, Opioid/therapeutic use ; Back Pain/drug therapy ; Low Back Pain/drug therapy ; Acute Pain/drug therapy
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2023-06-28
    Publishing country England
    Document type Randomized Controlled Trial ; Journal Article ; Comment
    ZDB-ID 3306-6
    ISSN 1474-547X ; 0023-7507 ; 0140-6736
    ISSN (online) 1474-547X
    ISSN 0023-7507 ; 0140-6736
    DOI 10.1016/S0140-6736(23)00671-2
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  3. Article ; Online: Questioning the Right to Pain Relief and Its Role in the Opioid Epidemic.

    Sullivan, Mark D / Ballantyne, Jane C

    Mayo Clinic proceedings

    2023  Volume 98, Issue 8, Page(s) 1216–1224

    Abstract: The new discipline of palliative care helped to establish the right to pain relief at the end of life and the necessity of using opioids to achieve that goal. Professional pain organizations followed the United Nations' model for universal human rights ... ...

    Abstract The new discipline of palliative care helped to establish the right to pain relief at the end of life and the necessity of using opioids to achieve that goal. Professional pain organizations followed the United Nations' model for universal human rights in their declaration of a universal right to pain management. Both palliative care and pain medicine specialties worked to establish pain as a legitimate focus of medical treatment separate from its association with disease. Pain intensity became the metric used to determine the need for treatment and the success of that treatment. Opioids were favored as the most reliable and feasible means to reduced pain intensity. The Harrison Act of 1914 restricted legitimate opioid use to that prescribed by medical professionals as analgesics. This legislation helped establish opioids as specific painkillers that had a distinct capacity to induce addiction. This understanding of opioids as having distinct and separable analgesic and addictive potential was challenged by the 1970s discovery of an endogenous opioid system, which integrates pain and reward functions to support survival. Our modern pain neurophysiology places the patient with pain in a passive position from which it makes sense to assert a right to pain relief. To prevent future opioid epidemics we need to abandon clinical outpatient use of pain intensity scores and redefine the medical necessity of pain treatment as less about the reduction of pain intensity and more about the capacity to pursue personally valued activities.
    MeSH term(s) Humans ; Analgesics, Opioid/adverse effects ; Pain Management ; Opioid Epidemic ; Pain/drug therapy ; Palliative Care
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2023-07-07
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 124027-4
    ISSN 1942-5546 ; 0025-6196
    ISSN (online) 1942-5546
    ISSN 0025-6196
    DOI 10.1016/j.mayocp.2023.03.008
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  4. Article ; Online: Understanding the Risks of Long-Term Opioid Therapy for Chronic Pain.

    Sullivan, Mark D / Ballantyne, Jane C

    The American journal of psychiatry

    2022  Volume 179, Issue 10, Page(s) 696–698

    MeSH term(s) Analgesics, Opioid/adverse effects ; Chronic Pain/drug therapy ; Humans ; Opioid-Related Disorders/drug therapy
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2022-09-30
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 280045-7
    ISSN 1535-7228 ; 0002-953X
    ISSN (online) 1535-7228
    ISSN 0002-953X
    DOI 10.1176/appi.ajp.20220592
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  5. Article ; Online: Is Chronic Pain a Disease?

    Ballantyne, Jane C / Sullivan, Mark D

    The journal of pain

    2022  Volume 23, Issue 10, Page(s) 1651–1665

    Abstract: It was not until the twentieth century that pain was considered a disease. Before that it was managed medically as a symptom. The motivations for declaring chronic pain a disease, whether of the body or of the brain, include increasing its legitimacy as ... ...

    Abstract It was not until the twentieth century that pain was considered a disease. Before that it was managed medically as a symptom. The motivations for declaring chronic pain a disease, whether of the body or of the brain, include increasing its legitimacy as clinical problem and research focus worthy of attention from healthcare and research organizations alike. But 1 problem with disease concepts is that having a disease favors medical solutions and tends to reduce patient participation. We argue that chronic pain, particularly chronic primary pain (recently designated a first tier pain diagnosis in International Diagnostic Codes 11), is a learned state that is not intransigent even if it has biological correlates. Chronic pain is sometimes a symptom, and may sometimes be its own disease. But here we question the value of a disease focus for much of chronic pain for which patient involvement is essential, and which may need a much broader societal approach than is suggested by the disease designation. PERSPECTIVE: This article examines whether designating chronic pain a disease of the body or brain is helpful or harmful to patients. Can the disease designation help advance treatment, and is it needed to achieve future therapeutic breakthrough? Or does it make patients over-reliant on medical intervention and reduce their engagement in the process of recovery?
    MeSH term(s) Chronic Pain/diagnosis ; Chronic Pain/therapy ; Humans
    Language English
    Publishing date 2022-05-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2018789-0
    ISSN 1528-8447 ; 1526-5900
    ISSN (online) 1528-8447
    ISSN 1526-5900
    DOI 10.1016/j.jpain.2022.05.001
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  6. Article ; Online: The Right to Pain Relief: Its Origins in End-of-life Care and Extension to Chronic Pain Care.

    Sullivan, Mark D / Ballantyne, Jane C

    The Clinical journal of pain

    2021  Volume 38, Issue 1, Page(s) 58–63

    Abstract: Objectives: The claim of a right to pain relief was made in recent decades by pain professionals, courts, and patient advocacy groups and likely contributed to increased opioid prescribing, overdose deaths, and addictions, but the origins and nature of ... ...

    Abstract Objectives: The claim of a right to pain relief was made in recent decades by pain professionals, courts, and patient advocacy groups and likely contributed to increased opioid prescribing, overdose deaths, and addictions, but the origins and nature of this right have not been investigated.
    Materials and methods: Relevant clinical, ethical, and legal literature concerning patient rights to pain care was reviewed.
    Results: The record describes the effort to improve end-of-life and cancer pain care in the 1980s and 1990s, which simultaneously legitimated pain relief as an independent goal of medical care and opioids as a safe and effective means to achieve this relief. In 1997, the US Supreme Court denied the right to assisted suicide but affirmed a right to palliative care to prevent dying in overwhelming pain. Other guidelines and regulations extended this right to pain relief from end-of-life care to chronic pain care, along with the titrate-to-effect principle, which specified that the correct opioid dose was the dose that relieved pain.
    Discussion: The most important consequence of combining the right to pain relief with the titrate-to-effect principle was the idea that a high pain score must not be ignored. This extension of the right to pain relief neglected important differences between end-of-life care and chronic pain care including: time frame, clinical setting and context, target of titration, and nature of iatrogenic harms. To help end our current opioid epidemic and prevent a future epidemic, we need to demedicalize pain and reintegrate it with the rest of human suffering as an experience connected to other personal behaviors and meanings.
    MeSH term(s) Analgesics, Opioid/therapeutic use ; Chronic Pain/drug therapy ; Humans ; Palliative Care ; Practice Patterns, Physicians' ; Terminal Care
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2021-10-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632582-8
    ISSN 1536-5409 ; 0749-8047
    ISSN (online) 1536-5409
    ISSN 0749-8047
    DOI 10.1097/AJP.0000000000001000
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  7. Article ; Online: When Physical and Social Pain Coexist: Insights Into Opioid Therapy.

    Sullivan, Mark D / Ballantyne, Jane C

    Annals of family medicine

    2020  Volume 19, Issue 1, Page(s) 79–82

    Abstract: The US opioid epidemic challenges us to rethink our understanding of the function of opioids and the nature of chronic pain. We have neatly separated opioid use and abuse as well as physical and social pain in ways that may not be consistent with the ... ...

    Abstract The US opioid epidemic challenges us to rethink our understanding of the function of opioids and the nature of chronic pain. We have neatly separated opioid use and abuse as well as physical and social pain in ways that may not be consistent with the most recent neuroscientific and epidemiological research. Physical injury and social rejection activate similar brain centers. Many of the patients who use opioid medications long term for the treatment of chronic pain have both physical and social pain, but these medications may produce a state of persistent opioid dependence that suppresses the endogenous opioid system that is essential for human socialization and reward processing. Recognition of the social aspects of chronic pain and opioid action can improve our treatment of chronic pain and our use of opioid medications.
    MeSH term(s) Analgesics, Opioid/adverse effects ; Analgesics, Opioid/therapeutic use ; Chronic Pain/drug therapy ; Humans ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology ; Psychological Distance ; Social Isolation/psychology
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2020-12-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2171425-3
    ISSN 1544-1717 ; 1544-1709
    ISSN (online) 1544-1717
    ISSN 1544-1709
    DOI 10.1370/afm.2591
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  8. Article ; Online: Clonal Hematopoiesis Risk Score and All-Cause and Cardiovascular Mortality in Older Adults.

    Saadatagah, Seyedmohammad / Uddin, Md Mesbah / Weeks, Lachelle D / Niroula, Abhishek / Ru, Meng / Takahashi, Koichi / Gondek, Lukasz / Yu, Bing / Bick, Alexander G / Ebert, Benjamin L / Platz, Elizabeth A / Natarajan, Pradeep / Ballantyne, Christie M

    JAMA network open

    2024  Volume 7, Issue 1, Page(s) e2351927

    Abstract: Importance: Clonal hematopoiesis (CH) with acquired pathogenic variants in myeloid leukemia driver genes is common in older adults but of unknown prognostic value.: Objective: To investigate the prevalence of CH and the utility of the CH risk score ( ... ...

    Abstract Importance: Clonal hematopoiesis (CH) with acquired pathogenic variants in myeloid leukemia driver genes is common in older adults but of unknown prognostic value.
    Objective: To investigate the prevalence of CH and the utility of the CH risk score (CHRS) in estimating all-cause and disease-specific mortality in older adults with CH.
    Design, setting, and participants: This population-based prospective cohort study involved community-dwelling older adults (aged 67-90 years) without hematologic malignant neoplasms (HMs) who were participants in the Atherosclerosis Risk in Communities Visit 5 at 4 US centers: Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; and Washington County, Maryland. Samples were collected from 2011 to 2013, sequencing was performed in 2022, and data analysis was completed in 2023.
    Exposure: The exposure was a diagnosis of CH. CHRS scores (calculated using 8 demographic, complete blood cell count, and molecular factors) were used to categorize individuals with CH into low-risk (CHRS ≤9.5), intermediate-risk (CHRS >9.5 to <12.5), and high-risk (CHRS ≥12.5) groups.
    Main outcomes and measures: The primary outcome was all-cause mortality, and secondary outcomes were HM mortality, cardiovascular disease mortality, and death from other causes.
    Results: Among 3871 participants without a history of HM (mean [SD] age, 75.7 [5.2] years; 2264 [58.5%] female individuals; 895 [23.1%] Black individuals; 2976 White individuals [76.9%]), 938 (24.2%) had CH. According to the CHRS, 562 (59.9%) were low risk, 318 (33.9%) were intermediate risk, and 58 (6.2%) were high risk. During a median (IQR) follow-up of 7.13 (5.63-7.78) years, 570 participants without CH (19.4%) and 254 participants with CH (27.1%) died. Mortality by CHRS risk group was 128 deaths (22.8%) for low risk, 93 (29.2%) for intermediate risk, and 33 (56.9%) for high risk. By use of multivariable competing risk regression, subdistribution hazard ratios (sHRs) for all-cause mortality were 1.08 (95% CI, 0.89-1.31; P = .42) for low-risk CH, 1.12 (95% CI, 0.89-1.41; P = .31) for intermediate-risk CH, and 2.52 (95% CI, 1.72-3.70; P < .001) for high-risk CH compared with no CH. Among individuals in the high-risk CH group, the sHR of death from HM (6 deaths [10.3%]) was 25.58 (95% CI, 7.55-86.71; P < .001) and that of cardiovascular death (12 deaths [20.7%]) was 2.91 (95% CI, 1.55-5.47; P < .001).
    Conclusions and relevance: In this cohort study, the CHRS was associated with all-cause, HM-related, and cardiovascular disease mortality in older adults with CH and may be useful in shared decision-making to guide clinical management and identify appropriate candidates for clinical trials.
    MeSH term(s) Female ; Humans ; Aged ; Male ; Cardiovascular Diseases ; Clonal Hematopoiesis ; Cohort Studies ; Prospective Studies ; Risk Factors
    Language English
    Publishing date 2024-01-02
    Publishing country United States
    Document type Journal Article
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2023.51927
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  9. Article ; Online: Reconsidering Fordyce's classic article, "Pain and suffering: what is the unit?" to help make our model of chronic pain truly biopsychosocial.

    Sullivan, Mark D / Sturgeon, John A / Lumley, Mark A / Ballantyne, Jane C

    Pain

    2022  Volume 164, Issue 2, Page(s) 271–279

    Abstract: Abstract: The biopsychosocial model (BPS) of chronic pain aspires to be comprehensive, incorporating psychological and social factors omitted from biomedical models. Although psychosocial factors are viewed as highly influential in understanding ... ...

    Abstract Abstract: The biopsychosocial model (BPS) of chronic pain aspires to be comprehensive, incorporating psychological and social factors omitted from biomedical models. Although psychosocial factors are viewed as highly influential in understanding behavioral and psychological responses to pain, these factors are usually viewed as modifiers of biological causes of the experience of pain itself, rather than as equal contributors to pain. To further advance the BPS model, we re-examine a classic 1994 article by Wilbert "Bill" Fordyce, "Pain and suffering: what is the unit?" In this article, Fordyce suggested that pain-related disability and suffering should be viewed as "transdermal," as having causes both inside and outside the body. We consider Fordyce's article theoretically important because this concept allows us to more fully break free of the medical model of chronic pain than customary formulations of the BPS model. It makes it possible to place psychological and social factors on an equal footing with biological ones in explaining pain itself and to remove distinctions between pain mechanisms and pain meanings. The brain's salience network now offers a platform on which diverse influences on pain experience-from nociception to multisensory indicators of safety or danger-can be integrated, bridging the gap between impersonal nociceptive mechanisms and personal meanings. We also argue that Fordyce's article is practically important because this concept expands the BPS model beyond the bounds of the clinical encounter, opening the door to the full range of social, psychological, and biological interventions, empowering patients and nonmedical providers to tackle chronic pain.
    MeSH term(s) Humans ; Chronic Pain ; Anxiety/etiology ; Disabled Persons ; Nociception ; Administration, Cutaneous
    Language English
    Publishing date 2022-08-15
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 193153-2
    ISSN 1872-6623 ; 0304-3959
    ISSN (online) 1872-6623
    ISSN 0304-3959
    DOI 10.1097/j.pain.0000000000002748
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  10. Article ; Online: Efficacy and safety of bempedoic acid in patients with and without metabolic syndrome: Pooled analysis of data from four phase 3 clinical trials.

    Shapiro, Michael D / Taub, Pam R / Louie, Michael J / Lei, Lei / Ballantyne, Christie M

    Atherosclerosis

    2023  Volume 378, Page(s) 117182

    Abstract: Background and aims: Bempedoic acid significantly lowers low-density lipoprotein cholesterol (LDL-C) in patients with hypercholesterolemia but its effects in patients with metabolic syndrome (MetS) have not been well characterized. We sought to ... ...

    Abstract Background and aims: Bempedoic acid significantly lowers low-density lipoprotein cholesterol (LDL-C) in patients with hypercholesterolemia but its effects in patients with metabolic syndrome (MetS) have not been well characterized. We sought to determine the efficacy and safety of bempedoic acid in patients with hypercholesterolemia by baseline MetS status.
    Methods: This study used pooled data from four phase 3 studies. Using modified International Atherosclerosis Society guidelines, patients were grouped into two pools: those with and those without MetS. Patients with diabetes were excluded. Endpoints assessed change from baseline to week 12 in lipid and glycemic parameters and high-sensitivity C-reactive protein (hsCRP), and safety.
    Results: The study included 936 patients with MetS (bempedoic acid, 648; placebo, 288) and 1573 without MetS (bempedoic acid, 1037; placebo, 536). Significant placebo-corrected reductions in LDL-C were observed with bempedoic acid (p < 0.0001), with a slightly larger decrease in patients with vs. without MetS (-22.3% vs. -18.4%; interaction p = 0.0472). Compared with placebo, bempedoic acid significantly (p < 0.0001) lowered total cholesterol, non-high-density lipoprotein cholesterol, apolipoprotein B, and hsCRP, with a similar magnitude of benefit observed between MetS categories. Triglycerides increased with bempedoic acid but only to a lesser extent than with placebo in patients without MetS (placebo-corrected difference, -4.4%; p = 0.02). Only patients with MetS experienced decreases in glycated hemoglobin (-0.07%; p < 0.0001) and fasting plasma glucose (-2.4 mg/dL; p = 0.002). Safety was comparable between MetS categories and treatment groups.
    Conclusions: These data suggest that bempedoic acid is a suitable therapy for patients with and without MetS who require additional lipid lowering.
    MeSH term(s) Humans ; Hypercholesterolemia/diagnosis ; Hypercholesterolemia/drug therapy ; Cholesterol, LDL ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Metabolic Syndrome/diagnosis ; Metabolic Syndrome/drug therapy ; C-Reactive Protein ; Fatty Acids/adverse effects ; Dicarboxylic Acids/adverse effects ; Cholesterol ; Treatment Outcome ; Anticholesteremic Agents/therapeutic use
    Chemical Substances 8-hydroxy-2,2,14,14-tetramethylpentadecanedioic acid (1EJ6Z6Q368) ; Cholesterol, LDL ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; C-Reactive Protein (9007-41-4) ; Fatty Acids ; Dicarboxylic Acids ; Cholesterol (97C5T2UQ7J) ; Anticholesteremic Agents
    Language English
    Publishing date 2023-06-29
    Publishing country Ireland
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80061-2
    ISSN 1879-1484 ; 0021-9150
    ISSN (online) 1879-1484
    ISSN 0021-9150
    DOI 10.1016/j.atherosclerosis.2023.06.973
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