Co-prescribing of antidepressants and opioids for non-cancer pain in England, 2010-2019: a descriptive study using CPRD primary care electronic health records.

Background: There is a complex relationship between pain and mood disorders, and interactions between opioids and antidepressants can affect the effectiveness and adverse effects of these medicines when taken together. However, little is known about the scale of co-prescription for these medicines.

Methods: We used routinely collected primary care data from the Clinical Practice Research Datalink to describe the extent of opioid and antidepressant co-prescribing in over 4.

Determining the most frequent combinations of drugs prescribed prior to bullous pemphigoid diagnosis using association rule mining: a UK population-based case-control study.

Background: Bullous pemphigoid (BP) is a serious autoimmune skin disease affecting older people. Given the highly prevalent polypharmacy in older people, identifying drug combinations associated with high BP risk is needed.

Objectives: To identify drug combinations frequently prescribed for older people prior to BP using association rule mining (ARM) and estimate their BP risk.

Non-insulin diabetes medicines: a narrative review for anaesthetists and intensivists.

Diabetes mellitus is characterised by an increased blood glucose concentration. Over the past two decades, multiple new agents have emerged to help treat the condition, of which several classes of agent have been shown to reduce the risk of cardiovascular morbidity and mortality. In addition, there have been several developments in the pharmacology of non-insulin diabetes medicines, working on different aspects of gut and renal glucose absorption, hepatic metabolism, insulin sensitivity, and incretin hormone physiology.

Development of insulin and its pharmacology and perioperative use: a narrative review.

Diabetes mellitus is characterised by an elevated blood glucose concentration. Over the last two decades, a plethora of new agents have emerged to help treat the condition, of which several classes of agent have been shown to reduce the risk of cardiovascular morbidity and mortality. In addition, there have been several developments in the pharmacology of insulin, improving the pharmacokinetics and pharmacodynamics of insulin analogues to better mimic physiological insulin concentrations in the liver, skeletal muscle, and other tissues.

Patterns of analgesic utilisation among people with knee osteoarthritis: a cohort study using UK primary care data.

Background: Osteoarthritis (OA) is a prevalent disabling joint disease affecting more than 300 million people globally and knees are most commonly affected. It is associated with pain and functional limitation that adversely affect mental well-being and compromise quality of life. Analgesic use is common among patients with knee osteoarthritis (KOA), however, data on patterns of analgesics use at an individual patient level are sparse.

Difficulties with prescribed opioids: a cross-sectional survey of primary care patients in England, United Kingdom.

Introduction: Knowledge of the potential for harm and adverse effects from long-term opioid medicines has led to reduced prescribing in recent years. However, the number of patients receiving opioid prescriptions from primary care in England remains substantial and understanding the difficulties patients experience with these medicines is important for the provision of care.

Objective: To understand the difficulties experienced by patients prescribed opioids for noncancer pain in primary care.

Association between drugs and vaccines commonly prescribed to older people and bullous pemphigoid: a case-control study.

Background: Bullous pemphigoid (BP) is an autoimmune skin disease that mainly affects older people. Based on case series and small hospital-based studies, a number of drugs have been associated with BP. More reliable and precise estimates of associations between a broad selection of drugs/vaccines and BP will enable greater awareness of any potential increased risk of BP following the administration of certain medicines and help identify clinical, histological and genomic characteristics of drug-induced BP for different culprit drugs.

Peri-operative pain management in adults: a multidisciplinary consensus statement from the Association of Anaesthetists and the British Pain Society.

Background: Nearly half of adult patients undergoing surgery experience moderate or severe postoperative pain. Inadequate pain management hampers postoperative recovery and function and may be associated with adverse outcomes. This multidisciplinary consensus statement provides principles that might aid postoperative recovery, and which should be applied throughout the entire peri-operative pathway by healthcare professionals, institutions and patients.

"Application of five different strategies to define a cohort of patients with knee osteoarthritis in a large primary care database".

Background: Electronic health records (EHR) are frequently used for epidemiological research including drug utilisation studies in a defined population such as the population with knee osteoarthritis (KOA). We sought to describe the process of defining a cohort of patients with KOA from a large UK primary care database and estimate the annual incidence of diagnosed KOA between 2000 and 2015.

Method: This was a retrospective study using data from the clinical practice research datalink (CPRD).

Temporal trends and patterns in initial opioid prescriptions after hospital discharge following colectomy in England over 10 years.

Background: While opioid analgesics are often necessary for the management of acute postoperative pain, appropriate prescribing practices are crucial to avoid harm. The aim was to investigate the changes in the proportion of people receiving initial opioid prescriptions after hospital discharge following colectomy, and describe trends and patterns in prescription characteristics.

Methods: This was a retrospective cohort study.

Chronic Low Back Pain with and without Concomitant Osteoarthritis: A Retrospective, Longitudinal Cohort Study of Patients in England.

Objective: Despite the high prevalence of chronic low back pain (CLBP) and osteoarthritis (OA), few estimates of the economic cost of these conditions in England have been published. The aim of the present analysis was to characterise the economic burden of moderate-to-severe pain associated with CLBP + OA and CLBP alone compared with general population-matched controls without CLBP or OA. The primary objective was to describe the total healthcare resource use (HCRU) and direct healthcare costs associated with the target patient populations.

Pandemic impact and adaptation to telehealth in chronic pain treatment providers across two COVID-19 pandemic years.

Objectives: The COVID-19 pandemic has had substantial impacts for both people using pain services and healthcare professionals delivering them. While the effects on service users have been studied, less is known about the effects for service providers. This study aimed to assess the impact of the pandemic on providers and the evolving role of telemedicine in treatment.

Frequency and impact of medication reviews for people aged 65 years or above in UK primary care: an observational study using electronic health records.

Background: Medication reviews in primary care provide an opportunity to review and discuss the safety and appropriateness of a person's medicines. However, there is limited evidence about access to and the impact of routine medication reviews for older adults in the general population, particularly in the UK. We aimed to quantify the proportion of people aged 65 years and over with a medication review recorded in 2019 and describe changes in the numbers and types of medicines prescribed following a review.

Analgesic utilization in people with knee osteoarthritis: A population-based study using primary care data.

Purpose: Osteoarthritis (OA) is a chronic painful condition that often affects large joints such as the knee. Treatment guidelines recommend paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids. Antidepressants and anti-epileptic drugs (AEDs) are commonly prescribed for chronic noncancer pain conditions including OA, as an off-label use.

Phenotyping Post-COVID Pain as a Nociceptive, Neuropathic, or Nociplastic Pain Condition.

Pain after an acute Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) condition (post-COVID pain) is becoming a new healthcare emergency. Precision medicine refers to an evidence-based method of grouping patients based on their diagnostic/symptom presentation and then tailoring specific treatments accordingly. Evidence suggests that post-COVID pain can be categorized as nociceptive (i.

Misappropriation of the 1986 WHO analgesic ladder: the pitfalls of labelling opioids as weak or strong.

Opioids have a vital role in alleviating pain from cancer and surgery. Despite good intentions, it is now recognised that the original WHO Cancer Pain Relief guidance from 1986, in which opioids were classified as either weak or strong, has been both inadvertently and purposefully misused, thereby contributing to harm from opioid use and misuse. However, the recommendation in the 2018 update of the WHO analgesic ladder that a combination of a high-potency opioid with simple analgesics is better than alternative analgesics for the maintenance of pain relief is also applicable to patients who require short-term opioids.

System-level policies on appropriate opioid use, a multi-stakeholder consensus.

Background: This consensus statement was developed because there are concerns about the appropriate use of opioids for acute pain management, with opposing views in the literature. Consensus statement on policies for system-level interventions may help inform organisations such as management structures, government agencies and funding bodies.

Methods: We conducted a multi-stakeholder survey using a modified Delphi methodology focusing on policies, at the system level, rather than at the prescriber or patient level.

Collaboration between adult patients and practitioners when making decisions about prescribing opioid medicines for chronic non-cancer pain in primary care: a scoping review.

Background: Long-term opioid therapy (>12 months) is not effective for improving chronic non-cancer pain and function. Where patients are not experiencing pain relief with long-term opioids, the opioid should be tapered and discontinuation considered. Practitioners may find it challenging to tell patients experiencing pain that they are better off reducing or not taking medicines that do not help.

The risk of all-cause and cause-specific mortality in people prescribed mirtazapine: an active comparator cohort study using electronic health records.

Background: Studies have reported an increased risk of mortality among people prescribed mirtazapine compared to other antidepressants. The study aimed to compare all-cause and cause-specific mortality between adults prescribed mirtazapine or other second-line antidepressants.

Methods: This cohort study used English primary care electronic medical records, hospital admission records, and mortality data from the Clinical Practice Research Datalink (CPRD), for the period 01 January 2005 to 30 November 2018.

Utility of unidimensional and functional pain assessment tools in adult postoperative patients: a systematic review.

Background: We aimed to appraise the evidence relating to the measurement properties of unidimensional tools to quantify pain after surgery. Furthermore, we wished to identify the tools used to assess interference of pain with functional recovery.

Methods: Four electronic sources (MEDLINE, Embase, CINAHL, PsycINFO) were searched in August 2020.

Association between opioid-related deaths and prescribed opioid dose and psychotropic medicines in England: a case-crossover study.

Background: Opioid-overdose deaths are associated with poisoning with prescription and illicit opioids in the USA. In contrast, opioid-related deaths (ORDs) in the UK often involve drugs and substances of misuse, and may not be associated with a high dose of prescribed opioids. This study aimed to investigate the association between prescribed opioid dose and ORDs in UK primary care.

Association between opioid-related deaths and persistent opioid prescribing in primary care in England: A nested case-control study.

Aim: This study aimed to evaluate the association between opioid-related deaths and persistent opioid utilisation in the United Kingdom (UK).

Methods: This nested case-control study used the UK Clinical Practice Research Datalink, linking the Office for National Statistics death registration. Adult opioid users with recorded opioid-related death between 2000 and 2015 were included and matched to four opioid users (controls) based on a disease risk score.