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(239) Detectable viral load may be associated with increased heat pain sensitivity in individuals with HIV
Abstracts
develop FAP or if it is a consequence of FAP and predicts poor prognosis with potential risk for relapses.
(237) Patterns in the use of prescription opioids among children: persistence and total daily dosage of short- and long-acting opioids S Banerjee, C Roland, L Garrison, J Mardekian, and R Willke; University of Washington, Seattle, WA
Persistence and total daily dosage are important features of drug utilization and prescribing behavior. Although prior research exists on patterns of prescription opioid use among adults, little is known about patterns in children. This study utilizes medical claims data from the Truven Health MarketScan for the period 2010-2013 to examine the persistence and total daily dosage of short-acting opioids (SAOs) and long-acting opioids (LAOs) among 7-17-year-old children who have a prescription opioid use claim. Our analyzed sample consisted of 843,946 children; the vast majority belonging to the 12-17 age group (n=703,803 (83.4%)), with preferred provider organizations being the predominant health insurance plan (n=534,171 (63.3%)). Persistence (capped at 360 days) was defined as the period between index date (earliest fill date for an opioid prescription during the time period) and last day of first 7-day gap in supply of index opioid medications. Mean (SD) persistence (in days) of the three most prevalent SAOs (codeine, oxycodone and hydrocodone and their combinations) among users of only SAOs was 11.8 (5.3), 12.1 (6.8), and 12.0 (6.5) days, respectively. Among LAO users, mean (SD) persistence was 20.8 (4.0) for oxycodone and 75.7 (81.3) for buprenorphine and its combinations—the two most prevalent LAOs. The mean (SD) total daily dosage (mg; morphine equivalents (MEQ)) of the most prevalent SAOs taken during the persistence period is 37.0 (225.2), 79.2 (378.3), and 53.3 (286.2) for codeine, oxycodone, and hydrocodone and its combinations, respectively. In case of the LAO users, estimates of total daily dosage are 54.1 (82.6) for oxycodone and 145.3 (322.0) for buprenorphine and its combinations. The vast majority of opioids prescribed are to children 12-17 years of age. Persistence on SAOs was shorter than LAOs. Total daily MEQ dosage ranged from 37.0-79.2 mg for the most prevalent SAOs, and 54.1-145.3 mg for the most prevalent LAOs.
(238) Withdrawn
B16 Pain in Infectious Disease (239) Detectable viral load may be associated with increased heat pain sensitivity in individuals with HIV
The Journal of Pain
S35
HIV. This may occur because HIV surface proteins stimulate astrocytes and glial cells, which subsequently elicit pro-inflammatory cascades. Additional human research is needed to test this hypothetical possibility.
B17 Pain in Minority Populations (240) Depressive symptoms and sleep efficiency mediate racial differences in endogenous pain facilitatory processes H Bulls, M Lynch, M Owens, E Gossett, S Terry, K Wesson-Sides, M Petrov, and B Goodin; University of Alabama at Birmingham, Birmingham, AL
Previous work conducted by our group revealed that older African Americans demonstrate significant hyperalgesia and augmented endogenous pain facilitation when compared to older non-Hispanic Whites. Psychological and behavioral factors that may help explain racial differences in the experience of pain among older adults remain largely unexplored. Thus, the current study sought to examine depressive symptoms and sleep efficiency as sequential mediators of racial differences in endogenous pain facilitatory processes. A total of 50 (26 African Americans and 24 non-Hispanic White) community-dwelling adults without chronic pain (mean age 50 years; range 22 to 77 years) initially completed the Center for Epidemiological Studies Depression Scale (CES-D) prior to seven consecutive nights of sleep monitoring with actigraphy in the home environment. Participants then returned to the laboratory for assessment of endogenous pain facilitation using a mechanical temporal summation protocol. Temporal summation was examined at both the dorsal hand and ipsilateral trapezius using fine pressure, results of which were then averaged across sites for an overall measure of mechanical temporal summation. Results supported the predicted three-path mediation model (95% Confidence Interval: -2.325 to -0.086). African American race was associated with greater depressive symptoms (t = -2.08, p = .043), which in turn was associated with poorer sleep efficiency (t = -2.55, p = .014), which was subsequently associated with augmented temporal summation of mechanical pain (t = -4.11, p < .001). Sex, education level, age, and risk for obstructive sleep apnea (assessed using the STOP-BANG questionnaire) were included in the analyses as covariates. This study lends support for the negative impact of depressive symptoms on sleep efficiency, and suggests that both sequentially mediate racial differences in endogenous pain facilitation. Additionally, it provides a foundation for incorporation of interventions intended to reduce depressive symptoms and improve sleep efficiency in those at risk for chronic pain.
M Owens, B Goodin, L Yessick, R Gaini, R Rainey, S Terry, S Heath, and J Merlin; University of Alabama at Birmingham, Birmingham, AL
(241) Pain and poverty: a study of the intersectionality of demographic and socioeconomic factors on pain interference
Initial findings derived from animals indicate that envelope proteins found on the surface of the human immunodeficiency virus (HIV) such as GP120 facilitate the endogenous processing of painful stimuli, and therefore could lead to exaggerated pain states such as hyperalgesia and allodynia. Minimal research to date has examined the relationship between HIV and pain sensitivity in humans. We hypothesized that HIV infected participants with a detectable viral load would be more sensitive to painful heat stimuli compared to those with an undetectable viral load as well as controls without HIV. Thus far, 42 HIV infected participants without chronic pain have been recruited from a local clinic that provides comprehensive core medical and social services to adults with HIV. A control group of 23 community-dwelling adults without HIV has also been recruited. Participants completed a quantitative sensory testing protocol to assess sensitivity to painful heat stimuli. Most recent viral load was collected from medical records, and viral load was considered to be detectable if the count was >50 copies/mL of blood. Of the 42 HIV infected participants, 8 (19%) had a detectable viral load, and mean viral load count for these individuals was 45,101 copies/mL. Participants with a detectable viral load demonstrated a significantly lower mean heat pain threshold (F = 3.24, p = .046), lower mean heat pain tolerance (F = 4.45, p = .016), and greater mean temporal summation of heat pain at 480C (F = 6.86, p = .002) compared to those with an undetectable viral load and controls. These results tentatively suggest that the detectable presence of virus may sensitize the peripheral and central nervous systems of individuals with
E Boyd, R Quiton, D Leibel, A Taylor, M Evans, S Waldstein, and A Zonderman; University of Maryland, Baltimore County, Baltimore, MD Pain disparities among sociodemographic groupings of race, ethnicity, sex, and age are well documented. However, few epidemiological studies have explored the intersection of sex, race, and age to determine whether specific groups are at greater risk for diminished pain-related quality of life. Furthermore, the effect of poverty on prevalence, incidence, and subjective experience of pain is understudied. Urban community dwelling adults (N=1,590; 56% women) between 30 to 64 years old were recruited for a longitudinal study examining cardiovascular risk factors (M=47.22, SD=9.37). Participants self-identified as either White (43.7%) or African-American (56.3%). Most participants obtained at least a high school diploma (64%), and 37% of participants had household incomes 125% below the national poverty level. Participants rated the degree to which bodily pain interfered with their normal routine of work (i.e. employment, daily chores, general tasks) with the Short-Form Health Survey (SF-12). Regression analyses were conducted using pain interference as the dependent measure; age, sex, race, and poverty status as predictors; and depression, perceived stress, literacy, and general health as covariates. There was a significant interaction of age and poverty (b = .24, t = 2.05, p < .05), and between sex and race (b = .12, t = 3.00, p < .01), such that older adults with household incomes below 125% of the poverty level and African American men were more likely to report that pain interfered with their daily work. These findings are novel in that they indicate
develop FAP or if it is a consequence of FAP and predicts poor prognosis with potential risk for relapses.
(237) Patterns in the use of prescription opioids among children: persistence and total daily dosage of short- and long-acting opioids S Banerjee, C Roland, L Garrison, J Mardekian, and R Willke; University of Washington, Seattle, WA
Persistence and total daily dosage are important features of drug utilization and prescribing behavior. Although prior research exists on patterns of prescription opioid use among adults, little is known about patterns in children. This study utilizes medical claims data from the Truven Health MarketScan for the period 2010-2013 to examine the persistence and total daily dosage of short-acting opioids (SAOs) and long-acting opioids (LAOs) among 7-17-year-old children who have a prescription opioid use claim. Our analyzed sample consisted of 843,946 children; the vast majority belonging to the 12-17 age group (n=703,803 (83.4%)), with preferred provider organizations being the predominant health insurance plan (n=534,171 (63.3%)). Persistence (capped at 360 days) was defined as the period between index date (earliest fill date for an opioid prescription during the time period) and last day of first 7-day gap in supply of index opioid medications. Mean (SD) persistence (in days) of the three most prevalent SAOs (codeine, oxycodone and hydrocodone and their combinations) among users of only SAOs was 11.8 (5.3), 12.1 (6.8), and 12.0 (6.5) days, respectively. Among LAO users, mean (SD) persistence was 20.8 (4.0) for oxycodone and 75.7 (81.3) for buprenorphine and its combinations—the two most prevalent LAOs. The mean (SD) total daily dosage (mg; morphine equivalents (MEQ)) of the most prevalent SAOs taken during the persistence period is 37.0 (225.2), 79.2 (378.3), and 53.3 (286.2) for codeine, oxycodone, and hydrocodone and its combinations, respectively. In case of the LAO users, estimates of total daily dosage are 54.1 (82.6) for oxycodone and 145.3 (322.0) for buprenorphine and its combinations. The vast majority of opioids prescribed are to children 12-17 years of age. Persistence on SAOs was shorter than LAOs. Total daily MEQ dosage ranged from 37.0-79.2 mg for the most prevalent SAOs, and 54.1-145.3 mg for the most prevalent LAOs.
(238) Withdrawn
B16 Pain in Infectious Disease (239) Detectable viral load may be associated with increased heat pain sensitivity in individuals with HIV
The Journal of Pain
S35
HIV. This may occur because HIV surface proteins stimulate astrocytes and glial cells, which subsequently elicit pro-inflammatory cascades. Additional human research is needed to test this hypothetical possibility.
B17 Pain in Minority Populations (240) Depressive symptoms and sleep efficiency mediate racial differences in endogenous pain facilitatory processes H Bulls, M Lynch, M Owens, E Gossett, S Terry, K Wesson-Sides, M Petrov, and B Goodin; University of Alabama at Birmingham, Birmingham, AL
Previous work conducted by our group revealed that older African Americans demonstrate significant hyperalgesia and augmented endogenous pain facilitation when compared to older non-Hispanic Whites. Psychological and behavioral factors that may help explain racial differences in the experience of pain among older adults remain largely unexplored. Thus, the current study sought to examine depressive symptoms and sleep efficiency as sequential mediators of racial differences in endogenous pain facilitatory processes. A total of 50 (26 African Americans and 24 non-Hispanic White) community-dwelling adults without chronic pain (mean age 50 years; range 22 to 77 years) initially completed the Center for Epidemiological Studies Depression Scale (CES-D) prior to seven consecutive nights of sleep monitoring with actigraphy in the home environment. Participants then returned to the laboratory for assessment of endogenous pain facilitation using a mechanical temporal summation protocol. Temporal summation was examined at both the dorsal hand and ipsilateral trapezius using fine pressure, results of which were then averaged across sites for an overall measure of mechanical temporal summation. Results supported the predicted three-path mediation model (95% Confidence Interval: -2.325 to -0.086). African American race was associated with greater depressive symptoms (t = -2.08, p = .043), which in turn was associated with poorer sleep efficiency (t = -2.55, p = .014), which was subsequently associated with augmented temporal summation of mechanical pain (t = -4.11, p < .001). Sex, education level, age, and risk for obstructive sleep apnea (assessed using the STOP-BANG questionnaire) were included in the analyses as covariates. This study lends support for the negative impact of depressive symptoms on sleep efficiency, and suggests that both sequentially mediate racial differences in endogenous pain facilitation. Additionally, it provides a foundation for incorporation of interventions intended to reduce depressive symptoms and improve sleep efficiency in those at risk for chronic pain.
M Owens, B Goodin, L Yessick, R Gaini, R Rainey, S Terry, S Heath, and J Merlin; University of Alabama at Birmingham, Birmingham, AL
(241) Pain and poverty: a study of the intersectionality of demographic and socioeconomic factors on pain interference
Initial findings derived from animals indicate that envelope proteins found on the surface of the human immunodeficiency virus (HIV) such as GP120 facilitate the endogenous processing of painful stimuli, and therefore could lead to exaggerated pain states such as hyperalgesia and allodynia. Minimal research to date has examined the relationship between HIV and pain sensitivity in humans. We hypothesized that HIV infected participants with a detectable viral load would be more sensitive to painful heat stimuli compared to those with an undetectable viral load as well as controls without HIV. Thus far, 42 HIV infected participants without chronic pain have been recruited from a local clinic that provides comprehensive core medical and social services to adults with HIV. A control group of 23 community-dwelling adults without HIV has also been recruited. Participants completed a quantitative sensory testing protocol to assess sensitivity to painful heat stimuli. Most recent viral load was collected from medical records, and viral load was considered to be detectable if the count was >50 copies/mL of blood. Of the 42 HIV infected participants, 8 (19%) had a detectable viral load, and mean viral load count for these individuals was 45,101 copies/mL. Participants with a detectable viral load demonstrated a significantly lower mean heat pain threshold (F = 3.24, p = .046), lower mean heat pain tolerance (F = 4.45, p = .016), and greater mean temporal summation of heat pain at 480C (F = 6.86, p = .002) compared to those with an undetectable viral load and controls. These results tentatively suggest that the detectable presence of virus may sensitize the peripheral and central nervous systems of individuals with
E Boyd, R Quiton, D Leibel, A Taylor, M Evans, S Waldstein, and A Zonderman; University of Maryland, Baltimore County, Baltimore, MD Pain disparities among sociodemographic groupings of race, ethnicity, sex, and age are well documented. However, few epidemiological studies have explored the intersection of sex, race, and age to determine whether specific groups are at greater risk for diminished pain-related quality of life. Furthermore, the effect of poverty on prevalence, incidence, and subjective experience of pain is understudied. Urban community dwelling adults (N=1,590; 56% women) between 30 to 64 years old were recruited for a longitudinal study examining cardiovascular risk factors (M=47.22, SD=9.37). Participants self-identified as either White (43.7%) or African-American (56.3%). Most participants obtained at least a high school diploma (64%), and 37% of participants had household incomes 125% below the national poverty level. Participants rated the degree to which bodily pain interfered with their normal routine of work (i.e. employment, daily chores, general tasks) with the Short-Form Health Survey (SF-12). Regression analyses were conducted using pain interference as the dependent measure; age, sex, race, and poverty status as predictors; and depression, perceived stress, literacy, and general health as covariates. There was a significant interaction of age and poverty (b = .24, t = 2.05, p < .05), and between sex and race (b = .12, t = 3.00, p < .01), such that older adults with household incomes below 125% of the poverty level and African American men were more likely to report that pain interfered with their daily work. These findings are novel in that they indicate