Robert A. Lavin

Risk factors associated with opioid medication misuse in community-dwelling older adults with chronic pain.

ObjectivesThe aim of the study was to identify physical, psychological, and social risk factors associated with opioid medication misuse among community-dwelling older adults with chronic pain. MethodsUsing a cross-sectional research design, a confidential survey was administered at 11 outpatient clinics affiliated with the Baltimore Veterans Affairs Medical Center and the University of Maryland Medical System. A sample of 163 older adults (response rate 80.7%) with chronic pain and receiving opioid medications provided demographic information and responded to survey items. Severity of pain, alcohol problems, physical disability, depressive symptoms, spirituality, social support, and social network were assessed. Descriptive statistics and exploratory regression analyses were employed to determine factors independently associated with misuse. ResultsHigher levels of pain severity and depressive symptoms, and lower physical disability scores were significantly associated with increased risk of opioid medication misuse. Alcohol problems, spirituality, social support, and social network were not associated with opioid medication misuse. DiscussionHigh pain intensity scores may indicate undertreatment of pain or may represent a rationalization to justify opioid medication use. Higher levels of depressive symptoms have been noted in the chronic pain population and may contribute to misuse of opioid medications for psychic effects. Less physically disabled persons are more likely to misuse opioid medications or older person receiving multiple medications may wish to avoid potential adverse drug effects. While there was an association between lower levels of disability and higher risk for opioid medication misuse, a causal relationship could not be determined.

A Characterization of Pain in Racially and Ethnically Diverse Older Adults A Review of the Literature

This article presents a critical review of the influence of interracial and ethnic variation on pain prevalence, intensity, interference/function/disability, and treatment in older adults. A search of scientific databases published from 1900 to 2011, using key words associated with pain, geriatrics, and race/ethnicity, identified 180 articles, of which 27 empirical studies met the inclusion criteria. Of the retained articles, 17 reported that race/ethnicity was a statistically significant factor at p < .05. Minority older adults reported a higher prevalence of pain and higher pain intensity, and variable responses regarding function/disability compared with responses by non-Hispanic White older adults. Minority older adults were less likely to receive prescription pharmacologic treatments and surgery, and they were more likely to use complementary and alternative medicine treatments. There are interracial/ethnic differences in pain assessment and treatment interventions among older adults.

Higher Hospital Spending on Occupational Therapy Is Associated With Lower Readmission Rates.

Hospital executives are under continual pressure to control spending and improve quality. While prior studies have focused on the relationship between overall hospital spending and quality, the relationship between spending on specific services and quality has received minimal attention. The literature thus provides executives limited guidance regarding how they should allocate scarce resources. Using Medicare claims and cost report data, we examined the association between hospital spending for specific services and 30-day readmission rates for heart failure, pneumonia, and acute myocardial infarction. We found that occupational therapy is the only spending category where additional spending has a statistically significant association with lower readmission rates for all three medical conditions. One possible explanation is that occupational therapy places a unique and immediate focus on patients’ functional and social needs, which can be important drivers of readmission if left unaddressed.

Choice of nonpharmacological pain therapies by ethnically diverse older adults

AIM This study compared nonpharmacological pain therapies used by ethnically diverse older adults with recommendations of family physicians and identified factors associated with nonpharmacological pain therapies use. METHODS Using a descriptive cross-sectional design, 281 participants in four ethnic groups (European Americans, Hispanics, African-Americans, Afro-Caribbeans) with chronic pain were surveyed. Binary logistic regression analyses were employed to determine associated factors. RESULTS & CONCLUSION Nonaquatic exercise and physical therapy were most frequently recommended by physicians, and nonaquatic exercise was most commonly used by participants. Lower pain levels predicted use of nonaquatic exercise, and ethnicity predicted use of prayer to manage chronic pain. Future research should examine barriers to use of psychological treatments and assess the value of combined physical and psychological treatments.

Temporal Relationship Between Lumbar Spine Surgeries, Return to Work, and Workers' Compensation Costs in a Cohort of Injured Workers

Objective: Determine the relationship between time to surgery, lost time, and insurance costs. Method: A cohort of 582 claimants undergoing lumbar spine surgery (1999 to 2002) in the state of Louisiana was observed for 7 years. Results: The shorter the time interval between injury and first lumbar surgery, the lower the cost and time lost from work. Average days lost from work and claim costs for 42% of those undergoing early lumbar surgery did not differ from injured workers who lost time from work for claims not involving lumbar surgery. Claim cost for the remaining 58% who had delayed surgery was 5.7 times greater than that for the early surgery cohort. Conclusion: The decision to perform lumbar surgery is not necessarily associated with high claim costs or longer time out from work, provided that the determination to operate is early.

Is Early Prescribing of Opioid and Psychotropic Medications Associated With Delayed Return to Work and Increased Final Workers' Compensation Cost?

Objective: To explore the association between the initial 60 days of prescriptions for psychotropic medications and final workers’ compensation claim outcomes. Methods: A cohort of 11,394 claimants involved in lost time injuries between 1999 and 2002 were followed through December 31, 2009. Logistic regressions and Cox Proportional Hazard Models were used in the analysis. Results: The initial 60 days of prescriptions for psychotropic medications were significantly associated with a final claim cost at least

Relationship between opioid prescribing patterns and claim duration and cost

100,000. Odds ratios were 1.88 for short-acting opioids, 2.14 for hypnotics, antianxiety agents, or antidepressants, and 3.91 for long-acting opioids, respectively. Significant associations were also found between decreased time lost from work and decreased claim closures during the study period. Conclusions: Early prescription of opioids and other psychotropic drugs may be useful predictors of high claim costs and time lost from work.

Factor Structure of Pain Medication Questionnaire in Community‐Dwelling Older Adults with Chronic Pain

Objective: The aim of this study was to assess the relationship between timing and duration of opioid prescriptions, disability duration, and claims costs for work-related injuries. Method: A retrospective cohort study using lost time compensation claimant data to examine the relationship between opioid prescription patterns and claim duration and cost. Logistic regression adjusted for sex, marital status, initial reserve, attorney involvement, and spinal surgeries. Results: Odds ratios for claim cost at least

Is Obesity Associated with Adverse Workers' Compensation Claims Outcomes?

100,000 and duration at least 3 years were not statistically different between groups prescribed opioids less than 30 days and those not prescribed opioids. Claims with short-acting opioids continued after 180 days; the odds ratios for claim cost at least

Work Enabling Opioid Management.

100,000 and duration at least 3 years were 6.21 (95% confidence interval 5.30 to 7.28) and 3.32 (95% confidence interval 2.94 to 3.74). Conclusion: Claim cost and lost time are related to when and how long opioids are prescribed for work-related injuries.