Michael A. Ashburn's research while affiliated with University of Pennsylvania and other places
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Publications (38)
Although certain risk factors can identify individuals who are most likely to develop chronic pain, few interventions to prevent chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention o...
Objective:
Enhanced recovery after surgery (ERAS) pathways have previously been shown to be feasible and safe in elective spinal procedures. As publications on ERAS pathways have recently emerged in elective neurosurgery, long-term outcomes are limited. We report on our 18-month experience with an ERAS pathway in elective spinal surgery.
Methods:...
Objective
The Centers for Disease Control and Prevention (CDC) and many state governments have issued guidelines for opioid prescribing for the treatment of chronic non‐cancer‐associated pain. We sought to decrease practice variation and increase adherence to these guidelines in a tertiary academic Rheumatology practice by developing an interdiscip...
Background:
Prescribing limits are one policy strategy to reduce short-term opioid prescribing, but there is limited evidence of their impact.
Objective:
Evaluate implementation of a state prescribing limit law and health system electronic medical record (EMR) alert on characteristics of new opioid prescriptions, refill rates, and clinical encou...
Objective:
To determine the association between preoperative benzodiazepine and nonbenzodiazepine receptor agonist ("Z-drugs") use and adverse outcomes after surgery.
Background:
Prescriptions for benzodiazepines and Z-drugs have increased over the past decade. Despite this, the association of preoperative benzodiazepines and Z-drug receipt with...
In 2017, an estimated 11 to 12 million people in the United States (4.2% of the total population) misused opioids (including heroin).¹ What most physicians do not recognize is that 92% of people who misuse opioids do so by taking prescription opioids,¹ and that 75% of individuals who use heroin report that they started misusing opioids through the...
Abstract Drug overdose deaths involving opioids have surged in recent years and the economic cost of the opioid epidemic is estimated to be over $500 billion annually. In the midst of calls for declaring a national emergency, health policy decision makers are considering the best ways to allocate resources to curb the epidemic. On June 9, 2017, 116...
Opioid use increased in the United States from the early 1990s until very recently, when opioid prescribing appears to have peaked and declined slightly.¹ Many institutions are working hard to put the opioid genie back in the bottle, so to speak, and the perioperative period offers a unique opportunity. The focus is on opioid stewardship, during wh...
Approximately 64 000 people died from drug overdose deaths in 2016, and many of these deaths involved opioids.¹ Opioid prescribing decisions are a major contributor to the ongoing opioid crises in America. Prescription opioids are by far the most commonly misused opioids, and 88% of people misusing prescription opioids obtained these medications fr...
Objective.:
The objective of this project was to develop core competencies for education on opioids and addiction to be used in all Pennsylvania medical schools.
Methods.:
The Pennsylvania Physician General created a task force that was responsible for the creation of the core competencies. A literature review was completed, and a survey of grad...
This study reports the results of a researcher-administered survey with 115 patients receiving chronic opioid therapy (>90 days) to obtain information regarding how chronic opioid therapy was started. Chronic opioids were started after surgery (27.0%, 95% confidence interval [CI], 18.5–35.5) or for the treatment of acute injury-related pain (27.0%,...
Objective
The use of opioids to treat chronic pain has come under increased scrutiny, as such use has been associated with significant risk of death, with limited data regarding the long-term effectiveness, especially when used to treat noncancer pain. The purpose of this manuscript is to discuss the cardiac effects associated with long-term opioid...
Although certain risk factors can identify individuals who are most likely to develop chronic pain, few interventions to prevent chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention o...
Methadone is associated with QT prolongation and serious cardiac complications, but this has been primarily demonstrated in opioid dependent patients receiving moderate to high doses. This study investigates the effect of low-dose methadone on the QTc interval in a chronic pain population.
We conducted a prospective cohort study in a chronic pain c...
The purpose of this study was to determine if the opioid risk tool (ORT) was clinically useful in guiding physician decision making during chronic opioid therapy and to determine whether there were differences between the patient-completed and physician-completed ORT.
Retrospective review of prospectively collected data.
A single-center tertiary ca...
As the overall population ages and patients continue to live longer, managing pain in the elderly in the USA will be more frequently encountered in clinical settings. While common in older patients, pain is not a normal part of aging, and treatments should be offered as they would be in young patients. Low back pain, osteoarthritis, postherpetic ne...
This manuscript reviews how patient-reported outcomes data can be used to guide efforts to improve patient outcomes.
Review Manuscript.
The clinical management of chronic, non-cancer pain.
Adult patients receiving treatment for chronic, non-cancer pain.
While there have been great advances in the science of pain and various therapeutic medications...
The global response to the 12 January 2010 earthquake in Haiti revealed the ability to mobilise medical teams quickly and effectively when academic medical centres partner non-governmental organisations (NGO) that already have a presence in a zone of devastation. Most established NGOs based in a certain region are accustomed to managing the medical...
The earthquake that struck Haiti on 10 January 2010, killed 200,000 persons and injured thousands more. Working with Partners in Health, a non-governmental organization already present in Haiti, Dartmouth College, and the University of Pennsylvania sent multidisciplinary surgical teams to hospitals in the villages of Hinche and Cange. The purpose o...
In response to disturbing rises in prescription opioid abuse, the Food and Drug Administration (FDA) has proposed the implementation of aggressive Risk Evaluation and Mitigation Strategies (REMS) that will require prescribers to obtain mandatory education, provide mandatory patient education, register patients into registries, and so forth before p...
Relief from pain is itself a marker of high-quality medical care. Quality assurance in the case of pain management could simply mean successful elimination of pain. Because the means of controlling pain are imperfect, it is essential to consider whether pain interventions actually achieve the primary goal of pain relief and also whether they are sa...
Current clinical guidelines have identified the need for studies comparing the effect of different short-acting or rapid-onset opioids for the treatment of breakthrough pain (BTP). In this study we evaluated the efficacy and safety of treatment with fentanyl buccal tablet (FBT) in comparison with immediate-release oxycodone in alleviating BTP in op...
On Tuesday, January 12, 2010 at 16:53 local time, a magnitude 7.0 M(w) earthquake struck Haiti. The global humanitarian attempt to respond was swift, but poor infrastructure and emergency preparedness limited many efforts. Rapid, successful deployment of emergency medical care teams was accomplished by organizations with experience in mass disaster...
Pain associated with superficial procedures, including intravenous (IV) access procedures, should be prevented when possible, especially in children.
To evaluate a topical local anesthetic patch containing lidocaine 70 mg/tetracaine 70 mg with a heating element designed to warm the skin and facilitate rapid delivery of local anesthetics into the sk...
The need to adequately treat postoperative pain has only been realized in the last 10 years. This paper reviews some of the history, rationale and major modalities currently used to treat postoperative pain. Advantages and risks of patient controlled analgesia and intraspinal opioids are discussed. The development and structure of an acute pain ser...
We compared the lidocaine/tetracaine patch [Synera (USA), Rapydan (Europe)], a novel heat-aided patch using a eutectic mixture of lidocaine 70 mg and tetracaine 70 mg, with a eutectic mixture of lidocaine 25 mg ml(-1) and prilocaine 25 mg ml(-1) (EMLA Cream). The agents were administered at different time periods for local topical anaesthesia befor...
Introduction Over the past decades, aggressive therapies for cancer have led to improved statistics for long-term survival. From 1996 to 2002, the 5-year survival rate for all cancers was 66%, which represents a significant increase from 51% in the short span between 1975 to 1977. Although 5-year survival rates do not represent the numbers of patie...
Citations
... Condición que adquiere mayor relevancia si se considera que la catastrofización y sus tres dimensiones (rumiación, magnificación y desesperanza) en relación a la intensidad del dolor también se ha descrito en pacientes con lumbalgia crónica (Castromán et al., 2018;Meints et al., 2019;Salt et al., 2020). La evidencia científica argumenta sustancialmente la complejidad y complicaciones que generan las patologías con dolor crónico tantos en las personas que las padecen como también en los sistemas de salud (Bildeny, 2019;Grimby et al., 2020;Gewandter et al., 2021;Lindell & Grimby, 2022;Weaver et al., 2022). ...
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... Each of the above increases the surgical and anesthetic risk. In order to mitigate such risks, the following methods have been advocated: reducing the duration of anesthesia and surgery, reducing the amount of opioids, increasing the safety of anesthesia, as well as early mobilization and rehabilitation [19,20]. Severe postoperative pain necessitates a high level of analgesia, increasing the risk of delirium and the need for intensive monitoring, thus increasing the duration and total cost of inpatient treatment [21]. ...
... Both Hester et al., 2019 [37] and Dowling et al., 2020 [38] aimed to reduce low-value bronchiolitis management in pediatric care. Other similarities were found between studies that aimed to improve; pain management [39,40], prescribing practices [40][41][42][43], quality of discharge [41,42,44] and unnecessary test ordering [45,46]. The remaining studies had unique aims such as adherence to pneumonia guidelines [47], reducing heart failure re-admissions [48], improving lung-protective ventilation strategies [49], improving blood pressure control [50], and improving quality of glioma care [51,52]. ...
... Using this protocol, the authors found a significant decrease in postoperative pain coupled with lower oral opioid consumption when compared with a historical opioidbased regimen. There are new concerns regarding potential adverse perioperative effects with gabapentinoids including pulmonary complications (30,31). At our institution, colleagues in anesthesia have expressed similar concerns. ...
... Many systems can be integrated with state-controlled substance databases to track prescriptions and ensure that patients are not "doctor shopping" to obtain multiple opioid prescriptions for the same condition (Holt et al., 2018). Other tools such as alerts within a patient's EHR can help notify providers of frequent users so that these patients can be referred for chronic pain outpatient management (Kahler et al., 2017;Lowenstein et al., 2020). ...
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... During the transfer of the patient to the operating room, benzodiazepines are among the most commonly used agents because they cause retrograde amnesia and increase patient satisfaction. In a large retrospective cohort study conducted with 94.887 procedures in general surgery and orthopedic surgery, benzodiazepine use was associated with increased postoperative side effects (10). The ERAS protocol does not recommend unnecessary premedication because benzodiazepines can cause neurocognitive disorders and opioids and other sedating agents prolong hospital stay (9,11). ...
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... Based on these guidelines, when needed, less potent opioids should be used first [40][41][42], as codeine has lower rates of overdose, misuse and addiction than more potent opioids [25][26][27][28]. Additionally, second-line opioids such as oxycodone, morphine and hydromorphone are not particularly responsive to chronic noncancer pain, and there is increasing evidence for the limited role of these opioids to treat chronic noncancer pain [25,[40][41][42][43][44]. ...
... Nevertheless, internationally, only 1 in every 6 people seeking treatment for opioid use disorder (OUD) receives it [8]. Several factors contribute to this so-called treatment gap [9], including stigma [10], limited clinical resources, insufficient investment, ambivalence toward and difficulties accessing MOUD [11][12][13][14], and stringent regulatory barriers [15]. Furthermore, vulnerable groups such as younger people [16], pregnant women, mothers [17,18], rural residents [19], racial and ethnic minority groups [20], and people experiencing displacement [21,22] or homelessness [23] disproportionately struggle to access MOUD. ...
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... 47 Most of the conventional wisdom addressing potential solutions to the problem of persistent opioid use after surgery have focused on proper opioid stewardship after operation, wherein opioids are used conservatively in combination with other analgesic adjuncts, and excessive opioid prescribing for home use is avoided. 48 A key observation unpinning this approach is that the quantity of opioid prescribed after operation is associated with higher patient-reported opioid consumption. 49 About one-quarter of patients receiving chronic opioid therapy first received opioids after operation. ...
... It can relieve mechanical allodynia in oxaliplatin-induced neuropathic mice model [18,19]. Gabapentin, an antiepileptic drug and structural analogue of the neurotransmitter gammaaminobutyric acid, was developed as an anticonvulsant and subsequently used for various chronic pain conditions [20][21][22]. However, the effects of the clonidine and gabapentin on the spontaneous pain, allodynia, and hyperalgesia in the model of SMIR have not been investigated until now. ...
