Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review.

BACKGROUND: Long-term opioid use, which may have significant individual and societal impacts, has been documented in up to 20% of patients after trauma or orthopaedic surgery. The objectives of this scoping review were to systematically map the research on strategies aiming to prevent chronic opioid use in these populations and to identify knowledge gaps in this area. METHODS: This scoping review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. We searched seven databases and websites of relevant organizations. Selected studies and guidelines were published between January 2008 and September 2021. Preventive strategies were categorized as: system-based, pharmacological, educational, multimodal, and others. We summarized findings using measures of central tendency and frequency along with p-values. We also reported the level of evidence and the strength of recommendations presented in clinical guidelines. RESULTS: A total of 391 studies met the inclusion criteria after initial screening from which 66 studies and 20 guidelines were selected. Studies mainly focused on orthopaedic surgery (62,1%), trauma (30.3%) and spine surgery (7.6%). Among system-based strategies, hospital-based individualized opioid tapering protocols, and regulation initiatives limiting the prescription of opioids were associated with statistically significant decreases in morphine equivalent doses (MEDs) at 1 to 3 months following trauma and orthopaedic surgery. Among pharmacological strategies, only the use of non-steroidal anti-inflammatory drugs and beta blockers led to a significant reduction in MEDs up to 12 months after orthopaedic surgery. Most studies on educational strategies, multimodal strategies and psychological strategies were associated with significant reductions in MEDs beyond 1 month. The majority of recommendations from clinical practice guidelines were of low level of evidence. CONCLUSIONS: This scoping review advances knowledge on existing strategies to prevent long-term opioid use in trauma and orthopaedic surgery patients. We observed that system-based, educational, multimodal and psychological strategies are the most promising. Future research should focus on determining which strategies should be implemented particularly in trauma patients at high risk for long-term use, testing those that can promote a judicious prescription of opioids while preventing an illicit use, and evaluating their effects on relevant patient-reported and social outcomes.

Pilot Study of French-Canadian Lifestyle Redesign® for Chronic Pain Management.

As chronic pain (CP) interferes with an individual's lifestyle by limiting meaningful activities and health-related quality of life (HRQoL), occupational therapy (OT) plays an important role in CP management interventions. This pilot study aimed to explore the influence of a 13-week French-Canadian Lifestyle Redesign® for CP. A mixed-methods research design including a preexperimental quantitative component pre-/posttest was used with 15 participants with fibromyalgia. Although pain remained unchanged after the intervention, improvements were observed in participants' engagement in meaningful activities (p < .01), life balance (p < .01), mental components of HRQoL (p < .01), depressive symptoms (p = .047), and pain self-efficacy (p < .01). After the intervention, phone interviews (n = 6) highlighted the participants' appreciation of the focus being placed on their daily routines and the development of a sense of belonging throughout the intervention. This study suggests the potential feasibility and benefits of an occupation-based approach in CP management.

The revised ghent nosology; reclassifying isolated ectopia lentis.

Inherited ectopia lentis (EL) is most commonly caused by Marfan syndrome (MFS), a multisystemic disorder caused by mutations in FBN1. Historically the diagnosis for patients with EL who have no systemic features of MFS is isolated EL (IEL). However, the Ghent nosology for MFS was updated in 2010 and made some important alterations. In particular, patients with EL and a FBN1 mutation are now categorically diagnosed with MFS, if their mutation has previously been described with aortic dilation/dissection. This carries significant systemic implications, as many patients previously diagnosed with IEL are now reclassified. We provide a review of all published cases of IEL caused by FBN1 mutations over the last 20 years to assess what impact the new Ghent nosology has on these. Indeed, 57/123 probands (46.3%) are now classified as MFS according to the revised Ghent nosology and 37/96 mutations (38.5%) reported to cause isolated EL have also been found in patients with aortic dilation/dissection. These findings suggest that EL caused by mutations in FBN1 is actually part of a spectrum of fibrillinopathies with MFS, and the term 'IEL' should be avoided in such cases.

The anesthetic management of a case of tracheogastric fistula.

IMPLICATIONS: A 68-yr-old man developed a tracheogastric fistula after esophageal resection with gastric interposition. We report the anesthetic management of this patient undergoing tracheal repair and fistula closure.

Interference effects in the conservation of weight.

On the assumption that the ability to overcome the effects of interference between the physical properties of an object is a basic component in the acquisition of conservation, we hypothesized that children would tend to negate conservation not only when the form of an object is altered but also when, without deforming the object, one of its properties (e.g., color or temperature) is altered; when variations (e.g., movement or orientation) are introduced into the concrete situation in which weight is exerted; or when other spatial properties (e.g., volume or surface) are made to interact with weight. The results indicate that children up to 8 years of age may have difficulty accepting the conservation of weight even when a transformation does not deform the object and that children up to 13 years may accept the conservation of weight but may find it difficult to explain why an object appears heavier in those instances where weight has to be coordinated with another spatial property. The theoretical implications of these results are discussed.