buprenorphine

Flare Reaction Following Intra-articular Steroid Injection in Frozen Shoulder. A Retrospective Study.

Khandelwal Ankur A, Sarma Sanghamitra S, Bhattacharjee Anirban A, Barman Bhupen B et al.

The objectives of this study were to determine the incidence, severity, temporal profile, and management outcomes of flare reactions following ultrasound (US)-guided intra-articular steroid injection (IASI) for frozen shoulder. This retrospective study included adult patients undergoing US-guided glenohumeral joint IASI for frozen shoulder over 1 year. Flare reactions were assessed using the Numeric Rating Scale at 1-, 4-, and 24-h postinjection. Analgesic strategies were evaluated based on pain severity. Among 84 patients, flare reaction occurred in 19 (22.6%). Most reactions were mild (63.2%) and self-limiting. Moderate-to-severe reactions (36.8%) required pharmacological treatment. Early-onset severe pain responded rapidly to low-dose sublingual buprenorphine, with complete relief in most patients within 4 h, while late-onset moderate pain was effectively managed with oral diclofenac. No adverse effects were observed. Flare reaction after IASI for frozen shoulder is not uncommon and, in most cases, can be effectively managed with appropriate analgesic strategies. Sublingual buprenorphine for moderate-severe early-onset pain ensures effective symptom control without major side effects.

Impact of Substance Use Disorder Curriculum and X-Waiver Training on Emergency Medicine Residents.

Chukwunyere Chigozie C, Heil Jessica J, Salzman Matthew M, Haroz Rachel R

We incorporated an 8-hour standardized substance use disorder (SUD) curriculum and X-waiver training into our emergency medicine (EM) residency. We sought to assess whether the implementation of the standardized SUD curriculum and X-waiver training affected graduated EM residents' comfort with treating SUD and prescribing practices, as well as their view of their future career paths. Physicians who completed their EM residency at our hospital from 2016-2022 were invited to complete the survey in 2023. The primary outcome measure was the proportion of surveyed graduates who reported comfort and confidence in treating patients with SUD, measured by affirmative responses to survey items. The secondary outcome measure was the proportion of surveyed graduates reporting that participation in the SUD curriculum and X-waiver training during residency influenced their career plans, measured by affirmative responses to career-related survey items. For each outcome measure, we compared percentages of affirmative responses between physicians who completed residency prior to and after the implementation of the SUD curriculum and X-waiver training. Among 81 graduated EM residents invited to complete the survey, 63 (78.8%) responded. We grouped them based on whether they had completed residency prior to the addition of the standardized SUD curriculum (pre-curriculum, 2016-2017) or after (post-curriculum, 2018-2022). Of the 63 participants, 17 were pre- and 46 were post-curriculum residents. Of the pre-curriculum residents, 58.8% prescribed buprenorphine in their practice after residency, compared to 76.1% of the post-curriculum residents (Fisher exact test, P = .22, odds ratio [OR] 0.46, 95% confidence interval, 0.12-1.76). Of the post-curriculum graduates, 93.5% noted that they were better prepared to treat patients with SUDs than their peers compared to 88.2% of the pre-curriculum graduates (Fisher exact test, P = .605, OR .529, 95% CI, 0.055-6.909), and 69.6% believed the training impacted their careers professionally and increased their interest in helping patients with opioid use disorder. Overall, a greater proportion of EM graduates who had been X waiver-trained in a substance use disorder curriculm during residency training at our institution prescribed buprenorphine to their patients than those who had not undergone specific training. Although the X-waiver is no longer a requirement, our SUD curriculum and training remain relevant for buprenorphine prescribing and may offer some opportunities for EM residents to develop their careers.

Targeting pain to improve opioid use disorder treatment outcomes: Results of a randomized trial.

Ilgen Mark M, Blow Frederic F, Piette John D JD, Goldstick Jason J et al.

Chronic pain is highly prevalent in adults receiving medications for opioid use disorder (MOUD) and predicts poorer longer-term functioning and greater substance use. This study evaluated whether adding a behavioral pain management intervention to prescribed buprenorphine improved treatment retention and clinical outcomes. Two hundred individuals receiving buprenorphine who reported pain for at least 3-months were randomized to receive either a telehealth delivered Psychosocial Pain Management Intervention (PPMI; n = 98) or Enhanced Usual Care (EUC; n = 102). Participants were assessed at 3- and 12-months post intervention on measures of treatment retention, substance use and pain severity. Primary outcomes were examined via both intent-to-treat and per-protocol analyses. At 3-month follow-up, in the intent-to-treat analysis, buprenorphine discontinuation was slightly higher in the EUC group (27.5%) compared to the PPMI group (20.4%), although not statistically significant (p = 0.24). However, in per-protocol analyses limited to those who received an adequate intervention dose (≥4 PPMI sessions or ≥ 1 EUC session), the PPMI group had statistically significantly lower rates of buprenorphine discontinuation at 3-months than the EUC group (PPMI: 7.5%; EUC: 20.2%; p = 0.04). In the intent-to-treat analyses, there were no significant differences in rates of opioid abstinence between groups. In the per-protocol analyses, the PPMI group had slightly higher rates of opioid abstinence at 3-months compared to the EUC group, although the magnitude of this difference was small (PPMI: 99.57%; EUC: 97.48%; p = 0.03). Among patients in the intent-to-treat sample, primary and secondary analyses did not find support for the behavioral intervention in enhancing OUD retention, pain outcomes, or substance-related outcomes among those receiving buprenorphine for OUD with co-occurring chronic pain. Participants reported high buprenorphine retention and substantial improvements in pain and substance use outcomes, with no overall differences between intervention and control conditions. However, post hoc analyses indicate that behavioral pain management interventions may initially improve retention and opioid abstinence for those who engage sufficiently, underscoring the potential value of new ways to engage and support patients receiving buprenorphine. More research is needed to determine the long-term impacts of the intervention. This study has been registered with ClincialTrials.gov under ID NCT04433975.

Abandonment of Prescribed Buprenorphine for Opioid Use Disorder, 2020-2024.

Jiang Xinyi X, Zhang Kun K, Chen Yijie Y, Shih Yi-Wen YW et al.