Journal club l.jpg
This presentation is the property of its rightful owner.
Sponsored Links
1 / 17

Journal Club PowerPoint PPT Presentation


  • 197 Views
  • Updated On :
  • Presentation posted in: General

Journal Club. Alcohol, Other Drugs, and Health: Current Evidence May-June 2007. Featured Article. Persistent pain is associated with substance use after detoxification: a prospective cohort analysis Larson MJ, et al. Addiction. 2007;(Online Early Articles):

Download Presentation

Journal Club

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Journal club l.jpg

Journal Club

Alcohol, Other Drugs, and Health: Current Evidence

May-June 2007

www.aodhealth.org


Featured article l.jpg

Featured Article

Persistent pain is associated with

substance use after detoxification:

a prospective cohort analysis

Larson MJ, et al. Addiction. 2007;(Online Early Articles):

doi: 10.1111/j.1360-0443.2007.01759.x.

www.aodhealth.org


Study objective l.jpg

Study Objective

To examine whether persistent pain is

associated with…

  • an increased odds of substance use after detoxification

www.aodhealth.org


Study design l.jpg

Study Design

  • This was a secondary analysis of 397 subjects who had participated in a randomized clinical trial.

  • All subjects had been admitted to an urban, residential drug and alcohol detoxification unit and interviewed periodically over 24 months.

  • Researchers assessed pain with the SF-36 Health Survey and substance use with the Addiction Severity Index.

  • Analyses were adjusted for potential confounders.

www.aodhealth.org


Assessing validity of an article about prognosis l.jpg

Assessing Validity of an Article about Prognosis

  • Are the results valid?

  • What are the results?

  • How can I apply the results to patient care?

www.aodhealth.org


Are the results valid l.jpg

Are the Results Valid?

  • Was the sample representative?

  • Were the subjects sufficiently homogeneous with respect to prognostic risk?

  • Was follow-up sufficiently complete?

  • Were objective and unbiased outcome criteria used?

www.aodhealth.org


Was the sample representative l.jpg

Was the sample representative?

  • The sample was a cohort of adults admitted to an urban, residential alcohol and drug detoxification unit.

    • It is unclear how many were referred; 470 of 642 consented to enroll in the randomized trial.

  • Because the primary study evaluated efforts to link patients to primary care after detoxification, patients who already had a primary care provider were excluded.

    • This somewhat limits the representativeness of the sample.

  • Other important exclusions included being pregnant, not being able to list 3 contacts, and not providing consent.

www.aodhealth.org


Were the subjects sufficiently homogeneous with respect to prognostic risk l.jpg

Were the subjects sufficiently homogeneous with respect to prognostic risk?

  • All patients received standard detoxification services.

  • Randomization occurred after detoxification, indicating that the risk of relapse should have been similar in all subjects.

  • No information was provided on the distribution of pain disorders across the two study arms.

www.aodhealth.org


Was follow up sufficiently complete l.jpg

Was follow-up sufficiently complete?

  • Subjects were assessed every 6 months over 24 months.

  • 69% completed the 24-month interview.

www.aodhealth.org


Were objective and unbiased outcome criteria used l.jpg

Were objective and unbiased outcome criteria used?

  • Self-reported outcomes (in the past 30 days) were assessed with the Addiction Severity Index and included...

    • Heavy alcohol use (>3 drinks on at least 1 day or intoxication)

    • Cocaine use

    • Heroin/opioid use

    • Any substance use (i.e., heavy alcohol use or illicit use of cocaine or opioids)

  • There was no mention of blinding to the primary independent variable of pain as assessed by the SF-36.

www.aodhealth.org


What are the results l.jpg

What are the Results?

  • How likely are the outcomes over time?

  • How precise are the estimates of likelihood?

www.aodhealth.org


How likely are the outcomes over time l.jpg

How likely are the outcomes over time?

Results (prospectively assessed):

  • 16% reported persistent pain (moderate-to-higher pain levels at all available interviews) in the 24 months after detoxification.

  • Subjects reporting persistent pain were more likely than those with mild or no pain to have (in the past 30 days at the 24-month follow-up)…

    • used any substance (odds ratio [OR], 4.21);

    • used heroin/opioids not prescribed for pain (OR, 5.36);

    • consumed >3 drinks on at least 1 day or been intoxicated (OR, 2.15);

    • used cocaine (OR, 2.05).

  • All results, except for cocaine use, were significant.

www.aodhealth.org


How precise are the estimates of likelihood l.jpg

How precise are the estimates of likelihood?

  • Confidence Intervals [CI] are wide:

    • For any substance use: OR, 4.21; 95% CI, 1.90-9.33

    • For heroin/opioid use: OR, 5.36; 95% CI, 2.09-13.75

    • For heavy alcohol use: OR, 2.15; 95% CI, 1.03-4.51

    • For cocaine use: OR, 2.05; 95% CI, 0.91-4.62

www.aodhealth.org


How can i apply the results to patient care l.jpg

How Can I Apply the Results to Patient Care?

  • Were the study patients and their management similar to those in my practice?

  • Was the follow-up sufficiently long?

  • Can I use the results in the management of patients in my practice?

www.aodhealth.org


Were the study patients similar to those in my practice l.jpg

Were the study patients similar to those in my practice?

  • Subjects are fairly representative of patients receiving residential detoxification.

  • However, patients with existing primary care providers were excluded.

www.aodhealth.org


Was the follow up sufficiently long l.jpg

Was the follow-up sufficiently long?

  • Follow-up occurred over 24 months.

  • This timeframe is clinically important.

www.aodhealth.org


Can i use the results in the management of patients in my practice l.jpg

Can I use the results in the management of patients in my practice?

  • These results should be primarily used to heighten clinicians’ concern about the risk of relapse to any substance–particularly opioids or alcohol–in their patients discharged from detoxification.

  • Next steps should include exploring various strategies (nonopioid vs. opioid) for treating pain in patients with persistent complaints of pain after detoxification.

www.aodhealth.org


  • Login