***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: & NA ; Comprised mainly of depression , anxiety , and high neuroticism , psychopathology diminishes the effectiveness of many chronic pain treatments . But , it is not known if it is associated with diminished  opioid analgesia in patients with chronic , noncancer pain . We tested the hypothesis that psychopathology diminishes  opioid analgesia  in patients with discogenic low back pain in 60 patients not on opioids  in a double blind , placebo controlled , r and om crossover design ed trial . Patients were stratified into three groups of psychological symptom severity ( LOW , MOD , and HIGH ) , based on composite scores on depression , anxiety for pain , and neuroticism scales . Subjects were given intravenous morphine ( 4–6 mg dosed by ideal body weight ) and placebo in r and om order on separate visits , and completed serial pain ratings over three hours at each session . With 20 subjects per group , there were nonsignificant differences between groups in the distribution of age , gender , baseline pain ( avg . 6.1/10 ) , radicular pain , and morphine dose ( 5.0 mg ) . For morphine analgesia , using a total pain relief calculation ( TOTPAR ) , the LOW group had 65.1 % TOTPAR vs. 41.0 % in the HIGH group , P=.026 . For placebo analgesia the LOW group had 7.7 % TOTPAR vs. 23.5 % in the HIGH group , P=.03 . A morphine minus placebo analgesia calculation revealed 59.2 % TOTPAR in the LOW group vs. 21.7 % in the HIGH group , P=.0001 . High levels of psychopathology are associated with diminished opioid analgesia in patients with discogenic low back pain . These results have implication s for the prescription of oral opioids to patients with chronic low back pain and psychopathology Background : Suicide among seniors is a significant health problem in north America , particularly for men in whom the rates rise steadily after 50 years of age . The goal of this study was to examine elder suicides identified from a large population -based data base using case – control methods to determine disease and medication factors related to suicide . Methods : A population -based 1 : 5 case – control study was conducted comparing seniors aged 66 years and older who had died by suicide with age and sex-matched controls . Case data were obtained through British Columbia ( BC ) Vital Statistics , whereas controls were r and omly selected from the BC Health Insurance Registry . Cases and controls were linked to the provincial PharmaCare data base to determine medication use and the provincial Physician Cl aims and Inpatient Hospitalization data bases to determine co-morbidity . Results : Between 1993 and 2002 a total of 602 seniors died by suicide in BC giving an annual rate of 13.2 per 100 000 . Firearms were the most common mechanism ( 28 % ) , followed by hanging/suffocation ( 25 % ) , self-poisoning ( 21 % ) , and jumping from height ( 7 % ) . In the adjusted logistic model , variables related to suicide included : lower socioeconomic status , depression/psychosis , neurosis , stroke , cancer , liver disease , parasuicide , benzodiazepine use , narcotic pain killer use and diuretic use . There was an elevated risk for those prescribed inappropriate benzodiazepines and for those using strong narcotic pain killers . Conclusion : This study is consistent with previous studies that have identified a relationship between medical or psychiatric co-morbidity and suicide in seniors . In addition , new and potentially useful information confirms that certain types and dosages of benzodiazepines are harmful to seniors and their use should be avoided OBJECTIVE To assess the prevalence , treatment and impact of chronic pain in Canada . METHODS A stratified r and om sample of 2012 adult Canadians ( weighted by sex , age and region according to 1996 census data ) was surveyed by telephone in 2001 to determine the prevalence of chronic pain , defined as continuous or intermittent pain for at least six months . A second sample of 340 chronic pain sufferers who were taking prescription medication for their pain was studied in detail to determine current therapeutic approaches and to assess the social and economic impact of chronic pain . RESULTS Chronic noncancer pain was reported by 29 % of the respondents , with increased frequency in women and older age groups . The average duration of pain was 10.7 years and the average intensity was 6.3 ( on a scale from 1 to 10 ) , with 80 % reporting moderate or severe pain . Anti-inflammatory agents were prescribed for 49 % of respondents and opioid analgesics were prescribed for 22 % ( two-thirds of these were codeine ) . Almost 70 % were worried about addiction potential , and one-third felt that strong analgesics should be reserved for terminal illnesses . Almost one-half were unable to attend social and family events , and the mean number of days absent from work in the past year due to chronic pain was 9.3 . INTERPRETATION Chronic noncancer pain is common in Canadian adults and has a major social and economic impact . Despite growing evidence supporting the efficacy and safety of major opioid analgesics for chronic noncancer pain , less than 10 % of chronic pain patients taking prescription medication were treated with a major opioid . Chronic pain is undertreated in Canada , and major opioid analgesics are probably underutilized in the management of moderate to severe pain as part of a multidisciplinary treatment program & NA ; Chronic pain patients who show aberrant drug‐related behavior often are discontinued from treatment when they are noncompliant with their use of opioids for pain . The purpose of this study was to conduct a r and omized trial in patients who were prescribed opioids for noncancer back pain and who showed risk potential for or demonstration of opioid misuse to see if close monitoring and cognitive behavioral substance misuse counseling could increase overall compliance with opioids . Forty‐two patients meeting criteria for high‐risk for opioid misuse were r and omized to either st and ard control ( High‐Risk Control ; N = 21 ) or experimental compliance treatment consisting of monthly urine screens , compliance checklists , and individual and group motivational counseling ( High‐Risk Experimental ; N = 21 ) . Twenty patients who met criteria indicating low potential for misuse were recruited to a low‐risk control group ( Low‐Risk Control ) . Patients were followed for 6 months and completed pre‐ and post‐ study question naires and monthly electronic diaries . Outcomes consisted of the percent with a positive Drug Misuse Index ( DMI ) , which was a composite score of self‐reported drug misuse ( Prescription Drug Use Question naire ) , physician‐reported abuse behavior ( Addiction Behavior Checklist ) , and abnormal urine toxicology results . Significant differences were found between groups with 73.7 % of the High‐Risk Control patients demonstrating positive scores on the DMI compared with 26.3 % from the High‐Risk Experimental group and 25.0 % from the Low‐Risk Controls ( p < 0.05 ) . The results of this study demonstrate support for the benefits of a brief behavioral intervention in the management of opioid compliance among chronic back pain patient at high‐risk for prescription opioid misuse Abstract Use of opioids for chronic non‐cancer pain is controversial and the efficacy of comprehensive pain rehabilitation programs ( CPRPs ) that incorporate opioid withdrawal requires further investigation . We test the hypothesis that patients with chronic pain and longst and ing opioid use who undergo opioid withdrawal in the course of rehabilitative treatment will experience significant and sustained improvement in pain and functioning similar to patients who were not taking opioids . A longitudinal design study compared 373 consecutive patients admitted to the Mayo Clinic Pain Rehabilitation Center at admission , discharge and six‐month posttreatment by opioid status at admission .  Measures of pain severity , depression , psychosocial functioning , health status , and pain catastrophizing were used to assess between‐ and within‐group differences . Treatment involved a 3‐week interdisciplinary pain rehabilitation program focused on functional restoration . Over one‐half of patients ( 57.1 % ) were taking opioids daily at admission . The majority of patients ( 91 % ) completed rehabilitation and 70 % of patients who completed the program returned question naires six months posttreatment . On admission , patients taking low‐ and high‐dose opioids reported significantly greater pain severity ( P = .001 ) and depression ( P = .001 ) than the non‐opioid group . Significant improvement was found on all outcome variables following treatment ( P < .001 ) and six‐month posttreatment ( P < .001 ) regardless of opioid status at admission . There were no differences between the opioid and non‐opioid groups upon discharge from the program or at six months following treatment . Conclusion : Patients with longst and ing CPRP on chronic opioid therapy , who choose to participate in interdisciplinary rehabilitation that incorporates opioid withdrawal , can experience significant and sustained improvement in pain severity and functioning BACKGROUND Opioids are used extensively for chronic pain management in the United States . The frequency of opioid use prior to presenting to interventional pain management setting s and in interventional pain management setting s has been shown to be above 90 % . Given that controlled substance abuse and illicit drug use are prevalent phenomena , adherence monitoring of patients that are prescribed opioids is becoming common . Adherence monitoring is carried out by an appropriate history , periodic evaluation of appropriate intake of drugs , r and om drug testing , and pill counts . Crucial to adherence monitoring is an initial controlled substance agreement and repeated review of the terms of this agreement with on-going education . However , the effect of adherence monitoring on drug abuse is unclear . OBJECTIVE To identify controlled substance abuse through implementation of the terms of a controlled substance agreement , including periodic review and monitoring outside the organization . STUDY DESIGN Prospect i ve evaluation with historical controls . METHODS Five hundred consecutive patients receiving prescription controlled substances were followed in a prospect i ve manner . The evaluation consisted of a chart review to monitor controlled substance intake , with special attention to drugs obtained from outside the organization . Data collection for this purpose included information from records , pharmacies , referring physicians , and all the physicians involved in the treatment of the patient . RESULTS Results from 500 consecutive patients were evaluated . Controlled substance abuse was seen in 9 % of patients ; overall , 5 % of patients were obtaining controlled substances from other physicians , and 4 % from illegal sources . CONCLUSION Adherence monitoring , including controlled substance agreements and various periodic measures of compliance was associated with a 50 % reduction in opioid abuse Objective : Depression and anxiety are common in sickle cell disease ( SCD ) but relatively little is known about their impact on SCD adults . This study measured prevalence of depression and anxiety in SCD adults , and their effects on crisis and noncrisis pain , quality -of-life , opioid usage , and healthcare utilization . Methods : The Pain in Sickle Cell Epidemiology Study is a prospect i ve cohort study in 308 SCD adults . Baseline variables included demographics , genotype , laboratory data , health-related quality -of-life , depression , and anxiety . Subjects completed daily diaries for up to 6 months , reporting sickle cell pain intensity , distress , interference , whether they were in a sickle cell crisis , as well as health care and opioid utilization . Results : Two hundred thirty-two subjects who completed at least 1 month of diaries were studied ; 27.6 % were depressed and 6.5 % had any anxiety disorder . Depressed subjects had pain on significantly more days than nondepressed subjects ( mean pain days 71.1 % versus 49.6 % , p < .001 ) . When in pain on noncrisis days , depressed subjects had higher mean pain , distress from pain , and interference from pain . Both depressed and anxious subjects had poorer functioning on all eight SF-36 subscales , even after controlling for demographics , hemoglobin type , and pain . The anxious subjects had more pain , distress from pain , and interference from pain , both on noncrisis pain days and on crisis days , and used opioids more often . Conclusions : Depression and anxiety predicted more daily pain and poorer physical and mental quality -of-life in adults with SCD , and accounted for more of the variance in all domains of quality -of-life than hemoglobin type . SCD = sickle cell disease ; PiSCES = Pain in Sickle Cell Epidemiology Study ; ED = emergency department ; PHQ = patient health question naire ; MOS SF-36 = Medical Outcome Study 36 item Short Form-36 ; MMSE = mini mental status examination BACKGROUND Prescription drug abuse and illicit drug use are common in chronic pain patients .  Adherence monitoring with screening tests , and urine drug testing , periodic monitoring with prescription monitoring programs , has become a common practice in recent years . R and om drug testing for appropriate use of opioids and use of illicit drugs is often used in pain management practice s. Thus , it is expected that r and om urine drug testing will deter use of illicit drugs , and also improve compliance . OBJECTIVES To study the prevalence of illicit drug use in patients receiving opioids for chronic pain management and to compare the results of illicit drug use with the results from a previous study . DESIGN A prospect i ve , consecutive study . SETTING Interventional pain management practice setting in the United States . METHODS A total of 500 consecutive patients on opioids , considered to be receiving stable doses of opioids supplemental to their interventional techniques , were studied by r and om drug testing . Testing was performed by rapid drug screen . Results were considered positive if one or more of the monitored illicit drugs including cocaine , marijuana ( THC ) , metham 
    Output:
    
Oxycodone , hydromorphone , and morphine can be tried in patients who have not responded to weaker opioids .
For by far most patients , the optimal dose will be well below a 200-mg morphine equivalent dose per day .