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Dr. Stephen R. Southworth is a three-time, board certified orthopedic surgeon in full time orthopedic surgery practice, and also has a research practice, at the Orthopaedic Institute of North Mississippi, PLLC. He holds memberships in the American Academy of Orthopedic Surgeons, the American Medical Association, the Association of Military Surgeons of the United States, the Society of Military Orthopaedic Surgeons, among other professional societies. Dr. Southworth is an Examiner for the American Board of Orthopaedic Surgery. Dr. Southworth is Chair of the Institutional Review Board for North Mississippi Health Services, a 7-hospital system based in Tupelo, Mississippi. Dr. Southworth was the first principal investigator to publish a large scale trial of intravenous ibuprofen for perioperative multimodal analgesia.

Dr. Southworth earned his medical degree and completed his residency training at the Medical College of Ohio. He went on to complete an orthopedic fellowship at Rancho Los Amigos National Medical Center in Downey, California. Outside of his medical education, Dr. Southworth also holds a MBA from Knoxville-based University of Tennessee and a Master of Science degree in biochemistry from the University of South Carolina.

In 2018 in the U.S., 128 people died every day from an overdose of an opioid.1 As prescriptions for opioid medications became more prevalent to treat pain, so did the widespread misuse and abuse of these drugs—an estimated 1.7 million people in the U.S. suffer from a substance use disorder related to prescription opioid pain relievers.

It is difficult to know which patients will succumb to this misuse (21-29%), an opioid use disorder (8-12%), or an overdose (increase of 54% in 2020 in 16 states).2-3 The data also tells us that about 80% of patients who use heroin first misused prescription opioids.4 In addition, the adverse drug and social effects from the chronic use, misuse, and abuse of opioids can be severe and affect more than just the person using them.

Surgical patients are especially at risk for opioid-based disorders, due to the prevalent use of these medications pre- and post-operatively. A study by Brummett and colleagues of surgical patients found that new persistent opioid use was associated with behavioral and pain disorders, which suggested addressable patient predictors and the revelation that persistent opioid use can be considered a common complication after surgery.5 Therefore, it is imperative that alternative solutions for pain alleviation be found.

It has been shown that preemptive administration of intravenous ibuprofen (IVIB) significantly reduced pain and opioid use in orthopedic surgery patients.6 IVIB should be considered in the analgesic regimen for peri-operative pain as it has a favorable safety profile with fewer substantial and non-substantial adverse events, significantly lesser levels of perioperative cytokines and catecholamines, and improved perioperative pain control with decreased consumption of opioid medications. If surgical patients are able to utilize less opioid medication, then the pathway to misuse, abuse, and overdose is significantly lessened.

This educational webinar will review patient cases and the clinical recommendations and evidence to assist the clinician in their decision-making with managing chronic pain.

References

1. National Institute of Drug Abuse. Opioid overdose crisis. Revised April 2020. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis (accessed 2020 May 12).

2. Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015;156(4):569-76.

3. Vivolo-Kantor AM, Seth P, Gladden RM, et al. Vital signs: trends in emergency department visits for suspected opioid overdoses—United States, July 2016-September 2017. Centers for Disease Control and Prevention.

4. Muhuri PK, Gfroerer JC, Davies MC. Associations of nonmedical pain reliever use and initiation of heroin use in the United States. CBHSQ Data Rev. August 2013.

5. Brummett CM, Waljee JF, Goesling J, et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017;152(6):e170504. https://jamanetwork.com/journals/jamasurgery/fullarticle/2618383 (accessed 2020 May 12).

6. Singla N, Rock A, Pavliv L. A multi-center, randomized, double-blind placebo-controlled trial of intravenous ibuprofen (IV-ibuprofen) for treatment of pain in post-operative orthopedic adult patients. Pain Med. 2010;11(8):1284-93.

LEARNING OBJECTIVES
1.Discuss the problem of opioid use in pre- and post-surgical patients.
2.Explain the pain management alternatives to opioids available.
3.Describe the use of intravenous ibuprofen as part of the multimodal pain pathway.
ACCREDITATION

Physicians - This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.

ScientiaCME designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)™ toward the AMA Physician’s Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Nurses - Educational Review Systems is an approved provider of continuing nursing education by the Alabama State Nursing Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Provider # 5-115. This program is approved for 1 hour of continuing nursing education. Educational Review Systems is also approved for nursing continuing education by the state of California, the state of Florida and the District of Columbia.

Pharmacists - Educational Review Systems is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program is approved for 1 hour (0.1 CEUs) of continuing pharmacy education credit. Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit. UAN# 0761-9999-20-084-L01-P

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