2024
Screening, brief intervention, and referral to treatment for pain management for veterans separating from military service: study protocol of a hybrid type 2 study testing implementation facilitation versus training-as-usual
Sellinger J, Rosen M, Lazar C, Gilstad-Hayden K, Dziura J, Li F, Mattocks K, Weede A, Sullivan-Tibbs M, Rose L, Vassallo G, Manhapra A, Turner A, Vogt D, Woodward E, Hartmann C, Haskell S, Mohammad A, Martino S. Screening, brief intervention, and referral to treatment for pain management for veterans separating from military service: study protocol of a hybrid type 2 study testing implementation facilitation versus training-as-usual. Pain Medicine 2024, 25: s99-s106. PMID: 39514877, DOI: 10.1093/pm/pnae062.Peer-Reviewed Original ResearchConceptsTraining-as-usualImplementation facilitatorsReferral to treatmentCase managementBrief interventionHybrid type 2 effectiveness-implementation trialPain managementImplementation strategiesPrimary implementation outcomeSubstance misuseProportion of participantsPain careUsefulness of screeningVeteran engagementVA sitesImplementation outcomesPragmatic trialPain serviceVeteran participantsCase management systemPain intensityDischarged veteransStudy enrollmentVeteransChronic painPotential Role for Buprenorphine in the Management of Comorbid Depression Among People with Chronic Pain and Long-Term Opioid Therapy Dependence
Manhapra A, Rosenheck R, Becker W. Potential Role for Buprenorphine in the Management of Comorbid Depression Among People with Chronic Pain and Long-Term Opioid Therapy Dependence. 2024, 148-164. DOI: 10.1093/9780197675250.003.0009.Peer-Reviewed Original ResearchLong-term opioid therapyKappa-opioid receptorsChronic painOpioid receptorsKappa-opioid receptor antagonismManagement of comorbid depressionTherapeutic agentsMOR agonismOpioid therapyOpioid taperAntidepressant effectsWorsening painOpioid dependenceSafety profileAgonist actionPoor outcomeClinical trialsAssociated with worsening depressionPainEtiological driversBuprenorphineReceptor affinityComorbid depressionOpioidReceptorsThe Impact of Non-Pain Factors on Pain Interference Among U.S. Service Members and Veterans with Symptoms of Mild Traumatic Brain Injury
Kennedy E, Manhapra A, Miles S, Martindale S, Rowland J, Mobasher H, Myers M, Panahi S, Walker W, Pugh M. The Impact of Non-Pain Factors on Pain Interference Among U.S. Service Members and Veterans with Symptoms of Mild Traumatic Brain Injury. Journal Of Neurotrauma 2024 PMID: 38907690, DOI: 10.1089/neu.2024.0126.Peer-Reviewed Original ResearchPredictors of pain interferencePain interferenceMild traumatic brain injuryTraumatic brain injuryU.S. service membersPain intensityAssociated with pain interferenceAssociated with functional limitationsService membersRates of traumatic brain injuryPain interference scoresPain intensity scoresHistory of traumatic brain injuryProspective longitudinal observational studyNon-pain symptomsTraumatic brain injury historyLongitudinal observational studyHolistic treatment approachSymptoms of mild traumatic brain injuryBrain injuryFunctional limitationsPain scoresChronic painIdentifying fatigueTargeting comorbiditiesChronic headaches after traumatic brain injury: Diagnostic complexity associated with increased cost.
McGeary D, Swan A, Kennedy E, Dismuke-Greer C, McGeary C, Sico J, Amuan M, Manhapra A, Bouldin E, Watson P, Kenney K, Myers M, Werner J, Mitchell J, Carlson K, Delgado R, Esmaeili A, Pugh M. Chronic headaches after traumatic brain injury: Diagnostic complexity associated with increased cost. Neurorehabilitation 2024, 55: 303-317. PMID: 39422976, DOI: 10.3233/nre-230277.Peer-Reviewed Original ResearchTraumatic brain injuryChronic headacheTraumatic brain injury diagnosisPost-9/11-era veteransPost-traumatic headacheAssociated with higher costsCare burdenBrain injuryHealthcare costsHeadache diagnosisEra veteransClinical characteristicsHeadache disordersHigher expendituresCareVeteransIndividual headachesHigh costHeadacheIntensive treatmentRefractory headacheOutcomesDiagnosisInjuryConfounding
2023
Are opioids effective analgesics and is physiological opioid dependence benign? Revising current assumptions to effectively manage long‐term opioid therapy and its deprescribing
Manhapra A, MacLean R, Rosenheck R, Becker W. Are opioids effective analgesics and is physiological opioid dependence benign? Revising current assumptions to effectively manage long‐term opioid therapy and its deprescribing. British Journal Of Clinical Pharmacology 2023, 90: 2962-2976. PMID: 37990580, PMCID: PMC11563311, DOI: 10.1111/bcp.15972.Peer-Reviewed Original ResearchLong-term opioid therapyOpioid therapyFunctional gainsChronic pain syndromeMaximum functional recoveryOngoing opioid crisisParadoxical worseningAnalgesic benefitAnalgesic therapyPain reliefPain syndromeEffective analgesicMost patientsAntinociceptive effectAntinociceptive systemChronic painFunctional recoveryOpioid actionOpioid dependenceMedical instabilityFunctional improvementPlacebo effectClinical principlesOpioid crisisTherapeutic inductionIs psychiatric diagnostic remission associated with reduced prevalence of moderate to severe pain interference and improved functioning among adults with lifetime psychiatric disorders?
Manhapra A, Zhou B, Rhee T, Rosenheck R. Is psychiatric diagnostic remission associated with reduced prevalence of moderate to severe pain interference and improved functioning among adults with lifetime psychiatric disorders? Journal Of Affective Disorders 2023, 344: 585-591. PMID: 37863364, DOI: 10.1016/j.jad.2023.10.094.Peer-Reviewed Original ResearchConceptsLifetime psychiatric disordersPast-year psychiatric disordersSevere pain interferencePain interferencePsychiatric disordersPD remissionChronic painNon-substance use psychiatric disordersPrevalence of painMental functioningLower physical functioningNational Epidemiologic SurveyRelated Conditions-IIIPoor mental functioningCommon comorbiditiesPhysical functionAdjusted oddsPhysical functioningObservational studyReduced prevalenceRemissionUS adultsDiagnostic remissionEpidemiologic SurveyPainMonotonic Association of Increasing Past-Year Substance Use Disorder across a Four-Level Trauma Post-Traumatic Stress Disorder (PTSD) Hierarchy in a Nationwide Sample
Jegede O, Manhapra A, Zhou B, Rhee T, Rosenheck R. Monotonic Association of Increasing Past-Year Substance Use Disorder across a Four-Level Trauma Post-Traumatic Stress Disorder (PTSD) Hierarchy in a Nationwide Sample. Journal Of Dual Diagnosis 2023, 19: 231-239. PMID: 37796996, DOI: 10.1080/15504263.2023.2260339.Peer-Reviewed Original ResearchConceptsSubstance use disordersTrauma exposureCurrent PTSDUse disordersComparison of adultPast-year substance use disorderSUD prevalencePTSDRelated Conditions Wave IIINational Epidemiologic SurveyTrauma groupNationwide sampleDifferential effectsGreater likelihoodSUD diagnosisUnadjusted resultsClinical consequencesHierarchical groupsEpidemiologic SurveyWave IIIAdultsDisordersMonotonic associationPrior groupPrevalenceBuprenorphine use and courses of care for opioid use disorder treatment within the Veterans Health Administration
Gordon A, Saxon A, Kertesz S, Wyse J, Manhapra A, Lin L, Chen W, Hansen J, Pinnell D, Huynh T, Baylis J, Cunningham F, Ghitza U, Bart G, Yu H, Sauer B. Buprenorphine use and courses of care for opioid use disorder treatment within the Veterans Health Administration. Drug And Alcohol Dependence 2023, 248: 109902. PMID: 37196572, PMCID: PMC10875624, DOI: 10.1016/j.drugalcdep.2023.109902.Peer-Reviewed Original ResearchConceptsOpioid use disorderVeterans Health AdministrationUse disordersHealth AdministrationOpioid use disorder treatmentHalf of patientsOpen cohort studyRetention of patientsCourse of careUse disorder treatmentLarge healthcare systemCohort studyMedian durationPatient characteristicsPatient demographicsDaily doseMedication treatmentBuprenorphine useClinical dataWhite racePatientsProportion daysDisorder treatmentMultiple coursesHealthcare systemPain Management in Older Adults Before and During the First Year of COVID-19 Pandemic: Prevalence, Trends, and Correlates
Manhapra A, Fortinsky R, Berg K, Ross J, Rhee T. Pain Management in Older Adults Before and During the First Year of COVID-19 Pandemic: Prevalence, Trends, and Correlates. The Journals Of Gerontology Series A 2023, 78: 1627-1640. PMID: 37096328, PMCID: PMC10460550, DOI: 10.1093/gerona/glad115.Peer-Reviewed Original ResearchConceptsHigh-impact chronic painChronic painPain managementOlder adultsCoronavirus diseasePain treatmentNational Health Interview SurveyNonpharmacological pain treatmentsUtilization of opioidsHealth Interview SurveyUS older adultsFirst yearOpioid useNonpharmacological treatmentsNonpharmacological interventionsTreatment utilizationLong-term effectsPainU.S. adultsPrevalenceInterview SurveyDiseaseAdultsCOVID-19 pandemicTreatmentRethinking clinically significant pain: a marker of recovery rather than a warning of injury
Manhapra A. Rethinking clinically significant pain: a marker of recovery rather than a warning of injury. Pain 2023, 164: e174-e174. PMID: 36779559, DOI: 10.1097/j.pain.0000000000002800.Peer-Reviewed Original Research
2022
Complex Persistent Opioid Dependence—an Opioid-induced Chronic Pain Syndrome
Manhapra A. Complex Persistent Opioid Dependence—an Opioid-induced Chronic Pain Syndrome. Current Treatment Options In Oncology 2022, 23: 921-935. PMID: 35435616, DOI: 10.1007/s11864-022-00985-x.Peer-Reviewed Original ResearchConceptsChronic pain syndromeOpioid dependenceOpioid taperingPain syndromeClinical conundrumLong-term opioid useWorse pain controlNon-cancer painOpioid use disorderPoor patient acceptanceSeparate clinical entityAnti-reward systemsOpioid doseOpioid therapyPain providersPain controlOpioid usePain mechanismsClinical entityMore painIatrogenic problemsPatient acceptanceTreatment choiceChronic cancerPain experiencePersistence of significant pain interference following substance use disorder remission: Negative association with psychosocial and physical recovery
Manhapra A, Stefanovics EA, Rhee TG, Rosenheck RA. Persistence of significant pain interference following substance use disorder remission: Negative association with psychosocial and physical recovery. Drug And Alcohol Dependence 2022, 232: 109339. PMID: 35121202, DOI: 10.1016/j.drugalcdep.2022.109339.Peer-Reviewed Original ResearchConceptsSubstance use disordersPast-year substance use disorderSevere pain interferencePain interferenceIndependent associationSUD remissionActive substance use disorderSignificant pain interferenceIndependent negative associationRelated Conditions Wave IIINegative associationPositive independent associationStrong negative associationUnited States adultsNational Epidemiologic SurveyPersistent painPhysical functionRemissionUS adultsUse disordersDisorder remissionEpidemiologic SurveyWave IIIClinical attentionStates adults
2021
Who Uses Veterans Mental Health Services?
Manhapra A, Stefanovics EA, Rhee TG, Rosenheck RA. Who Uses Veterans Mental Health Services? The Journal Of Nervous And Mental Disease 2021, 209: 702-709. PMID: 33993183, DOI: 10.1097/nmd.0000000000001369.Peer-Reviewed Original ResearchConceptsVeterans Health AdministrationPosttraumatic stress disorderHealth service usersMH service usersSubstance use disorder diagnosisClinical practice guidelinesMental health servicesMental health service usersClinical characteristicsMedicaid insurancePain interferenceService usersBlack raceSimilar prevalenceMental health researchMH researchPractice guidelinesGreater prevalenceHealth AdministrationHealth servicesPTSD diagnosisRacial distributionMH statusStress disorderDisorder diagnosisTwelve-Month Retention in Opioid Agonist Treatment for Opioid Use Disorder Among Patients With and Without HIV
Wyse JJ, McGinnis KA, Edelman EJ, Gordon AJ, Manhapra A, Fiellin DA, Moore BA, Korthuis PT, Kennedy AJ, Oldfield BJ, Gaither JR, Gordon KS, Skanderson M, Barry DT, Bryant K, Crystal S, Justice AC, Kraemer KL. Twelve-Month Retention in Opioid Agonist Treatment for Opioid Use Disorder Among Patients With and Without HIV. AIDS And Behavior 2021, 26: 975-985. PMID: 34495424, PMCID: PMC8840957, DOI: 10.1007/s10461-021-03452-0.Peer-Reviewed Original ResearchConceptsOpioid agonist therapyOpioid use disorderVeterans Aging Cohort StudyHIV statusUse disordersOpioid agonist treatmentAging Cohort StudyDiagnosis of HCVTwelve-month retentionPositive health outcomesOAT retentionAgonist therapyCohort studyHIV managementAgonist treatmentPredictors of retentionPatientsHealth outcomesHistory of homelessnessHIVLower likelihoodImproved likelihoodLikelihood of initiationBuprenorphineDisordersThe association of opioid use disorder and homelessness nationally in the veterans health administration
Manhapra A, Stefanovics E, Rosenheck R. The association of opioid use disorder and homelessness nationally in the veterans health administration. Drug And Alcohol Dependence 2021, 223: 108714. PMID: 33865213, DOI: 10.1016/j.drugalcdep.2021.108714.Peer-Reviewed Original ResearchConceptsOpioid use disorderSubstance use disordersVeterans Health AdministrationRisk factorsUse disordersHealth AdministrationUnited States Veterans Health AdministrationCo-morbid risk factorsPrevalence of OUDMajor risk factorMultivariate logistic regressionHomeless veteransHigher unadjusted oddsCross-sectional analysisClinical factorsVHA patientsNon-homeless veteransUnadjusted oddsVHA careFiscal year 2012US veteransOdds ratioHigh prevalenceHigher oddsPsychiatric diagnosisAssessment of Common Comorbidity Phenotypes Among Older Adults With Knee Osteoarthritis to Inform Integrated Care Models
Lentz T, Hellkamp A, Bhavsar N, Goode A, Manhapra A, George S. Assessment of Common Comorbidity Phenotypes Among Older Adults With Knee Osteoarthritis to Inform Integrated Care Models. Mayo Clinic Proceedings Innovations Quality & Outcomes 2021, 5: 253-264. PMID: 33997625, PMCID: PMC8105527, DOI: 10.1016/j.mayocpiqo.2020.09.011.Peer-Reviewed Original ResearchKnee osteoarthritisMedicare beneficiariesDiagnosis of KOAConcordant conditionsOlder adultsNon-OA controlsChronic pain syndromeIntegrated care modelValue-based health careComorbidity phenotypesPain syndromeLow comorbidityComorbid conditionsKnee OARheumatic diseasesMusculoskeletal conditionsPsychological comorbiditiesCare pathwayVascular diseaseClinical pathwayCare modelCondition subgroupsControl groupComorbiditiesOsteoarthritis diagnosis
2020
Association of symptom severity, pain and other behavioral and medical comorbidities with diverse measures of functioning among adults with post-traumatic stress disorder
Manhapra A, Stefanovics EA, Rhee TG, Rosenheck RA. Association of symptom severity, pain and other behavioral and medical comorbidities with diverse measures of functioning among adults with post-traumatic stress disorder. Journal Of Psychiatric Research 2020, 134: 113-120. PMID: 33383494, DOI: 10.1016/j.jpsychires.2020.12.063.Peer-Reviewed Original ResearchConceptsMental health composite scoresPhysical function scoresPost-traumatic stress disorderSubstance use disordersMedical comorbiditiesPain interferencePTSD symptomsStatistical Manual-5 (DSM-5) criteriaSymptom severityMental health-related qualityStress disorderPast-year post-traumatic stress disorderShort Form-12Health-related qualityNational Epidemiologic SurveyNegative associationCommon comorbiditiesChronic painForm-12Medical illnessSubstantial disabilityPsychiatric comorbidityPTSD symptom severityFunction scoresIndependent associationComplex Persistent Opioid Dependence with Long-term Opioids: a Gray Area That Needs Definition, Better Understanding, Treatment Guidance, and Policy Changes
Manhapra A, Sullivan MD, Ballantyne JC, MacLean RR, Becker WC. Complex Persistent Opioid Dependence with Long-term Opioids: a Gray Area That Needs Definition, Better Understanding, Treatment Guidance, and Policy Changes. Journal Of General Internal Medicine 2020, 35: 964-971. PMID: 33159241, PMCID: PMC7728942, DOI: 10.1007/s11606-020-06251-w.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyOpioid taperingOpioid dependenceChronic pain refractoryUtilization of buprenorphineLong-term opioidsSevere chronic painOpioid use disorderMultitude of treatmentsLimited supportive evidenceOpioid therapyPain refractoryBuprenorphine treatmentChronic painClinical instabilityRecent guidelinesClinical definitionUS adultsUse disordersDiagnosis/Treatment guidancePainComplicationsTreatmentSupportive evidenceEnsuring Patient Protections When Tapering Opioids: Consensus Panel Recommendations
Covington E, Argoff C, Ballantyne J, Cowan P, Gazelka H, Hooten W, Kertesz S, Manhapra A, Murphy J, Stanos S, Sullivan M. Ensuring Patient Protections When Tapering Opioids: Consensus Panel Recommendations. Mayo Clinic Proceedings 2020, 95: 2155-2171. PMID: 33012347, DOI: 10.1016/j.mayocp.2020.04.025.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyOpioid therapyConsensus panel recommendationsOngoing pain managementSerious withdrawal symptomsSerious adverse outcomesDifferent patient populationsHealth care professionalsLong-term useOpioid reductionOpioid taperTapering opioidsUncontrolled painPain cliniciansPain managementAdverse outcomesCertain patientsPatient populationWithdrawal symptomsPrimary careCare professionalsPatient advocatesOpioidsIllicit substancesBeneficial effectsAll-cause mortality among males living with and without HIV initiating long-term opioid therapy, and its association with opioid dose, opioid interruption and other factors
Gordon K, Manhapra A, Crystal S, Dziura J, Edelman E, Skanderson M, Kerns R, Justice A, Tate J, Becker W. All-cause mortality among males living with and without HIV initiating long-term opioid therapy, and its association with opioid dose, opioid interruption and other factors. Drug And Alcohol Dependence 2020, 216: 108291. PMID: 33011662, PMCID: PMC7644145, DOI: 10.1016/j.drugalcdep.2020.108291.Peer-Reviewed Original ResearchConceptsMorphine equivalent daily doseCause mortalityLong-term opioid therapyTime-updated Cox regressionStrong dose-response relationshipUnnatural deathsEquivalent daily doseDose-response relationshipOpioid doseOpioid therapyUninfected patientsOpioid useDaily doseCox regressionMortality outcomesTherapy doseHigh doseMale veteransOverdose fatalitiesOverdose mortalityPLWHMortalityHIVPatientsDose