2023
Is 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 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 mortalityPLWHMortalityHIVPatientsDoseAssociations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation
Oliva E, Bowe T, Manhapra A, Kertesz S, Hah J, Henderson P, Robinson A, Paik M, Sandbrink F, Gordon A, Trafton J. Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation. The BMJ 2020, 368: m283. PMID: 32131996, PMCID: PMC7249243, DOI: 10.1136/bmj.m283.Peer-Reviewed Original ResearchConceptsLength of treatmentVeterans Health AdministrationOpioid treatmentHealth AdministrationLong patientsObservational evaluationRisk of deathHazards regression modelsFocus of guidelinesLong-term useOpioid cessationOpioid prescriptionsOpioid analgesicsOutpatient prescriptionsPlace patientsSafe prescribingPatient deathUS veteransNon-proportional hazards regression modelsPatient's perspectiveFiscal year 2014OpioidsPatientsOverdoseGreater riskNonconsensual Dose Reduction Mandates are Not Justified Clinically or Ethically: An Analysis
Kertesz S, Manhapra A, Gordon A. Nonconsensual Dose Reduction Mandates are Not Justified Clinically or Ethically: An Analysis. The Journal Of Law, Medicine & Ethics 2020, 48: 259-267. PMID: 32631183, PMCID: PMC7938366, DOI: 10.1177/1073110520935337.Peer-Reviewed Original Research
2019
High-dose prescribed opioids are associated with increased risk of heroin use among United States military veterans.
Banerjee G, Edelman EJ, Barry DT, Crystal S, Gordon KS, Gordon AJ, Gaither JR, Green TC, Kerns RD, Manhapra A, Moore BA, Fiellin DA, Marshall BDL. High-dose prescribed opioids are associated with increased risk of heroin use among United States military veterans. Pain 2019, 160: 2126-2135. PMID: 31145217, PMCID: PMC6699915, DOI: 10.1097/j.pain.0000000000001606.Peer-Reviewed Original ResearchConceptsHigh-dose opioid prescriptionsOpioid prescriptionsHeroin useCohort studyPrior receiptHepatitis C virus (HCV) infection statusLong-term opioid prescriptionsPast-year heroin useVeterans Aging Cohort StudyHigh-dose opioidsOpioid-prescribing patternsProspective cohort studyAging Cohort StudyOpioid use disorderCurrent national guidelinesUnhealthy alcohol useUnited States veteransUnited States military veteransVirus infection statusPosttraumatic stress disorderOpioid receiptPrescribed opioidsPain interferenceCox regressionStates veteransSystematic Review of Pain Severity and Opioid Craving in Chronic Pain and Opioid Use Disorder
MacLean RR, Spinola S, Manhapra A, Sofuoglu M. Systematic Review of Pain Severity and Opioid Craving in Chronic Pain and Opioid Use Disorder. Pain Medicine 2019, 21: e146-e163. PMID: 32034413, DOI: 10.1093/pm/pnz228.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyOpioid use disorderChronic painPain severityOpioid therapyOpioid cravingUse disordersEligible studiesSystematic reviewOpioid use disorder patientsChronic pain populationsRisk of biasInclusion/exclusion criteriaPain populationObservational studyExclusion criteriaPainDisorder patientsPsycINFO databasesTherapyMean levelsDisordersSeverityStudy of individualsCraving
2018
Multimodal Treatment Options, Including Rotating to Buprenorphine, Within a Multidisciplinary Pain Clinic for Patients on Risky Opioid Regimens: A Quality Improvement Study
Oldfield BJ, Edens EL, Agnoli A, Bone CW, Cervone DJ, Edmond SN, Manhapra A, Sellinger JJ, Becker WC. Multimodal Treatment Options, Including Rotating to Buprenorphine, Within a Multidisciplinary Pain Clinic for Patients on Risky Opioid Regimens: A Quality Improvement Study. Pain Medicine 2018, 19: s38-s45. PMID: 30203007, DOI: 10.1093/pm/pny086.Peer-Reviewed Original ResearchConceptsPrimary care providersIntake appointmentMorphine equivalent daily dosePartial opioid agonist buprenorphineVeterans Health Administration hospitalsPartial agonist therapiesPrescribed opioid dosesRetrospective cohort studyUnsafe useEquivalent daily doseMultidisciplinary pain clinicMultimodal treatment optionsChronic pain managementPrimary care settingQuality improvement studyHealth system levelHealth system improvementOpioid dosesCohort studyPain clinicDaily doseOpioid regimensPain managementMultidisciplinary clinicTreatment optionsThe Conundrum of Opioid Tapering in Long-Term Opioid Therapy for Chronic Pain: A Commentary
Manhapra A, Arias A, Ballantyne J. The Conundrum of Opioid Tapering in Long-Term Opioid Therapy for Chronic Pain: A Commentary. Substance Abuse 2018, 39: 152-161. PMID: 28929914, PMCID: PMC6129223, DOI: 10.1080/08897077.2017.1381663.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyOpioid taperingChronic painOpioid therapyOpioid dependencePsychiatric symptomsHigher-dose long-term opioid therapyClinical scenariosPoor pain controlTerm opioid therapyUse of opioidsDifficult clinical scenariosUnique clinical challengesOpioid needsPain controlNeuroplasticity effectsAbstinence syndromeFunctional statusOpioid epidemicClinical challengeFunctional declinePainAffective symptomsPsychiatric instabilityAvailable evidence