Opioid Analgesic Use and Risk for Invasive Pneumococcal Diseases
Authors: Toshihiko Takada, Yuki Kataoka
Journal: Annals of Internal Medicine (2018)

Letters4 September 2018Opioid Analgesic Use and Risk for Invasive Pneumococcal DiseasesToshihiko Takada, PhD and Yuki Kataoka, MD, MPHToshihiko Takada, PhDFukushima Medical University, Fukushima, Japan (T.T.) and Yuki Kataoka, MD, MPHHyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan (Y.K.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0294 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read Wiese and colleagues' article (1) with interest, especially their sensitivity analysis to address residual confounding. Although this analysis suggested that only weak, unmeasured confounders affected the result, residual confounding by indication cannot be excluded. As the authors described in their previous study (2), pain might lead to both opioid use and susceptibility to infection. Nonsignificant association between use of nonsteroidal anti-inflammatory drugs and invasive pneumococcal disease made this hypothesis less likely. However, more severe pain that requires opioids may impair the immune system. Further investigation, including assessment of the severity of pain, is expected.The ...References1. Wiese AD, Griffin MR, Schaffner W, Stein CM, Greevy RA, Mitchel EF, et al. Opioid analgesic use and risk for invasive pneumococcal diseases: a nested case–control study. Ann Intern Med. 2018;168:396-404. [PMID: 29435555]. doi:10.7326/M17-1907 LinkGoogle Scholar2. Wiese AD, Griffin MR, Stein CM, Mitchel EF, Grijalva CG. Opioid analgesics and the risk of serious infections among patients with rheumatoid arthritis: a self-controlled case series study. Arthritis Rheumatol. 2016;68:323-31. [PMID: 26473742] doi:10.1002/art.39462 CrossrefMedlineGoogle Scholar3. Guyatt G, Montori V, Devereaux PJ, Schünemann H, Bhandari M. Patients at the center: in our practice, and in our use of language [Editorial]. ACP J Club. 2004;140:A11-2. [PMID: 14711297] AbstractGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Fukushima Medical University, Fukushima, Japan (T.T.)Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan (Y.K.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L18-0294. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoOpioid Analgesic Use and Risk for Invasive Pneumococcal Diseases Andrew D. Wiese , Marie R. Griffin , William Schaffner , C. Michael Stein , Robert A. Greevy , Edward F. Mitchel Jr. , and Carlos G. Grijalva Opioid Analgesic Use and Risk for Invasive Pneumococcal Diseases Andrew D. Wiese , Marie R. Griffin , William Schaffner , C. Michael Stein , and Carlos G. Grijalva Metrics 4 September 2018Volume 169, Issue 5Page: 354KeywordsAnalgesicsDisclosureDrugsImmune systemOpioidsPrevention, policy, and public health ePublished: 4 September 2018 Issue Published: 4 September 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...