The first 24 h: opioid administration in people with spinal cord injury and neurologic recovery.
Adult
Analgesics, Opioid
/ administration & dosage
Drug Administration Schedule
Female
Humans
Male
Middle Aged
Pain
/ diagnosis
Pain Measurement
/ drug effects
Quality of Life
/ psychology
Recovery of Function
/ drug effects
Spinal Cord Injuries
/ diagnosis
Time Factors
Treatment Outcome
Young Adult
Journal
Spinal cord
ISSN: 1476-5624
Titre abrégé: Spinal Cord
Pays: England
ID NLM: 9609749
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
14
01
2020
accepted:
01
05
2020
revised:
29
04
2020
pubmed:
29
5
2020
medline:
6
8
2021
entrez:
29
5
2020
Statut:
ppublish
Résumé
Retrospective chart review. The objective of this study was to characterize opioid administration in people with acute SCI and examine the association between opioid dose and (1) changes in motor/functional scores from hospital to rehabilitation discharge, and (2) pain, depression, and quality of life (QOL) scores 1-year post injury. Spinal Cord Injury Model System (SCIMS) inpatient acute rehabilitation facility. Patients included in the SCIMS from 2008 to 2011 were linked to the National Trauma Registry and the electronic medical record. Three opioid dose groups (low, medium, and high) were defined based on the total morphine equivalence in milligrams at 24 h. The associations between opioid dose groups and functional/motor outcomes were assessed, as well as 1-year follow-up pain and QOL surveys. In all, 85/180 patients had complete medication records. By 24 h, all patients had received opioids. Patients receiving higher amounts of opioids had higher pain scores 1 year later compared with medium- and low-dose groups (pain levels 5.5 vs. 4 vs. 1, respectively, p = 0.018). There was also an 8× greater risk of depression 1 year later in the high-dose group compared with the low-dose group (OR: 8.1, 95% CI: 1.2-53.7). In analyses of motor scores, we did not find a significant interaction between opioid dose and duration of injury. These preliminary findings suggest that higher doses of opioids administered within 24 h of injury are associated with increased pain in the chronic phase of people with SCI.
Identifiants
pubmed: 32461572
doi: 10.1038/s41393-020-0483-x
pii: 10.1038/s41393-020-0483-x
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1080-1089Références
Kumar R, Lim J, Mekary RA, Rattani A, Dewan MC, Sharif SY, et al. Traumatic spinal injury: global epidemiology and worldwide volume. World Neurosurg. 2018;113:e345–63.
doi: 10.1016/j.wneu.2018.02.033
Klingler HC, Pycha A, Schmidbauer J, Marberger M. Use of peripheral neuromodulation of the S3 region for treatment of detrusor overactivity: a urodynamic-based study. Urology. 2000;56:766–71.
doi: 10.1016/S0090-4295(00)00727-5
Hook MA, Liu GT, Washburn SN, Ferguson AR, Bopp AC, Huie JR, et al. The impact of morphine after a spinal cord injury. Behav Brain Res. 2007;179:281–93.
doi: 10.1016/j.bbr.2007.02.035
Hook MA, Moreno G, Woller S, Puga D, Hoy K Jr., Balden R, et al. Intrathecal morphine attenuates recovery of function after a spinal cord injury. J Neurotrauma. 2009;26:741–52.
doi: 10.1089/neu.2008.0710
Hook MA, Washburn SN, Moreno G, Woller SA, Puga D, Lee KH, et al. An IL-1 receptor antagonist blocks a morphine-induced attenuation of locomotor recovery after spinal cord injury. Brain Behav Immun. 2011;25:349–59.
doi: 10.1016/j.bbi.2010.10.018
Woller SA, Moreno GL, Hart N, Wellman PJ, Grau JW, Hook MA. Analgesia or addiction?: implications for morphine use after spinal cord injury. J Neurotrauma. 2012;29:1650–62.
doi: 10.1089/neu.2011.2100
Woller SA, Malik JS, Aceves M, Hook MA. Morphine self-administration following spinal cord injury. J Neurotrauma. 2014;31:1570–83.
doi: 10.1089/neu.2013.3293
Hook MA, Woller SA, Bancroft E, Aceves M, Funk MK, Hartman J, et al. Neurobiological effects of morphine after spinal cord injury. J Neurotrauma. 2017;34:632–44.
doi: 10.1089/neu.2016.4507
Aceves M, Terminel MN, Okoreeh A, Aceves AR, Gong YM, Polanco A, et al. Morphine increases macrophages at the lesion site following spinal cord injury: protective effects of minocycline. Brain Behav Immun. 2019;79:125–38.
doi: 10.1016/j.bbi.2019.01.023
Scherrer JF, Salas J, Lustman PJ, Burge S, Schneider FD.Residency Research Network of Texas, et al. Change in opioid dose and change in depression in a longitudinal primary care patient cohort. Pain. 2015;156:348–55.
doi: 10.1097/01.j.pain.0000460316.58110.a0
Scherrer JF, Svrakic DM, Freedland KE, Chrusciel T, Balasubramanian S, Bucholz KK, et al. Prescription opioid analgesics increase the risk of depression. J Gen Intern Med. 2014;29:491–9.
doi: 10.1007/s11606-013-2648-1
Ilgen MA, Bohnert AS, Ganoczy D, Bair MJ, McCarthy JF, Blow FC. Opioid dose and risk of suicide. Pain. 2016;157:1079–84.
doi: 10.1097/j.pain.0000000000000484
Salas J, Scherrer JF, Schneider FD, Sullivan MD, Bucholz KK, Burroughs T, et al. New-onset depression following stable, slow, and rapid rate of prescription opioid dose escalation. Pain. 2017;158:306–12.
doi: 10.1097/j.pain.0000000000000763
Hoffman JM, Bombardier CH, Graves DE, Kalpakjian CZ, Krause JS. A longitudinal study of depression from 1 to 5 years after spinal cord injury. Arch Phys Med Rehabil. 2011;92:411–8.
doi: 10.1016/j.apmr.2010.10.036
Cao Y, Massaro JF, Krause JS, Chen Y, Devivo MJ. Suicide mortality after spinal cord injury in the United States: injury cohorts analysis. Arch Phys Med Rehabil. 2014;95:230–5.
doi: 10.1016/j.apmr.2013.10.007
Neighbor ML, Honner S, Kohn MA. Factors affecting emergency department opioid administration to severely injured patients. Acad Emerg Med. 2004;11:1290–6.
doi: 10.1197/j.aem.2004.07.014
Archer KR, Heins SE, Abraham CM, Obremskey WT, Wegener ST, Castillo RC. Clinical significance of pain at hospital discharge following traumatic orthopedic injury: general health, depression, and PTSD outcomes at 1 year. Clin J Pain. 2016;32:196–202.
doi: 10.1097/AJP.0000000000000246
Katz J, Seltzer Z. Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert Rev Neurother. 2009;9:723–44.
doi: 10.1586/ern.09.20
Kyranou M, Puntillo K. The transition from acute to chronic pain: might intensive care unit patients be at risk? Ann Intensive Care. 2012;2:36.
doi: 10.1186/2110-5820-2-36
Opioid Coversion Calculator. 2016. https://www.practicalpainmanagement.com .
Poritz JMP, Mignogna J, Christie AJ, Holmes SA, Ames H. The Patient Health Questionnaire depression screener in spinal cord injury. J Spinal Cord Med. 2018;41:238–44.
doi: 10.1080/10790268.2017.1294301
Chen A, Ashburn MA. Cardiac effects of opioid therapy. Pain Med. 2015;16:S27–31.
doi: 10.1111/pme.12915
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370:1453–7.
doi: 10.1016/S0140-6736(07)61602-X
Chamberlain JD, Brinkhof MWG. Using strong inference to answer causal questions in spinal cord injury research. Spinal Cord. 2019;57:907–8.
doi: 10.1038/s41393-019-0344-7
Harvey LA. Relationships, associations, risk factors and correlations: nebulous phrases without obvious clinical implications. Spinal Cord. 2020;58:1–2.
doi: 10.1038/s41393-019-0396-8