Association of Refractory Pain in the Acute Phase After Subarachnoid Hemorrhage With Continued Outpatient Opioid Use.

Acute Pain / diagnosis Adult Aged Ambulatory Care / methods Analgesics, Opioid / administration & dosage Female Follow-Up Studies Humans Male Middle Aged Outpatients Pain, Intractable / diagnosis Patient Discharge / trends Prospective Studies Subarachnoid Hemorrhage / complications

Journal

Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060

Informations de publication

Date de publication:
11 05 2021
Historique:
received: 17 08 2020
accepted: 05 02 2021
pubmed: 27 3 2021
medline: 16 6 2021
entrez: 26 3 2021
Statut: ppublish

Résumé

Little is known about the prevalence of continued opioid use following aneurysmal subarachnoid hemorrhage (aSAH) despite guidelines recommending their use during the acute phase of disease. We sought to determine prevalence of opioid use following aSAH and test the hypothesis that acute pain and higher inpatient opioid dose increased outpatient opioid use. We reviewed consecutively admitted patients with aSAH from November 2015 through September 2019. We retrospectively collected pain scores and daily doses of analgesics. Pain burden was calculated as area under the pain-time curve. Univariate and multivariable regression models determined risk factors for continued opioid use at discharge and outpatient follow-up. We identified 234 patients with aSAH with outpatient follow-up. Continued opioid use was common at discharge (55% of patients) and follow-up (47% of patients, median 63 [interquartile range 49-96] days from admission). Pain burden, craniotomy, and racial or ethnic minority status were associated with discharge opioid prescription in multivariable analysis. At outpatient follow-up, pain burden (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.5-2.4), depression (OR 3.1, 95% CI 1.1-8.8), and racial or ethnic minority status (OR 2.1, 95% CI 1.1-4.0) were independently associated with continued opioid use; inpatient opioid dose was not. Continued opioid use following aSAH is prevalent and related to refractory pain during acute illness, but not inpatient opioid dose. More efficacious analgesic strategies are needed to reduce continued opioid use in patients following aSAH. This study provides Class II evidence that continued opioid use following aSAH is associated with refractory pain during acute illness but not hospital opioid exposure.

Identifiants

DOI: 10.1212/WNL.0000000000011906 PMID: 33766993 PMC: PMC8166442
pubmed: 33766993
pii: WNL.0000000000011906
doi: 10.1212/WNL.0000000000011906
pmc: PMC8166442
doi:

Substances chimiques

Analgesics, Opioid 0

Types de publication

Journal Article Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

e2355-e2362

Subventions

Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States

Commentaires et corrections

Type : CommentIn

Informations de copyright

© 2021 American Academy of Neurology.

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Auteurs

Matthew N Jaffa (MN)

From the Departments of Neurology (M.N.J., J.E.P., A.K., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), Emergency Medicine (W.-T.W.C.), Pharmacy Services (M.J.A.), Neurosurgery (J.M.S.), Pathology (J.M.S.), and Physiology (J.M.S.), and Program in Trauma, R. Adams Cowley Shock Trauma Center (M.N.J., J.E.P., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), University of Maryland School of Medicine (M.C.S., A.F., A.K.), Baltimore; and Department of Neurology, Division of Neurocritical Care and Emergency Neurology (K.N.S.), Yale School of Medicine, New Haven, CT.

Jamie E Podell (JE)

From the Departments of Neurology (M.N.J., J.E.P., A.K., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), Emergency Medicine (W.-T.W.C.), Pharmacy Services (M.J.A.), Neurosurgery (J.M.S.), Pathology (J.M.S.), and Physiology (J.M.S.), and Program in Trauma, R. Adams Cowley Shock Trauma Center (M.N.J., J.E.P., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), University of Maryland School of Medicine (M.C.S., A.F., A.K.), Baltimore; and Department of Neurology, Division of Neurocritical Care and Emergency Neurology (K.N.S.), Yale School of Medicine, New Haven, CT.

Madeleine C Smith (MC)

From the Departments of Neurology (M.N.J., J.E.P., A.K., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), Emergency Medicine (W.-T.W.C.), Pharmacy Services (M.J.A.), Neurosurgery (J.M.S.), Pathology (J.M.S.), and Physiology (J.M.S.), and Program in Trauma, R. Adams Cowley Shock Trauma Center (M.N.J., J.E.P., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), University of Maryland School of Medicine (M.C.S., A.F., A.K.), Baltimore; and Department of Neurology, Division of Neurocritical Care and Emergency Neurology (K.N.S.), Yale School of Medicine, New Haven, CT.

Arshom Foroutan (A)

From the Departments of Neurology (M.N.J., J.E.P., A.K., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), Emergency Medicine (W.-T.W.C.), Pharmacy Services (M.J.A.), Neurosurgery (J.M.S.), Pathology (J.M.S.), and Physiology (J.M.S.), and Program in Trauma, R. Adams Cowley Shock Trauma Center (M.N.J., J.E.P., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), University of Maryland School of Medicine (M.C.S., A.F., A.K.), Baltimore; and Department of Neurology, Division of Neurocritical Care and Emergency Neurology (K.N.S.), Yale School of Medicine, New Haven, CT.

Adam Kardon (A)

From the Departments of Neurology (M.N.J., J.E.P., A.K., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), Emergency Medicine (W.-T.W.C.), Pharmacy Services (M.J.A.), Neurosurgery (J.M.S.), Pathology (J.M.S.), and Physiology (J.M.S.), and Program in Trauma, R. Adams Cowley Shock Trauma Center (M.N.J., J.E.P., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), University of Maryland School of Medicine (M.C.S., A.F., A.K.), Baltimore; and Department of Neurology, Division of Neurocritical Care and Emergency Neurology (K.N.S.), Yale School of Medicine, New Haven, CT.

Wan-Tsu W Chang (WW)

From the Departments of Neurology (M.N.J., J.E.P., A.K., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), Emergency Medicine (W.-T.W.C.), Pharmacy Services (M.J.A.), Neurosurgery (J.M.S.), Pathology (J.M.S.), and Physiology (J.M.S.), and Program in Trauma, R. Adams Cowley Shock Trauma Center (M.N.J., J.E.P., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), University of Maryland School of Medicine (M.C.S., A.F., A.K.), Baltimore; and Department of Neurology, Division of Neurocritical Care and Emergency Neurology (K.N.S.), Yale School of Medicine, New Haven, CT.
ORCID: 0000-0002-7559-2982

Melissa Motta (M)

From the Departments of Neurology (M.N.J., J.E.P., A.K., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), Emergency Medicine (W.-T.W.C.), Pharmacy Services (M.J.A.), Neurosurgery (J.M.S.), Pathology (J.M.S.), and Physiology (J.M.S.), and Program in Trauma, R. Adams Cowley Shock Trauma Center (M.N.J., J.E.P., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), University of Maryland School of Medicine (M.C.S., A.F., A.K.), Baltimore; and Department of Neurology, Division of Neurocritical Care and Emergency Neurology (K.N.S.), Yale School of Medicine, New Haven, CT.

Gunjan Y Parikh (GY)

From the Departments of Neurology (M.N.J., J.E.P., A.K., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), Emergency Medicine (W.-T.W.C.), Pharmacy Services (M.J.A.), Neurosurgery (J.M.S.), Pathology (J.M.S.), and Physiology (J.M.S.), and Program in Trauma, R. Adams Cowley Shock Trauma Center (M.N.J., J.E.P., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), University of Maryland School of Medicine (M.C.S., A.F., A.K.), Baltimore; and Department of Neurology, Division of Neurocritical Care and Emergency Neurology (K.N.S.), Yale School of Medicine, New Haven, CT.
ORCID: 0000-0002-8447-1349

Kevin N Sheth (KN)

From the Departments of Neurology (M.N.J., J.E.P., A.K., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), Emergency Medicine (W.-T.W.C.), Pharmacy Services (M.J.A.), Neurosurgery (J.M.S.), Pathology (J.M.S.), and Physiology (J.M.S.), and Program in Trauma, R. Adams Cowley Shock Trauma Center (M.N.J., J.E.P., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), University of Maryland School of Medicine (M.C.S., A.F., A.K.), Baltimore; and Department of Neurology, Division of Neurocritical Care and Emergency Neurology (K.N.S.), Yale School of Medicine, New Haven, CT.

Neeraj Badjatia (N)

From the Departments of Neurology (M.N.J., J.E.P., A.K., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), Emergency Medicine (W.-T.W.C.), Pharmacy Services (M.J.A.), Neurosurgery (J.M.S.), Pathology (J.M.S.), and Physiology (J.M.S.), and Program in Trauma, R. Adams Cowley Shock Trauma Center (M.N.J., J.E.P., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), University of Maryland School of Medicine (M.C.S., A.F., A.K.), Baltimore; and Department of Neurology, Division of Neurocritical Care and Emergency Neurology (K.N.S.), Yale School of Medicine, New Haven, CT.
ORCID: 0000-0003-1509-9034

Michael J Armahizer (MJ)

From the Departments of Neurology (M.N.J., J.E.P., A.K., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), Emergency Medicine (W.-T.W.C.), Pharmacy Services (M.J.A.), Neurosurgery (J.M.S.), Pathology (J.M.S.), and Physiology (J.M.S.), and Program in Trauma, R. Adams Cowley Shock Trauma Center (M.N.J., J.E.P., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), University of Maryland School of Medicine (M.C.S., A.F., A.K.), Baltimore; and Department of Neurology, Division of Neurocritical Care and Emergency Neurology (K.N.S.), Yale School of Medicine, New Haven, CT.

J Marc Simard (JM)

From the Departments of Neurology (M.N.J., J.E.P., A.K., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), Emergency Medicine (W.-T.W.C.), Pharmacy Services (M.J.A.), Neurosurgery (J.M.S.), Pathology (J.M.S.), and Physiology (J.M.S.), and Program in Trauma, R. Adams Cowley Shock Trauma Center (M.N.J., J.E.P., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), University of Maryland School of Medicine (M.C.S., A.F., A.K.), Baltimore; and Department of Neurology, Division of Neurocritical Care and Emergency Neurology (K.N.S.), Yale School of Medicine, New Haven, CT.

Nicholas A Morris (NA)

From the Departments of Neurology (M.N.J., J.E.P., A.K., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), Emergency Medicine (W.-T.W.C.), Pharmacy Services (M.J.A.), Neurosurgery (J.M.S.), Pathology (J.M.S.), and Physiology (J.M.S.), and Program in Trauma, R. Adams Cowley Shock Trauma Center (M.N.J., J.E.P., W.-T.W.C., M.M., G.Y.P., N.B., N.A.M.), University of Maryland School of Medicine (M.C.S., A.F., A.K.), Baltimore; and Department of Neurology, Division of Neurocritical Care and Emergency Neurology (K.N.S.), Yale School of Medicine, New Haven, CT. nicholas.morris@som.umaryland.edu.
ORCID: 0000-0002-1270-9805

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Classifications MeSH

questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Manifestations neurologiques › Douleur aigüe › Association of Refractory Pain in the Acute...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Association of Refractory Pain in the Acute...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Association of Refractory Pain in the Acute...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins ambulatoires › Association of Refractory Pain in the Acute...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents du système nerveux central › Dépresseurs du système nerveux central › Stupéfiants › Analgésiques morphiniques › Association of Refractory Pain in the Acute...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études de suivi › Association of Refractory Pain in the Acute...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Association of Refractory Pain in the Acute...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Association of Refractory Pain in the Acute...
questionsmedicales.fr › Personnes › Patients › Patients en consultation externe › Association of Refractory Pain in the Acute...
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Manifestations neurologiques › Douleur rebelle › Association of Refractory Pain in the Acute...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Continuité des soins › Sortie du patient › Association of Refractory Pain in the Acute...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Association of Refractory Pain in the Acute...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Hémorragie › Hémorragies intracrâniennes › Hémorragie meningée › Association of Refractory Pain in the Acute...