Global trends in opioid use for pain management in acute pancreatitis: A multicentre prospective observational study.
abdominal pain
acute necrotic collections
acute pancreatitis
analgesia
opioids
walled‐off necrosis
Journal
United European gastroenterology journal
ISSN: 2050-6414
Titre abrégé: United European Gastroenterol J
Pays: England
ID NLM: 101606807
Informations de publication
Date de publication:
14 Aug 2024
14 Aug 2024
Historique:
received:
08
04
2024
accepted:
06
07
2024
medline:
14
8
2024
pubmed:
14
8
2024
entrez:
14
8
2024
Statut:
aheadofprint
Résumé
Since there is no current international consensus on the optimal approach for pain management in acute pancreatitis (AP), analgesic practices may vary across different healthcare settings. This study explored global disparities in analgesic use, in particular opioids, during admission and at discharge in hospitalised AP patients. This was a post hoc analysis of the prospective PAINAP database, which included all admissions for AP between April and June 2022 with a 1-month follow-up. Demographic details, analgesic use, and clinical outcomes were recorded during admission and at discharge. Odds ratios (ORs) for opioid use during admission and at discharge were identified using multivariable regression analyses. Amongst the 1864 patients (52% males, median age 56 (interquartile range, 41-71)) across three different continents, simple analgesics were predominantly used as the primary analgesic (70%). Opioid use during admission was lowest in European centres (67%). Admission in Asian (OR, 2.53 (95% confidence interval (CI), 1.59-4.04), p < 0.001), and Australian (OR, 5.81 (95% CI, 3.19-10.56), p < 0.001) centres was associated with opioid administration during admission compared with European centres. Increased pain severity, longer pre-admission pain duration, organ failure, and longer length of admission increased opioid use during admission. At discharge, Asian (OR, 2.01 (95% CI, 1.40-2.88), p < 0.001) and Australian (OR, 1.91 (95% CI, 1.28-2.85), p = 0.002) centres were associated with opioid prescription compared with European centres. Increased pain severity, longer pre-admission pain duration, acute necrotic collections, and walled-off necrosis also increased the likelihood of opioid prescription at discharge. There are substantial intercontinental differences in opioid use for AP pain. Accordingly, there is a need for international guidelines on pain management in AP.
Sections du résumé
BACKGROUND
BACKGROUND
Since there is no current international consensus on the optimal approach for pain management in acute pancreatitis (AP), analgesic practices may vary across different healthcare settings.
OBJECTIVE
OBJECTIVE
This study explored global disparities in analgesic use, in particular opioids, during admission and at discharge in hospitalised AP patients.
METHODS
METHODS
This was a post hoc analysis of the prospective PAINAP database, which included all admissions for AP between April and June 2022 with a 1-month follow-up. Demographic details, analgesic use, and clinical outcomes were recorded during admission and at discharge. Odds ratios (ORs) for opioid use during admission and at discharge were identified using multivariable regression analyses.
RESULTS
RESULTS
Amongst the 1864 patients (52% males, median age 56 (interquartile range, 41-71)) across three different continents, simple analgesics were predominantly used as the primary analgesic (70%). Opioid use during admission was lowest in European centres (67%). Admission in Asian (OR, 2.53 (95% confidence interval (CI), 1.59-4.04), p < 0.001), and Australian (OR, 5.81 (95% CI, 3.19-10.56), p < 0.001) centres was associated with opioid administration during admission compared with European centres. Increased pain severity, longer pre-admission pain duration, organ failure, and longer length of admission increased opioid use during admission. At discharge, Asian (OR, 2.01 (95% CI, 1.40-2.88), p < 0.001) and Australian (OR, 1.91 (95% CI, 1.28-2.85), p = 0.002) centres were associated with opioid prescription compared with European centres. Increased pain severity, longer pre-admission pain duration, acute necrotic collections, and walled-off necrosis also increased the likelihood of opioid prescription at discharge.
CONCLUSION
CONCLUSIONS
There are substantial intercontinental differences in opioid use for AP pain. Accordingly, there is a need for international guidelines on pain management in AP.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Novo Nordisk Fonden
ID : #NNF19OC0057331
Informations de copyright
© 2024 The Author(s). United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.
Références
Iannuzzi JP, King JA, Leong JH, Quan J, Windsor JW, Tanyingoh D, et al. Global incidence of acute pancreatitis is increasing over time: a systematic review and meta‐analysis. Gastroenterology. 2022;162(1):122–134. https://doi.org/10.1053/j.gastro.2021.09.043
Szatmary P, Grammatikopoulos T, Cai W, Huang W, Mukherjee R, Halloran C, et al. Acute pancreatitis: diagnosis and treatment. Drugs. 2022;82(12):1251–1276. https://doi.org/10.1007/s40265‐022‐01766‐4
Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence‐based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4 Suppl 2):e1–e15.
Yokoe M, Takada T, Mayumi T, Yoshida M, Isaji S, Wada K, et al. Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015. J Hepatobiliary Pancreat Sci. 2015;22(6):405–432. https://doi.org/10.1002/jhbp.259
Thavanesan N, White S, Lee S, Ratnayake B, Oppong KW, Nayar MK, et al. Analgesia in the initial management of acute pancreatitis: a systematic review and meta‐analysis of randomised controlled trials. World J Surg. 2022;46(4):878–890. https://doi.org/10.1007/s00268‐021‐06420‐w
Wu BU, Butler RK, Chen W. Factors associated with opioid use in patients hospitalized for acute pancreatitis. JAMA Netw Open. 2019;2(4):e191827. https://doi.org/10.1001/jamanetworkopen.2019.1827
Scholten WK, Christensen A.‐E, Olesen AE, Drewes AM. Quantifying the adequacy of opioid analgesic consumption globally: an updated method and early findings. Am J Public Health. 2019;109(1):52–57. https://doi.org/10.2105/ajph.2018.304753
Pandanaboyana S, Huang W, Windsor JA, Drewes AM. Update on pain management in acute pancreatitis. Curr Opin Gastroenterol. 2022;38(5):487–494. https://doi.org/10.1097/mog.0000000000000861
Balbale SN, Keswani RN. Opioid use for acute pancreatitis—toward a research agenda to optimize patient safety. JAMA Netw Open. 2019;2(4):e191834. https://doi.org/10.1001/jamanetworkopen.2019.1834
Pandanaboyana S, Knoph CS, Olesen SS, Jones M, Lucocq J, Samanta J, et al. Opioid analgesia and severity of acute pancreatitis: an international multicentre cohort study on pain management in acute pancreatitis. United Eur Gastroenterol J. 2024;4.
Matta B, Gougol A, Gao X, Reddy N, Talukdar R, Kochhar R, et al. Worldwide variations in demographics, management, and outcomes of acute pancreatitis. Clin Gastroenterol Hepatol. 2020;18(7):1567–1575.e2. https://doi.org/10.1016/j.cgh.2019.11.017
McHenry N, Shah I, Ahmed A, Freedman SD, Kothari DJ, Sheth SG. Racial variations in pain management and outcomes in hospitalized patients with acute pancreatitis. Pancreas. 2022;51(9):1248–1250. https://doi.org/10.1097/mpa.0000000000002160
McHenry N, Ahmed A, Shah I, Freedman SD, Nee J, Lembo A, et al. Racial and ethnic disparities in opioid prescriptions in benign and malignant pancreatic disease in the United States. Pancreas. 2022;51(10):1359–1364. https://doi.org/10.1097/mpa.0000000000002180
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–111. https://doi.org/10.1136/gutjnl‐2012‐302779
Collins GS, Reitsma JB, Altman DG, Moons KGM. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD Statement. BMC Med. 2015;13(1):1–10. https://doi.org/10.1016/j.eururo.2014.11.025
Vargas‐Schaffer G. Is the WHO analgesic ladder still valid? Twenty‐four years of experience. Can Fam Physician. 2010;56(6):514–517. e202‐5.
Jayawardana S, Forman R, Johnston‐Webber C, Campbell A, Berterame S, de Joncheere C, et al. Global consumption of prescription opioid analgesics between 2009‐2019: a country‐level observational study. EClinicalMedicine. 2021;42:101198. https://doi.org/10.1016/j.eclinm.2021.101198
Degenhardt L, Grebely J, Stone J, Hickman M, Vickerman P, Marshall BDL, et al. Global patterns of opioid use and dependence: harms to populations, interventions, and future action. Lancet. 2019;394(10208):1560–1579. https://doi.org/10.1016/s0140‐6736(19)32229‐9
Barnett ML, Olenski AR, Jena AB. Opioid‐prescribing patterns of emergency physicians and risk of long‐term use. N Engl J Med. 2017;376(7):663–673. https://doi.org/10.1056/nejmsa1610524
Dawson A, List T. Comparison of pain thresholds and pain tolerance levels between Middle Easterners and Swedes and between genders. J Oral Rehabil. 2009;36(4):271–278. https://doi.org/10.1111/j.1365‐2842.2009.01943.x
Richards GC, Aronson JK, Mahtani KR, Heneghan C. Global, regional, and national consumption of controlled opioids: a cross‐sectional study of 214 countries and non‐metropolitan territories. Br J Pain. 2022;16(1):34–40. https://doi.org/10.1177/20494637211013052
Mahapatra SJ, Jain S, Bopanna S, Gupta S, Singh P, Trikha A, et al. Pentazocine, a kappa‐opioid agonist, is better than diclofenac for analgesia in acute pancreatitis: a randomized controlled trial. Am J Gastroenterol. 2019;114(5):813–821. https://doi.org/10.14309/ajg.0000000000000224
Saini M, Samanta J, Kumar A, Choudhury A, Dhar J, Jafra A, et al. Buprenorphine versus diclofenac for pain relief in acute pancreatitis: a double‐blinded randomized controlled trial. Clin Gastroenterol Hepatol. 2023.
Jakobs R, Adamek Ac Von MU. Buprenorphine or procaine for pain relief in acute pancreatitis A prospective randomized study. Scand J Gastroenterol. 2000;35(12):1319–1323. https://doi.org/10.1080/003655200453692
Gülen B, Dur A, Serinken M, Karcioğlu Ö, Sönmez E. Pain treatment in patients with acute pancreatitis: a randomized controlled trial. Turkish J Gastroenterol. 2016;27(2):192–196. https://doi.org/10.5152/tjg.2015.150398
Peiró AM, Martínez J, Martinez E, Madaria E, Llorens P, Horga J, et al. Efficacy and tolerance of metamizole versus morphine for acute pancreatitis pain. Pancreatology. 2008;8(1):25–29. https://doi.org/10.1159/000114852
Kumar NS, Muktesh G, Samra T, Sarma P, Samanta J, Sinha SK, et al. Comparison of efficacy of diclofenac and tramadol in relieving pain in patients of acute pancreatitis: a randomized parallel group double blind active controlled pilot study. Eur J Pain. 2020;24(3):639–648. https://doi.org/10.1002/ejp.1515
Knoph CS, Cook ME, Fjelsted CA, Novovic S, Mortensen MB, Nielsen LBJ, et al. Effects of the peripherally acting μ‐opioid receptor antagonist methylnaltrexone on acute pancreatitis severity: study protocol for a multicentre double‐blind randomised placebo‐controlled interventional trial, the PAMORA‐AP trial. Trials. 2021;22(1):940. https://doi.org/10.1186/s13063‐021‐05885‐3
Sirtl S, Hohmann E, Beyer G, Hamm J, Neesse A, Ammer‐Herrmenau C. The four seasons of pancreatitis—etiology of acute pancreatitis during the course of the year. Z Gastroenterol. 2024.
Wu D, Tang M, Zhao Y, Zhou S, Xu X, Wang F, et al. Impact of seasons and festivals on the onset of acute pancreatitis in Shanghai, China. Pancreas. 2017;46(4):496–503. https://doi.org/10.1097/mpa.0000000000000795
Guarino M, Bologna A, Ursini F, De Giorgi A, Alfano F, Gambuti E, et al. Chronobiology of acute pancreatitis in a single Italian centre. Eur Rev Med Pharmacol Sci. 2020;24(4):1988–1994.
European Pancreatic Club. European interdisciplinary guidelines on pain management in acute pancreatitis. https://www.europeanpancreaticclub.org/about‐us/diagnosis‐and‐treatment‐guidelines/european‐interdisciplinary‐guidelines‐on‐pain‐management‐in‐acute‐pancreatitis/