A Multimodal Intervention Using Nonopioid Analgesics Is Associated With Reduced Intravenous Opioid Exposure Among Hospitalized Patients With Inflammatory Bowel Diseases

Abstract

INTRODUCTION: Opioid use in patients with inflammatory bowel disease (IBD) is associated with increased mortality. Previous interventions targeting reduced intravenous opioid (IVOPI) exposure for all patients admitted to a general medical unit have decreased total opioid use without compromising pain control. We therefore performed a prospective evaluation of a multimodal intervention encouraging the use of nonopioid alternatives to reduce IVOPI exposure among patients with IBD hospitalized at our institution. METHODS: This was a prospective evaluation of a multimodal intervention to reduce IVOPI use among patients with IBD aged ≥18 years admitted to a general medical unit at a large urban academic medical center from January 1, 2019, to June 30, 2019. Intravenous and total (all routes) opioid exposures were measured as proportions and intravenous morphine milligram equivalents/patient day and compared with preintervention (January 1, 2018, to December 31, 2018) data. Hospital length of stay (LOS), 30-day readmission rates (RRs), and pain scores (1–10 scale) were also assessed. RESULTS: Our study involved 345 patients with IBD with similar baseline characteristics in preintervention (n = 241) and intervention (n = 104) periods. Between study periods, we observed a significant reduction in the proportion of patients receiving IVOPIs (43.6% vs 30.8%, P = 0.03) and total opioid dose exposure (15.6 vs 8.5 intravenous morphine mg equivalents/d, P = 0.02). We observed similar mean pain scores (3.9 vs 3.7, P = 0.55) and significantly reduced mean LOS (7.2 vs 5.3 days, P = 0.03) and 30-day RRs (21.6% vs 11.5%, P = 0.03). DISCUSSION: A multimodal intervention was associated with reduced opioid exposure, LOS, and 30-day RRs for hospitalized patients with IBD. Additional research is needed to determine long-term benefits of reduced opioid exposure in this population.

Effects of a Proactive Analgesic Protocol On Pain and Opioid Use in Hospitalized Patients with Inflammatory Bowel Disease: Results from a Randomized Control Trial

“…A recent observational study looked at the impact of encouraging providers to use a multi-modal, opioid-sparing approach in hospitalized patients with IBD and found a reduction in parenteral opioid consumption and total parenteral opioid dose after implementing their educational program. 21 They were able to demonstrate this reduction in opioid-use by recommending non-opioid analgesics through consultant notes and text messages to providers. While some of the medications in this study were similar to those included in our protocol, there are important differences.…”

“…8,11 In a retrospective observational analysis, a multi-modal analgesic approach was associated with reduced opioid-use in hospitalized patients with IBD. 21 To better understand the implications of an opioid-sparing approach to pain control we conducted a randomized controlled trial to compare a proactive, opioid-sparing analgesic protocol to usual care among hospitalized patients with IBD.…”

Moving Toward a Multimodal Analgesic Regimen for Acute Sickle Cell Pain with Non-Opioid Analgesic Adjuncts: A Narrative Review

“…rheumatoid arthritis 55 , 56 and ankylosing spondylarthritis 57 ) and inflammatory bowel disease. 58 , 59 …”

Editorial: opioids in inflammatory bowel disease—primum non nocere

“…Second, the stepwise pain management should be critically reviewed, focussing on non‐opioid pharmacological alternatives (COX‐2 inhibitors, tricyclic antidepressants) and psychological and behavioural support 8 . A recent study shows that a multimodal intervention, including an IV acetaminophen protocol, a gastroenterology consult note ‘smartphrase’, an IBD pain management pathway, and automated text message alerts, substantially reduced intravenous opioid use and hospital length of stay, with similar pain scores 9 . Implementation of a multidisciplinary team and a holistic approach in order to reduce chronic opioid use and prevent further harm is of vital importance.…”