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

Jaffa, Matthew; Podell, Jamie; Smith, Madeleine C; Foroutan, Arshom; Kardon, Adam; Chang, Wan‐Tsu W.; Motta, Melissa; Parikh, Gunjan; Sheth, Kevin N; Badjatia, Neeraj; Armahizer, Michael; Simard, J. Marc; Morris, Nicholas

doi:10.1212/wnl.0000000000011906

Cited by 13 publications

(13 citation statements)

References 14 publications

(21 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although their initial pain scores were low, nearly three of four patients in group 3 continued to use opioids at outpatient follow-up. We have previously reported that persistent, poorly controlled pain during hospitalization was the major contribution to the continuation of opioid use in patients treated for SAH [ 7 ]. Early recognition of high-risk patient trajectories may inform multimodal analgesic strategies aimed at reducing pain, limiting postacute opioid prescriptions, and preventing chronic opioid use.…”

Section: Discussionmentioning

confidence: 99%

“…We compared outcomes across trajectory groups using the χ 2 or Fisher’s exact test for categorical variable and the Kruskal–Wallis test for ordinal variables. To determine whether trajectory group membership was an independent predictor of outcome, we used logistic regression, adjusting for clinically relevant covariates selected a priori on the basis of previously reported data from this patient cohort: race/ethnicity, a history of depression, a history of opioid use, craniotomy, and insurance type [ 7 ]. We evaluated goodness of fit using a Hosmer–Lemeshow test.…”

Section: Methodsmentioning

confidence: 99%

“…The few studies available concur that the headache following SAH is severe but have found disparate results regarding the temporal course of pain during the acute hospitalization [ 4 – 6 ]. Similar to other conditions associated with severe acute pain, SAH is associated with high rates of long-term opioid use [ 7 , 8 ], a fact made more salient by the fact that the current opioid crisis in the United States is in part driven by opioid prescriptions for acute medical conditions [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pain Trajectories Following Subarachnoid Hemorrhage are Associated with Continued Opioid Use at Outpatient Follow-up

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background Subarachnoid hemorrhage (SAH) is characterized by the worst headache of life and associated with long-term opioid use. Discrete pain trajectories predict chronic opioid use following other etiologies of acute pain, but it is unknown whether they exist following SAH. If discrete pain trajectories following SAH exist, it is uncertain whether they predict long-term opioid use. We sought to characterize pain trajectories after SAH and determine whether they are associated with persistent opioid use. Methods We reviewed pain scores from patients admitted to a single tertiary care center for SAH from November 2015 to September 2019. Group-based trajectory modeling identified discrete pain trajectories during hospitalization. We compared outcomes across trajectory groups using χ 2 and Kruskal–Wallis tests. Multivariable regression determined whether trajectory group membership was an independent predictor of long-term opioid use, defined as continued use at outpatient follow-up. Results We identified five discrete pain trajectories among 305 patients. Group 1 remained pain free. Group 2 reported low scores with intermittent spikes and slight increase over time. Group 3 noted increasing pain severity through day 7 with mild improvement until day 14. Group 4 experienced maximum pain with steady decrement over time. Group 5 reported moderate pain with subtle improvement. In multivariable analysis, trajectory groups 3 (odds ratio [OR] 3.5; 95% confidence interval [CI] 1.5–8.3) and 5 (OR 8.0; 95% CI 3.1–21.1), history of depression (OR 3.6; 95% CI 1.3–10.0) and racial/ethnic minority (OR 2.3; 95% CI 1.3–4.1) were associated with continued opioid use at follow-up (median 62 days following admission, interquartile range 48–96). Conclusions Discrete pain trajectories following SAH exist. Recognition of pain trajectories may help identify those at risk for long-term opioid use.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pain Trajectories Following Subarachnoid Hemorrhage are Associated with Continued Opioid Use at Outpatient Follow-up

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…2,3 Opioids remain the backbone of pharmacotherapy and may contribute to unacceptably high rates of post-SAH chronic opioid use. 4 Multimodal analgesic strategies are used for other conditions in the intensive care unit in order to limit opioid usage and avoid opioid dependence. 5 More recently, interest has surged in the utilization of nonpharmacological adjuncts to pain management.…”

Section: Introductionmentioning

confidence: 99%

Pain Control and Anxiolysis After Subarachnoid Hemorrhage Using Immersive Virtual Reality: A Case Report

Kardon

Murray²,

Khalid

et al. 2022

The Neurohospitalist

Self Cite

View full text Add to dashboard Cite

Debilitating headache persists after acute aneurysmal subarachnoid hemorrhage (SAH). Despite high prevalence, little is known regarding optimal treatment strategies for SAH-related headache. Nonpharmacologic adjunctive therapies are emerging as tools to help treat pain and limit opioid exposure in the hospital. Virtual reality (VR) is an immersive audiovisual experience that has been shown to reduce pain perception in other patient populations. The role of VR in acute brain injury is unknown. Here we report a patient with SAH who suffered from persistent headache during her hospitalization despite escalation of analgesic pharmacotherapy. A trial of VR was used as an adjunct to medication over four days. The patient reported subjective improvement in pain and anxiety. VR may provide additional analgesia and anxiolysis over pharmacologic measures alone and warrants further study in patients with acute brain injury.

show abstract

“…Among soldiers returning from active duty who have a TBI diagnosis, nearly 60% are prescribed an opioid during the postdeployment year 21 22. In a study of patients with acute neurological injury suffering from aneurysmal subarachnoid haemorrhage, opioid use was associated with discrete pain trajectories, pain burden and craniotomy 23 24. Opioid sparing during hospitalisations with acute pain is an important component of addressing the current opioid epidemic 25.…”

Section: Introductionmentioning

confidence: 99%

Adjunctive virtual reality pain relief following traumatic injury: protocol for a randomised within-subjects clinical trial

Felix

Rao²,

Khalid

et al. 2021

BMJ Open

View full text Add to dashboard Cite

Introduction The annual mortality and national expense of the opioid crisis continue to rise in the USA (130 deaths/day, $50 billion/year). Opioid use disorder usually starts with the prescription of opioids for a medical condition. Its risk is associated with greater pain intensity and coping strategies characterised by pain catastrophising. Non-pharmacological analgesics in the hospital setting are critical to abate the opioid epidemic. One promising intervention is virtual reality (VR) therapy. It has performed well as a distraction tool and pain modifier during medical procedures; however, little is known about VR in the acute pain setting following traumatic injury. Furthermore, no studies have investigated VR in the setting of traumatic brain injury (TBI). This study aims to establish the safety and effect of VR therapy in the inpatient setting for acute traumatic injuries, including TBI. Methods and analysis In this randomised within-subjects clinical study, immersive VR therapy will be compared with two controls in patients with traumatic injury, including TBI. Affective measures including pain catastrophising, trait anxiety and depression will be captured prior to beginning sessions. Before and after each session, we will capture pain intensity and unpleasantness, additional affective measures and physiological measures associated with pain response, such as heart rate and variability, pupillometry and respiratory rate. The primary outcome is the change in pain intensity of the VR session compared with controls. Ethics and dissemination Dissemination of this protocol will allow researchers and funding bodies to stay abreast in their fields through exposure to research not otherwise widely publicised. Study protocols are compliant with federal regulation and University of Maryland Baltimore’s Human Research Protections and Institutional Review Board (protocol number HP-00090603). Study results will be published on completion of enrolment and analysis, and deidentified data can be shared by request to the corresponding author. Trial registration number NCT04356963; Pre-results.

show abstract

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

Cited by 13 publications

References 14 publications

Pain Trajectories Following Subarachnoid Hemorrhage are Associated with Continued Opioid Use at Outpatient Follow-up

Pain Trajectories Following Subarachnoid Hemorrhage are Associated with Continued Opioid Use at Outpatient Follow-up

Pain Control and Anxiolysis After Subarachnoid Hemorrhage Using Immersive Virtual Reality: A Case Report

Adjunctive virtual reality pain relief following traumatic injury: protocol for a randomised within-subjects clinical trial

Contact Info

Product

Resources

About