Chronic Pain and Chronic Opioid Use After Intensive Care Discharge – Is It Time to Change Practice?

Abstract

Almost half of patients treated on intensive care unit (ICU) experience moderate to severe pain. Managing pain in the critically ill patient is challenging, as their pain is complex with multiple causes. Pharmacological treatment often focuses on opioids, and over a prolonged admission this can represent high cumulative doses which risk opioid dependence at discharge. Despite analgesia the incidence of chronic pain after treatment on ICU is high ranging from 33–73%. Measures need to be taken to prevent the transition from acute to chronic pain, whilst avoiding opioid overuse. This narrative review discusses preventive measures for the development of chronic pain in ICU patients. It considers a number of strategies that can be employed including non-opioid analgesics, regional analgesia, and non-pharmacological methods. We reason that individualized pain management plans should become the cornerstone for critically ill patients to facilitate physical and psychological well being after discharge from critical care and hospital.

Long-Lasting Anti-Inflammatory and Antinociceptive Effects of Acute Ammonium Glycyrrhizinate Administration: Pharmacological, Biochemical, and Docking Studies

“…Available therapy for the management of chronic and inflammatory pain is not fully adequate in most cases. Furthermore, the common treatments of inflammatory pain, NSAIDs and opioids, lead to severe toxicities, including gastrointestinal lesions and nephrotoxicity [4] in the case of NSAIDs and respiratory depression, tolerance, and physical dependence for opioids when they are used for a long time [35]. Thus, identification of new potential targets which may affect pain and inflammatory processes is becoming an urgent clinical and therapeutic need.…”

Long-term outcomes after critical illness: recent insights

“…Persistent pain is also a frequent problem in ICU survivors and can be both nociceptive and neuropathic. Some potential sources of prolonged or chronic pain include poorly treated acute pain with overuse of opioids [ 22 ], immobilization and subsequent stiffness of tendons or ligaments, and nerve injuries or degeneration [ 23 ]. Importantly, there is a strong interplay between physical, mental and psychological disorders, which merits more attention.…”

Neurological toll of COVID-19

“…The incidence of psychiatric disorders is seen to increase in patients with more severe COVID-19 symptoms [92]. Another concern of opioid use and disability management post-acute COVID-19 recovery still remains a matter of concern among pain management specialists [89,93]. Finally, clinical trials are urgently needed to establish the optimal treatment options for COVID-19's neuropsychiatric and other possible long-term consequences.…”