Early pain, stress, and opioid use following traumatic injury

Abstract

Objective: Prescription opioids are an effective pain treatment strategy but can lead to long-term opioid misuse. Identifying at risk patients during hospitalization can inform the development of prevention interventions post-discharge. Using the Opioid Risk Tool (ORT) as a screening measure, this study predicted factors associated with pain and opioid use at 2 weeks post-discharge in trauma patients.Design: A quality improvement prospective study design was used.Setting: Participant recruitment took place at an inpatient Level 1 trauma center in Houston, Texas.Participants: Participants (n = 103) were patients admitted to the adult trauma service. Patients completed the ORT in the hospital and a survey at 2 weeks post-discharge.Main outcome measure: The survey assessed pain intensity and interference, injury-related stress, medication use, and need for additional pain treatment. Wilcoxon–Mann–Whitney U test, the Spearman rank-order correlation, and chi-square test of independence tested the ORT as a predictor of follow-up outcomes. Post hoc analyses relied on logistic and quantile regression.Results: The ORT identified 15.5 percent of patients at high risk for opioid-related aberrant behavior. Survey results indicated high percentages of patients reporting moderate to severe pain (79.6 percent), pain interference (77.9 percent), taking pain pills (59.6 percent), experiencing stress (76.9 percent), and needing pain treatment (52.4 percent). The ORT predicted injury-related stress with the high-risk category having higher stress levels than low risk (Z = 2.518, p = 0.012).Conclusion: Risk of opioid misuse assessed in hospitalized trauma patients was associated with injury-related stress reported post-discharge. This highlights the importance of including stress assessments in follow-up appointments.

Opioid Risk Tool, in-hospital opioid exposure, and opioid demand predict pain outcomes following traumatic injury

“…From September of 2018 to March of 2019, the ORT was completed by 631 patients enrolled in the MAST study during their hospitalization, with 606 also agreeing to participate in a QI project involving post-discharge survey assessment (please see (Kessler et al, 2022; Yoon et al, 2022) for more details). The web-based text messaging platform confirmed delivery of 416 text messages.…”

Acute pain management after trauma: What you need to know

“…However, as mentioned earlier, patients can sometimes have concomitant emotions or psychiatric conditions that modulate the somatic perception of pain. 30 This can often lead to the overtreatment of pain and the undertreatment of the concomitant condition. While some pain scales are increasingly incorporating or using more objective information, we currently do not have a criterion standard for the measurement of acute pain.…”

“…A patient's perception of pain is vital to adequate treatment. However, as mentioned earlier, patients can sometimes have concomitant emotions or psychiatric conditions that modulate the somatic perception of pain 30 . This can often lead to the overtreatment of pain and the undertreatment of the concomitant condition.…”