Pain management in trauma patients affected by the opioid epidemic: A narrative review

Karamchandani, Kunal; Klick, John; Dougherty, Melissa; Bonavia, Anthony; Allen, Steven R.; Carr, Zyad J.

doi:10.1097/ta.0000000000002292

Cited by 37 publications

(12 citation statements)

References 86 publications

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“…1 Furthermore, patients with OUD have been shown to be at increased risk of motor vehicle collisions and other traumatic injuries, necessitating inpatient trauma services. 2,3 In a statewide database study, Holman et al observed that patients admitted after orthopedic trauma had a greater proportion of preinjury opiate use compared with the general population. 4 Studies examining the impact of preoperative OUD on surgical outcomes have largely focused on elective orthopedic surgery.…”

Section: Introductionmentioning

confidence: 99%

Impact of opioid use disorder on resource utilization and readmissions after operative trauma

Tran

Madrigal

Pan

et al. 2022

Surgery

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Background: Although patients with opioid use disorder have been shown to be more susceptible to traumatic injury, the impact of opioid use disorder after trauma-related admission remains poorly characterized. The present nationally representative study evaluated the association of opioid use disorder on clinical outcomes after traumatic injury warranting operative intervention. Methods: The 2010 to 2018 Nationwide Readmissions Database was used to identify adult trauma victims who underwent major operative procedures. Injury severity was quantified using International Classification of Diseases Trauma Mortality Prediction Model. Entropy balancing was used to adjust for intergroup differences. Multivariable regression models were developed to assess the association of opioid use disorder on in-hospital mortality, perioperative complications, resource utilization, and readmissions. Results: Of an estimated 5,089,003 hospitalizations, 54,097 (1.06%) had a diagnosis of opioid use disorder with increasing prevalence during the study period. Compared with others, opioid use disorder had a lower proportion of extremity injuries and falls but greater predicted mortality measured by Trauma Mortality Prediction Model. After adjustment, opioid use disorder was associated with decreased odds of in-hospital mortality (adjusted odds ratio: 0.61; 95% confidence interval, 0.53e0.70) but had greater likelihood of pneumonia, infectious complications, and acute kidney injury. Additionally, opioid use disorder was associated with longer hospitalization duration as well as greater index costs and risk of readmission within 30 days (adjusted odds ratio: 1.36; 95% confidence interval, 1.25e1.49). Conclusion: Opioid use disorder in operative trauma has significantly increased in prevalence and is associated with decreased in-hospital index mortality but greater resource utilization and readmission.

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Section: Introductionmentioning

confidence: 99%

Impact of opioid use disorder on resource utilization and readmissions after operative trauma

Tran

Madrigal

Pan

et al. 2022

Surgery

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“…Identifying pain or withdrawal is difficult in patients with impaired consciousness due to the inability to self‐report symptoms. Furthermore, the hemodynamic responses caused by pain and withdrawal can be masked by sepsis, vasopressor support, and other pharmacologic interventions 71 . Some patients who are able to communicate their symptoms are not forthcoming about their history of opioid use due to the stigma attached to opioid dependence.…”

Section: Pain Management In Patients Actively Misusing Opioidsmentioning

confidence: 99%

“…Abrupt cessation of alcohol or benzodiazepines in patients with unknown chronic use can be life threatening, while withdrawal from chronic opioid use, although extremely unpleasant, does not, in isolation, carry critical risk 55,71 . As with patients on MOUD, early opioid withdrawal detection is essential, and COWS should be used in conscious patients to detect withdrawal while DSM‐V criteria and signs of opioid withdrawal should be used for patients with impaired consciousness.…”

Section: Pain Management In Patients Actively Misusing Opioidsmentioning

confidence: 99%

Pain Management Considerations in Patients With Opioid Use Disorder Requiring Critical Care

Smith

Wang

Abdukalikov

et al. 2022

The Journal of Clinical Pharma

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The opioid epidemic has resulted in increased opioid‐related critical care admissions, presenting challenges in acute pain management. Limited guidance exists in the management of critically ill patients with opioid use disorder (OUD). This narrative review provides the intensive care unit clinician with guidance and treatment options, including nonopioid analgesia, for patients receiving medications for OUD and for patients actively misusing opioids. Verification and continuation of the patient's outpatient medications for OUD regimen, specifically buprenorphine and methadone formulations; assessment of pain and opioid withdrawal; and treatment of acute pain with nonopioid analgesia, nonpharmacologic strategies, and short‐acting opioids as needed, are all essential to adequate management of acute pain in patients with OUD. A multidisciplinary approach to treatment and discharge planning in patients with OUD may be beneficial to engage patients with OUD early in their hospital stay to prevent withdrawal, stabilize their OUD, and reduce the risk of unplanned discharge and other associated morbidity.

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“…Effective pain management is fundamental to trauma care, and opioids are indispensable for treating acute pain. However, the use and misuse of prescribed opioids is an escalating problem, which has resulted in a national health crisis in the United States [ 18 ]. A study conducted in the United States indicates that more than 50% of trauma patients are discharged with an opioid prescription [ 19 ], reflecting both the severity of post-injury pain and the prescribing traditions.…”

Section: Introductionmentioning

confidence: 99%

Discharge from the trauma centre: exposure to opioids, unmet information needs and lack of follow up—a qualitative study among physical trauma survivors

Finstad

Røise

Rosseland

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Physical trauma is associated with mortality, long-term pain and morbidity. Effective pain management is fundamental in trauma care and opioids are indispensable for treating acute pain; however, the use and misuse of prescribed opioids is an escalating problem. Despite this, few studies have been directed towards trauma patients in an early phase of rehabilitation with focusing on experiences and perspectives of health and recovery including pain and persistent use of prescribed opioids with abuse potential. To explore pre- and post-discharge trauma care experiences, including exposure to opioids, physical trauma survivors were recruited from a major trauma centre in Norway that provides the highest level of surgical trauma care. Method Qualitative exploratory study. Individual semi-structured interviews were conducted among 13 trauma patients with orthopedic injuries, known to be associated with severe pain, six weeks post-discharge. The interviews were recorded, transcribed verbatim, and thematically analyzed with an interdisciplinary approach. Results The overarching theme was that discharge from the trauma centre and the period that immediately followed were associated with feelings of insecurity. The three main themes that were identified as contributing to this was (a) unmet information needs about the injury, (b) exposure to opioids, and (c) lack of follow-up after discharge from the hospital. Participants experienced to be discharged with prescribed opioids, but without information about their addictive properties or tapering plans. This, and lack of attention to mental health and psychological impact of trauma, gave rise to unmet treatment needs of pain management and mental health problems during hospitalization and following discharge. Conclusion The findings from this study suggest that in addition to delivery of high-quality biomedical trauma care, health professionals should direct more attention to psychosocial health and safe pain management, including post-discharge opioid tapering and individually tailored follow-up plans for physical trauma survivors.

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Pain management in trauma patients affected by the opioid epidemic: A narrative review

Cited by 37 publications

References 86 publications

Impact of opioid use disorder on resource utilization and readmissions after operative trauma

Impact of opioid use disorder on resource utilization and readmissions after operative trauma

Pain Management Considerations in Patients With Opioid Use Disorder Requiring Critical Care

Discharge from the trauma centre: exposure to opioids, unmet information needs and lack of follow up—a qualitative study among physical trauma survivors

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