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

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    Author
    Jaffa, Matthew N
    Jha, Ruchira M
    Elmer, Jonathan
    Kardon, Adam
    Podell, Jamie E
    Zusman, Benjamin E
    Smith, Madeleine C
    Simard, J Marc
    Parikh, Gunjan Y
    Armahizer, Michael J
    Badjatia, Neeraj
    Morris, Nicholas A
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    Date
    2021-06-09
    Journal
    Neurocritical Care
    Publisher
    Springer Nature
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1007/s12028-021-01282-5
    https://doi.org/10.1007/s12028-021-01370-6
    Abstract
    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 χ2 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.
    Description
    An amendment to this paper has been published and can be accessed via a link at https://doi/org/10.1007/s12028-021-01370-6.
    Keyword
    Chronic opioid use
    Headache
    Pain trajectory
    Subarachnoid hemorrhage
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/16033
    ae974a485f413a2113503eed53cd6c53
    10.1007/s12028-021-01282-5
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