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

Authors

Matthew N. Jaffa, Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA.
Ruchira M. Jha, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.Follow
Jonathan Elmer, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Adam Kardon, Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA.
Jamie E. Podell, Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA.
Benjamin E. Zusman, Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Madeleine C. Smith, Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA.
J Marc Simard, Department of Neurosurgery, School of Medicine, University of Maryland, Baltimore, MD, USA.
Gunjan Y. Parikh, Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA.
Michael J. Armahizer, Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, MD, USA.
Neeraj Badjatia, Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA.
Nicholas A. Morris, Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA. nicholas.morris@som.umaryland.edu.

Document Type

Article

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 χ 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.

Medical Subject Headings

Analgesics, Opioid (therapeutic use); Ethnicity; Follow-Up Studies; Humans; Minority Groups; Outpatients; Pain (etiology); Subarachnoid Hemorrhage (complications)

Publication Date

12-1-2021

Publication Title

Neurocritical care

E-ISSN

1556-0961

Volume

35

Issue

3

First Page

806

Last Page

814

PubMed ID

34109554

Digital Object Identifier (DOI)

10.1007/s12028-021-01282-5

Recommended Citation

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; and Morris, Nicholas A., "Pain Trajectories Following Subarachnoid Hemorrhage are Associated with Continued Opioid Use at Outpatient Follow-up" (2021). Neurology. 1353.
https://scholar.barrowneuro.org/neurology/1353