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Kessler DA, Webber HE, de Dios C, Yoon JH, Schmitz JM, Lane SD, Harvin JA, Heads AM, Green CE, Kapoor S, Stotts AL, Motley KL, Suchting R. Opioid Risk Tool, in-hospital opioid exposure, and opioid demand predict pain outcomes following traumatic injury. J Health Psychol 2024:13591053241242543. [PMID: 38641873 DOI: 10.1177/13591053241242543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024] Open
Abstract
Prescribed opioids are a mainstay pain treatment after traumatic injury, but a subgroup of patients may be at risk for continued opioid use. We evaluated the predictive utility of a traditional screening tool, the Opioid Risk Tool (ORT), and two other measures: average in-hospital milligram morphine equivalents (MME) per day and an assessment of opioid demand in predicting pain outcomes. Assessments of pain-related outcomes (pain intensity, interference, injury-related stress, and need for additional pain treatment) were administered at 2 weeks and 12 months post-discharge in a sample of 34 patients hospitalized for traumatic injury. Bayesian linear models were used to evaluate changes in responses over time as a function of predictors. High-risk ORT, higher MME per day, and greater opioid demand predicted less change in outcomes over time. This report provides first evidence that malleable factors of opioid and opioid demand have utility in predicting pain outcomes following traumatic injury.
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Affiliation(s)
| | | | | | - Jin H Yoon
- University of Texas Health Science Center at Houston, USA
| | - Joy M Schmitz
- University of Texas Health Science Center at Houston, USA
| | - Scott D Lane
- University of Texas Health Science Center at Houston, USA
| | - John A Harvin
- University of Texas Health Science Center at Houston, USA
| | - Angela M Heads
- University of Texas Health Science Center at Houston, USA
| | | | - Shweta Kapoor
- Mayo Clinic Alix School of Medicine, Mayo Clinic, USA
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Harvin JA, Green CE, Vincent LE, Motley KL, Podbielski J, Miller CC, Tyson JE, Holcomb JB, Wade CE, Kao LS. Multi-modal Analgesic Strategies for Trauma (MAST): protocol for a pragmatic randomized trial. Trauma Surg Acute Care Open 2018; 3:e000192. [PMID: 30206549 PMCID: PMC6109800 DOI: 10.1136/tsaco-2018-000192] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/09/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pain management after injury is critically important for functional recovery. Although opioids have been a mainstay for treatment of pain, they are associated with adverse events and may contribute to long-term use or abuse. Opioid-minimizing multimodal pain regimens have the potential to reduce exposure to opioids without compromising pain control. This article details an ongoing clinical trial comparing two pill-based, opioid-minimizing, multimodal pain strategies. METHODS This is a single-center, parallel-group, randomized, controlled comparative effectiveness trial comparing two multimodal pain regimens in adult trauma patients. All patients 16 years and older admitted to the Red Duke Trauma Institute are eligible unless they are pregnant, a prisoner, under observation status, or a non-acute trauma patient. At admission to the trauma service, patients are enrolled and randomized to one of two multimodal pain regimens. The primary outcome is opioid use, measured by morphine milligram equivalents per patient per day. The secondary outcomes include pain scores, ventilator days, hospital and intensive care unit lengths of stay, occurrence of opioid-related complications, hospital and pharmacy costs, and incidence of hospital discharge with opioid prescription. Outcomes will be compared using Bayesian methods. DISCUSSION This trial will determine the effectiveness of two multimodal pain treatment strategies on reducing in-hospital opioid exposure in adult trauma patients. Furthermore, it will compare the two strategies on pain control and patient safety. Knowledge gained in this study can improve quality of care at this hospital and other trauma centers regardless of which medication regimen proves superior.
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Affiliation(s)
- John A Harvin
- Department of Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Center for Translational Injury Research, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Center for Evidence Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Charles E Green
- Center for Evidence Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Laura E Vincent
- Center for Translational Injury Research, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kandice L Motley
- Center for Translational Injury Research, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jeanette Podbielski
- Center for Translational Injury Research, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Charles C Miller
- Center for Evidence Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jon E Tyson
- Center for Evidence Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - John B Holcomb
- Department of Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Center for Translational Injury Research, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Charles E Wade
- Center for Translational Injury Research, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Center for Translational Injury Research, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Center for Evidence Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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