M Gabrielle Pagé1,2, Paul J Karanicolas3,4, Sean Cleary5,6, Alice C Wei5, Paul McHardy7, Salima S J Ladak8,9, Nour Ayach10, Jason Sawyer7, Stuart A McCluskey10, Coimbatore Srinivas10, Joel Katz8,10,11, Natalie Coburn3,4, Julie Hallet3, Calvin Law3,4, Paul Greig3, Hance Clarke8,10. 1. Centre de recherche du Centre hospitalier de l' Université de Montréal (CRCHUM), Montreal, Québec, Canada. 2. Department of anesthesiology and pain medicine, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada. 3. Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. 4. Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada. 5. Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. 6. Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic - Rochester, Rochester, Minnesota. 7. Department of Anaesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. 8. Department of Anaesthesia and Pain Management, University Health Network, University of Toronto, Toronto, Ontario, Canada. 9. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada. 10. Pain Research Unit, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada. 11. Department of psychology, Faculty of Arts, York University, Toronto, Ontario, Canada.
Abstract
BACKGROUND: The study aims were to model acute pain intensity and opioid consumption trajectories up to 72 hr after open hepatic resection, identify predictors of trajectory membership and examine the association between trajectory memberships and 6-month pain and psychological outcomes. This is a long-term analysis of a published randomized controlled trial on the impact of medial open transversus abdominis plane catheters on post-operative outcomes. METHODS: A total of 152 patients (89 males; mean age 63.0 [range: 54-72]) completed questionnaires on pain and related characteristics pre-operatively and 6 months post-operatively. Total opioid use was recorded several times over a 72-hr period while self-reported pain intensity scores were collected multiple times until hospital discharge. Analyses were carried out using growth mixture modelling, logistic regression and general linear models. RESULTS: Both pain intensity and opioid consumption showed that a four-trajectory model best fits the data. Patients in the lowest opioid consumption trajectory were more likely to be classified in the constant mild pain intensity trajectory. Age and baseline levels of anxiety significantly predicted opioid trajectory membership while baseline depressive symptoms significantly predicted pain intensity trajectory membership. Patients in the two highest opioid consumption trajectories reported significantly higher levels of pain catastrophizing at 6 months compared to patients in the other 3 trajectories (all p < 0.05). CONCLUSION: High consumption of opioids after surgery is associated with higher levels of pain catastrophizing 6 months later. Identification of patients within these trajectories may lead to the development of early interventions targeted to high risk individuals. SIGNIFICANCE: Differences in initial levels of opioid consumption and rates of change in opioid consumption shortly after surgery can help predict long-term psychological responses to pain. Identifying key characteristics associated with initial opioid consumption can lead to the development of cost-effective early interventions targeted to high risk individuals.
RCT Entities:
BACKGROUND: The study aims were to model acute pain intensity and opioid consumption trajectories up to 72 hr after open hepatic resection, identify predictors of trajectory membership and examine the association between trajectory memberships and 6-month pain and psychological outcomes. This is a long-term analysis of a published randomized controlled trial on the impact of medial open transversus abdominis plane catheters on post-operative outcomes. METHODS: A total of 152 patients (89 males; mean age 63.0 [range: 54-72]) completed questionnaires on pain and related characteristics pre-operatively and 6 months post-operatively. Total opioid use was recorded several times over a 72-hr period while self-reported pain intensity scores were collected multiple times until hospital discharge. Analyses were carried out using growth mixture modelling, logistic regression and general linear models. RESULTS: Both pain intensity and opioid consumption showed that a four-trajectory model best fits the data. Patients in the lowest opioid consumption trajectory were more likely to be classified in the constant mild pain intensity trajectory. Age and baseline levels of anxiety significantly predicted opioid trajectory membership while baseline depressive symptoms significantly predicted pain intensity trajectory membership. Patients in the two highest opioid consumption trajectories reported significantly higher levels of pain catastrophizing at 6 months compared to patients in the other 3 trajectories (all p < 0.05). CONCLUSION: High consumption of opioids after surgery is associated with higher levels of pain catastrophizing 6 months later. Identification of patients within these trajectories may lead to the development of early interventions targeted to high risk individuals. SIGNIFICANCE: Differences in initial levels of opioid consumption and rates of change in opioid consumption shortly after surgery can help predict long-term psychological responses to pain. Identifying key characteristics associated with initial opioid consumption can lead to the development of cost-effective early interventions targeted to high risk individuals.
Authors: Mandy Mj Li; Don Daniel Ocay; Alisson R Teles; Pablo M Ingelmo; Jean A Ouellet; M Gabrielle Pagé; Catherine E Ferland Journal: J Pain Res Date: 2019-05-23 Impact factor: 3.133
Authors: Richard Gordon-Williams; Andreia Trigo; Paul Bassett; Amanda Williams; Stephen Cone; Martin Lees; Brigitta Brandner Journal: Pain Res Manag Date: 2021-04-02 Impact factor: 3.037