Exposure to Opioids in the ICU May Not Be Associated With Persistent Pain

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The brief pain inventory was administered to adult survivors of critical illness at 3 months and 12 months post-ICU discharge.
The brief pain inventory was administered to adult survivors of critical illness at 3 months and 12 months post-ICU discharge.

Persistent pain — which is common in survivors of critical illnesses — may not be associated with opioid exposure during intensive care unit (ICU) stays, according to a study published in Anesthesia & Analgesia.

The brief pain inventory (BPI) was administered to 295 adult survivors of critical illness by blinded neuropsychology professionals to evaluate pain intensity and pain interference with daily living at 3 months and 12 months post-ICU discharge. Cumulative exposure to opioids in the ICU (for both analgesia and sedation) was assessed via a review of medical records.

Persistent pain and pain interference with daily living were reported at 3- and 12-month follow-up (pain, 77% and 74% of patients, respectively; pain interference, 59% and 62%, respectively). The median pain intensity score was 3 on a scale of 1 to 10 (mild pain), and the median overall pain interference score was 2 at 3- and 12-month follow-up.

Patients who were exposed to opioids during their ICU stay did not report increased pain intensity at 3- or 12-month follow-up (3 months: odds ratio [OR], 2.12; 95% CI, 0.92- 4.93; P =.18; 12 months: OR, 2.58; 95% CI, 1.26-5.29; P =.04) or increased pain interference in daily life (3 months: OR, 1.48; 95% CI, 0.65-3.38; P =.64; 12 months: OR, 1.46; 95% CI. 0.72-2.96; P =.58).

Findings from this study may not generalize to patients in non-academic hospital settings, and reliable pain scores could not be obtained in some nonverbal critically ill patients.

“We observed that pain after ICU discharge interferes with the ability to function normally in daily life, and thus, is likely to affect post-ICU quality of life,” concluded the study authors. “While disability can be unavoidable in some ICU patients, addressing persistent pain symptoms as a long-term cause of functional impairment may improve long-term outcomes,” they added.

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Reference

style="line-height: 115%; border: none;">Hayhurst CJ, Jackson JC, Archer KR, et al. Pain and its long-term interference of daily life after critical illness [published online April 11, 2018]. Anesth Analg. doi:10.1213/ANE.0000000000003358

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