Multimodal Pain Care May Lead to Shorter Hospital Stays in Opioid-Tolerant Patients

Evidence shows that the rise of opioids, especially when used without any other pain treatments, does not correspond to better pain management or patient satisfaction.

PALM SPRINGS, Calif. — For patients who are already taking opioids, pain care can be improved by treating them with multiple non-opioid modalities during hospitalization, according to research presented at the 32nd Annual Meeting of the American Academy of Pain Medicine (AAPM). Patients treated in this way were less likely to be readmitted to the hospital within 60 days.

For David Edwards, MD, PhD, clinical chief of pain at Vanderbilt University Medical Center in Nashville, and colleagues, a major concern was the historically high hospital readmission rates seen in opioid-tolerant patients because of continued pain. At Massachusetts General Hospital, retrospective data showed that opioid-tolerant patients had 20% longer hospital stay, a 40% 60-day hospital/ER return rate, and reported lower HCAHPS scores.

TRENDING ON CPA: AAPM 2016 Annual Meeting: Ensuring Access to Pain Care

According to Dr Edwards, patients with a tolerance of opioids who require surgeries or other procedures are at a heightened risk of suffering from acute pain, and have a particular need for alternative treatment plans.

“Being on high dose opioid treatment is associated with several psychological and physiological comorbidities,” Dr Edwards told Clinical Pain Advisor in an interview. “This puts these particular patients at an increased risk of adverse outcomes. In addition pain can be difficult to control in patients who are tolerant to opioids or hyperalgesic from opioids.”

Opioids are still the best and most potent way to treat pain for many surgical and non-surgical patients, he noted. However, evidence shows that the rise of opioids, especially when used without any other pain treatments, does not correspond to better pain management or patient satisfaction, and instead contributes to poor patient outcomes and a societal burden when patients are discharged on high doses.

“By solely increasing opioids to control pain, patients do not demonstrate improved perception of pain control,” Dr Edwards said. “This may be a reflection of other components contributing to the patients dissatisfaction, such as opioid tolerance, poor communication, high anxiety, unrealistic expectations, complications, among many other possibilities. This has been repeatedly shown to be the case. It has also been shown to be true that a decrease in opioid prescribing has not increased patient dissatisfaction.”

To investigate how treating opioid-tolerant patients with multiple non-opioid approaches would affect their hospital readmission rates and pain outcomes, the researchers designed a Targeted Care Pathway that incorporated evidence-based features meant to lower pain severity, adverse events, readmission rates, and length of stay, while improving patient satisfaction.