In‐hospital opioid consumption, but not pain intensity scores, predicts 6‐month levels of pain catastrophizing following hepatic resection: A trajectory analysis

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.

Influential factors of postoperative pain trajectories in patients receiving intravenous patient-controlled analgesia: a single-centre cohort study in Taiwan

“…Second, we used the numerical rating scale as a measurement tool of pain intensity, instead of analgesic consumption. Recent study has reported different trajectories between postoperative pain and opioid consumption 28. Although the validity and reliability of self-report pain rating scale have been verified in Chinese adults,29 biases may exist in some subpopulations 30.…”

“…Recent study has reported different trajectories between postoperative pain and opioid consumption. 28 Although the validity and reliability of self-report pain rating scale have been verified in Chinese adults, 29 biases may exist in some subpopulations. 30 Third, we did not analyse the adverse events of analgesic medication (eg, respiratory depression), and unintended bolus and malfunction of IV-PCA due to data unavailability.…”

Daily pain and opioid administration in hospitalized patients with cancer: the importance of psychological factors, recent surgery, and current opioid use

“…Several other studies have also identified that while anxiety or catastrophizing were associated with greater opioid use after surgery or during patients' hospitalizations, depression in fact was not. 6,20,21,38,40,45 While opioids should continue to be readily available to treat cancer-related pain, oncology care teams need to screen and treat psychological symptoms that cooccur with cancer pain because these symptoms are associated with worse pain outcomes and research has shown that psychological symptoms are risk factors for opioid misuse. 12,41 Future studies which explicitly investigate interactions between depression and other psychological symptoms in the treatment of cancer-related pain are merited.…”

“…22 Previous studies in patients with chronic noncancer pain suggest that higher psychological distress and pain catastrophizing are associated with worse pain outcomes, including during hospitalization. 21,38 Yet, to the best of our knowledge, no study has examined whether these and other salient factors are associated with worse pain outcomes among hospitalized cancer patients.…”

Influential Factors and Personalized Prediction Model of Acute Pain Trajectories after Surgery for Renal Cell Carcinoma

“…Secondly, instead of the dosage of analgesics consumption, we used NRS, a self-reporting subjective pain scale, as a tool to evaluate pain intensity. Although NRS had been considered a valid, reliable, and appropriate tool, a recent study showed different trajectories between pain intensity scores and opioid consumption [ 44 ]. This is a potential confounder of our study.…”