Is Admission to the Intensive Care Unit Associated With Chronic Opioid Use? A 4-Year Follow-Up of Intensive Care Unit Survivors

Yaffe, Paul B.; Green, Robert S.; Butler, Michael B.; Witter, Tobias

doi:10.1177/0885066615618189

Cited by 34 publications

(44 citation statements)

References 29 publications

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“…25 There is evidence from surgical populations that pre-surgical opioid use is associated with an increased risk of postoperative opioid use and misuse, 98 and a large retrospective epidemiological study in Canada identified pre-admission opioid use (in 6.2% of admissions) was a significant predictor of opioid use at 1 yr post-ICU discharge. 99 A further study showed that 5% of the elderly population admitted to the ICU was taking chronic opioids and that 63% continued to use them post-discharge. Those most likely to continue opioids were medical patients who were using fentanyl and benzodiazepines at admission.…”

Section: Potential Risk Factorsmentioning

confidence: 99%

Chronic pain in critical care survivors: a narrative review

Kemp

Laycock

Costello

et al. 2019

British Journal of Anaesthesia

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Chronic pain is an important problem after critical care admission. Estimates of the prevalence of chronic pain in the year after discharge range from 14% to 77% depending on the type of cohort, the tool used to measure pain, and the time point when pain was assessed. The majority of data available come from studies using health-related quality of life tools, although some have included pain-specific tools. Nociceptive, neuropathic, and nociplastic pain can occur in critical care survivors, but limited information about the aetiology, body site, and temporal trajectory of pain is currently available. Older age, pre-existing pain, and medical co-morbidity have been associated with pain after critical care admission. No trials were identified of interventions to target chronic pain in survivors specifically. Larger studies, using pain-specific tools, over an extended follow-up period are required to confirm the prevalence, identify risk factors, explore any association between acute and chronic pain in this setting, determine the underlying pathological mechanisms, and inform the development of future analgesic interventions.

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Section: Potential Risk Factorsmentioning

confidence: 99%

Chronic pain in critical care survivors: a narrative review

Kemp

Laycock

Costello

et al. 2019

British Journal of Anaesthesia

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“…For analysis of chronic post ICU pain (CPIP) and chronic opioid use after ICU, articles were excluded if they didn’t clearly state in the methods that patients were treated in the ICU, that included pediatric patients, that did not clearly refer to chronic pain and chronic opioid use after ICU discharge. Nine articles were included for analysis of chronic pain after ICU (Granja et al, 2002; Boyle et al, 2004; Korošec Jagodič et al, 2006; Jenewein et al, 2009; Timmers et al, 2011; Battle et al, 2013; Griffiths et al, 2013; Choi et al, 2014; Baumbach et al, 2016) and one article for chronic opioid use (Yaffe et al, 2017).…”

Section: Methodsmentioning

confidence: 99%

“…Chou et al (2009) adapted Von Korff et al (2008) definition of chronic opioid therapy as “daily or near-daily use of opioids for at least 90 days, often indefinitely.” One study was identified that considered opioid use following ICU discharge. Yaffe et al (2017) investigated opioid use in ICU survivors with surgical and non-surgical diagnoses by retrospectively analyzing electronic patient charts. They identified opioid use in 12.2% of patients at hospital discharge.…”

Section: Methodsmentioning

confidence: 99%

“…This was hypothesized to reflect non-opioid pain management, a change in opioid prescribing for non-cancer pain and the lack of adequate tools to define chronic pain syndromes. However, chronic opioid use prior to ICU admission and length of hospital stay were associated with post-discharge chronic opioid use (Yaffe et al, 2017). The study, however, did not evaluate consequences of long-term opioid use or the intensity and type of pain experienced by chronic opioid users.…”

Section: Methodsmentioning

confidence: 99%

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Chronic Pain and Chronic Opioid Use After Intensive Care Discharge – Is It Time to Change Practice?

et al. 2019

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Almost half of patients treated on intensive care unit (ICU) experience moderate to severe pain. Managing pain in the critically ill patient is challenging, as their pain is complex with multiple causes. Pharmacological treatment often focuses on opioids, and over a prolonged admission this can represent high cumulative doses which risk opioid dependence at discharge. Despite analgesia the incidence of chronic pain after treatment on ICU is high ranging from 33–73%. Measures need to be taken to prevent the transition from acute to chronic pain, whilst avoiding opioid overuse. This narrative review discusses preventive measures for the development of chronic pain in ICU patients. It considers a number of strategies that can be employed including non-opioid analgesics, regional analgesia, and non-pharmacological methods. We reason that individualized pain management plans should become the cornerstone for critically ill patients to facilitate physical and psychological well being after discharge from critical care and hospital.

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“…Studies will be included if they satisfy the following criteria, based on a PICO format question: studies with adults aged 18 years or older, on long-term or chronic opioid therapy (intending to reflect use of prescribed opioids more than 70% of days for at least 3 months [29] and that present to an acute healthcare setting secondary to a complication of prescribed opioid use; that include an intervention representing a harm reduction strategy, as defined as an attempt to decrease adverse consequences of long-term opioid use; that either compare the efficacy of the different interventions between each other or of individual interventions compared to current care; and that address patient or system related outcomes (e.g., ED visits, hospitalization, ICU admission, economic considerations).…”

Section: Methods and Analysismentioning

confidence: 99%

Association between harm reduction strategies and healthcare utilization in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a protocol for a systematic review and meta-analysis

et al. 2019

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Introduction Opioids are routinely used to treat a variety of chronic conditions associated with pain. However, they are a class of medications with a significant potential for adverse health effects, with and without misuse. Opioid misuse, as defined as inappropriate use of appropriately prescribed opioids, is becoming more well-recognized publicly but does not have clear treatment options. Opioid misuse has been linked to variety of poor outcomes and its consequences have a significant impact on healthcare resource utilization. The evidence on harm reduction strategies to mitigate adverse events prompting presentation to acute care settings for patients presenting with long-term opioid use is sparse. Methods and analysis We will perform a systematic review and meta-analysis to catalog effective harm reduction strategies and identify the most effective ones to reduce avoidable healthcare utilization in patients on long-term opioid therapy who present to acute health care settings with complications attributed to opioid misuse. A search strategy will be developed and executed by an information specialist; electronic databases (MEDLINE, EMBASE, CINAHL, Cochrane Library) and additional sources will be searched. Search themes will include opioids, chronic drug use, and acute healthcare settings. Citation screening, selection, quality assessment, and data abstraction will be performed in duplicate. A comprehensive inventory of harm reduction strategies will be developed. Data will be collected on patient-related outcomes associated with each identified harm reduction strategy. When sufficiently homogeneous data on interventions, population, and outcomes is available, it will be pooled for aggregate analysis. Evaluation of the methodological quality of individual studies and of the quality of the body of evidence will be performed. Our primary objective will be to identify harm reduction strategies that have been shown to result in clinically relevant and statistically significant improvements in patient outcomes and/or decreased healthcare utilization. Discussion This study will better characterize harm reduction strategies for patients on long-term prescribed opioids presenting to acute healthcare settings. It will also add new knowledge and generate greater understanding of key knowledge gaps of the long-term prescribed opioid use and its impact on healthcare utilization. Systematic review registration CRD42018088962 . Electronic supplementary material The online version of this article (10.1186/s13643-019-0997-5) contains supplementary material, which is available to authorized users.

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Is Admission to the Intensive Care Unit Associated With Chronic Opioid Use? A 4-Year Follow-Up of Intensive Care Unit Survivors

Abstract: Admission to ICU and duration of ICU stay were not associated with chronic opioid use.

Cited by 34 publications

References 29 publications

Chronic pain in critical care survivors: a narrative review

Chronic pain in critical care survivors: a narrative review

Chronic Pain and Chronic Opioid Use After Intensive Care Discharge – Is It Time to Change Practice?

Association between harm reduction strategies and healthcare utilization in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a protocol for a systematic review and meta-analysis

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