Opioid analgesic use among patients presenting with acute abdominal pain and factors associated with surgical diagnoses

Abstract

Background The prevalence of chronic opioid use among non-cancer patients presenting with acute abdominal pain (AAP) is unknown. The aim was to characterize opioid use, constipation, diagnoses, and risk factors for surgical diagnoses among non-cancer patients presenting with AAP to an emergency department (ED). Methods We performed a retrospective, observational cohort study of all (n=16,121) adult patients (88% from Minnesota, Iowa and Wisconsin) presenting during 2014 with AAP. We used electronic medical records, and focused on 2352 adults with AAP who underwent abdominal CT scan within 24 hours of presentation. We determined odds ratios of association with constipation and features predicting conditions that may require surgery (surgical diagnosis). Key Results There were 2,352 eligible patients; 18.8% were opioid users. Constipation was more frequent in opioid (35.1%) compared to non-opioid users [OR 2.88 (95% CI 2.28, 3.62)]. Prevalence of surgical diagnosis in the opioid and non-opioid users was 35.3% and 41.7% respectively (p=0.019). By univariate analysis, age and neutrophil count independently predicted increased risk, and chronic opioid use decreased risk of surgical diagnosis. Internal validation of logistic models using a randomly selected validation subset (25% of entire cohort, 587/2352) showed receiver operating characteristic (ROC) curves for the validation and full cohorts were similar. Conclusions & Inferences Approximately 19% of adults presenting with AAP were opioid users; constipation is almost 3 times as likely in opioid users compared to non-opioid users presenting with AAP. Factors significantly associated with altered risk of surgical diagnoses were age, opioid use, and neutrophil count.

Ameliorating effects of optimized gastric electrical stimulation and mechanisms involving nerve growth factor and opioids in a rodent model of gastric hypersensitivity

“…Opioids have been used to treat pain for many years, including the treatment of visceral pain. [50][51][52]66 The analgesic effect of the GES method developed in this study was found to be mediated via the opioid mechanisms, particularly, via the µ-opioid receptor. Both naloxone and CTOP blocked GES-induced suppression of EMG responses to GD in the IA-treated rats.…”

“…It is unknown whether NGF plays a major role in the rodent model of FD and whether the possible GES effects on gastric hypersensitivity might be mediated via the NGF mechanism. Opioids, such as μ‐opioid receptor (OR), κ‐OR agonist, and δ‐OR antagonist (eluxadoline), have been used to treat pain, including visceral pain in gastrointestinal functional disorders, such as irritable bowel syndrome . We were also interested in possible analgesic effects of GES on opioid mechanisms.…”

“…Opioids, such as μ-opioid receptor (OR), κ-OR agonist, and δ-OR antagonist (eluxadoline), have been used to treat pain, including visceral pain in gastrointestinal functional disorders, such as irritable bowel syndrome. [50][51][52] We were also interested in possible analgesic effects of GES on opioid mechanisms.…”

Opioids in Gastroenterology: Treating Adverse Effects and Creating Therapeutic Benefits

“…Emergency evaluation is commonly sought for pain control and to evaluate for causes of abdominal pain that may be found in these patients, such as kidney stones and bowel obstruction. 75 …”

“…The indication for the opioids was abdominal pain in 21% (93/442) of these patients, suggesting that, despite the lack of evidence of efficacy or safety, μ opioid agonists are being prescribed for patients with non-cancer-related abdominal pain, which likely includes IBS. 75 …”