Pain Relief Now, More Pain Later?

Early Use of Opioids Worsens Pain Down the Road for Spinal Cord Injury Patients

Article ID: 689151

Released: 12-Feb-2018 8:00 AM EST

Source Newsroom: Association of Academic Physiatrists (AAP)

Newswise — Atlanta – A new study presented this week at the Association of Academic Physiatrists Annual Meeting in Atlanta found that opioids prescribed to patients soon after an acute traumatic spinal cord injury is associated to increased pain just one year later.

“Opioids are often used for pain management of acute traumatic spinal cord injury patients,” says Jennifer N. Bush, BS, a medical student at the McGovern Medical School of the University of Texas Health Science Center in Houston and the presenting author of the study. "However, studies of animals with spinal cord injury show that using opioids soon after injury can have a negative effect on later quality of life, including pain and motor function.”

To find out how opioids might affect people with spinal cord injuries, Bush and her research team compared previously collected measures of quality of life one year after injury to the amount of opioids used directly after their injuries. The research team reviewed data on 180 patients admitted to the hospital with traumatic spinal cord injury from 2008 to 2011. Out of the 180 patients, the researchers had complete initial motor exam and opioid prescription information for 85 people. Out of these 85 patients, 27 had also completed telephone surveys a year after their injuries that measured their pain. These patients were referred to as ‘responders,’ while those who had initial motor exams, but no follow up survey were called ‘non-responders.’

The researchers used this information to look at recovery one-year post injury. They found no differences between patients who responded and those who did not respond except one: responders received a higher total dosage of opioids within 24 hours of injury. Among the responders, the researchers found that taking opioids for pain in the first day or up to one week after traumatic spinal cord injury was associated with increased pain one year later. “Every milligram of opioid medication increased the patient’s pain scores at one year by a set amount,” explains Bush. “This leads us to believe that, as with everything done in the acute period, the use of opioids should be scrutinized as the effects last much longer than the acute period.”                                                                                          

What the researchers can’t conclude from this study is causation. “While the correlation supports the animal evidence, and the implications on pain and motor recovery are clinically meaningful, we can’t say the opioids caused the worsened pain or prevented motor recovery at one year,” explains Principal Investigator in the study, Argyrios Stampas, MD; spinal cord injury medicine research director of TIRR Memorial Hermann. To that end, Dr. Stampas and Bush plan to conduct more prospective studies to evaluate and validate the connection between opioid use for acute pain and long-term pain outcomes.

“If we were – through larger, multi-systems studies – to find opioids are causing slower motor recovery and more pain down the road for patients with spinal cord injury, it could be a complete game-changer in how we treat these patients,” says Dr. Stampas. “I suspect that kind of finding would lead to more patients opting for greater chances of neurologic recovery instead of higher opioid use immediately following injury.”

 

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The Association of Academic Physiatrists (AAP) is the only academic association dedicated to the specialty of physiatry. The AAP is an organization of leading physicians, researchers, in-training physiatrists, and others involved or interested in mentorship, leadership, and discovery in physiatry. The AAP holds an Annual Meeting, produces a leading medical journal in rehabilitation, AJPM&R, and leads a variety of programs and activities that support and enhance academic physiatry. To learn more about the Association and field of physiatry, visit physiatry.org and follow us on Twitter using @AAPhysiatrists. To learn more about the AAP's 2018 Annual Meeting, visit physiatry.org/2018.

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