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IBD pain not well controlled during hospitalisation

Pain scores in patients with inflammatory bowel disease did not improve during hospitalization despite high opioid use.

Sameer K. Berry, MD, MBA, of University of Michigan Medicine, and Gil Melmed, MD, MS, of Cedars-Sinai Medical Center
told Healio Gastroenterology that they set out to conduct the retrospective study because they saw a lot of patients in the hospital with high levels of pain.

“We felt, anecdotally, that their pain was not well controlled,” Berry said said. “In addition, we started to feel that these patients were getting a significant amount of opioid analgesics, which we know is one of 10 quality control metrics from the Crohn’s and Colitis Foundation to measure quality of IBD care.”

Berry and colleagues conducted a review of 57 patients to quantify pain and opioid consumption among IBD-related admissions over a 3-month period. They assessed the average and maximum pain scores for each day to measure changes in pain from admission to discharge.

The daily average pain score over the course of the entire hospitalization was 4.23 ± 2.09, while the maximum pain score was 8.28 ± 1.75. Among patients who used opioids (n = 51), the scores were 4.65 ± 2.16 and 7.53 ± 2.56, respectively.

Investigators found that there was a less than one-point change in daily average pain scores across the whole cohort and no change in maximum pain from admission to discharge. They saw similar findings among patients who used opioids.

Berry said the similar findings between the overall and opioid groups were concerning.

“People with higher pain received higher doses of opioids,” he said. “You would expect to see that, but you would hope to see on discharge that they would have lower pain scores. Despite the known risks associated with opioid use in IBD, pain scores did not improve when [patients] received opioids.”

Additionally, researchers found that patients naive to opioids used similar doses compared with patients who used opioids prior to admission. Nearly half of the patients were discharged with a prescription for opioids, and 71% of those patients were not on opioids prior to hospitalization.

Although they currently lack evidence, Berry said they have a few ideas about why pain is hard to control during IBD-related hospitalizations.

“Pain in IBD is associated with psychological factors, like anxiety, depression and stress,” he said. “Giving patients an opioid or non-opioid analgesic doesn’t really address the underlying psychological distress these patients feel.”

Read IBD pain not well controlled during hospitalisation by Alex Young

Posted on: June 9 2020

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