Relationship between acute pain trajectories after an emergency department visit and chronic pain: a Canadian prospective cohort study

Raoul Daoust, Jean Paquet, Alexis Cournoyer, Éric Piette, Judy Morris, Justine Lessard, Gilles Lavigne, Jean-Marc Chauny, Raoul Daoust, Jean Paquet, Alexis Cournoyer, Éric Piette, Judy Morris, Justine Lessard, Gilles Lavigne, Jean-Marc Chauny

Abstract

Objectives: Inadequate acute pain management can reduce the quality of life, cause unnecessary suffering and can often lead to the development of chronic pain. Using group-based trajectory modelling, we previously identified six distinct pain intensity trajectories for the first 14-day postemergency department (ED) discharge; two linear ones with moderate or severe pain during follow-up (~40% of the patients) and four cubic polynomial order trajectories with mild or no pain at the end of the 14 days (low final pain trajectories). We assessed if previously described acute pain intensity trajectories over 14 days after ED discharge are predictive of chronic pain 3 months later.

Design: Prospective cohort study.

Setting: Tertiary care trauma centre academic hospital.

Participants: This study included 18 years and older ED patients who consulted for acute (≤2 weeks) pain conditions that were discharged with an opioid prescription. Patients completed a 14-day diary in which they listed their daily pain intensity (0-10 numeric rating scale).

Outcomes: Three months after ED visit, participants were questioned by phone about their current pain intensity (0-10 numeric rating scale). Chronic pain was defined as patients with current pain intensity ≥4 at 3 months.

Results: A total of 305 participants remained in the study at 3 months, 49% were women and a mean age of 55±15 years. Twelve per cent (11.9; 95% CI 8.2 to 15.4) of patients had chronic pain at the 3-month follow-up. Controlling for age, sex and pain condition, patients with moderate or severe pain trajectories and those with only a severe pain trajectory were respectively 5.1 (95% CI 2.2 to 11.8) and 8.2 (95% CI 3.4 to 20.0) times more likely to develop chronic pain 3 months later compared with patients in the low final pain trajectories.

Conclusion: Specific acute pain trajectories following an ED visit are closely related to the development of chronic pain 3 months later.

Trial registration number: NCT02799004; Results.

Keywords: accident & emergency medicine; pain management; trauma management.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. Chang AK, Bijur PE, Munjal KG, et al. . Randomized clinical trial of hydrocodone/acetaminophen versus codeine/acetaminophen in the treatment of acute extremity pain after emergency department discharge. Acad Emerg Med 2014;21:227–35. 10.1111/acem.12331
    1. Larsen MJ, Fosnocht DE, Swanson ER. Pain management after discharge from the emergency department. Ann Emerg Med 2004;44:S88 10.1016/j.annemergmed.2004.07.287
    1. Johnston CC, Gagnon AJ, Pepler CJ, et al. . Pain in the emergency department with one-week follow-up of pain resolution. Pain Res Manag 2005;10:67–70. 10.1155/2005/781916
    1. Pavlin DJ, Chen C, Penaloza DA, et al. . A survey of pain and other symptoms that affect the recovery process after discharge from an ambulatory surgery unit. J Clin Anesth 2004;16:200–6. 10.1016/j.jclinane.2003.08.004
    1. Morrison RS, Magaziner J, McLaughlin MA, et al. . The impact of post-operative pain on outcomes following hip fracture. Pain 2003;103:303–11. 10.1016/S0304-3959(02)00458-X
    1. Voerman JS, de Klerk C, Vander Heyden KM, et al. . Pain is associated with poorer grades, reduced emotional well-being, and attention problems in adolescents. Clin J Pain 2017;33:44–50. 10.1097/AJP.0000000000000367
    1. Young Casey C, Greenberg MA, Nicassio PM, et al. . Transition from acute to chronic pain and disability: a model including cognitive, affective, and trauma factors. Pain 2008;134:69–79. 10.1016/j.pain.2007.03.032
    1. Sinatra R. Causes and consequences of inadequate management of acute pain. Pain Med 2010;11:1859–71. 10.1111/j.1526-4637.2010.00983.x
    1. Friedman BW, Conway J, Campbell C, et al. . Pain one week after an emergency department visit for acute low back pain is associated with poor three-month outcomes. Acad Emerg Med 2018;25:1138–45. 10.1111/acem.13453
    1. Griffioen MA, Greenspan JD, Johantgen M, et al. . Acute pain characteristics in patients with and without chronic pain following lower extremity injury. Pain Manag Nurs 2017;18:33–41. 10.1016/j.pmn.2016.10.002
    1. Pierik JGJ, IJzerman MJ, Gaakeer MI, et al. . Incidence and prognostic factors of chronic pain after isolated musculoskeletal extremity injury. Eur J Pain 2016;20:711–22. 10.1002/ejp.796
    1. Althaus A, Arránz Becker O, Neugebauer E. Distinguishing between pain intensity and pain resolution: using acute post-surgical pain trajectories to predict chronic post-surgical pain. Eur J Pain 2014;18:513–21. 10.1002/j.1532-2149.2013.00385.x
    1. Lavand'homme PM, Grosu I, France M-N, et al. . Pain trajectories identify patients at risk of persistent pain after knee arthroplasty: an observational study. Clin Orthop Relat Res 2014;472:1409–15. 10.1007/s11999-013-3389-5
    1. Gilron I, Vandenkerkhof E, Katz J, et al. . Evaluating the association between acute and chronic pain after surgery: impact of pain measurement methods. Clin J Pain 2017;33:588–94. 10.1097/AJP.0000000000000443
    1. Chapman CR, Donaldson GW, Davis JJ, et al. . Improving individual measurement of postoperative pain: the pain trajectory. J Pain 2011;12:257–62. 10.1016/j.jpain.2010.08.005
    1. Chapman CR, Fosnocht D, Donaldson GW. Resolution of acute pain following discharge from the emergency department: the acute pain trajectory. J Pain 2012;13:235–41. 10.1016/j.jpain.2011.11.007
    1. Sipilä RM, Haasio L, Meretoja TJ, et al. . Does expecting more pain make it more intense? Factors associated with the first week pain trajectories after breast cancer surgery. Pain 2017;158:922–30. 10.1097/j.pain.0000000000000859
    1. Downie AS, Hancock MJ, Rzewuska M, et al. . Trajectories of acute low back pain: a latent class growth analysis. Pain 2016;157:225–34. 10.1097/j.pain.0000000000000351
    1. Kannampallil T, Galanter WL, Falck S, et al. . Characterizing the pain score trajectories of hospitalized adult medical and surgical patients: a retrospective cohort study. Pain 2016;157:2739–46. 10.1097/j.pain.0000000000000693
    1. Okamoto A, Yamasaki M, Yokota I, et al. . Classification of acute pain trajectory after breast cancer surgery identifies patients at risk for persistent pain: a prospective observational study. J Pain Res 2018;11:2197–206. 10.2147/JPR.S171680
    1. Nagin DS, Odgers CL. Group-Based trajectory modeling in clinical research. Annu Rev Clin Psychol 2010;6:109–38. 10.1146/annurev.clinpsy.121208.131413
    1. Daoust R, Emond M, Bergeron E, et al. . Risk factors of significant pain syndrome 90 days after minor thoracic injury: trajectory analysis. Acad Emerg Med 2013;20:1139–45. 10.1111/acem.12248
    1. Thomazeau J, Rouquette A, Martinez V, et al. . Predictive factors of chronic post-surgical pain at 6 months following knee replacement: influence of postoperative pain trajectory and genetics. Pain Physician 2016;19:E729–41.
    1. Daoust R, Paquet J, Cournoyer A, et al. . Acute pain resolution after an emergency department visit: a 14-day trajectory analysis. Ann Emerg Med 2019;74:224–232. 10.1016/j.annemergmed.2019.01.019. [Epub ahead of print: 20 Feb, 2019].
    1. Daoust R, Paquet J, Cournoyer A, et al. . Quantity of opioids consumed following an emergency department visit for acute pain: a Canadian prospective cohort study. BMJ Open 2018;8:e022649. 10.1136/bmjopen-2018-022649
    1. Bonica JJ. The need of a taxonomy. Pain 1979;6:247–8. 10.1016/0304-3959(79)90046-0
    1. Daoust R, Paquet J, Cournoyer A, et al. . Quantity of opioid to prescribe for acute pain to limit misuse after emergency department discharge. Acad Emerg Med 2017;24:S225.
    1. Steingrímsdóttir Ólöf Anna, Landmark T, Macfarlane GJ, et al. . Defining chronic pain in epidemiological studies: a systematic review and meta-analysis. Pain 2017;158:2092–107. 10.1097/j.pain.0000000000001009
    1. King W, et al. Acute Pain, Subacute Pain and Chronic Pain. Berlin, Heidelberg: Springer Berlin Heidelberg, 2007.
    1. Harris PA, Taylor R, Thielke R, et al. . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–81. 10.1016/j.jbi.2008.08.010
    1. O'Neil JT, Wang ML, Kim N, et al. . Prospective evaluation of opioid consumption after distal radius fracture repair surgery. Am J Orthop 2017;46:E35–40.
    1. Berdine HJ, Nesbit SA. Equianalgesic dosing of opioids. J Pain Palliat Care Pharmacother 2006;20:79–84. 10.1080/J354v20n04_16
    1. Hoppe JA, Nelson LS, Perrone J, et al. . Opioid prescribing in a cross section of US emergency departments. Ann Emerg Med 2015;66:253–9. 10.1016/j.annemergmed.2015.03.026
    1. Schopflocher D, Taenzer P, Jovey R. The prevalence of chronic pain in Canada. Pain Res Manag 2011;16:445–50. 10.1155/2011/876306
    1. Rushton AB, Evans DW, Middlebrook N, et al. . Development of a screening tool to predict the risk of chronic pain and disability following musculoskeletal trauma: protocol for a prospective observational study in the United Kingdom. BMJ Open 2018;8:e017876. 10.1136/bmjopen-2017-017876

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit