University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
Spinal Cord. 2020 Oct;58(10):1080-1089. doi: 10.1038/s41393-020-0483-x. Epub 2020 May 27.
Retrospective chart review.
The objective of this study was to characterize opioid administration in people with acute SCI and examine the association between opioid dose and (1) changes in motor/functional scores from hospital to rehabilitation discharge, and (2) pain, depression, and quality of life (QOL) scores 1-year post injury.
Spinal Cord Injury Model System (SCIMS) inpatient acute rehabilitation facility.
Patients included in the SCIMS from 2008 to 2011 were linked to the National Trauma Registry and the electronic medical record. Three opioid dose groups (low, medium, and high) were defined based on the total morphine equivalence in milligrams at 24 h. The associations between opioid dose groups and functional/motor outcomes were assessed, as well as 1-year follow-up pain and QOL surveys.
In all, 85/180 patients had complete medication records. By 24 h, all patients had received opioids. Patients receiving higher amounts of opioids had higher pain scores 1 year later compared with medium- and low-dose groups (pain levels 5.5 vs. 4 vs. 1, respectively, p = 0.018). There was also an 8× greater risk of depression 1 year later in the high-dose group compared with the low-dose group (OR: 8.1, 95% CI: 1.2-53.7). In analyses of motor scores, we did not find a significant interaction between opioid dose and duration of injury.
These preliminary findings suggest that higher doses of opioids administered within 24 h of injury are associated with increased pain in the chronic phase of people with SCI.
回顾性病历审查。
本研究旨在描述急性脊髓损伤（SCI）患者的阿片类药物使用情况，并探讨阿片类药物剂量与（1）从住院到康复出院期间运动/功能评分的变化，以及（2）损伤后 1 年时疼痛、抑郁和生活质量（QOL）评分之间的相关性。
脊髓损伤模型系统（SCIMS）住院急性康复机构。
将 2008 年至 2011 年期间纳入 SCIMS 的患者与国家创伤登记处和电子病历进行了关联。根据 24 小时内吗啡等效物的总毫克数，将患者分为三组（低、中、高）。评估了阿片类药物剂量组与功能/运动结局之间的相关性，以及 1 年随访时的疼痛和 QOL 调查。
共有 85/180 名患者有完整的药物记录。到 24 小时时，所有患者都接受了阿片类药物治疗。接受高剂量阿片类药物的患者 1 年后疼痛评分高于中、低剂量组（疼痛水平分别为 5.5、4 和 1，p=0.018）。高剂量组患者 1 年后抑郁的风险也增加了 8 倍，与低剂量组相比（OR：8.1，95%CI：1.2-53.7）。在运动评分分析中，我们没有发现阿片类药物剂量与损伤持续时间之间存在显著的交互作用。
这些初步研究结果表明，损伤后 24 小时内给予较高剂量的阿片类药物与 SCI 患者慢性期疼痛增加有关。
