Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD, USA.
Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA.
Neurocrit Care. 2021 Dec;35(3):806-814. doi: 10.1007/s12028-021-01282-5. Epub 2021 Jun 9.
Subarachnoid hemorrhage (SAH) is characterized by the worst headache of life and associated with long-term opioid use. Discrete pain trajectories predict chronic opioid use following other etiologies of acute pain, but it is unknown whether they exist following SAH. If discrete pain trajectories following SAH exist, it is uncertain whether they predict long-term opioid use. We sought to characterize pain trajectories after SAH and determine whether they are associated with persistent opioid use.
We reviewed pain scores from patients admitted to a single tertiary care center for SAH from November 2015 to September 2019. Group-based trajectory modeling identified discrete pain trajectories during hospitalization. We compared outcomes across trajectory groups using χ and Kruskal-Wallis tests. Multivariable regression determined whether trajectory group membership was an independent predictor of long-term opioid use, defined as continued use at outpatient follow-up.
We identified five discrete pain trajectories among 305 patients. Group 1 remained pain free. Group 2 reported low scores with intermittent spikes and slight increase over time. Group 3 noted increasing pain severity through day 7 with mild improvement until day 14. Group 4 experienced maximum pain with steady decrement over time. Group 5 reported moderate pain with subtle improvement. In multivariable analysis, trajectory groups 3 (odds ratio [OR] 3.5; 95% confidence interval [CI] 1.5-8.3) and 5 (OR 8.0; 95% CI 3.1-21.1), history of depression (OR 3.6; 95% CI 1.3-10.0) and racial/ethnic minority (OR 2.3; 95% CI 1.3-4.1) were associated with continued opioid use at follow-up (median 62 days following admission, interquartile range 48-96).
Discrete pain trajectories following SAH exist. Recognition of pain trajectories may help identify those at risk for long-term opioid use.
蛛网膜下腔出血（SAH）的特征是一生中最剧烈的头痛，并伴有长期使用阿片类药物。其他急性疼痛病因的离散疼痛轨迹可预测慢性阿片类药物的使用，但尚不清楚 SAH 后是否存在这种情况。如果 SAH 后存在离散的疼痛轨迹，那么尚不清楚它们是否可预测长期使用阿片类药物。我们旨在描述 SAH 后的疼痛轨迹，并确定它们是否与持续使用阿片类药物有关。
我们回顾了 2015 年 11 月至 2019 年 9 月期间在一家三级医疗中心因 SAH 住院的患者的疼痛评分。基于群组的轨迹建模确定了住院期间的离散疼痛轨迹。我们使用卡方检验和 Kruskal-Wallis 检验比较了轨迹组之间的结局。多变量回归确定轨迹组别的成员身份是否是长期使用阿片类药物的独立预测因素，长期使用阿片类药物定义为在门诊随访时继续使用。
在 305 名患者中，我们确定了五种离散的疼痛轨迹。第 1 组保持无痛。第 2 组报告间歇性出现轻度疼痛，且疼痛程度随时间略有增加。第 3 组在第 7 天疼痛程度达到最高，此后略有改善，直至第 14 天。第 4 组在整个过程中疼痛程度逐渐减轻。第 5 组报告中度疼痛，略有改善。在多变量分析中，轨迹组 3（比值比 [OR] 3.5；95%置信区间 [CI] 1.5-8.3）和 5（OR 8.0；95% CI 3.1-21.1）、抑郁症病史（OR 3.6；95% CI 1.3-10.0）和少数民族（OR 2.3；95% CI 1.3-4.1）与随访时继续使用阿片类药物相关（中位随访时间为入院后 62 天，四分位间距 48-96）。
SAH 后存在离散的疼痛轨迹。识别疼痛轨迹可能有助于识别那些有长期使用阿片类药物风险的患者。
