The Relationship Between Type of Opioid Used During Critical Illness and Transition to Chronic Pain
Abstract
The FY20 CPMRP Investigator-Initiated Research Award Focus Area of this proposal is chronification of pain (i.e., the transition of acute pain to chronic pain) specifically by development of mechanistically justified therapies to prevent chronification and identification of risk or protective factors for patients susceptible to chronification including relevant subpopulations. Additionally, this work will use pragmatic approaches (i.e., use of available large databases). Many individuals in the active military and receiving care as Veterans require care in an intensive care unit and support from mechanical ventilation (a breathing machine). These sickest patients usually are given opioid medications (such as morphine) to treat pain and keep them sedated while sick. However, we know that some patients may go on to become dependent on these opioid medications and also have chronic pain. Different specific types of opioids have different actions on the body. One in particular, fentanyl, that is used frequently to provide pain relief to critically ill patients can paradoxically make someone very sensitive to being touched (hyperalgesia). Right now we do not know how often this happens or if this characteristic of fentanyl means that people have different long-term experiences of pain and pain medications. This study aims to look in detail at whether receiving different opioids means that patients get overall different amounts of the medications and whether it impacts if they receive pain medications or need to seek out care from pain doctors long term. This work will help all people who develop any kind of critical illness who go on to have chronic pain and need opioids long term; the study may show us a way to reduce the chance that transition will happen. In particular, we know that people who have had surgery or trauma are at higher risk of needing opioids long term and we will look at these subgroups of people separately. This work will: (1) allow us to understand if the type of pain medication prescribed makes a difference to patients while in very sick in the hospital; and (2) allow us to understand whether we can make a difference to patients by understanding what is the best possible medication for them to keep them comfortable but minimize risks. There are large clinical applications as each time an opioid is prescribed in an intensive care unit (millions of times a year in the U.S.), there is the possibility we may be increasing or decreasing the risk of someone having chronic pain. We can very easily substitute one opioid for another and perhaps reduce this risk for critically ill patients. If this work shows that there may be differences in care and outcomes for people who need critical care, we could see alterations in practice in intensive care units as soon as this work is published and read by critical care doctors, nurses, and pharmacists. We also expect that our study will be read by the experts who create guidelines for care that will allow them to revise their guidelines and suggest changes in practice. Therefore, person-related outcomes could be affected by this work immediately following the completion of this work in just 3 years.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110593
Entities
People
- Hannah Wunsch
Organizations
- Sunnybrook Research Institute
- United States Army