Abstract
Study design
Retrospective chart review.
Objectives
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.
Setting
Spinal Cord Injury Model System (SCIMS) inpatient acute rehabilitation facility.
Methods
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.
Results
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.
Conclusions
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.
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Data availability
The datasets generated and/or analyzed during the current study are not publicly available due to large datasets without a comprehensive legend, but are available from the corresponding author on reasonable request.
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Acknowledgements
We would like to acknowledge the Memorial Hermann—The Woodlands Trauma Services (Trauma Registry) for their assistance.
Funding
The research efforts of AS are supported by Mission Connect, a project of the TIRR Foundation. Further support was provided to AS and MH by Mission Connect Grants 016-104 and 016-115.
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AS was responsible for designing the study, linking the databases, extracting and analyzing data, interpreting results, writing the paper, and respondinging to revisions. CP was responsible for analyzing the data, interpreting results, writing the paper, and responding to revisions. JNB was responsible for extracting data and writing the paper. ARF and JLKK were responsible for guidance in statistical analyses and paper edits. MH was responsible for interpreting results, writing the paper, and respondinging to revisions.
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The authors declare that they have no conflict of interest.
Ethical approval
AS received approval for this study from the Institutional Review Board.
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Stampas, A., Pedroza, C., Bush, J.N. et al. The first 24 h: opioid administration in people with spinal cord injury and neurologic recovery. Spinal Cord 58, 1080–1089 (2020). https://doi.org/10.1038/s41393-020-0483-x
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DOI: https://doi.org/10.1038/s41393-020-0483-x
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