Colleen M. Trevino

Does opiate use in traumatically injured individuals worsen pain and psychological outcomes

UNLABELLED Opiate use for chronic pain is becoming increasingly controversial. There has been a shift away from supporting the use of opiates for treatment of chronic pain. In addition to lack of effectiveness, concerns for adverse clinical outcomes, addiction, and death have provided the impetus for this change. The purpose of this study was to investigate the percent of trauma patients still using opiates, their pain levels, and psychological outcomes 4 months posttrauma. This was a study to evaluate chronic pain at 4 months posttrauma in 101 participants from a single level 1 trauma center. Eighty of the 101 participants developed chronic pain 4 months after their initial traumatic injury (79%). Of those who developed chronic pain, 27 (26%) were still using opiates. Those using narcotics at 4 months posttrauma had significantly more pain, life interference, depression, and anxiety. Posttraumatic stress disorder (PTSD) was not significantly influenced by narcotic use in this analysis. However, the mean associated with those using narcotics was higher and diagnostic for PTSD. Those taking opiates did not have significantly better relief from their pain using treatments or medications than those not using opiates (F = 8, P = .08). These findings bring into question the appropriate use of opiates for chronic pain and the possible exacerbating effects on pain and psychopathology in traumatically injured patients. PERSPECTIVE This article identifies data that provide evidence that narcotic pain medication needs to be used carefully in traumatically injured patients with chronic pain, especially in those individuals with comorbid psychological pathology.

Chronic pain at 4 months in hospitalized trauma patients: incidence and life interference.

Many studies report on the incidence of chronic pain. However, deficiencies exist in prior research making it difficult to generalize results to trauma patients. This study evaluated the incidence of chronic pain in trauma patients at 4 months posttrauma and effect chronic pain has on life interference. The incidence of chronic pain was present in 79.2% of trauma patients 4 months posttrauma and a strong positive correlation (n = 80, r = 0.79, P < 0.001) existed between chronic pain severity and the effect on life interference. Chronic pain is prevalent and causes significant life interference in traumatically injured patients.

Predictors of chronic pain in traumatically injured hospitalized adult patients

It is unclear what causes chronic pain in traumatically injured hospitalized adults. A total of 101 patients admitted to a level 1 trauma center completed interviews during their inpatient stay and at 4 months, and data on biologic, psychologic, and sociologic variables were collected. Statistical analysis used hierarchical logistical regression,&khgr;2, and independent-samples t tests. Prevalence of chronic pain at 4 months was 79.2%. Those with chronic pain at 4 months had more posttraumatic stress disorder, anxiety, and depression. High initial pain score was the only significant predictor of chronic pain. Initial pain intensity predicts chronic pain.

Small bowel obstruction: the art of management.

Strategies for the management of small bowel obstructions have changed significantly over the years. Nonoperative medical management has become the mainstay of treatment of many small bowel obstructions. However, the key to the management of small bowel obstructions is identifying those patients who need surgical intervention. Identification of those at risk for bowel ischemia and bowel death is an art as much as it is a science. Using the current literature and the past knowledge regarding small bowel obstructions, the clinician must carefully identify the signs and symptoms that suggest the need for operative intervention. Classification of the obstruction, history and physical examination, imaging, response to decompression and resuscitation, and resolution or progression of symptoms are the key factors influencing the management of small bowel obstructions.

Implementation of an adhesive small bowel obstruction protocol using low-osmolar water soluble contrast and the impact on patient outcomes

BACKGROUND Small bowel obstruction (SBO) is a common condition leading to numerous hospital admissions and operations. Standardized care of adhesive SBO patients has not been widely implemented in hospital systems. METHODS A prospective cohort of SBO patients was compared to a historical cohort of SBO patients after implementation of a SBO protocol using evidence-based guidelines and Omnipaque, a low-osmolar water soluble contrast. Patients without a history of abdominal surgery were excluded and data was collected through chart review. RESULTS Univariate analyses demonstrated a decrease in both LOS by 1.35 days and in the proportion of patients receiving surgery (37% vs 25%; p < 0.05). There was a decrease in time to surgery, rate of SBR, and rate of complications, yet an increase in readmission, although these findings were not statistically significant. CONCLUSIONS Utilizing an evidence-based SBO protocol can lead to shorter LOS and may result in fewer operations for adhesive SBO patients.