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Pain and Its Long-term Interference of Daily Life After Critical Illness

Hayhurst, Christina J., MD*; Jackson, Jim C., PsyD; Archer, Kristin R., PhD; Thompson, Jennifer L., MPH§; Chandrasekhar, Rameela, PhD; Hughes, Christopher G., MD

doi: 10.1213/ANE.0000000000003358
Critical Care and Resuscitation: Original Clinical Research Report

BACKGROUND: Persistent pain likely interferes with quality of life in survivors of critical illness, but data are limited on its prevalence and risk factors. We sought to determine the prevalence of persistent pain after critical illness and its interference with daily life. Additionally, we sought to determine if intensive care unit (ICU) opioid exposure is a risk factor for its development.

METHODS: In a cohort of adult medical and surgical ICU survivors, we used the brief pain inventory (BPI) to assess pain intensity and pain interference of daily life at 3 and 12 months after hospital discharge. We used proportional odds logistic regression with Bonferroni correction to evaluate the independent association of ICU opioid exposure with BPI scores, adjusting for potential confounders including age, preadmission opioid use, frailty, surgery, severity of illness, and durations of delirium and sepsis while in the ICU.

RESULTS: We obtained BPI outcomes in 295 patients overall. At 3 and 12 months, 77% and 74% of patients reported persistent pain symptoms, respectively. The median (interquartile range) pain intensity score was 3 (1, 5) at both 3 and 12 months. Pain interference with daily life was reported in 59% and 62% of patients at 3 and 12 months, respectively. The median overall pain interference score was 2 (0, 5) at both 3 and 12 months. ICU opioid exposure was not associated with increased pain intensity at 3 months (odds ratio [OR; 95% confidence interval], 2.12 [0.92–4.93]; P = .18) or 12 months (OR, 2.58 [1.26–5.29]; P = .04). ICU opioid exposure was not associated with increased pain interference of daily life at 3 months (OR, 1.48 [0.65–3.38]; P = .64) or 12 months (OR, 1.46 [0.72–2.96]; P = .58).

CONCLUSIONS: Persistent pain is prevalent after critical illness and frequently interferes with daily life. Increased ICU opioid exposure was not associated with worse pain symptoms. Further studies are needed to identify modifiable risk factors for persistent pain in the critically ill and the effects of ICU opioids on patients with and without chronic pain.

From the *Division of Anesthesiology Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee

Division of Pulmonary and Critical Care Medicine and Center for Health Services Research, Vanderbilt University School of Medicine; Research Service, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, Tennessee

Department of Orthopedic Surgery and Physical Medicine and Rehabilitation

§Department of Biostatistics

Department of Biostatistics

Division of Anesthesiology Critical Care Medicine and Center for Health Services Research, Vanderbilt University School of Medicine, Nashville, Tennessee.

Published ahead of print April 11, 2018.

Accepted for publication February 16, 2018.

Funding: C.G.H. is supported by American Geriatrics Society Jahnigen Career Development Award and National Institutes of Health R01HL111111, R03AG045085 (Bethesda, MD). This project was supported by the National Institutes on Aging AG027472 (Bethesda, MD).

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Trial Registry Number: NCT00392795.

Reprints will not be available from the authors.

Address correspondence to Christina J. Hayhurst, MD, Division of Anesthesiology Critical Care Medicine, Vanderbilt University School of Medicine, 1211 21st Ave S, Medical Arts Bldg 526, Nashville, TN 37212. Address e-mail to christina.j.hayhurst@vanderbilt.edu.

© 2018 International Anesthesia Research Society
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