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Abstract Details

Pain Trajectories Following Subarachnoid Hemorrhage are Associated with Persistent Opioid Use
Neuro Trauma, Critical Care, and Sports Neurology
Neurocritical Care Posters (7:00 AM-5:00 PM)
007
To characterize acute pain trajectories in patients hospitalized after subarachnoid hemorrhage (SAH) and determine if they were associated with continued outpatient opioid use.
SAH presents as the worst headache of life and leads to 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 reviewed pain scores from consecutive patients admitted following SAH from November 2015 through September 2019. Group-based trajectory modeling identified multiple discrete trajectories of pain scores from hospital day 2 through 14. We compared outcomes across trajectory groups using Chi-squared and Kruskal-Wallis tests. Multivariable regression determined if trajectory group membership was an independent predictor of opioid use at follow-up.
We identified 5 distinct pain trajectories among 305 eligible patients. Group 1 remained essentially pain free. Group 2 reported low pain scores with intermittent spikes and slight increase over time. Group 3 reported increasing pain severity through day 7 with improvement of moderate levels until day 14. Group 4 experienced maximum pain immediately with a steady decrement to mild pain over time. Group 5 reported moderate pain severity with slight abatement over time. In multivariable analysis, trajectory groups 3 (Odds Ratio [OR] 3.6, 95% Confidence Interval [CI] 1.5-8.4) and 5 (OR 8.0, 95% CI 3.1-20.8), history of depression (OR 3.8, 95% CI 1.4-10.6), and non-Caucasian race (OR 2.2, 95% CI 1.3-4.0) were associated with continued opioid use at follow up (median 62 days following admission, Interquartile Range 48-96).

We delineated five distinct pain trajectories following SAH. Groups with moderate pain at day 14 were at risk for continued opioid use. Future study is warranted to determine whether interventions alter pain trajectories and limit long-term opioid use.
Authors/Disclosures
Matthew N. Jaffa, DO (Ayer Neuroscience Institute, Hartford Hospital)
PRESENTER 		Dr. Jaffa has nothing to disclose.
Ruchira M. Jha, MD (Barrow Neurological Institute) Dr. Jha has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. An immediate family member of Dr. Jha has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Legal fees. The institution of Dr. Jha has received research support from NIH/NINDS, Chuck Noll Foundation, University of Pittsburgh, Barrow Neurological Foundation.
Jonathan Elmer No disclosure on file
Adam Kardon, DO Dr. Kardon has nothing to disclose.
Jamie E. Podell, MD The institution of Dr. Podell has received research support from University of Maryland, Baltimore Institute for Clinical and Translational Research. The institution of Dr. Podell has received research support from R Adams Cowley Shock Trauma Center.
Benjamin Zusman, MD (MGB Neurology) Mr. Zusman has received research support from University of Pittsburgh .
No disclosure on file
J. Marc Simard, MD, PhD (University of Maryland Neurosurgery) Dr. Simard has nothing to disclose.
No disclosure on file
Neeraj Badjatia, MD (University of Maryland School of Medicine) The institution of Dr. Badjatia has received research support from NIH/DOD.
Nicholas A. Morris, MD, FAAN (University of Maryland Medical Center) Dr. Morris has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for HANCOCK, DANIEL & JOHNSON, P.C.. Dr. Morris has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for The Jacob D. Fuchsberg Law Firm. The institution of Dr. Morris has received research support from National Institute of Neurological Disorders and Stroke. The institution of Dr. Morris has received research support from 好色先生. Dr. Morris has received personal compensation in the range of $0-$499 for serving as a Grand Rounds Speaker with New York University. Dr. Morris has received personal compensation in the range of $500-$4,999 for serving as a Grand Rounds Speaker with Mount Sinai Health System. Dr. Morris has received personal compensation in the range of $500-$4,999 for serving as a Continuum Article Author with 好色先生. Dr. Morris has received personal compensation in the range of $0-$499 for serving as a Reviewer with Society of Critical Care Medicine. Dr. Morris has received personal compensation in the range of $500-$4,999 for serving as a Grand Rounds Speaker with New York Medical College. Dr. Morris has received personal compensation in the range of $500-$4,999 for serving as a Webinar Speaker with Kreg Therapeutics. Dr. Morris has a non-compensated relationship as a Editorial Board Member with 好色先生 that is relevant to AAN interests or activities. Dr. Morris has a non-compensated relationship as a Editorial Board Member with Neurocritical Care Society that is relevant to AAN interests or activities.