Evaluation of psychosocial risk factors for persistent opioid

use in trauma pain clinic – a quality improvement initiative

Sunnybrook Health Sciences Centre: level 1 American College of Surgeons

certified trauma center in Canada with over 2,000 trauma team activations/year

– Multiple concomitant injuries: orthopedic fractures, soft tissue, nerve, vascular, and

traumatic brain injuries

– Patients have prolonged intensive care unit admission, multiple surgical

procedures, therefore potential for significant and prolonged pain

– In 2021, a Trauma Recovery Clinic was established at Sunnybrook Health

Sciences, a one-of-a-kind multidisciplinary clinic focused on helping trauma

patients rehabilitate and transition to community care

– Quality improvement initiatives are exempt from IRB approval by local guidelines

– Patient intake questionnaires for clinical care in the TPC were collected for new

patient referrals between May 2021 and Oct 2022

– Patient medical records were also reviewed for additional data

– Intake questionnaire consisted of :

1. demographic information (age, social habits, employment status)

2. pain patterns (body pain diagram)

3. validated pain and function questionnaire - Brief Pain Inventory (BPI)

4. analgesic medication at discharge and use at time of TPC intake

5. history of surgical interventions

– Descriptive analyses were carried out using SAS (Version 9.4)

OBJECTIVE: Analyze characteristics of the initial patient cohort referred to the

TPC to help provide improved services for transitional pain care

– 170 questionnaires collected

– Male: 65% ; Female: 35%

– Patients reporting 7/10 or greater for average pain on the brief pain inventory (BPI)

accounted for 55%; while patients reporting 7/10 or greater for worst pain on the

BPI accounted for 80%.

– An overwhelming number of patients (91%) were given follow-up appointments for

further pain care

24%

34%

33%

7.80%

4.80%

0% 10% 20% 30% 40%

Tobacco

Alcohol

Cannabis

Recreational drugs

Opioids

Prior Trauma Substances

51%

34%

13%

15%

13%

0% 10% 20% 30% 40% 50%

Depression/anxiety

Previous/current antidepressentats

Self-harm

Alcohol/drugs problems

Psychiatric

hospitalization

Psychosocial History

– Patients with traumatic injuries for trauma activation can range from soft tissue

injuries to numerous and severe multisystemic injuries

– Patients are often provided multimodal analgesic treatment including opioids with

nearly 80% of patients given opioid prescriptions at discharge

– Approximately 60% of these patients were able to wean opioid use by the time of

presentation to the TPC, our data demonstrates a concerning trend of more than

30% of patients with persistent opioid use 1 month following hospital discharge

– Traumatic injury has been associated with persistent opioid use and these patients

have an increased risk of death in the 6-18 months after trauma.

– Long-term opioid therapy is also associated with increased risk for an opioid abuse or

dependence diagnosis

– Mental health disorders have been noted to be associated with increased risk of

chronic opioid use

– High rate of anxiety/depression identified in our population (51%) and prevalence of

post-traumatic stress disorder following trauma

– Highlights a need to better address the pain and psychiatric barriers faced by patients

following trauma to reduce the incidence of chronic opioid use.

– Need for a multidisciplinary and multi-faceted approach to pain management of

trauma patients following hospital discharge

1. von Oelreich E, Eriksson M, Brattstrom O, et al. Risk factors and outcomes of chronic

opioid use following trauma. Br J Surg 2020;107(4):413-21. doi: 10.1002/bjs.11507

[published Online First: 20200207]

2. Edlund MJ, Martin BC, Russo JE, et al. The role of opioid prescription in incident

opioid abuse and dependence among individuals with chronic noncancer pain: the role

of opioid prescription. Clin J Pain 2014;30(7):557-64.

doi:10.1097/AJP.0000000000000021

3. Richardson LP, Russo JE, Katon W, et al. Mental health disorders and long-term

opioid use among adolescents and young adults with chronic pain. J Adolesc Health

2012;50(6):553-8. doi: 10.1016/j.jadohealth.2011.11.011 [published Online First:

20120228]

– The Trauma Pain Clinic (TPC) within the Trauma

Recovery Clinic was established to help manage

transitional pain needs of trauma patients

– Patients are screened by an intake officer at 4

weeks following discharge from hospital and are

referred to the TPC if their pain numerical rating

scale is >4

– Given the paucity of published data available on the

pain needs of trauma patients following discharge,

we have undertaken this quality improvement

initiative to better understand the patient population

and its needs.