Summary: Chronic pain is among the primary symptoms in IBD patients. This pain is especially severe among hospitalized patients, often requiring opioid use. However, now doctors have created a protocol that helps minimize opioid use, without compromising on treatment quality. This new protocol is even better at pain control and promotes faster recovery.
Chronic pain is on the rise. However, it is clear that widespread opioid use or prescription is not the best way to manage those living with chronic pain. Hence, doctors are now exploring safer ways of pain management and reducing opioid use. It appears that, in many instances, doctors are just too quick to prescribe opioids. Researchers at Cedars-Sinai in Los Angeles developed The Proactive Analgesic Inpatient Narcotic-Sparing (P.A.I.N.-Sparing) protocol. The new study published in Scientific Reports shows that this protocol is effective at reducing opioid use in hospitalized IBD patients without compromising on pain control (1).
IBD is not a rare condition, and it is among the most severe autoimmune diseases, causing frequent flares, pain, and hospitalization. Pain is one of the primary symptoms in those hospitalized for the condition. IBD causes chronic pain, but it becomes worse during exacerbations of the disease. Hence, doctors often need to use opioids to manage severe pain in these patients. But, opioid use is associated with many complications, dependence, addiction, and even death. Hence, there is a need to find ways to reduce their use.
How can doctors reduce opioid use for IBD pain?
With proper planning and understanding of pain management, there are many options for reducing acute and chronic pains. Instead of switching to opioids, doctors may gradually increase the dosage of safer and commonly used painkillers and add anti-anxiety and anti-seizure drugs to the treatment. But, the question remains about how to do this. Doctors felt that there was a need to develop a protocol that was proven to be safe and that worked so that they could use it in their clinical practice.
Researchers at Cedars-Sinai could establish exactly that. They came up with a P.A.I.N.-Sparing protocol that could significantly reduce opioid use and yet control pain better. It is all about delaying opioid use and exploring alternative pain treatment medications.
Of course, it is insufficient to have a protocol. It is vital to prove that the protocol is safe and good for pain control. Hence, researchers carried out clinical trials. Of the 329 eligible patients, researchers enrolled 33 patients in the study, and half of them were treated using the newly developed narcotic sparing protocol.
The researchers found that by using this narcotic-sparing protocol, doctors could not only reduce opioid use but also provide better pain control. Thus, the intervention group had better pain control than the non-intervention group (3.02±0.90 vs. 4.29±0.81; P=0.059). Doctors could significantly reduce morphine use by following the protocol (11.8±15.3 vs. 30.9±42.2; P=0.027).
Not only could narcotic sparing protocol help control pain better, but it was also better at improving quality of life. This was evident from the greater mobility among those treated with the protocol. Those on P.A.I.N.-Sparing protocol walked more on day four (2,330±1,709 vs. 1,050±1,214; P=0.014).
Is opioid-sparing pain control better for IBD patients?
These findings are incredible in many ways. Using this protocol does not increase the risk of side effects. What is remarkable is that it is more effective for pain control than introducing opioids early in the pain treatment. Further, delayed opioid use is also associated with better quality of life, mobility, and most likely faster recovery from the underlying condition.
Frequently asked questions
Why is IBD so painful?
Inflammatory bowel disease is one of the most severe autoimmune diseases. It causes chronic pain, frequent flares and hospital stays. The pain gets worse during flares, when the disease is most active, and it is especially severe in patients who are admitted to the hospital. That is why doctors so often reach for opioids during an IBD admission.
Are opioids the best painkillers for IBD in the hospital?
Not as the first step. The P.A.I.N.-Sparing protocol delays opioids. Instead, doctors gradually raise the dose of safer, commonly used painkillers and add anti-anxiety and anti-seizure drugs. In the trial, patients treated this way used less morphine and reported better pain control than patients who got opioids early.
What are the risks of opioids for Crohn’s disease and colitis pain?
Opioids carry many complications, including dependence, addiction and even death. That is the reason doctors are looking for ways to use fewer of them in people with inflammatory bowel disease. The protocol on this page cut morphine use without raising the risk of side effects, and patients were more mobile during their hospital stay.
What is the P.A.I.N.-Sparing protocol?
It is the Proactive Analgesic Inpatient Narcotic-Sparing protocol, developed by researchers at Cedars-Sinai in Los Angeles for adults hospitalized with IBD. In the trial, 33 patients were enrolled and half were treated with it. They used less morphine (11.8 vs. 30.9) and walked more on day four (2,330 vs. 1,050) than the comparison group.
References
1. Berry SK, Takakura W, Patel D, Govalan R, Ghafari A, Kiefer E, et al. A randomized controlled trial of a proactive analgesic protocol demonstrates reduced opioid use among hospitalized adults with inflammatory bowel disease. Sci Rep. 2023 Dec 16;13(1):22396.