A new protocol cuts opioid use in hospitalized patients with inflammatory bowel disease (IBD). Pain is one of the main IBD symptoms. In the hospital, doctors often treat it with opioids. The protocol cut opioid use. It also controlled pain better and sped recovery.
Summary: Chronic pain is one of the main symptoms of IBD. The pain is especially severe in patients in the hospital, and it often requires opioids. Now doctors have made a protocol that helps keep opioid use low. It does this without lowering the quality of care. The new protocol is even better at pain control and helps people recover faster.
Chronic pain is on the rise. But it is clear that widespread opioid use or prescribing is not the best way to care for people with chronic pain. So doctors now look for safer ways to treat pain and use fewer opioids. It appears that, in many cases, doctors are just too quick to prescribe opioids. Researchers at Cedars-Sinai in Los Angeles built a new plan. It is called The Proactive Analgesic Inpatient Narcotic-Sparing (P.A.I.N.-Sparing) protocol. A new study in Scientific Reports shows that it works. It cuts opioid use in IBD patients in the hospital without giving up pain control (1).
IBD is not a rare condition. It is one of the most severe autoimmune diseases. It causes frequent flares, pain, and hospital stays. Pain is one of the main symptoms in people in the hospital for it. IBD causes chronic pain, but the pain gets worse during flares. So doctors often need opioids to manage severe pain in these patients. But opioid use is associated with many complications, dependence, addiction, and even death. That is why we need ways to use them less.
How can doctors reduce opioid use for IBD pain?
With good planning and a clear grasp of pain care, doctors have many ways to reduce acute and chronic pain. Instead of switching to opioids, they may slowly raise the dose of safer, common painkillers. They may also add anti-anxiety and anti-seizure drugs. But the question remains: how should they do this? Doctors felt they needed a protocol proven to be safe and to work. Then they could use it in their clinical practice.
Researchers at Cedars-Sinai did exactly that. They created a P.A.I.N.-Sparing protocol that could significantly reduce opioid use and still control pain better. It is all about delaying opioids and trying other pain medicines first.
Of course, a protocol alone is not enough. It is vital to prove that the protocol is safe and good for pain control. So researchers ran clinical trials. Of the 329 eligible patients, researchers enrolled 33 in the study. Half of them were treated with the new narcotic-sparing protocol.
The researchers found that with this narcotic-sparing protocol, doctors could cut opioid use and also give better pain control. 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).
The narcotic-sparing protocol did more than control pain better. It was also better at improving quality of life. You can see this in how much more the patients on it moved. Those on the 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 raise the risk of side effects. What is remarkable is that it controls pain better than starting opioids early. Delaying opioids is also associated with better quality of life and better mobility. It is most likely tied to faster recovery from the underlying condition too.
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. 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 slowly raise the dose of safer, commonly used painkillers. They also add anti-anxiety and anti-seizure drugs. In the trial, patients treated this way used less morphine. They also 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 why doctors want 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. Patients were also more mobile during their hospital stay.
What is the P.A.I.N.-Sparing protocol?
It is the Proactive Analgesic Inpatient Narcotic-Sparing protocol. Researchers at Cedars-Sinai in Los Angeles made it for adults in the hospital with IBD. In the trial, 33 patients were enrolled and half were treated with it. They used less morphine (11.8 vs. 30.9) than the comparison group. They also walked more on day four (2,330 vs. 1,050).
Related reading
Mindfulness Cuts Opioid Treatment Dropout and Relapse · Methadone Cuts Opioid Use After Tonsillectomy in Kids · Steroids and Brain Gray and White Matter Changes · How Chronic Pain and Opioid Addiction Are Related
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.