Pain Clinical Trial
Official title:
Influence of Body Size and Composition on Response to Hydromorphone in ED Patients With Acute Pain
Pain is the most common complaint for patients presenting to the emergency department (ED). Inadequate pain relief is also a common problem in ED. Patients' pain perceptions and responses to intravenous opioids vary widely and are influenced by multiple factors. The objective of the current study is to examine the association between total body weight, BMI (body mass index) and clinical response to a fixed dose of intravenous hydromorphone.
Pain is the most common complaint for patients presenting to the emergency department (ED).
Morphine and hydromorphone are the two most commonly administrated intravenous opioid
analgesics. However, a large inter-individual variation in the response to morphine or
hydromorphone has been observed and a significant number of patients do not have satisfactory
pain relief after receiving commonly administered doses of these two medications. Current
studies have focused on investigating optimal strategies of intravenous opioid use for
moderate and severe pain in the ED.
Contrary to the commonly recommended total body weight (TBW) based dosing strategy, a recent
publication did not demonstrate a linear relationship between TBW and clinical response to
morphine.
The ultimate goal of the research is to identify optimal methods of dosing opioids to
alleviate pain in ED patients. The objective of this study is to examine the association
between two measures of body size/body composition and response to a standard dose of
hydromorphone. The null hypothesis is that there is no association between the measures of
body size/composition and response to 1 mg hydromorphone, and thus no difference between the
associations. If a strong association exists between TBW or BMI and pain response, it will
lend support for the importance of taking body size or composition into account when making
decisions about hydromorphone dosing in the ED. It will lay the groundwork for future studies
of analgesic dosing. This is of particular importance given the increasing prevalence of
obesity in the US and other developed nations.
Specific Aims:
1. To test the association between analgesic response to a standard dose of hydromorphone
and total body weight in ED patients with acute pain requiring intravenous opioid
analgesia.
2. To test the association between analgesic response to a standard dose of hydromorphone
and BMI.
3. To compare the associations between analgesic response to a standard dose of
hydromorphone and the two measures of body size/composition, BMI and TBW.
4. To assess whether the associations between response to hydromorphone and these measures
of body size/composition are confounded or modified by gender, age, ethnicity and
certain genetic polymorphisms.
The results of the current study will suggest whether body size or composition play a role in
the clinical response to hydromorphone and may lay the groundwork for further studies to
determine whether dosing should be modified to take these characteristics into account either
continuously, e.g. 0.015 mg/kg hydromorphone or categorically (increasing doses by category
of BMI).
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