AEM Early Access 44: Opioid-induced euphoria among emergency department patients with acute severe pain

Welcome to the forty-fourth episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to a recent AEM Article or Article in Press, with an author interview podcast and suggested supportive educational materials for EM learners.

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DISCUSSING (OPEN ACCESS THROUGH november 2020; CLICK ON TITLE TO ACCESS)

Article: Opioid-induced euphoria among emergency department patients with acute severe pain. Lorena Abril Ochoa MD, Farnia Naeem MS, Deborah J. White MD, Polly E. Bijur PhD, Benjamin W. Friedman MD, MS

LISTEN NOW: INTERVIEW WITH author Dr. Benjamin Friedman

Benjamin W. Friedman, M.D., M.S.

Professor of Emergency Medicine, Albert Einstein College of Medicine

ABSTRACT:

Background

Parenteral opioids are commonly used to treat acute severe pain. We measured pleasurable sensations in patients administered intravenous analgesics to determine if these sensations were associated with receipt of an opioid, after controlling for relief of pain. Pleasurable sensations not accounted for by relief of pain were considered opioid‐induced euphoria.

Methods

These data were from a randomized study of 1 mg of hydromorphone versus 120 mg of lidocaine for abdominal pain. To assess euphoria, participants were asked to provide a 0 to 10 response to each of these questions: 1) How good did the medication make you feel? 2) How high did the medication make you feel? and 3) How happy did the medication make you feel? Pain at baseline and 30 minutes was also measured on a 0 to 10 scale. To determine the relative importance of pain relief versus medication type, we built three linear regression models in which each euphoria question was the dependent variable and pain relief, medication type, and medication‐induced side effects were the independent variables.

Results

Seventy‐seven patients received lidocaine and 77 hydromorphone. Hydromorphone patients reported greater pain improvement than lidocaine patients (mean difference = 1.5, 95% confidence interval [CI] = 0.6 to 2.3) and higher scores on all three euphoria questions (“feeling good” difference = 1.9, 95% CI = 0.8 to 3.0; “feeling high” difference = 1.5, 95% CI = 0.4 to 2.7; “feeling happy” difference = 1.7, 95% CI = 0.6 to 2.8). In the regression models, hydromorphone administration (β‐coefficient = 0.16, p = 0.03) and pain relief (β‐coefficient = 0.45, p < 0.01) were both associated with “feeling good.” “Feeling high” and “feeling happy” were associated with pain improvement (p < 0.01) but not with hydromorphone administration (p = 0.07 for “high” and p = 0.06 for “happy”). Medication‐induced side effects were not associated with these measures of euphoria.

Conclusion

Among emergency department patients with acute pain, hydromorphone‐induced euphoria, though measurable, was generally less important for patients than relief of pain.