Hidradenitis suppurativa pain leads to long-term opioid use

By Mardi Chapman

20 Sep 2019

hidradenitis suppurativaPain is a huge factor in hidradenitis suppurativa (HS) as demonstrated by a study that has shown patients have a high risk of long-term opioid use.

The retrospective study of electronic health record data from 22,277 adults with HS compared to 828,832 controls found the overall 1-year incidence of long-term opioid use was 0.33% compared to 0.14%.

“In the fully adjusted model, patients with HS had 1.53 … times the odds of incident long-term opioid use compared with controls,” the study investigators said.

Oxycodone (74.3%) and hydrocodone (59.5%) were the most commonly prescribed Schedule ll opioids in long-term users and tramadol was the most commonly prescribed non-schedule ll opioid.

The researchers said the incidence of long-term opioid use in their study was comparable to that in patients with newly diagnosed musculoskeletal pain and those undergoing various surgical procedures.

“These are populations for whom increased vigilance and monitoring for long-term opioid use have been recommended.”

“As such, our results suggest that similar monitoring may be warranted for patients with HS, particularly if other risk factors, such as smoking and depression, are present.”

Brisbane dermatologist Dr Erin McMeniman said a local survey of more than 200 patients with HS at Princess Alexandra Hospital and in her private rooms had also shown pain was the main problem.

“100% of patients said pain was a major problem of the condition. 76% said the smell is a major problem and 88% said leakage of pus is a major problem.”

She said patients with a flare in their groin might have trouble walking due to the pain or might not be able to sit down.

However long-term management with complex analgesics was not the best way forward.

“My focus as a dermatologist is much more on trying to settle the underlying inflammation so the person is in less pain than directly managing complex pain needs with analgesics.”

“It’s much better that I control the inflammation and the flares either through medical therapy or surgical therapy.”

Dr McMeniman, deputy director of dermatology at the Princess Alexandra Hospital, told the limbic pain was one of the major indicators for surgery and a procedure to de-roof the sinus network could make a huge difference to patients.

In research yet to be published, she said patient pain scores went from 6.7 on a 10-point pain scale pre-operatively to no pain in the scar site three months after surgery.

“So we haven’t fixed the whole body but often patients have just one or two areas that really bother their quality of life and if you can treat them surgically you have made a huge impact.”

“They still get lesions elsewhere from time to time but I’ve found in many patients there are one or two areas on their body that give them most of their pain.”

She said most dermatologists were very cautious about prescribing opioids and in patients with long-term complex pain management she would refer to a specialised pain clinic.

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