While opioids are routinely prescribed for painful and chronic wounds, the effects of the medications are not well described in literature. Past studies suggest that stimulation of mu-opiate receptors on keratinocytes may induce transforming growth factor-beta (TGF-beta) and cytokeratin 16 (CK16), which are molecules that appear in wound healing environments. However, other studies suggest opioids may impede immune activation and negatively affect healing. This longitudinal observational study sought to elucidate the effect of opioids on healing of wounds in the Wound Healing and Etiology (WE-HEAL) Study, a repository of 450 patients. Parameters such as pain score, longitudinal opioid exposure, and total wound surface area (tWSA) were investigated.
Patients in the WE-HEAL study were followed at tertiary referral centers that focus on the management of patients with chronic wounds. To be included in the study, one had to have an open wound at the initial visit and more than one follow-up visit. Data investigated included tWSA (sum of total wounds), pain score (0-10; 0 being “no pain,” 10 “worst pain ever”), and opiate exposure (calculated as a patient’s daily morphine-equivalent exposure). Because the three variables were expected to be positively correlated, the investigators sought to further tease out the effects of opioid treatment on healing with statistical methods such as univariate association, static multivariate logistic regression models, time-to-event analyses, and dynamic fixed-effects mixed model regression.
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