Opiod Induced Pruritus: The Need for Palliative Care for a Palliative Medicine (S707)

Abstract

•Give the prevalence of opioid induced pruritus in a pediatric population.•List at least 3 main risk factors for the development of opioid induced pruritus (OIP). Opioids are frequently utilized in the pediatric hematology and oncology population for pain control. Pruritus from opioids can be as distressing and debilitating as pain. Little is known about opioid-induced pruritus (OIP) in the pediatric population, and even less in the pediatric hematology and oncology population. This study sought to assess the prevalence and characteristics of OIP in the pediatric hematology and oncology population admitted to Virginia Commonwealth University Health System between June 2008 and December 2012. A retrospective chart review was performed. Descriptive statistics were calculated for pruritus, predictor variables, and relevant covariates with Chi-square and Wilcoxon rank-sum tests to detect differences in the covariates and predictor variables by pruritus status. Poisson regression was used to determine the association between the predictor variables and pruritus. SAS version 9.3 was used for all analyses. The incidence of OIP was 5.98% for the final sample size (n=435). Multiple predictors were significant in bivariate analyses. In adjusted Poisson regression: morphine was 12 times more likely to cause OIP compared to those who were in the other opioid group (p=0.005); patients with allergies were almost 3 times more likely to have OIP compared to patients without allergies (p= 0.01); and the risk of pruritus increased by approximately 14% with every one-unit (mg/kg) increase in the dose of opioid (p= 0.007). The incidence of OIP for the pediatric hematology and oncology population was similar to previous studies (mainly in adults). Type of opioid and dose of opioid were also found to be important predictors of OIP in the current study. An unexpected finding was allergies being an independent risk factor for OIP.