Analgesic Use after Aneurysmal Subarachnoid Hemorrhage: A Population-Based Case-Control Study of 1187 Patients

The purpose of this population-based case-control study was to evaluate analgesic use after subarachnoid hemorrhage (SAH) caused by rupture of a saccular intracranial aneurysm (sIA).

The study consisted of 1187 patients alive 12 months after an sIA-SAH who were admitted to Kuopio University Hospital (KUH) between 1995 and 2014. Three controls, matched with age, sex, and birthplace, were included for each patient. Data on ruptured sIA cases admitted to KUH from a defined catchment population in Eastern Finland were obtained from the KUH intracranial aneurysm database. Analgesics were classified according to the Anatomical Therapeutic Chemical Classification system. Data on analgesic medication were retrieved from the Finnish national registry of prescribed medicines of the Social Insurance Institution of Finland.

Among 1187 patients with sIA-SAH who were alive 12 months after admission, 83 (7.0%) commenced analgesics use within 12 months after the sIA-SAH versus 53 (1.5%) of the 3561 population controls. The results revealed significantly greater initiation rate of analgesic use among patients with sIA-SAH within a year after sIA-SAH as compared with that of matched population controls (odds ratio 5.0; 95% confidence interval 3.5-7.0; P < 0.001). Analgesic use commencement within 12 months of an sIA-SAH was independently associated with the presence of an intracerebral hematoma. Among patients, commencing analgesic use increased 11% when we compared a year before and a year after sIA-SAH.

Our results indicate that patients with sIA-SAH had an increased risk for new pain after sIA-SAH as compared with that of matched control population.