BACKGROUND: Initial management of acute occupational low back pain (AOLBP) commonly occurs in the emergency department (ED), where opioid prescribing can vary from the clinical guidelines that recommend limited use. OBJECTIVE: The objective of this study was to explore how opioids are prescribed in the ED and the impact on work disability and other outcomes in AOLBP. METHODS: A retrospective cohort study was conducted. All acute compensable lost-time LBP cases seen initially in the ED with a date of injury from January 1, 2009 to December 31, 2011 were identified within a nationally representative Workers' Compensation dataset. Multivariate models estimated the effect of early opioids (received within 2 days of ED visit) on disability duration, long-term opioid use, total medical costs, and subsequent surgeries. RESULTS: Of the cohort (N = 2887), 12% received early opioids; controlling for severity, this was significantly associated with long-term opioid use (adjusted risk ratio = 1.29; 95% confidence interval 1.05-1.58) and increased total medical costs for those in the highest opioid dosage quartile, but not associated with disability duration or subsequent low back surgery. CONCLUSIONS: Early opioid prescribing in the ED for uncomplicated AOLBP increased long-term opioid use and medical costs, and should be discouraged, as opioid use for low back pain has been associated with a variety of adverse outcomes. However, ED providers may be becoming more compliant with current LBP treatment guidelines.
BACKGROUND: Initial management of acute occupational low back pain (AOLBP) commonly occurs in the emergency department (ED), where opioid prescribing can vary from the clinical guidelines that recommend limited use. OBJECTIVE: The objective of this study was to explore how opioids are prescribed in the ED and the impact on work disability and other outcomes in AOLBP. METHODS: A retrospective cohort study was conducted. All acute compensable lost-time LBP cases seen initially in the ED with a date of injury from January 1, 2009 to December 31, 2011 were identified within a nationally representative Workers' Compensation dataset. Multivariate models estimated the effect of early opioids (received within 2 days of ED visit) on disability duration, long-term opioid use, total medical costs, and subsequent surgeries. RESULTS: Of the cohort (N = 2887), 12% received early opioids; controlling for severity, this was significantly associated with long-term opioid use (adjusted risk ratio = 1.29; 95% confidence interval 1.05-1.58) and increased total medical costs for those in the highest opioid dosage quartile, but not associated with disability duration or subsequent low back surgery. CONCLUSIONS: Early opioid prescribing in the ED for uncomplicated AOLBP increased long-term opioid use and medical costs, and should be discouraged, as opioid use for low back pain has been associated with a variety of adverse outcomes. However, ED providers may be becoming more compliant with current LBP treatment guidelines.
Authors: Martinus Megalla; Chinwe Ogedegbe; Angeline M Sanders; Nicole Cox; Thomas DiSanto; Haley Johnson; Michael Kelly; John D Koerner Journal: Cureus Date: 2022-02-04
Authors: Ayman R Ibrahim; Mohamed E Elgamal; Moaz O Moursi; Bara A Shraim; Muath A Shraim; Mujahed Shraim; Basem Al-Omari Journal: Int J Environ Res Public Health Date: 2022-09-25 Impact factor: 4.614