Raoul Daoust1,2, Jean Paquet3, Alexis Cournoyer3,4, Éric Piette3,4, Judy Morris3,4, Justine Lessard3,4, Véronique Castonguay3,4, Gilles Lavigne5,6, Vérilibe Huard3,4, Jean-Marc Chauny3,4. 1. Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada. raoul.daoust@videotron.ca. 2. Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada. raoul.daoust@videotron.ca. 3. Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada. 4. Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada. 5. Faculties of Dental Medicine and Medicine, Université de Montréal, Montréal, QC, Canada. 6. Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, QC, Canada.
Abstract
OBJECTIVES: Treatment of acute pain after emergency department (ED) discharge remains a challenge in the opioid crisis context. Our objective was to determine the proportion of patients using opioid vs non-opioid pain medication following discharge from the ED with acute pain, and the association of type of pain medication with average pain intensity before pain medication intake and report of pain relief. METHODS: This was a prospective cohort study of ED patients aged ≥ 18 years with an acute pain (≤ 2 weeks) who were discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain intensity level before each pain medication intake (0-10 numeric rating scale), type of pain medication use (opioid vs non-opioid), and if pain was relieved by the medication used that day. Multilevel analyses were used to compare the effect of type of analgesic used on pain intensity and relief. RESULTS: A total of 381 participants completed the 14-day diary; 50% were women and median age was 54 years (IQR = 43-66). Average daily pain intensity before pain medication intake was significantly higher for patients who used opioids (5.9; 95% CI 5.7-6.2) as compared to non-opioid analgesics (4.2; 95% CI 4.0-4.5) or no pain medication (2.2; 95% CI 1.9-2.5). Controlling for pain intensity, patients using opioids were more likely to report a pain relief (OR = 1.3; 95% CI 1.1-1.8) as compared to those who used non-opioid analgesics. CONCLUSION: Overall, opioids appear to be effective and used as intended by the prescribing physician.
OBJECTIVES: Treatment of acute pain after emergency department (ED) discharge remains a challenge in the opioid crisis context. Our objective was to determine the proportion of patients using opioid vs non-opioid pain medication following discharge from the ED with acute pain, and the association of type of pain medication with average pain intensity before pain medication intake and report of pain relief. METHODS: This was a prospective cohort study of ED patients aged ≥ 18 years with an acute pain (≤ 2 weeks) who were discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain intensity level before each pain medication intake (0-10 numeric rating scale), type of pain medication use (opioid vs non-opioid), and if pain was relieved by the medication used that day. Multilevel analyses were used to compare the effect of type of analgesic used on pain intensity and relief. RESULTS: A total of 381 participants completed the 14-day diary; 50% were women and median age was 54 years (IQR = 43-66). Average daily pain intensity before pain medication intake was significantly higher for patients who used opioids (5.9; 95% CI 5.7-6.2) as compared to non-opioid analgesics (4.2; 95% CI 4.0-4.5) or no pain medication (2.2; 95% CI 1.9-2.5). Controlling for pain intensity, patients using opioids were more likely to report a pain relief (OR = 1.3; 95% CI 1.1-1.8) as compared to those who used non-opioid analgesics. CONCLUSION: Overall, opioids appear to be effective and used as intended by the prescribing physician.
Authors: Ryan Gleber; Gary M Vilke; Edward M Castillo; Jesse Brennan; Leslie Oyama; Christopher J Coyne Journal: Am J Emerg Med Date: 2019-06-06 Impact factor: 2.469
Authors: Douglas P Barnaby; Andrew E Chertoff; Andrew J Restivo; Caron M Campbell; Scott Pearlman; Deborah White; Polly E Bijur; E John Gallagher Journal: Ann Emerg Med Date: 2018-08-14 Impact factor: 5.721
Authors: Benjamin W Friedman; Andrew A Dym; Michelle Davitt; Lynne Holden; Clemencia Solorzano; David Esses; Polly E Bijur; E John Gallagher Journal: JAMA Date: 2015-10-20 Impact factor: 56.272
Authors: Victor Cohen; Sergey Motov; Bradley Rockoff; Andrew Smith; Christian Fromm; Dimitri Bosoy; Rukhsana Hossain; Antonios Likourezos; Samantha P Jellinek-Cohen; John Marshall Journal: Am J Health Syst Pharm Date: 2015-12-01 Impact factor: 2.637