Nine recommendations for the emergency department for patients presenting with low back pain based on management and post-discharge outcomes in an Australian, tertiary emergency department.
emergency department
low back pain
opioid analgesics
pain management
patient discharge
Journal
Emergency medicine Australasia : EMA
ISSN: 1742-6723
Titre abrégé: Emerg Med Australas
Pays: Australia
ID NLM: 101199824
Informations de publication
Date de publication:
Apr 2024
Apr 2024
Historique:
revised:
15
10
2023
received:
06
11
2022
accepted:
14
11
2023
pubmed:
6
12
2023
medline:
6
12
2023
entrez:
6
12
2023
Statut:
ppublish
Résumé
To ascertain and develop recommendations for analgesic management, discharge planning and further healthcare utilisation of adults presenting to an Australian tertiary ED with radicular or low back pain (LBP). This prospective cohort study included adults presenting with non-specific LBP or radicular pain to an Australian tertiary ED. Participants with trauma/cancer-related pain, and those requiring hospital admission or surgical interventions were excluded. The primary outcome was pharmacological and non-pharmacological management delivered in ED, retrospectively collected via electronic medical records. The secondary outcomes include discharge management use, and changes made due to post-discharge healthcare utilisation, as observed by weekly telephone questionnaires over 4-weeks follow-up. Of the 100 participants recruited, 94 completed follow-up. In ED, pharmacological management was received by 85%, including opioids (62%) and non-steroidal anti-inflammatory drugs (NSAIDS, 63%). Non-pharmacological management was received by 73%, including patient education (71%) and exercise prescription (37%). In the first-week post-discharge, changes to initial discharge plan occurred in 50%, mostly carried out by GPs (76%). Over the follow-up period, 51% received additional investigations/referrals. Pharmacological use decreased by 38% and non-pharmacological use decreased by 10%. 16% of opioid-naïve patients continued using opioids 4-weeks post-discharge. ED presentations for LBP were more often treated pharmacologically than non-pharmacologically, with opioids commonly prescribed and NSAIDs potentially under-utilised. Post-discharge, additional investigations/referrals, discharge analgesia reductions and maintenance of non-pharmacological management were common. Opioid initiation as a result of LBP presentations, signifies a potential 'gateway' towards unintentional long-term use. Key study findings form our nine recommendations to inform ED LBP pain management.
Identifiants
pubmed: 38054252
doi: 10.1111/1742-6723.14354
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
310-317Informations de copyright
© 2023 Australasian College for Emergency Medicine.
Références
Australian Government Department of Health. Low Back Pain Clinical Care Standard. Sydney: ACSQHC, 2022.
Burton AK, Balague F, Cardon G et al. Chapter 2. European guidelines for prevention in low back pain. Eur. Spine J. 2006; 15 Suppl 2: S136-S168.
Howe JF, Loeser JD, Calvin WH. Mechanosensitivity of dorsal root ganglia and chronically injured axons: a physiological basis for the radicular pain of nerve root compression. Pain 1977; 3: 25-41.
Australian Institute of Health and Welfare. Emergency Department Care 2017-18: Australian Hospital Statistics. Canberra: AIHW, 2018 96 p. Health services series no. 89. Cat. no. HSE 216.
Coombs DM, Machado GC, Richards B et al. Healthcare costs due to low back pain in the emergency department and inpatient setting in Sydney, Australia. Lancet Reg. Health West. Pac. 2021; 7: 1-7.
Manchikanti L, Singh V, Falco FJ, Benyamin RM, Hirsch JA. Epidemiology of low back pain in adults. Neuromodulation 2014; 17: 3-10.
Seneviratne U, McLaughlin K, Reilly J. Pharmacological and nonpharmacological management and outcomes of adults presenting to the emergency department with low back or radicular pain: A systematic review (Under review). PROSPERO registration number: CRD42021227818.
World Health Organization. ICD-10: International Statistical Classification of Diseases and Related Health Problems: Tenth Revision, 2nd edn. Geneve: WHO Press - World Health Organization; 2004.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int. J. Surg. 2014; 12: 1495-1499.
Faculty of Pain Medicine ANZCA. Opioid Calculator v.2.9. Melbourne: FPM ANZCA, 2019 Available from URL: http://www.opioidcalculator.com.au/opioidsource.html
Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J. Research electronic data capture (REDCap) - a metadata-driven methodology and workflow process for providing translational research informatics support. J. Biomed. Inform. 2009; 42: 377-381.
Foster NE, Anema JR, Cherkin D et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet 2018; 391: 2368-2383.
McCaughey EJ, Li L, Georgiou A, Golding MH, Westbrook JI. Imaging for patients presenting to an emergency department with back pain: impact on patient pathway. Emerg. Med. Australas. 2016; 28: 412-418.
Machado GC, Ghinea N, Rogan E, Day RO, Maher CG. Emergency department care for low back pain: should we adopt recommendations from primary care guidelines? Emerg. Med. Australas. 2020; 32: 890-892.
NSW Agency for Clinical Innovation. Management of People With Acute Low Back Pain: Model of Care. Chatswood: NSW Agency for Clinical Innovation, 2016.
Doherty S, Knott J, Bennets S, Jazayeri M, Huckson S. National project seeking to improve pain management in the emergency department setting: findings from the NHMRC-NICS National Pain Management Initiative. Emerg. Med. Australas. 2013; 25: 120-126.
Ferreira GE, Machado GC, Abdel Shaheed C et al. Management of low back pain in Australian emergency departments. BMJ Qual. Saf. 2019; 28: 826-834.
Ly J, Roman CP, Luckhoff C, Cameron PA, Dooley MJ, Mitra B. Introduction of a modified analgesic ladder in the emergency department: effect on oxycodone use for back pain. J. Opioid Manag. 2021; 17: 55-61.
Mehta V, Langford R. Acute pain management in opioid dependent patients. Rev. Pain 2009; 3: 10-14.
de Campos TF. Low back pain and sciatica in over 16s: assessment and management NICE Guideline [NG59]. J. Physiother. 2017; 63: 120.
Dingley C, Daugherty K, Derieg MK, Persing R. Improving patient safety through provider communication strategy enhancements. In: Henriksen K, Battles J, Keyes M, eds. Advances in Patient Safety: New Directions and Alternative Approaches (Vol 3: Performance and Tools). Rockville (MD): Agency for Healthcare Research and Quality (US), 2008.
Hayden JA, Ellis J, Asbridge M et al. Prolonged opioid use among opioid-naive individuals after prescription for nonspecific low back pain in the emergency department. Pain 2021; 162: 740-748.
Walker BF, Muller R, Grant WD. Low back pain in Australian adults: prevalence and associated disability. J. Manipulative Physiol. Ther. 2004; 27: 238-244.
Stevens JA. One quantum of solace for all? Anaesth. Intensive Care 2020; 48: 7-10.
Williams CM, Maher CG, Hancock MJ et al. Low back pain and best practice care: a survey of general practice physicians. Arch. Intern. Med. 2010; 170: 271-277.