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
© 2023 Australasian College for Emergency Medicine..
OBJECTIVE: 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).
METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:36 |
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| Enthalten in: |
Emergency medicine Australasia : EMA - 36(2024), 2 vom: 28. März, Seite 310-317 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Seneviratne, Uvin [VerfasserIn] |
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| Links: |
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| Themen: |
Analgesics, Opioid |
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| Anmerkungen: |
Date Completed 19.03.2024 Date Revised 19.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/1742-6723.14354 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM365451754 |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 Australasian College for Emergency Medicine. | ||
| 520 | |a OBJECTIVE: 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) | ||
| 520 | |a METHODS: 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 | ||
| 520 | |a RESULTS: 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 | ||
| 520 | |a CONCLUSION: 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 | ||
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| 700 | 1 | |a Luckhoff, Carl |e verfasserin |4 aut | |
| 700 | 1 | |a Myles, Paul |e verfasserin |4 aut | |
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