1. Opioid Analgesics and Persistent Pain After an Acute Pain Emergency Department Visit: Evidence from a Cohort of Suspected Urolithiasis Patients
- Author
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Wentz, Anna E, Wang, Ralph C, Marshall, Brandon DL, Shireman, Theresa I, Liu, Tao, and Merchant, Roland C
- Subjects
Adult ,Analgesics ,Emergency Service ,Physicians' ,emergency department ,urolithiasis ,Pain Research ,Clinical Sciences ,Neurosciences ,Opioid ,Practice Patterns ,Acute Pain ,Emergency Care ,Emergency & Critical Care Medicine ,United States ,opioid analgesia ,Hospital ,Substance Misuse ,Urolithiasis ,Clinical Research ,Humans ,Prescription Drug Abuse ,Chronic Pain ,Acute pain - Abstract
BackgroundSevere acute pain is still commonly treated with opioid analgesics in the United States, but this practice could prolong the duration of pain.ObjectivesEstimate the risk of experiencing persistent pain after opioid analgesic use after emergency department (ED) discharge among patients with suspected urolithiasis.MethodsWe analyzed data collected for a longitudinal, multicenter clinical trial of ED patients with suspected urolithiasis. We constructed multilevel models to estimate the odds ratios (ORs) of reporting pain at 3, 7, 30, or 90 days after ED discharge, using multiple imputation to account for missing outcome data. We controlled for clinical, demographic, and institutional factors and used weighting to account for the propensity to be prescribed an opioid analgesic at ED discharge.ResultsAmong 2413 adult ED patients with suspected urolithiasis, 62% reported persistent pain 3 days after discharge. Participants prescribed an opioid analgesic at discharge were OR 2.51 (95% confidence interval [CI] 1.82-3.46) more likely to report persistent pain than those without a prescription. Those who reported using opioid analgesics 3 days after discharge were OR 2.24 (95% CI 1.77-2.84) more likely to report pain at day 7 than those not using opioid analgesics at day 3, and those using opioid analgesics at day 30 had OR 3.25 (95% CI 1.96-5.40) greater odds of pain at day 90.ConclusionsOpioid analgesic prescription doubled the odds of persistent pain among ED patients with suspected urolithiasis. Limiting opioid analgesic prescribing at ED discharge for these patients might prevent persistent pain in addition to limiting access to these medications.
- Published
- 2021