Trends and risk factors for opioid administration for non-emergent lower back pain

Abstract

BACKGROUND Non-emergent low-back pain (LBP) is one of the most prevalent presenting complaints to the emergency department (ED) and has been shown to contribute to overcrowding in the ED as well as diverting attention away from more serious complaints. There has been an increasing focus in current literature regarding ED admission and opioid prescriptions for general complaints of pain, however, there is limited data concerning the trends over the last decade in ED admissions for non-emergent LBP as well as any subsequent opioid prescriptions by the ED for this complaint. AIM To determine trends in non-emergent ED visits for back pain; annual trends in opioid administration for patients presenting to the ED for back pain; and factors associated with receiving an opioid-based medication for non-emergent LBP in the ED METHODS Patients presenting to the ED for non-emergent LBP from 2010 to 2017 were retrospectively identified from the National Hospital Ambulatory Medical Care Survey database. The “year” variable was transformed to two-year intervals, and a weighted survey analysis was conducted utilizing the weighted variables to generate incidence estimates. Bivariate statistics were used to assess differences in count data, and logistic regression was performed to identify factors associated with patients being discharged from the ED with narcotics. Statistical significance was set to a P value of 0.05. RESULTS Out of a total of 41658475 total ED visits, 3.8% (7726) met our inclusion and exclusion criteria. There was a decrease in the rates of non-emergent back pain to the ED from 4.05% of all cases during 2010 and 2011 to 3.56% during 2016 and 2017. The most common opioids prescribed over the period included hydrocodone-based medications (49.1%) and tramadol-based medications (16.9), with the combination of all other opioid types contributing to 35.7% of total opioids prescribed . Factors significantly associated with being prescribed narcotics included age over 43.84-years-old, higher income, private insurance, the obtainment of radiographic imaging in the ED, and region of the United States (all, P < 0.05). Emergency departments located in the Midwest [odds ratio (OR): 2.42, P < 0.001], South (OR: 2.35, < 0.001), and West (OR: 2.57, P < 0.001) were more likely to prescribe opioid-based medications for non-emergent LBP compared to EDs in the Northeast. CONCLUSION From 2010 to 2017, there was a significant decrease in the number of non-emergent LBP ED visits, as well as a decrease in opioids prescribed at these visits. These findings may be attributed to the increased focus and regulatory guidelines on opioid prescription practices at both the federal and state levels. Since non-emergent LBP is still a highly common ED presentation, conclusions drawn...

Opioid and Sedative NarxCare Scores Greater Than 300 Are Associated with Adverse Outcomes After Non-Emergent Spine Surgery

“…The lack of quantitative characterization of the association between opioid or sedative use and outcomes after nonemergency spine surgery among published investigations hinders a data-driven patient-specific risk assessment in clinical settings 4,8–11,30. The present study found that higher preoperative NCS-opioids, especially those above 300, are associated with an approximately twofold increase in the risk of prolonged LOS and 90-day readmission in addition to a potentially significant association with a higher incidence of 90-day reoperation as outlined by the propensity score-matched comparison.…”

“…1 In spine disorders, opioids and sedatives remain among the most commonly prescribed, dispensed, and consumed medications for acute as well as chronic back relief. [2][3][4][5] Such pattern persists despite several resolute medical as well as legislative reforms and the increasing body of contemporary literature that disputes the pain relief efficacy of opioids and sedatives compared to nonsteroidal anti-inflammatory medications or even placebo. [6][7][8][9] The association between preoperative opioid or sedative use and adverse postoperative outcomes remains controversial.…”

“…At least 6.2% of the US population self-reported abusing at least one prescription drug in 2018, such as stimulants, sedatives, and opioids 1. In spine disorders, opioids and sedatives remain among the most commonly prescribed, dispensed, and consumed medications for acute as well as chronic back relief 2–5. Such pattern persists despite several resolute medical as well as legislative reforms and the increasing body of contemporary literature that disputes the pain relief efficacy of opioids and sedatives compared to nonsteroidal anti-inflammatory medications or even placebo 6–9…”

Chiropractic spinal manipulation and likelihood of tramadol prescription in adults with radicular low back pain: a retrospective cohort study using US data

“…The main limitation of this study is the potential for unmeasured confounders to influence results. Certain variables that may influence the likelihood of tramadol prescription are unavailable or poorly represented in the TriNetX dataset, including pain severity,58 60 income,60 insurance type,60 geographic location,60 type of medical clinician seen,74 75 education level,59 marital status,59 patients’ requests for medication (ie, pressure to prescribe), or conversely, reluctance to consider taking a prescription opioid 36 37 76. Although the TriNetX database contains medical record data, we did not have access to detailed patient charts to directly validate our results due to the deidentified, aggregated nature of the dataset sourced from multiple healthcare organisations.…”

“…Social determinants of health: problems related to education59 and economic circumstances (positive)60…”