Disparities in Analgesia and Opioid Prescribing Practices for Patients With Musculoskeletal Pain in the Emergency Department

2006 ◽  
Vol 32 (3) ◽  
pp. 219-224 ◽  
Author(s):  
Janet Kaye Heins ◽  
Alan Heins ◽  
Marianthe Grammas ◽  
Melissa Costello ◽  
Kun Huang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Musculoskeletal Pain ◽  
Prescribing Practices ◽  
Opioid Prescribing

scholarly journals P113: Examining emergency physicians’ self-reported opioid prescribing practices for the treatment of acute pain: A Newfoundland perspective

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S105-S106
Author(s):  
P. Doran ◽  
G. Sheppard ◽  
B. Metcalfe
Keyword(s):  
Emergency Department ◽  
Acute Pain ◽  
Oral Morphine ◽  
Prescribing Patterns ◽  
Evidence Based ◽  
Emergency Physicians ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Ensure Patient Safety ◽  
Evidence Based Guidelines

Introduction: Canadians are the second largest consumers of prescription opioids per capita in the world. Emergency physicians tend to prescribe stronger and larger quantities of opioids, while family physicians write the most opioid prescriptions overall. These practices have been shown to precipitate future dependence, toxicity and the need for hospitalization. Despite this emerging evidence, there is a paucity of research on emergency physicians’ opioid prescribing practices in Canada. The objectives of this study were to describe our local emergency physicians’ opioid prescribing patterns both in the emergency department and upon discharge, and to explore factors that impact their prescribing decisions. Methods: Emergency physicians from two urban, adult emergency departments in St. John's, Newfoundland were anonymously surveyed using a web-based survey tool. All 42 physicians were invited to participate via email during the six-week study period and reminders were sent at weeks two and four. Results: A total of 21 participants responded to the survey. Over half of respondents (57.14%) reported that they “often” prescribe opioids for the treatment of acute pain in the emergency department, and an equal number of respondents reported doing so “sometimes” at discharge. Eighty-five percent of respondents reported most commonly prescribing intravenous morphine for acute pain in the emergency department, and over thirty-five percent reported most commonly prescribing oral morphine upon discharge. Patient age and risk of misuse were the most frequently cited factors that influenced respondents’ prescribing decisions. Only 4 of the 22 respondents reported using evidence-based guidelines to tailor their opioid prescribing practices, while an overwhelming majority (80.95%) believe there is a need for evidence-based opioid prescribing guidelines for the treatment of acute pain. Sixty percent of respondents completed additional training in safe opioid prescribing, yet less than half of respondents (42.86%) felt they could help to mitigate the opioid crisis by prescribing fewer opioids in the emergency department. Conclusion: Emergency physicians frequently prescribe opioids for the treatment of acute pain and new evidence suggests that this practice can lead to significant morbidity. While further research is needed to better understand emergency physicians’ opioid prescribing practices, our findings support the need for evidence-based guidelines for the treatment of acute pain to ensure patient safety.

scholarly journals Pain management in the emergency department: a clinical review

2021 ◽  
Vol 8 (4) ◽  
pp. 268-278
Author(s):  
Sergey M. Motov ◽  
Katherine Vlasica ◽  
Igor Middlebrook ◽  
Alexis LaPietra
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Clinical Review ◽  
Musculoskeletal Pain ◽  
Pharmacological Treatment ◽  
Treatment Modalities ◽  
Evidence Based ◽  
Opioid Prescribing ◽  
Analgesic Regimen ◽  
Current Practices

Pain is one of the most common reasons for patients to visit the emergency department. The ever-growing research on emergency department analgesia has challenged the current practices with respect to the optimal analgesic regimen for acute musculoskeletal pain, safe and judicious opioid prescribing, appropriate utilization of non-opioid therapeutics, and non-pharmacological treatment modalities. This clinical review is set to provide evidence-based answers to these challenging questions.

scholarly journals Emergency Department Opioid Prescribing Practices for Chronic Pain: a 3-Year Analysis

2014 ◽  
Vol 11 (3) ◽  
pp. 288-294 ◽  
Author(s):  
Victoria J. Ganem ◽  
Alejandra G. Mora ◽  
Shawn M. Varney ◽  
Vikhyat S. Bebarta
Keyword(s):  
Emergency Department ◽  
Chronic Pain ◽  
Prescribing Practices ◽  
Opioid Prescribing

scholarly journals MP15: Predictors of emergency department opioid use and variability of prescribing practices in a large multicenter Canadian cohort

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S47-S48
Author(s):  
T. Lau ◽  
J. Hayward ◽  
G. Innes
Keyword(s):  
Emergency Department ◽  
Pain Score ◽  
Rating Scale ◽  
Pain Treatment ◽  
Future Research ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Opioid Administration ◽  
Unit Increase

Introduction: Emergency department (ED) opioid prescribing has been linked to long-term use and dependence. Anecdotally, significant opioid practice variability exists between physicians and institutions, but this is poorly defined. Our objective was to collate and analyze multicenter data looking at predictors of ED opioid use and to identify potential areas for opioid stewardship. Methods: We linked administrative and computerized physician order entry (CPOE) data from all four ED's within our municipality over a one-year period. Eligible patients included those with a Canadian Triage and Acuity Scale (CTAS) pain complaint or an arrival numeric rating scale (NRS) pain score of greater than 3/10. Patients with missing demographic or chief complaint data were excluded. Multiple imputation was used for missing NRS pain scores. We performed descriptive analyses of opioid-treated and non-treated patients, followed by a multivariable logistic regression to identify predictors of ED opioid administration. Results: A total of 129,547 patients were studied. The mean age was 47.4 years and 55.4% were female. The median pain score was 6.6 in the no-opioid group and 8 in the opioid group. The most common pain categories were abdominal pain (23%), trauma (18.2%) and chest pain (15.3%). Overall, opioids were prescribed to 34% of patients. The most common CTAS score was CTAS 3 (44%), CTAS 1-2 42%) and CTAS 4-5 (13.9%). Multivariable predictors of opioid-use included the need for admission (adjusted OR 6.57; CI = 6.34-6.79), NRS pain score (aOR 1.24 per unit increase, CI 1.23-1.25), higher numerical CTAS score (aOR 0.89 per unit increase, CI 0.87-0.91), and chief complaints of back (aOR 7.69, CI 7.1-8.1), abdominal (aOR 5.9, CI 5.6-6.2), and flank pain (OR 3.8, CI 3.5-4). Oral opioids were prescribed in 39.8% of back pain presentations and 18.5% received IV opioids. Increasing age was a predictor but sex was not. There were significant institutional differences in opioid prescribing rates, with Hospital B being the least likely to prescribe opioids (aOR 0.82, CI 0.80-0.85) followed by Hospital C (aOR 0.83, CI 0.79-0.86) compared to the reference standard of Hospital A. Hospital D was most likely to prescribe opioids (aOR 1.32, CI 1.27-1.37). Conclusion: Predictors of ED opioid use were characterized using multicenter administrative data. Future research should seek to describe the physician- and site-level factors driving regional variation in opioid-based pain treatment.

Opioid prescribing practices in academic otolaryngology: A single institutional survey

2021 ◽  
Vol 42 (5) ◽  
pp. 103038
Author(s):  
Tara E. Mokhtari ◽  
Lauren E. Miller ◽  
Jenny X. Chen ◽  
Christopher J. Hartnick ◽  
Mark A. Varvares
Keyword(s):  
Prescribing Practices ◽  
Opioid Prescribing

Opioid prescribing practices of members of the national dental practice based research network

2015 ◽  
Vol 156 ◽  
pp. e145
Author(s):  
Jenna L. McCauley ◽  
Valeria V. Gordan ◽  
Joseph L. Riley ◽  
Roger B. Fillingim ◽  
Sonia K. Makhija ◽  
...  
Keyword(s):  
Research Network ◽  
Dental Practice ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Practice Based Research

Comparing two doses of intramuscular ketorolac for treatment of acute musculoskeletal pain in a military emergency department

2021 ◽  
Author(s):  
Nathaniel J. Turner ◽  
Drew A. Long ◽  
Joseph R. Bongiorno ◽  
Timothy P. Katoski ◽  
Lisa M. Jin ◽  
...  
Keyword(s):  
Emergency Department ◽  
Musculoskeletal Pain ◽  
Intramuscular Ketorolac
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