scholarly journals LO10: Quantity of opioid to prescribe for acute pain to limit misuse after emergency department discharge

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S30-S31
Author(s):  
R. Daoust ◽  
J. Paquet ◽  
E. Piette ◽  
J. Morris ◽  
A. Cournoyer ◽  
...  
Keyword(s):  
Pain Relief ◽  
Neck Pain ◽  
Acute Pain ◽  
Rating Scale ◽  
Final Diagnosis ◽  
Numeric Rating Scale ◽  
Pain Medication ◽  
Urban Hospital ◽  
Opioid Prescription ◽  
Emergency Department Discharge

Introduction: A 2008 survey found that 1.9% of the entire US population was using prescription pain medication non-medically and that 56% obtained them from a friend or relatives. Diversion of pain medication may occur when a portion of the prescription is unused for pain relief after an ED visit. We hypothesized that at least 10 pills (~40%) of an opioid prescription 2 weeks after an ED visit, will not be consumed and become available for potential misuse. Objective: Determine the quantity of unused opioids pills for common acute pain diagnoses, 2 weeks after an ED visit for acute pain. Methods: Prospective observational cohort study of consecutive ED patients from a tertiary academic urban hospital with 60,000 ED visits annually. Inclusion criteria: aged ≥18 years, acute pain conditions present ≤2 weeks, pain intensity at triage of ≥4 (on a 0-10 numeric rating scale; NRS), and discharged with a new opioid prescription. ED physicians identified (24/7) eligible patients. They recorded the pain complaint/location, the final diagnosis, the quantity and type of prescribed pain medication. Discharged patients completed paper or electronic 14-day diary (REDCap database) to document their pain medication consumption. As a mitigation strategy, they were also contacted by phone at 2 weeks for the same information. A paired t-test was used to test the difference between the amounts of opioids prescribed and consumed. Results: 350 patients were recruited. Mean age 50 (SD ±16) and 54.2% were men. Painful diagnosis: fracture (18.2%), acute back pain (15.3%), renal colic (15.3%), Sprain (excluding back/neck pain) (6.9%), Contusion (6.4%), acute neck pain (5.8%), abdominal pain (4.9%), and other (27.2%). Opioids prescribed: oxycodone (47%), morphine (37%) and hydromorphone (16%). Means quantity of opioid pills prescribed: 24 (IC95%: 23-26). Filled opioid prescription: 92%. Means quantity of opioid pills consumed: 8 (IC95%: 7-9). Means quantity of unused opioids pills: 16. Opioid pills available for misuse in our cohort: 5,600 pills. Conclusion: After an ED visit for acute pain a significant portion of opioids prescribed is unused and available for misuse. A large pragmatic study should be done to confirm that an opioid prescription strategy based on our results will limit unused opioid pills while maintaining pain relief.

scholarly journals P030: Acute pain resolution after an emergency department visit: a 14-day trajectory analysis

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S73-S74
Author(s):  
R. Daoust ◽  
J. Paquet ◽  
A. Cournoyer ◽  
E. Piette ◽  
J. Morris ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Acute Pain ◽  
Linear Models ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
The Other ◽  
Future Research ◽  
Intensity Level ◽  
Opioid Prescription ◽  
Mild Pain

Introduction: The objective of the study was to evaluate the acute pain intensity evolution in ED discharged patients using Group-based trajectory modeling (GBTM). This method identified patient groups with similar profiles of change over time without assuming the existence of a particular pattern or number of groups. Methods: This was a prospective cohort study of ED patients aged ≥18 years with an acute pain condition (≤ 2 weeks) and discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain intensity level (0-10 numeric rating scale) and pain medication use. Results: Among the 372 included patients, six distinct post-ED pain intensity trajectories were identified: two started with severe levels of pain, one remained with severe pain intensity (12.6% of the sample) and the other ended with moderate pain intensity level (26.3%). Two other trajectories had severe initial pain, one decreased to mild pain (21.7%) and the other to no-pain (13.8%). Another trajectory had moderate initial pain which decreased to a mild level (15.9%) and the last one started with mild pain intensity and had no pain at the end of the 14-day (9.7%). The pain trajectory patterns were significantly associated with age, type of painful conditions, pain intensity at ED discharge, and with opioid consumption. Conclusion: Acute pain resolution following an ED visit seems to progress through six different trajectory patterns that are more informative than simple linear models and could be useful to adapt acute pain management in future research.

scholarly journals P029: Are acute pain trajectories after an emergency department visit associated with chronic pain at 3 months?

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S73
Author(s):  
R. Daoust ◽  
J. Paquet ◽  
A. Cournoyer ◽  
E. Piette ◽  
J. Morris ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chronic Pain ◽  
Pain Intensity ◽  
Acute Pain ◽  
Severe Pain ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Intensity Level ◽  
Opioid Prescription ◽  
Pain Condition

Introduction: Studies suggest that acute pain evolution after an emergency department (ED) visit has been associated with the development of chronic pain. Using group-based trajectory modeling (GBTM), we aimed to evaluate if ED discharged patients with similar pain intensity profiles of change over 14 days are associated with chronic pain at 3 months. Methods: This is a prospective cohort study of patients aged 18 years or older who visited the ED for an acute pain condition (≤2 weeks) and were discharged with an opioid prescription. Patients completed a 14-day diary in which they listed their daily pain intensity level (0-10 numeric rating scale). Three months post-ED visit, participants were interviewed by phone to report their pain intensity related to the initial pain. Results: A total of 305 patients were retained at 3 months (mean age ± SD: 55 ± 15 years, 49% women). Using GBTM, six distinct pain intensity trajectories were identified during the first 14 days of the acute pain period; two linear one with moderate or severe pain during the follow-up (representing almost 40% of the patients) and four cubic polynomial order trajectories, with mild or no-pain at the end of the 14 days (low final pain). Twelve percent (11.9; ±95%CI: 8.2-15.4) of the patients had chronic pain at 3 months. Controlling for age, sex and types of pain condition, patients with trajectories of moderate or severe pain and those with only severe pain were 5.1 (95%CI: 2.2-11.8) and 8.2 (95%CI: 3.4-20.0) times more likely to develop chronic pain at 3 months, respectively, compared to the low final pain group. Conclusion: Trajectories could be useful to early identification of patients at risk of chronic pain.

Intranasal Ketorolac for Acute Pain in Adult Emergency Department Patients

2021 ◽  
pp. 019394592110303
Author(s):  
Elizabeth Gaul ◽  
Tracy Barbour ◽  
Amy S. Nowacki ◽  
Sharon E. Mace
Keyword(s):  
Emergency Department ◽  
Side Effects ◽  
Pain Relief ◽  
Acute Pain ◽  
Rating Scale ◽  
Rapid Onset ◽  
Numeric Rating Scale ◽  
Needlestick Injury ◽  
Interquartile Range ◽  
Numeric Rating

Pain is a common complaint in the emergency department. An alternative to opioids is desirable. Oral medications are not feasible with gastrointestinal disorders or NPO. Intravenous medications require skill and time. Intravenous/intramuscular medications are painful with potential needlestick injury. Intranasal medications have rapid onset, easy administration, do not need skilled providers, and no risk of needlestick injury. A total of 28 adults with acute pain (numeric rating scale ≥ 4) received intranasal ketorolac. Numeric rating scale decreased in all: 32% complete pain relief, median (interquartile range) decrease −5 (−6.8 to −4) ( p < .001). Pain relief onset was median [interquartile range] 5 (2.3, 15.0) min. Vital signs remained normal. There were no nasal mucosal changes, no complications. Minor side effects, mostly nasal burning, in 43%, resolved within 5 min. Patients and nurses were satisfied with intranasal ketorolac, and would use it again. Intranasal ketorolac had a rapid onset, was effective, safe, well tolerated with minor side effects that resolved quickly.

scholarly journals Effects of a Single Application of ScenarTM, a Low-Frequency Modulated Electric Current Therapy, for Pain Relief in Patients with Low Back and Neck Pain: A Randomized Single Blinded Trial

2021 ◽  
Vol 10 (23) ◽  
pp. 5570
Author(s):  
Mireille Michel-Cherqui ◽  
Avit Guirimand ◽  
Barbara Szekely ◽  
Titouan Kennel ◽  
Marc Fischler ◽  
...  
Keyword(s):  
Neck Pain ◽  
Rating Scale ◽  
Low Frequency ◽  
Numeric Rating Scale ◽  
Current Therapy ◽  
Low Back ◽  
Experienced Pain ◽  
The Difference ◽  
Pain At Rest ◽  
Numeric Rating

We aimed to demonstrate the antalgic effectiveness of ScenarTM (Self-Controlled Electro Neuro Adaptative Regulation) in patients experiencing low back and neck pain. Sixty patients were included and equally assigned by randomization to a Scenar-On group and to a Scenar-Off group (sham group). All patients received a 20 min application of ScenarTM on the area where they experienced pain. The pain at rest and during movement and the sensation of stiffness were assessed using a numeric rating scale at baseline, immediately after the session and 24 h after the session. The patients’ characteristics at entry were similar between groups. The pain at rest decreased after the session in both groups (from 8 (4) to 5.0 (3) in the Scenar-Off group, p = 0.0001, and from 7 (3) to 4 (4) in the Scenar-On group, p < 0.0001). The difference was not statistically significant for the groups (p = 0.22). Similar results were observed during movement, but the sensation of stiffness was not modified. Such beneficial results did not last until the next day. No undesirable major effects were noticed. Our study does not support the fact that one ScenarTM session improves low back and neck pain better than a sham session.

Neck Pain and Disability: Are They Related to Dysfunctional Breathing and Stress?

2021 ◽  
Author(s):  
Sarah Stephen ◽  
Corlia Brandt ◽  
Benita Olivier
Keyword(s):  
Neck Pain ◽  
Rating Scale ◽  
Hold Time ◽  
Neck Disability Index ◽  
Numeric Rating Scale ◽  
Cross Sectional Study ◽  
Breath Hold ◽  
Cross Sectional ◽  
Dysfunctional Breathing ◽  
Neck Disability

Purpose: People with neck pain are likely to have negative respiratory findings. The purpose of this study was to investigate the relationship between neck pain and dysfunctional breathing and to examine their relationship to stress. Method: This cross-sectional study included 49 participants with neck pain and 49 age- and sex-matched controls. We measured neck pain using the numeric rating scale (NRS); neck disability using the Neck Disability Index (NDI); dysfunctional breathing using the Nijmegen Questionnaire (NQ), Self-Evaluation of Breathing Questionnaire (SEBQ), breath hold time, and respiratory rate (RR); and stress using the Perceived Stress Scale (PSS). Results:Participants with neck pain scored higher on the NQ ( p < 0.001) and the SEBQ ( p < 0.001) than controls. NQ and SEBQ scores correlated moderately with NDI scores ( r > 0.50; 95% CI: 0.25, 0.68 and 0.33, 0.73, respectively) and PSS scores ( r > 0.50; 95% CI: 0.29, 0.78 and 0.31, 0.73, respectively). SEBQ scores showed a fair correlation with NRS scores and RR a fair correlation with NDI scores. Conclusions: Participants with neck pain had more dysfunctional breathing symptoms than participants without neck pain, and dysfunctional breathing was correlated with increased neck disability and increased stress. The NQ and SEBQ can be useful in assessing dysfunctional breathing in patients with neck pain.

scholarly journals Tramadol/dexketoprofen (TRAM/DKP) compared with tramadol/paracetamol in moderate to severe acute pain: results of a randomised, double-blind, placebo and active-controlled, parallel group trial in the impacted third molar extraction pain model (DAVID study)

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e023715 ◽  
Author(s):  
Cosme Gay-Escoda ◽  
Magdi Hanna ◽  
Antonio Montero ◽  
Thomas Dietrich ◽  
Stefano Milleri ◽  
...  
Keyword(s):  
Pain Relief ◽  
Primary Endpoint ◽  
Acute Pain ◽  
Severe Pain ◽  
Rating Scale ◽  
Third Molar ◽  
Surgical Removal ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Time Points

ObjectivesTo compare efficacy/safety of oral tramadol 75 mg/dexketoprofen 25 mg (TRAM/DKP) and TRAM 75 mg/paracetamol 650 mg (TRAM/paracetamol) in moderate to severe pain following surgical removal of impacted lower third molar.DesignMulticentre, randomised, double-blind, placebo-controlled, phase IIIb study.ParticipantsHealthy adult patients scheduled for surgical extraction of at least one fully/partially impacted lower third molar requiring bone manipulation. 654 patients were randomised and 653 were eligible for analysis.InterventionsSurgery was performed under local anaesthetic. No sedation was permitted. Patients rated pain intensity (PI) using an 11-Numerical Rating Scale (NRS) (0 no pain; 10 worst pain). Participants experiencing moderate/severe pain (≥4) within 4 hours of surgery were randomised (2:2:1 ratio) to a single oral dose of TRAM/DKP 75/25 mg, TRAM/paracetamol 75/650 mg or placebo.Main outcome measuresEfficacy was based patients’ electronic diaries. Analgesia and pain were recorded as follows: pain relief (PAR) on a 5-point Verbal Rating Scale (0=‘no relief’, 1=‘a little (perceptible) relief’, 2=‘some (meaningful) relief’, 3=‘lot of relief’, 4=‘complete relief’) at the predefined postdose time points t15 min, t30 min, t1 hour, t1.5 hour, t2 hour, t4 hour, t6 hour and t8 hour and PI on the 11-point NRS at t0 and at the same predefined postdose time points. Onset of analgesia documented using double stopwatch method over a 2-hour period. Primary endpoint was total pain relief over 6 hours (TOTPAR6). Rescue medication was available during the treatment period.ResultsTRAM/DKP was superior to TRAM/paracetamol and placebo at the primary endpoint TOTPAR6 (p<0.0001). Mean (SD) TOTPAR6 in the TRAM/DKP group was 13 (6.97), while those in the active control and placebo groups were 9.1 (7.65) and 1.9 (3.89), respectively. Superiority of TRAM/DKP over active comparator and placebo was observed at all secondary endpoints. Incidence of adverse events was comparable between active groups.ConclusionsTRAM/DKP (75/25 mg) is effective and superior to TRAM/paracetamol (75/650 mg) in relieving moderate to severe acute pain following surgical removal of impacted lower third molar, with a faster onset of action, greater and durable analgesia, together with a favourable safety profile.Trial registration numberEudraCT 2015-004152-22 and NCT02777970.

Nebulized morphine for analgesia in an emergency setting

2018 ◽  
Vol 5 (1) ◽  
pp. 23 ◽  
Author(s):  
Vincent Bounes, MD ◽  
Jean Louis Ducassé, MD ◽  
Annie Momo Bona, MD ◽  
Florent Battefort, MD ◽  
Charles-Henri Houze-Cerfon, MD ◽  
...  
Keyword(s):  
Pain Relief ◽  
Acute Pain ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Statistical Significance ◽  
A Priori ◽  
Primary Outcome Measure ◽  
Point Estimate ◽  
Emergency Setting ◽  
Significant Difference

Objective: To evaluate the efficacy and safety of inhaled morphine delivered in patients experiencing severe acute pain in an emergency setting.Patients and Methods: Patients were eligible for inclusion if they were aged 18 years or older, with a severe acute pain defined by a numerical rating scale (NRS) score of 60/100 or higher. The intervention involved administering a single dose of 0.2 mg/kg morphine nebulized using a Misty-Neb nebulizer system. NRSs were recorded and were repeated at 1, 3, 5, and 10 minute after the end of inhalation (T10). The protocol-defined primary outcome measure was pain relief (defined by an NRS score of 30/100 or lower) at T10. Secondary outcomes included differences between pain scores at baseline and at T10 and incidence of adverse events.Results: A total of 28 patients were included in this study. No patient experienced pain relief 10 minutes after the end of inhalation, and no adverse effects were recorded. Respective initial and final median NRS scores were 80 (70-90) and 70 (60-80), p < 0.0001. Despite achieving statistical significance, the value of this point estimate is less than the 14 NRS difference that was defined a priori as representing a minimum clinically significant difference in pain severity.Conclusion: 0.2 mg/kg nebulized morphine is not effective in managing acute pain in an emergency setting. In spite of the potential advantages of the pulmonary route of administration, opioids should be intravenous prescribed at short fixed intervals to control severe acute pain in an emergency setting.

scholarly journals Hubungan intensitas pemakaian gawai dengan neck pain pada usia 15-20 tahun

2019 ◽  
Vol 2 (2) ◽  
pp. 71-76
Author(s):  
Yuni Tri Yustianti ◽  
Pusparini Pusparini
Keyword(s):  
Neck Pain ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Chi Square ◽  
Cross Sectional ◽  
Numeric Rating

LATAR BELAKANG Dekade terakhir menunjukkan neck pain pada remaja semakin meningkat, bersamaan dengan meningkatnya penggunaan gawai (gadget). Seiring perkembangan zaman, gawai menjadi kebutuhan dan gaya hidup masyarakat luas. Pelajar menjadi pasar terbesar dalam penggunaan gawai sehubungan dengan kebutuhan belajar yang memerlukan akses Internet. Salah satu faktor penyebab neck pain pada pengguna gawai adalah intensitas penggunaan gawai yang mempengaruhi lamanya posisi fleksi pada otot leher. Tujuan penelitian ini adalah untuk mengetahui hubungan intensitas pemakaian gawai dengan neck pain pada usia 15-20 tahun. METODE Penelitian ini merupakan studi observasional dengan desain cross sectional yang mengikutsertakan 164 pelajar SMAN 28 Jakarta dan Fakultas Hukum Universitas Trisakti. Data dikumpulkan dengan cara pengisian kuesioner yang meliputi usia, jenis kelamin, intensitas pemakaian gawai dan keluhan neck pain. Penilaian neck pain menggunakan NRS (Numeric Rating Scale). Analisis data dilakukan dengan uji Chi-square dengan tingkat kemaknaan p<0.05. HASIL Subjek perempuan berjumlah 121 orang (73.8%). Paparan gawai dengan intensitas >56 jam/minggu dijumpai pada 109 subjek (66.5%). Keluhan neck pain dijumpai pada 138 subjek (84.1%). Uji Chi-square menunjukkan terdapat hubungan yang bermakna antara intensitas penggunaan gawai dengan neck pain pada usia 15-20 tahun dengan nilai p=0.004. KESIMPULAN Terdapat hubungan yang bermakna antara intensitas penggunaan gawai dengan neck pain pada usia 15-20 tahun.    

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