Abstract
Objectives
To describe changes in the prevalence and severity of pain and prescribing of non-opioid
analgesics in US emergency departments (EDs) from 2000 to 2010.
Methods
Analysis of serial cross-sectional data regarding ED visits from the National Hospital
Ambulatory Medical Care Survey. Visits were limited to patients ≥
18 years old without malignancy. Outcome measures included annual volume of visits
among adults with a primary symptom or diagnosis of pain, annual rates of patient-reported
pain severity, and predictors of non-opioid receipt for non-malignant pain.
Results
Rates of pain remained stable, representing approximately 45% of visits from 2000
through 2010. Patients reported pain as their primary symptom twice as often as providers
reported a primary pain diagnosis (40% vs 20%). The percentage of patients reporting
severe pain increased from 25% (95% confidence intervals [CI] 22%-27%) in 2003 to
40% (CI 37%-42%) in 2008. From 2000 to 2010, the proportion of pain visits treated
with pharmacotherapies increased from 56% (CI 53%-58%) to 71% (CI 69%-72%), although
visits treated exclusively with non-opioids decreased 21% from 28% (CI 27%-30%) to
22% (CI 20%-23%). The adjusted odds of non-opioid rather than opioid receipt were
greater among visits for patients 18 to 24 years old (odds ratio [OR] 1.35, CI 1.24-1.46),
receiving fewer medicines (OR 2.91, CI 2.70-3.15) and those with a diagnosis of mental
illness (OR 2.24, CI 1.99-2.52).
Conclusions
Large increases in opioid utilization in EDs have coincided with reductions in the
use of non-opioid analgesics and an unchanging prevalence of pain among patients.
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Article Info
Publication History
Published online: January 23, 2014
Accepted:
January 14,
2014
Received in revised form:
January 13,
2014
Received:
October 11,
2013
Footnotes
☆Support. Dr Alexander is supported by the Agency for Healthcare Research and Quality (RO1 HS0189960). These funding sources had no role in the design and conduct of the study, analysis, or interpretation of the data; and preparation or final approval of the manuscript prior to publication.
☆☆Disclosures. Dr Alexander is an ad hoc member of the FDA's Drug Safety and Risk Management Advisory Committee, serves as a paid consultant to IMS Health, and serves on an IMS Health scientific advisory board. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. Dr Kruszewski has served as general and case-specific expert for multiple plaintiff litigation involving OxyContin, Neurontin and Zyprexa and has had false claims settled as co-plaintiff with the United States against Southwood Psychiatric Hospital, Pfizer (Geodon) and AstraZeneca (Seroquel).
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
