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Return Rates After Opioids for Back Pain in the Emergency Department

April 15, 2021

Written by Nickolas Srica

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Patients who received opioids in the ED for low back pain were significantly more likely to return to the ED within 30 days for the same complaint when compared to those who received only NSAIDs, acetaminophen, or a combination of the two. 

Why does this matter?
The data continue to pile up against the use of opioids for both acute and chronic low back pain, as well as other general musculoskeletal complaints, not only because they do not seem to improve pain levels compared to other non-opioid strategies, but also because the risk for harm and long-term use or misuse is high. This study gives us yet another reason to avoid the use of opioids for low back pain.

Treating back pain can be such a pain in the…backside
This was a retrospective multicenter observational study performed across 21 community and academic EDs within a single health system that included data from 836 adult patients who were ultimately discharged from the ED after a diagnosis of low back pain. Admitted patients with low back pain were excluded.  299 (36%) of the patients received opioids during their ED visit. Patients who received any opioid (32%, OR 1.78, 95% CI 1.21-2.64), IV opioids (33%, OR 1.83, 95% CI 1.18-2.86), or IM opioids (39%, OR 2.38, 95% CI 1.35-4.12) had significantly higher rates of return ED visits within 30 days than those who received NSAIDs (19%), acetaminophen (20%), or a combination of the two (8%).  Those who received oral opioids, benzodiazepines, or antispasmodics had no statistically significant difference compared to the NSAID/acetaminophen groups. Though this study alone can’t answer for us why those who received opioids seemed more likely to return to the ED, the habit-forming nature and lack of benefit of opioids certainly may be playing a role, and we should all continue to try to avoid their use for low back pain.

Relationship Between Pain Management Modality and Return Rates for Lower Back Pain in the Emergency Department. The Journal of Emergency Medicine.  2021 Feb 23. doi: 10.1016/j.jemermed.2021.01.022