Written by Gabby Leonard
Spoon Feed
Patients who are discharged from the emergency department after presenting with abdominal pain and receiving opioids have 57% greater odds of return within 30 days. This population is also at higher risk for adverse effects from these medications.
Why does this matter?
Abdominal pain is the most common presenting complaint to the ED. The opioid epidemic has been an ongoing crisis affecting hundreds of thousands of patients worldwide. This study evaluates return rates of patients discharged from the ED after presenting with abdominal pain and receiving either an opioid or acetaminophen/ibuprofen for pain management.
My favorite Painkillers…are in St. John
Opioid administration in the ED is likely connected to long-term opioid use disorder, with an estimated 10% contribution to long-term opioid use disorder. Patients who present with undifferentiated abdominal pain are often given opioid medication in the immediate setting for symptomatic relief. This study looked at 30-day return visit rate for patients treated with IV, oral or IM opioids compared to acetaminophen and/or NSAIDs.
Patients who received opioids in the acute setting had a 22% 30-day return rate for abdominal pain compared to 14.7% of patients who received acetaminophen and/or NSAIDs, OR 1.57 (95%CI 1.27 to 1.95).
It is important to remember that opioids can also cause detrimental side effects including nausea, constipation, and addiction. Additionally, there is a paucity of data surrounding opioid effectiveness in targeting nonspecific abdominal pain.
While there certainly is a place and time for opioid administration in the ED, it may be feasible to try symptomatic control with acetaminophen, NSAIDs, or other agents – such as dicyclomine, famotidine, and aluminum/magnesium hydroxide (Maalox) prior to opioid administration.
Editor’s note: Don’t forget to check out the JournalFeed podcast for the audio version of our spoon feeds! Including a harsh critical review of this article ????. ~Nick Zelt
Source
Return Rates for Opioid versus Nonopioid Management of Patients with Abdominal Pain in the Emergency Department. J Emerg Med. 2023 Apr;64(4):471-475. doi: 10.1016/j.jemermed.2023.01.008. Epub 2023 Mar 28.
Please put a one liner in the spoonful for these articles saying “this is a 500 patient retrospective cohort study” or whatever so we can at least make a decision if we’re going to pay attention to it.
This review makes no comment about retrospective nature of this study and nearly falsely implies a causative relationship. That should be the editor’s comment. It’s certainly possible that ED treatment modality is feeding the opioid epidemic. It’s also quite plausible that more severe patients with more severe presentations, or those with low pain tolerance and therefore more painful distress are more likely to get IV analgesics and also more likely to have future difficulty tolerating pain and therefore bounce back. Without any causality. Newby mistake by the reviewer and should certainly be commented on by the editor
Great point. We should have been clearer. Nick is planning to dissect this article in the podcast that drops this weekend. So, never fear. A thorough critique is coming. But we should have included a word in the written post to that effect.