Written by Gabby Leonard
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.
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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.