Opioid Treatment Is Associated with Recurrent Healthcare Visits, Increased Side Effects, and Pain

Area of Science:

• Emergency Medicine
• Pain Management
• Pharmacology

Background:

• Acute pain is a frequent reason for emergency department (ED) visits.
• Treatment decisions involve balancing efficacy, healthcare utilization, and patient-centered outcomes like side effects.
• Understanding post-discharge healthcare utilization is crucial for effective pain management strategies.

Purpose of the Study:

• To investigate the association between acute pain treatment regimens (opioids, intranasal NSAIDs, or both) and unscheduled healthcare visits after ED discharge.
• To determine if pain severity and medication side effects mediate the relationship between treatment and subsequent visits.

Main Methods:

• Secondary analysis of the prospective, observational AMPED cohort study.
• Cox proportional hazards analysis for time to first unscheduled visit.
• Repeated measures logistic regression for any unscheduled visits, including mediation analysis for pain and side effects.

Main Results:

• 16.9% of 831 participants had an unscheduled visit within five days of ED discharge, most occurring one day post-visit.
• Intranasal NSAID monotherapy was associated with fewer unscheduled visits compared to opioid monotherapy (AOR 0.63).
• Opioid use was linked to higher odds of unscheduled visits, mediated by side effects (AOR 2.24) and higher pain levels (AOR 1.33).

Conclusions:

• Opioid treatment for acute pain correlates with increased unscheduled healthcare visits compared to intranasal ketorolac.
• Higher ongoing pain levels and increased medication side effects explain the disparity in healthcare utilization.
• These findings highlight the importance of considering treatment-related factors beyond immediate pain relief in ED pain management.