Clinical and Translational Research
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2021; 12(9): 700-709
Published online Sep 18, 2021. doi: 10.5312/wjo.v12.i9.700
Trends and risk factors for opioid administration for non-emergent lower back pain
Chukwuweike U Gwam, Ahmed K Emara, Noor Chughtai, Sameer Javed, T David Luo, Kevin Y Wang, Morad Chughtai, Tadhg O'Gara, Johannes F Plate
Chukwuweike U Gwam, T David Luo, Kevin Y Wang, Tadhg O'Gara, Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
Ahmed K Emara, Noor Chughtai, Sameer Javed, Morad Chughtai, Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Johannes F Plate, Department of Orthopaedic Surgery, University of Pittsburgh, 5200 Centre Avenue, Suite 415, Pittsburgh, PA 15232, USA
Author contributions: Gwam CU, Javed S, and Chughtai N wrote the initial draft; Gwam CU, Luo TD, Chughtai M, and Plate JF was involved in conceptualization; Gwam CU, Emara AK, Wang KY, and Plate JF performed statistical analysis; Emara AK and Wang KY did data procurement; Emara AK, Chughtai N, Luo TD, Chughtai M, and O’Gara T performed critical draft revisions; Chughtai M, O’Gara T contributed to supervision.
Institutional review board statement: The present investigation was a retrospective study that utilized a publicly available deidentified database; therefore, no institutional review board.
Informed consent statement: The present study utilized a publicly available database. Therefore, Informed consent statement were not required.
Conflict-of-interest statement: Plate FJ has the following disclosures, all of which are not related to the topic of the present investigation: Biocomposites Inc.: Research support; Total Joint Orthopedics: Paid consultant; VisualDX: Publishing royalties, financial or material support; Other authors have nothing to disclose
Data sharing statement: All authors had access to the data for the current investigation.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Morad Chughtai, MD, Surgeon, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, United States. chughtm@ccf.org
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: March 31, 2021
Revised: April 8, 2021
Accepted: August 24, 2021
Article in press: August 24, 2021
Published online: September 18, 2021
Abstract
BACKGROUND

Non-emergent low-back pain (LBP) is one of the most prevalent presenting complaints to the emergency department (ED) and has been shown to contribute to overcrowding in the ED as well as diverting attention away from more serious complaints. There has been an increasing focus in current literature regarding ED admission and opioid prescriptions for general complaints of pain, however, there is limited data concerning the trends over the last decade in ED admissions for non-emergent LBP as well as any subsequent opioid prescriptions by the ED for this complaint.

AIM

To determine trends in non-emergent ED visits for back pain; annual trends in opioid administration for patients presenting to the ED for back pain; and factors associated with receiving an opioid-based medication for non-emergent LBP in the ED

METHODS

Patients presenting to the ED for non-emergent LBP from 2010 to 2017 were retrospectively identified from the National Hospital Ambulatory Medical Care Survey database. The “year” variable was transformed to two-year intervals, and a weighted survey analysis was conducted utilizing the weighted variables to generate incidence estimates. Bivariate statistics were used to assess differences in count data, and logistic regression was performed to identify factors associated with patients being discharged from the ED with narcotics. Statistical significance was set to a P value of 0.05.

RESULTS

Out of a total of 41658475 total ED visits, 3.8% (7726) met our inclusion and exclusion criteria. There was a decrease in the rates of non-emergent back pain to the ED from 4.05% of all cases during 2010 and 2011 to 3.56% during 2016 and 2017. The most common opioids prescribed over the period included hydrocodone-based medications (49.1%) and tramadol-based medications (16.9), with the combination of all other opioid types contributing to 35.7% of total opioids prescribed. Factors significantly associated with being prescribed narcotics included age over 43.84-years-old, higher income, private insurance, the obtainment of radiographic imaging in the ED, and region of the United States (all, P < 0.05). Emergency departments located in the Midwest [odds ratio (OR): 2.42, P < 0.001], South (OR: 2.35, < 0.001), and West (OR: 2.57, P < 0.001) were more likely to prescribe opioid-based medications for non-emergent LBP compared to EDs in the Northeast.

CONCLUSION

From 2010 to 2017, there was a significant decrease in the number of non-emergent LBP ED visits, as well as a decrease in opioids prescribed at these visits. These findings may be attributed to the increased focus and regulatory guidelines on opioid prescription practices at both the federal and state levels. Since non-emergent LBP is still a highly common ED presentation, conclusions drawn from opioid prescription practices within this cohort is necessary for limiting unnecessary ED opioid prescriptions.

Keywords: Opioids, Low back pain, Emergency Department, Spine, Complications, Trends

Core Tip: A trend of diminishing opioid prescription for low back pain in the emergency department can be appreciated over a span of eight years. Such a trend may be a reflection of policies and guidelines aiming at opioid regulation. Factors that may increase the likelihood of opioid prescription for low back pain include age over 43.84-years-old, higher income, private insurance, the obtainment of radiographic imaging in the emergency department, and presenting within the Midwest/South/West regions of the United States. Providers should be cognizant of such risk factors given the burden imposed by opioid prescriptions on the healthcare system.