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Use of opioids and analgesics among ED patients with dental and low back pain: A national perspective

Published:August 23, 2018DOI:https://doi.org/10.1016/j.ajem.2018.08.062

      Abstract

      Objectives

      Emergency department (ED) visits for dental pain and low back pain (LBP) are common. Many such patients have severe pain and receive opioids. Increased opioid-related deaths has led to efforts to reduce opioid prescriptions. We compared recent trends in use of analgesics and opioids in the ED and at discharge among patients with dental or LBP.

      Methods

      We conducted a secondary analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS) of patients with dental pain or LBP from 2010 to 2015. We performed univariate and multivariate analyses exploring the association between pain location and use of analgesics and opioids controlling for age, gender, and pain severity.

      Results

      There were an estimated 16 and 49 million patient visits for dental and LBP, respectively. Prescription of opioids at discharge decreased from 59% to 50% (p = 0.02) in dental and 46% to 39% in LBP patients (p = 0.09). Compared to patients with LBP, patients with dental pain were less likely to receive analgesics (OR 0.65, 95% CI, 0.57–0.74) or opioids (OR 0.51, 95% CI, 0.44–0.59) while in the ED. In contrast, dental pain patients were more likely to have analgesics (OR 1.32, 95% CI, 1.16–1.51) or opioids (OR 1.65, 95% CI, 1.47–1.85) prescribed at the time of ED discharge than patients with LBP.

      Conclusions

      Prescription of opioids decreased for ED dental patients. While less likely to receive analgesics and opioids in the ED, patients with dental pain were more likely to be prescribed analgesics and opioids at the time of ED discharge than those with LBP.
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