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

Published:August 23, 2018DOI:



      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.


      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.


      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.


      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.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lewis C.W.
        • Mckinney C.M.
        • Lee H.H.
        • Melbye M.L.
        • Rue T.C.
        Visits to US emergency departments by 20- to 29-year-olds with toothache during 2001–2010.
        J Am Dent Assoc. 2015; 146: 295-302.e2
        • Okunseri C.
        • Okunseri E.
        • Thorpe J.M.
        • Xiang Q.
        • Szabo A.
        Patient characteristics and trends in nontraumatic dental condition visits to emergency departments in the United States.
        Clin Cosmet Investig Dent. 2012; 4: 1-7
        • Rechenberg D.K.
        • Held U.
        • Burgstaller J.M.
        • Bosch G.
        • Attin T.
        Pain levels and typical symptoms of acute endodontic infections: a prospective, observational study.
        BMC Oral Health. 2016; 16: 61
        • Becker D.E.
        Pain management: part 1: managing acute and postoperative dental pain.
        Anesth Prog. 2010; 57: 67-79
      1. Opioid overdose fact sheet. Centers for Disease Control and Prevention. Accessed October 12, 2017.

      2. CDC guideline for prescribing opioids for chronic pain.
        • Cantrill S.
        • Brown M.D.
        • Carlisle R.J.
        • et al.
        Clinical policy: critical issues in the prescribing of opioids for adult patients in the emergency department.
        Ann Emerg Med. 2012; 60: 499-525
        • McCaig L.F.
        • Burt C.W.
        Understanding and interpreting the National Hospital Ambulatory Medical Care Survey: key questions and answers.
        Ann Emerg Med. 2012; 60: 716-721
        • Martin A.
        • Mitchell A.
        • Wakeman S.
        • White B.
        • Raja A.
        Emergency department treatment of opioid addiction: an opportunity to lead.
        Acad Emerg Med. 2018; 25: 601-604
        • Shah A.
        • Hayes C.J.
        • Martin B.C.
        Factors influencing long-term opioid use among opioid naive patients: an examination of initial prescription characteristics and pain etiologies.
        J Pain. 2017; 18: 1374-1383
        • Dijkers M.
        Comparing quantification of pain severity by verbal rating and numeric rating scales.
        J Spinal Cord Med. 2010; 33: 232-242
        • Okunseri C.
        • Okunseri E.
        • Fischer M.C.
        • Sadeghi S.N.
        • Xiang Q.
        • Szabo A.
        Nontraumatic dental condition-related visits to emergency departments on weekdays, weekends and night hours: findings from the National Hospital Ambulatory Medical Care survey.
        Clin Cosmet Investig Dent. 2013; 5: 69-76
        • Cohen L.A.
        • Harris S.L.
        • Bonito A.J.
        • et al.
        Low-income and minority patient satisfaction with visits to emergency departments and physician offices for dental problems.
        J Am Coll Dent. 2009; 76: 23-31
        • Shaikh M.
        • Östör A.J.
        Evaluating the patient with low back pain.
        Practitioner. 2015; 259 (2-3): 21-24
        • Salomon D.
        • Heidel R.E.
        • Kolokythas A.
        • Miloro M.
        • Schlieve T.
        Does restriction of public health care dental benefits affect the volume, severity, or cost of dental-related hospital visits?.
        J Oral Maxillofac Surg. 2017; 75: 467-474
        • Dodd M.D.
        • Graham C.A.
        Unintentional overdose of analgesia secondary to acute dental pain.
        Br Dent J. 2002; 193: 211-212
        • Rudd R.A.
        • Seth P.
        • David F.
        • Scholl L.
        Increases in drug and opioid-involved overdose deaths United States, 2010–2015.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 1445-1452
        • Dowell D.
        • Haegerich T.M.
        • Chou R.
        CDC guideline for prescribing opioids for chronic pain — United States, 2016.
        MMWR Recomm Rep. 2016; 65: 1-49