TY - JOUR
T1 - Patient-reported Outcomes from A National, Prospective, Observational Study of Emergency Department Acute Pain Management with an Intranasal Nonsteroidal Anti-inflammatory Drug, Opioids, or Both
AU - Pollack, Charles V.
AU - Diercks, Deborah B.
AU - Thomas, Stephen H.
AU - Shapiro, Nathan I.
AU - Fanikos, John
AU - Mace, Sharon E.
AU - Rafique, Zubaid
AU - Todd, Knox H.
N1 - Publisher Copyright:
© 2016 by the Society for Academic Emergency Medicine.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Objectives Patient compliance and satisfaction with analgesics prescribed after emergency department (ED) care for acute pain are poorly understood, largely because of the lack of direct patient follow-up with the ED provider. Our objective was to compare patient satisfaction with three analgesia regimens prescribed for post-ED care - a nasally administered nonsteroidal anti-inflammatory drug (NSAID), an opioid, or combination therapy - by collecting granular follow-up on analgesic use, pain scores, side effects, work activity levels, and overall satisfaction directly from patients. Methods We designed a prospective registry linking ED assessment and analgesic management for acute pain of specific musculoskeletal or visceral etiologies with self-reported automated telephonic follow-up daily for the 4 days post-ED discharge. Patients were prescribed a specific NSAID (SPRIX, ketorolac tromethamine for nasal instillation) only, an oral opioid only, or both with the opioid clearly defined as rescue therapy, at the ED provider's discretion. Results There were 824 evaluable subjects. Maximum pain scores improved day to day more effectively with a ketorolac-based approach. Self-reported rates of return to work and work effectiveness were higher with SPRIX than with opioids or combination therapy. Adverse effects of nausea, constipation, drowsiness, and abdominal pain were higher each day among patients taking an opioid; nasal irritation was more common with SPRIX. Overall satisfaction at the end of the follow-up period was higher with SPRIX-based treatment than with opioid monotherapy. Conclusions Automated telephonic follow-up of ED patients prescribed short-term analgesia is feasible. Ketorolac-based analgesia after an ED visit for many acute pain syndromes was associated with favorable patient outcomes and higher satisfaction than opioid-based therapy. SPRIX, an NSAID that is not available over the counter and has a novel delivery approach, may be useful for short-term post-ED outpatient analgesia.
AB - Objectives Patient compliance and satisfaction with analgesics prescribed after emergency department (ED) care for acute pain are poorly understood, largely because of the lack of direct patient follow-up with the ED provider. Our objective was to compare patient satisfaction with three analgesia regimens prescribed for post-ED care - a nasally administered nonsteroidal anti-inflammatory drug (NSAID), an opioid, or combination therapy - by collecting granular follow-up on analgesic use, pain scores, side effects, work activity levels, and overall satisfaction directly from patients. Methods We designed a prospective registry linking ED assessment and analgesic management for acute pain of specific musculoskeletal or visceral etiologies with self-reported automated telephonic follow-up daily for the 4 days post-ED discharge. Patients were prescribed a specific NSAID (SPRIX, ketorolac tromethamine for nasal instillation) only, an oral opioid only, or both with the opioid clearly defined as rescue therapy, at the ED provider's discretion. Results There were 824 evaluable subjects. Maximum pain scores improved day to day more effectively with a ketorolac-based approach. Self-reported rates of return to work and work effectiveness were higher with SPRIX than with opioids or combination therapy. Adverse effects of nausea, constipation, drowsiness, and abdominal pain were higher each day among patients taking an opioid; nasal irritation was more common with SPRIX. Overall satisfaction at the end of the follow-up period was higher with SPRIX-based treatment than with opioid monotherapy. Conclusions Automated telephonic follow-up of ED patients prescribed short-term analgesia is feasible. Ketorolac-based analgesia after an ED visit for many acute pain syndromes was associated with favorable patient outcomes and higher satisfaction than opioid-based therapy. SPRIX, an NSAID that is not available over the counter and has a novel delivery approach, may be useful for short-term post-ED outpatient analgesia.
UR - http://www.scopus.com/inward/record.url?scp=84960424967&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84960424967&partnerID=8YFLogxK
U2 - 10.1111/acem.12902
DO - 10.1111/acem.12902
M3 - Article
C2 - 26782787
AN - SCOPUS:84960424967
SN - 1069-6563
VL - 23
SP - 331
EP - 341
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 3
ER -