• Pain Med · Feb 2021

    Trends in the Evaluation and Management of Back Pain in Emergency Departments, United States, 2007-2016.

    • Peter M Mullins, John Gates Merriman, Todd A Jaffe, Maryann Mazer-Amirshahi, and Scott G Weiner.
    • Department of Emergency Medicine, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA.
    • Pain Med. 2021 Feb 4; 22 (1): 67-74.

    ObjectiveBack pain is one of the most common pain syndromes in the United States, but there has been limited recent description of the role of emergency departments (EDs) in caring for patients with back pain. We investigated trends in the evaluation and management of back pain in U.S. EDs from 2007 to 2016.MethodsWe performed a retrospective analysis of the National Hospital Ambulatory Medical Care Survey, a nationally representative annual survey of ED visits, which includes data on patient-, hospital-, and visit-level characteristics. We evaluated trends among adult ED visits for back pain, including demographics, resource utilization, and disposition. Trends were assessed through the use of survey-weighted analyses.ResultsVisit rates as a proportion of overall ED visits were stable from 2007 to 2016 (9.1% [95% confidence interval (CI): 8.5-9.6] vs. 9.3% [95% CI: 8.6-10.0]; P = 0.44). Admission rates declined from 6.4% (95% CI: 5.1-8.0) to 5.0% (95% CI: 3.5-6.9; P < 0.001). Imaging utilization increased from 51.7% (95% CI: 49.3-54.1) to 57.6% (95% CI: 53.3-61.7; P = 0.023), with an increase of 58.3% in computed tomography. Overall opioid utilization declined from 53.5% (95% CI: 49.4-57.5) to 46.5% (95% CI: 43.2-49.8; P < 0.001). Tramadol use increased over the study period (4.1% [95% CI: 3.0-5.8] vs. 8.4% [95% CI: 6.6-10.7]; P < 0.001).ConclusionsOpioid utilization during ED visits for back pain decreased from 2007 to 2016, whereas tramadol use more than doubled. Care intensity increased significantly despite declining admission rates. Further research into optimal strategies for back pain management in the ED is needed.© The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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