• Emerg Med Australas · Apr 2024

    Nine recommendations for the emergency department for patients presenting with low back pain based on management and post-discharge outcomes in an Australian, tertiary emergency department.

    • Uvin Seneviratne, Kerry McLaughlin, Jennifer Reilly, Carl Luckhoff, and Paul Myles.
    • The Alfred, Melbourne, Victoria, Australia.
    • Emerg Med Australas. 2024 Apr 1; 36 (2): 310317310-317.

    ObjectiveTo ascertain and develop recommendations for analgesic management, discharge planning and further healthcare utilisation of adults presenting to an Australian tertiary ED with radicular or low back pain (LBP).MethodsThis prospective cohort study included adults presenting with non-specific LBP or radicular pain to an Australian tertiary ED. Participants with trauma/cancer-related pain, and those requiring hospital admission or surgical interventions were excluded. The primary outcome was pharmacological and non-pharmacological management delivered in ED, retrospectively collected via electronic medical records. The secondary outcomes include discharge management use, and changes made due to post-discharge healthcare utilisation, as observed by weekly telephone questionnaires over 4-weeks follow-up.ResultsOf the 100 participants recruited, 94 completed follow-up. In ED, pharmacological management was received by 85%, including opioids (62%) and non-steroidal anti-inflammatory drugs (NSAIDS, 63%). Non-pharmacological management was received by 73%, including patient education (71%) and exercise prescription (37%). In the first-week post-discharge, changes to initial discharge plan occurred in 50%, mostly carried out by GPs (76%). Over the follow-up period, 51% received additional investigations/referrals. Pharmacological use decreased by 38% and non-pharmacological use decreased by 10%. 16% of opioid-naïve patients continued using opioids 4-weeks post-discharge.ConclusionED presentations for LBP were more often treated pharmacologically than non-pharmacologically, with opioids commonly prescribed and NSAIDs potentially under-utilised. Post-discharge, additional investigations/referrals, discharge analgesia reductions and maintenance of non-pharmacological management were common. Opioid initiation as a result of LBP presentations, signifies a potential 'gateway' towards unintentional long-term use. Key study findings form our nine recommendations to inform ED LBP pain management.© 2023 Australasian College for Emergency Medicine.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…