Guillén-Astete Carlos A, Cardona-Carballo César, de la Casa-Resino Cristina
Rheumatology Department Emergency Department, University Hospital Ramón y Cajal Emergency Department, University Hospital La Paz, Madrid, Spain.
Medicine (Baltimore). 2017 Nov;96(45):e8403. doi: 10.1097/MD.0000000000008403.
Nontraumatic musculoskeletal disorders are the main reason for presentation to the emergency department (ED), with rachialgia (back pain) being the most common reason to request medical assessment among them. This also generates the highest demand for reassessments due to poor pain control or onset of adverse reactions to the treatment prescribed in the initial assessment.A retrospective observational study based on usual clinical practice was conducted in patients attending the ED due to low back pain during a period of 24 months. The primary objective was to determine the demand for reassessments in the ED by these patients in the following 30 days, according to the type of therapeutic approach used in the initial assessment.A total of 732 patients who requested medical assessment due to back pain in the ED of our hospital were analyzed, 91 of whom were treated with tapentadol whereas 641 received another treatment. In the first month after the initial assessment, reassessments were less common in the tapentadol group; this difference was significant from days 8 to 15 (P = 0.001, odds ratio [OR] 0.252 with 95% confidence interval [CI] 0.100-0.635) and days 15 to 30 (P < 10, OR 0.277 with 95% CI 0.136-0.563). Patients who received tapentadol also had a better clinical evolution of pain compared to those who did not receive it (P < 10) and to those who received tramadol (P < 10).In this study in patients with back pain, tapentadol shows clear advantages over the other analgesics analyzed, in terms of pain control and less need for reassessments.
非创伤性肌肉骨骼疾病是患者前往急诊科（ED）就诊的主要原因，其中臂痛（背痛）是请求医疗评估的最常见原因。由于疼痛控制不佳或对初始评估中所开治疗产生不良反应，这也导致了对重新评估的最高需求。在24个月期间，对因腰痛前往急诊科就诊的患者进行了一项基于常规临床实践的回顾性观察研究。主要目的是根据初始评估中使用的治疗方法类型，确定这些患者在接下来30天内对急诊科重新评估的需求。对我院急诊科732例因背痛请求医疗评估的患者进行了分析，其中91例接受了曲马多治疗，641例接受了其他治疗。在初始评估后的第一个月，曲马多组的重新评估较少见；这种差异在第8至15天（P = 0.001，优势比[OR] 0.252，95%置信区间[CI] 0.100 - 0.635）和第15至30天（P < 0.01，OR 0.277，95% CI 0.136 - 0.563）具有统计学意义。与未接受曲马多的患者（P < 0.01）以及接受曲马多的患者（P < 0.01）相比，接受曲马多治疗的患者在疼痛的临床进展方面也更好。在这项针对背痛患者的研究中，在疼痛控制和减少重新评估需求方面，曲马多比其他分析的镇痛药显示出明显优势。
