a Department of Emergency Medicine , Medical College of Wisconsin , Milwaukee , WI , USA.
b Medical College of Wisconsin , Milwaukee , WI , USA.
Clin Toxicol (Phila). 2018 Aug;56(8):744-750. doi: 10.1080/15563650.2017.1401081. Epub 2017 Nov 23.
Prescription opioid abuse and misuse is a significant public health crisis. In 2012, an opioid prescribing pathway for patients with chronic pain presenting to the Emergency Department (ED) was implemented. The objective of this study is to determine the impact of the pathway for administration of opioids in the ED as well as the prescribing of opioids for home use after discharge.
Retrospective pre- and post-intervention time series study of consecutive patients presenting to the ED with acute and chronic pain complaints before and after implementation of the pathway. For the purposes of this study, we included patients with chronic abdominal or back pain - defined as pain present for greater than three months - and acute pain as acute long bone fracture.
Before pathway implementation, there was no statistically significant difference in the mean morphine equivalent (MEQ) dose administered for chronic or acute pain patients. After pathway implementation, there was a decrease in IV/IM morphine administered to patients with chronic pain (p = .0200) but not to patients with acute pain (p = .0820). Overall, MEQs administered did not change in either group. In the acute pain group, no significant differences were found in the number of patients who received opioid prescriptions upon discharge (p = .7749). However, in the chronic pain group, the number of patients who received opioid prescriptions upon discharge decreased with statistical significance (p = .0017).
After the implementation of a chronic pain management pathway in an ED, there is a decrease noted in opioids administered to patients with chronic pain both in the ED and prescriptions on discharge. In patients presenting with acute pain, there was no change in administration or prescription of opioids.
处方类阿片类药物滥用和误用是一个严重的公共卫生危机。2012 年，为在急诊部（ED）就诊的慢性疼痛患者制定了一种阿片类药物处方途径。本研究的目的是确定 ED 中管理阿片类药物的途径以及出院后开处阿片类药物的影响。
对实施该途径前后连续出现急性和慢性疼痛的 ED 患者进行回顾性前后干预时间序列研究。在这项研究中，我们包括了患有慢性腹部或背部疼痛的患者（定义为疼痛持续超过三个月）和急性长骨骨折的急性疼痛患者。
在实施途径之前，慢性或急性疼痛患者接受的平均吗啡等效剂量（MEQ）没有统计学差异。实施途径后，慢性疼痛患者静脉/肌内注射吗啡的用量减少（p=0.0200），但急性疼痛患者没有减少（p=0.0820）。总的来说，两组的 MEQ 用量都没有变化。在急性疼痛组中，出院时接受阿片类药物处方的患者数量没有显著差异（p=0.7749）。然而，在慢性疼痛组中，出院时接受阿片类药物处方的患者数量显著减少（p=0.0017）。
在 ED 中实施慢性疼痛管理途径后，无论是在 ED 还是出院时，接受慢性疼痛患者的阿片类药物用量均减少。在出现急性疼痛的患者中，阿片类药物的使用或处方没有变化。
