Department of Emergency Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord-de-l'Île de-Montréal), 5400 Gouin Blvd. West, Montreal, QC, H4J 1C5, Canada.
Département de Médecine Familiale et de Médecine d'Urgence, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
CJEM. 2021 May;23(3):342-350. doi: 10.1007/s43678-020-00041-3. Epub 2021 Jan 4.
Treatment of acute pain after emergency department (ED) discharge remains a challenge in the opioid crisis context. Our objective was to determine the proportion of patients using opioid vs non-opioid pain medication following discharge from the ED with acute pain, and the association of type of pain medication with average pain intensity before pain medication intake and report of pain relief.
This was a prospective cohort study of ED patients aged ≥ 18 years with an acute pain (≤ 2 weeks) who were discharged with an opioid prescription. Patients completed a 14-day diary assessing daily pain intensity level before each pain medication intake (0-10 numeric rating scale), type of pain medication use (opioid vs non-opioid), and if pain was relieved by the medication used that day. Multilevel analyses were used to compare the effect of type of analgesic used on pain intensity and relief.
A total of 381 participants completed the 14-day diary; 50% were women and median age was 54 years (IQR = 43-66). Average daily pain intensity before pain medication intake was significantly higher for patients who used opioids (5.9; 95% CI 5.7-6.2) as compared to non-opioid analgesics (4.2; 95% CI 4.0-4.5) or no pain medication (2.2; 95% CI 1.9-2.5). Controlling for pain intensity, patients using opioids were more likely to report a pain relief (OR = 1.3; 95% CI 1.1-1.8) as compared to those who used non-opioid analgesics.
Overall, opioids appear to be effective and used as intended by the prescribing physician.
在阿片类药物危机背景下，处理急诊科（ED）出院后急性疼痛仍然是一个挑战。我们的目的是确定 ED 急性疼痛出院患者中使用阿片类药物与非阿片类药物的比例，以及疼痛药物类型与疼痛药物摄入前平均疼痛强度和疼痛缓解报告的关系。
这是一项前瞻性队列研究，纳入了年龄≥18 岁、伴有急性疼痛（≤2 周）且出院时开具阿片类药物处方的 ED 患者。患者完成了为期 14 天的日记，记录每天疼痛强度水平（0-10 数字评分量表），疼痛药物的使用类型（阿片类药物与非阿片类药物），以及当天使用的药物是否缓解了疼痛。多水平分析用于比较使用的镇痛药物类型对疼痛强度和缓解的影响。
共有 381 名参与者完成了 14 天的日记；50%为女性，中位年龄为 54 岁（IQR=43-66）。与非阿片类镇痛药（4.2；95%CI 4.0-4.5）或无疼痛药物（2.2；95%CI 1.9-2.5）相比，使用阿片类药物的患者在服用疼痛药物前的平均每日疼痛强度显著更高（5.9；95%CI 5.7-6.2）。控制疼痛强度后，与使用非阿片类镇痛药的患者相比，使用阿片类药物的患者更有可能报告疼痛缓解（OR=1.3；95%CI 1.1-1.8）。
总体而言，阿片类药物似乎是有效的，并且符合处方医生的预期。
