Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.
Department of Emergency Medicine, University of California, San Francisco, San Francisco, California.
J Emerg Med. 2021 Dec;61(6):637-648. doi: 10.1016/j.jemermed.2021.09.002. Epub 2021 Oct 21.
Severe acute pain is still commonly treated with opioid analgesics in the United States, but this practice could prolong the duration of pain.
Estimate the risk of experiencing persistent pain after opioid analgesic use after emergency department (ED) discharge among patients with suspected urolithiasis.
We analyzed data collected for a longitudinal, multicenter clinical trial of ED patients with suspected urolithiasis. We constructed multilevel models to estimate the odds ratios (ORs) of reporting pain at 3, 7, 30, or 90 days after ED discharge, using multiple imputation to account for missing outcome data. We controlled for clinical, demographic, and institutional factors and used weighting to account for the propensity to be prescribed an opioid analgesic at ED discharge.
Among 2413 adult ED patients with suspected urolithiasis, 62% reported persistent pain 3 days after discharge. Participants prescribed an opioid analgesic at discharge were OR 2.51 (95% confidence interval [CI] 1.82-3.46) more likely to report persistent pain than those without a prescription. Those who reported using opioid analgesics 3 days after discharge were OR 2.24 (95% CI 1.77-2.84) more likely to report pain at day 7 than those not using opioid analgesics at day 3, and those using opioid analgesics at day 30 had OR 3.25 (95% CI 1.96-5.40) greater odds of pain at day 90.
Opioid analgesic prescription doubled the odds of persistent pain among ED patients with suspected urolithiasis. Limiting opioid analgesic prescribing at ED discharge for these patients might prevent persistent pain in addition to limiting access to these medications.
在美国，严重的急性疼痛仍常采用阿片类镇痛药治疗，但这种做法可能会延长疼痛持续时间。
估计疑似尿路结石的急诊科（ED）出院患者使用阿片类镇痛药后持续性疼痛的风险。
我们分析了一项针对疑似尿路结石的 ED 患者的纵向、多中心临床试验所收集的数据。我们构建了多水平模型，使用多重插补法估计 ED 出院后 3、7、30 或 90 天报告疼痛的比值比（OR），并使用加权法控制临床、人口统计学和机构因素，以及处方阿片类镇痛药的倾向。
在 2413 名疑似尿路结石的成年 ED 患者中，62%的患者在出院后 3 天报告持续性疼痛。与未开具处方的患者相比，出院时开具阿片类镇痛药的患者报告持续性疼痛的可能性高 2.51 倍（95%置信区间 [CI]，1.82-3.46）。在出院后第 3 天报告使用阿片类镇痛药的患者在第 7 天报告疼痛的可能性高 2.24 倍（95%CI，1.77-2.84），而在第 3 天未使用阿片类镇痛药的患者报告疼痛的可能性高 2.24 倍（95%CI，1.77-2.84）；在第 30 天使用阿片类镇痛药的患者在第 90 天报告疼痛的可能性高 3.25 倍（95%CI，1.96-5.40）。
阿片类镇痛药处方使疑似尿路结石的 ED 患者持续性疼痛的可能性增加了一倍。限制这些患者在 ED 出院时开具阿片类镇痛药可能不仅能限制这些药物的获取，还能预防持续性疼痛。
