Gwam CU, Emara AK, Chughtai N, Javed S, Luo TD, Wang KY, Chughtai M, O'Gara T, Plate JF. Trends and risk factors for opioid administration for non-emergent lower back pain . World J Orthop 2021; 12(9): 700-709 [PMID: 34631453 DOI: 10.5312/wjo.v12.i9.700]
Corresponding Author of This Article
Morad Chughtai, MD, Surgeon, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, United States. chughtm@ccf.org
Research Domain of This Article
Orthopedics
Article-Type of This Article
Clinical and Translational Research
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Sep 18, 2021; 12(9): 700-709 Published online Sep 18, 2021. doi: 10.5312/wjo.v12.i9.700
Trends and risk factors for opioid administration for non-emergent lower back pain
Chukwuweike U Gwam, Ahmed K Emara, Noor Chughtai, Sameer Javed, T David Luo, Kevin Y Wang, Morad Chughtai, Tadhg O'Gara, Johannes F Plate
Chukwuweike U Gwam, T David Luo, Kevin Y Wang, Tadhg O'Gara, Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
Ahmed K Emara, Noor Chughtai, Sameer Javed, Morad Chughtai, Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Johannes F Plate, Department of Orthopaedic Surgery, University of Pittsburgh, 5200 Centre Avenue, Suite 415, Pittsburgh, PA 15232, USA
Author contributions: Gwam CU, Javed S, and Chughtai N wrote the initial draft; Gwam CU, Luo TD, Chughtai M, and Plate JF was involved in conceptualization; Gwam CU, Emara AK, Wang KY, and Plate JF performed statistical analysis; Emara AK and Wang KY did data procurement; Emara AK, Chughtai N, Luo TD, Chughtai M, and O’Gara T performed critical draft revisions; Chughtai M, O’Gara T contributed to supervision.
Institutional review board statement: The present investigation was a retrospective study that utilized a publicly available deidentified database; therefore, no institutional review board.
Informed consent statement: The present study utilized a publicly available database. Therefore, Informed consent statement were not required.
Conflict-of-interest statement: Plate FJ has the following disclosures, all of which are not related to the topic of the present investigation: Biocomposites Inc.: Research support; Total Joint Orthopedics: Paid consultant; VisualDX: Publishing royalties, financial or material support; Other authors have nothing to disclose
Data sharing statement: All authors had access to the data for the current investigation.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Morad Chughtai, MD, Surgeon, Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, United States. chughtm@ccf.org
Received: February 25, 2021 Peer-review started: February 25, 2021 First decision: March 31, 2021 Revised: April 8, 2021 Accepted: August 24, 2021 Article in press: August 24, 2021 Published online: September 18, 2021 Processing time: 201 Days and 6.1 Hours
ARTICLE HIGHLIGHTS
Research background
Low back pain a major cause of emergency department (ED) visits and ranges in incidence between 49% and 80% in the United States. Patients presenting to the ED for non-emergent LBP often receive unnecessary prescriptions of opioid pain medication.
Research motivation
Several guidelines have been implemented to mitigate opioid prescription for low-back pain. However, the impact of such guidelines is yet to be ascertained.
Research objectives
This study aimed to outline the trends of annual opioid prescriptions for patients presenting to the ED with non-emergent back pain; and risk factors associated with being prescribed an opioid based prescription for non-emergent LBP in the ED.
Research methods
We reviewed the National Hospital Ambulatory Medical Care Survey for all patients who presented to the ED with low back pain. Patients over 18 years of age who were not subsequently admitted were included. The primary outcome was opioid-based medication prescription. Trends and factors of opioid-based medication prescription were evaluated to identify chronological and patient-specific risk factors.
Research results
We reviewed the National Hospital Ambulatory Medical Care Survey for all patients who presented to the ED with low back pain. Patients over 18 years of age who were not subsequently admitted were included. The primary outcome was opioid-based medication prescription. Trends and factors of opioid-based medication prescription were evaluated to identify chronological and patient-specific risk factors.
Research conclusions
Overall opioid prescription demonstrated a mild decrease over the past decade; however, a pattern of diminished hydrocodone-based medications is associated with a mild increase in tramadol-based medication prescription. This pattern may be due to recent legislative guidelines.
Research perspectives
Further research is required to identify future trends that may be a more veritable reflection of more recent policies regulating opioid prescription for low back pain – particularly tramadol based medications.
