LO65: Assessing opioid-prescribing patterns for low back pain patients before and after the implementation of clinician performance indicators in the emergency department

Introduction: Canada is in the midst of an opioid crisis. The number of apparent opioid-related deaths between January and March 2018 increased by 44% compared to the same period in 2016. The increasing use of prescription opioids and higher doses of opioids can lead to opioid addiction, toxicity and even death. Opioids are commonly prescribed for low back pain management in the ED, but the variability in opioid-prescribing patterns suggested an opportunity for improvement. Our centre implemented Clinician Performance Indicators (CPI) in 2015. CPIs were reported to each ED physician every 3 months and included the percentage of patients who were prescribed opioids. The intent was to raise awareness of opioid-prescribing patterns at our institution. Therefore, we evaluated opioid-prescribing patterns for patients with low back pain (LBP) before and after the CPI implementation. Methods: Data were obtained retrospectively for patients discharged from the ED from July 2015 to December 2018 with LBP-associated ICD 10 codes. We excluded admitted patients, those with specialist consultations, and patients who left without being seen. The primary outcome was opioid prescribing patterns for patients with LBP before and after CPI implementation. We performed a descriptive analysis of the data and compared the prescribing rates pre-implementation (July-Dec 2015) to post-implementation (July-Dec 2016) following a 6-month wash-out period. Moreover, we analyzed opioid-prescribing patterns over an extended period until December 2018. Results: After the exclusion criteria were applied, 8993 patients were included in the analysis. 53.5% were female and the mean (SD) age was 48.3 (19.78). During the three years of the study period, the percentage of LBP patients who received opioids showed a decreasing trend. Comparison of the pre and post CPI implementation periods showed a decrease in opioid prescriptions (42.0% vs 35.5%, 95%CI 2.9% to 10.2%). There was variation in opioids prescribed at our institution, the most common being hydromorphone (29.9%), followed by acetaminophen-oxycodone (24.2%) and acetaminophen-tramadol (20.0%). Conclusion: The implementation of CPIs positively impacted physicians' opioid-prescribing patterns for patients presenting with LBPs at our institution. Future studies are required to further improve the effectiveness of CPIs in influencing opioid-prescribing patterns.

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Opioid Prescribing Patterns for Low Back Pain Among Commercially Insured Children

Neurosurgery ◽

10.1093/neuros/nyz310_203 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Tej D Azad ◽

Michael D Harries ◽

Daniel Vail ◽

Yi Jonathan Zhang ◽

John K Ratliff

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pediatric Patients ◽

Pediatric Population ◽

Prescribing Patterns ◽

Low Back ◽

Age Group ◽

Newly Diagnosed ◽

Opioid Prescription ◽

Opioid Prescribing

Abstract INTRODUCTION Low back pain (LBP) may affect up to 20% of the pediatric population. No specific guidelines exist regarding pharmacotherapy for acute LBP in the pediatric population. Given this observation and the lack of data available regarding pharmacotherapy for pediatric LBP, we sought to characterize patterns of opioid prescribing in the pediatric population. METHODS We used a national database to identify pediatric patients (age 5-17) with newly diagnosed with LBP between 2008 and 2015 who did not have a red flag diagnosis, had not received an opioid prescription in the 6 mo prior to diagnosis, and had 12-mo of continuous enrollment after diagnosis. We used logistic regression to model the association between sex, geographic region, categorical age, and our primary outcome, receipt of an opioid prescription in the year following diagnosis. RESULTS Our sample included 268 228 opioid-naïve pediatric patients diagnosed with LBP between 2008 and 2015. We observed that 47 631 (17.8%) patients received physical therapy, 29 903 (11.2%) patients received chiropractic manipulative therapy, 658 (0.25%) patients received epidural steroid injection, and 281 (0.10%) patients received surgery. A total of 35 274 (13.2%) pediatric LBP patients were prescribed opioids within 12 mo from their diagnosis. Opioid prescribing decreased in all age groups over the study period age group 5 to 9 decreased from 4.2% to 2.7%, age group 10 to 14 decreased from 10.3% to 7.7%, and age group 15 to 18 yr decreased from 20.9% to 17.1%. Female pediatric patients were more likely than male patients to receive an opioid prescription (OR, 1.12, P < .0001). Patients ages 10 to 14 (OR, 2.89, P < .0001) and 15 to 18 (OR, 6.98, P < .0001) were significantly more likely to be prescribed opioids compared to patients in the youngest age group. CONCLUSION To our knowledge, we report the first observational cohort study of opioids and LBP in the pediatric population. Our findings indicate that opioids are being used for newly diagnosed LBP and receipt of opioids are associated with patient demographic factors.

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Opioid Prescribing Patterns for Low Back Pain Among Commercially Insured Children

Spine ◽

10.1097/brs.0000000000003657 ◽

2020 ◽

Vol 45 (21) ◽

pp. E1365-E1366

Author(s):

Tej D. Azad ◽

Michael D. Harries ◽

Anand Veeravagu ◽

John K. Ratliff

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Prescribing Patterns ◽

Low Back ◽

Opioid Prescribing

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Gait Analysis of Patients with Low Back Pain Before and After Surgery

Spine ◽

10.1097/00007632-199309010-00008 ◽

1993 ◽

Vol 18 (11) ◽

pp. 1451-1455

Author(s):

Soussan Khodadadeh ◽

Stephen M. Eisenstein

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Gait Analysis ◽

Low Back ◽

Before And After

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Association of Serum Serotonin and Pain in Patients with Chronic Low Back Pain before and after Spinal Surgery

Pain Research and Treatment ◽

10.1155/2018/4901242 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Afshin Farhanchi ◽

Behrouz Karkhanei ◽

Negar Amani ◽

Mashhood Aghajanloo ◽

Elham Khanlarzadeh ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Rating Scale ◽

Numerical Rating Scale ◽

Low Back ◽

Significant Difference ◽

Before And After ◽

Postoperative Serum ◽

Serum Serotonin

Introduction. In this study we are aiming to evaluate the changes of serum serotonin and its association with pain in patients suffering from chronic low back pain before and after lumbar discectomy surgery. Patients and Methods. A prospective study was performed on the patients referring to the outpatient clinic in Besat hospital, Hamadan University of Medical Sciences, Hamadan, Iran, during 2016. A 2 mL fasting blood sample was collected from each patient at preoperative day 1 and postoperative day 14 and they were measured for level of serum serotonin. Besides, all patients were asked for severity of their low back pain in preoperative day 1 and postoperative day 14 and scored their pain from zero to ten using a Numerical Rating Scale. Results. Forty patients with the mean age of 47 ± 13 yrs/old (range 25–77) including 15 (37.5%) males were enrolled into the study. The overall mean score of preoperative pain was significantly decreased from 7.4 ± 2.18 (range 4–10) to the postoperative pain score 3.87 ± 2.92 (range 0–10) (P < .001). The overall levels of pre- and postoperative serum serotonin were 3.37 ± 1.27 (range 1.1–6.4) and 3.58 ± 1.32 (range .94–7.1) ng/mL, respectively, with no significant difference (P = .09). The levels of pre- and postoperative serum serotonin were significantly higher in males and patients older than 50 yrs/old compared to the females and patients younger than 50 yrs/old, respectively (P = .03 and .005, respectively). A significant inverse correlation between the postoperative levels of pain and serum serotonin was observed (r = -.36 and P = .02). Conclusion. A negative medium strength linear relationship may exist between the postoperative serum serotonin and low back pain.

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EFFECTIVENESS OF LUMBAR MANIPULATION (HIGH VELOCITY LOW AMPLITUDE) FOR THE TREATMENT OF LOW BACK PAIN IN COMPARISON TO BACK STRETCHING EXERCISES

Pakistan Journal of Rehabilitation ◽

10.36283/pjr.zu.1.1/004 ◽

2012 ◽

Vol 1 (1) ◽

pp. 23-27

Author(s):

Syed Abid Mehdi Kazmi ◽

Nabiha Mujahid Faruq ◽

Sumaira Imran Farooqui ◽

Jharna Devi

Keyword(s):

Low Back Pain ◽

Back Pain ◽

High Velocity ◽

Low Back ◽

Before And After ◽

History Of ◽

Group A ◽

Group B ◽

Low Amplitude ◽

Stretching Exercises

OBJECTIVES To assess the effectiveness of lumbar manipulation (high velocity low amplitude) for the treatment of low back pain in comparison to back stretching exercises. Randomized Control Trial (Experimental Study) The study was conducted on 200 patients at the Physiotherapy Department of Ziauddin Hospital among patients with history of low back pain of acute, sub acute or chronic origin. In this study, patients were divided into two groups, group A and group B equally. Group A of 100 patients received Lumbar Manipulation (High Velocity Low Amplitude) and at the same time Group B of 100 patients were treated by back stretching exercises. A pre tested and structured questionnaire was used to collect data. Data was entered and analyzed by using SPSS. Pain was measured on Visual Analogue Scale before and after the given treatment. The study showed significant results for both the interventions in the treatment of low back pain but Lumbar Manipulation has been more effective in different types of low back pain while stretching exercises are less effective. On the basis of this study, we are very confident that lumbar manipulation is more effective for the treatment of low back pain compared to back stretching

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Time of Day is Associated with Opioid Prescribing for Low Back Pain in Primary Care

Journal of General Internal Medicine ◽

10.1007/s11606-018-4521-8 ◽

2018 ◽

Vol 33 (11) ◽

pp. 1828-1830 ◽

Cited By ~ 8

Author(s):

Lindsey M. Philpot ◽

Bushra A. Khokhar ◽

Daniel L. Roellinger ◽

Priya Ramar ◽

Jon O. Ebbert

Keyword(s):

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Time Of Day ◽

Low Back ◽

Opioid Prescribing

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PENGARUH AKUPRESUR TITIK BLADDER 23 TERHADAP INTENSITAS NYERI PUNGGUNG BAWAH IBU HAMIL TRIMESTER III DI UPTD PUSKESMAS I DENPASAR UTARA

Jurnal Midwifery Update (MU) ◽

10.32807/jmu.v2i2.91 ◽

2020 ◽

Vol 2 (2) ◽

pp. 75

Author(s):

Ni Luh Putu Sentania Widhi Permana Putri ◽

Ni Wayan Suarniti ◽

Ni Nyoman Budiani

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pregnant Women ◽

Mean Value ◽

Lumbar Region ◽

Low Back ◽

Third Trimester ◽

Purposive Sampling ◽

Before And After ◽

Pharmacological Method

Nyeri punggung bawah pada kehamilan digambarkan sebagai nyeri pada daerah lumbar, diatas sakrum yang menyebabkan ketidaknyamanan selama kehamilan. Akupresur titik bladder 23 merupakan metode non-farmakologi yang dapat mengurangi nyeri punggung bawah. Tujuan penelitian ini untuk mengetahui pengaruh akupresur titik bladder 23 terhadapintensitas nyeri punggung bawah ibu hamil trimester III di UPTD Puskesmas I Dinas Kesehatan Kecamatan Denpasar Utara. Penelitian ini menggunakan pre eksperimental dengan rancangan one grup pretest-posttest design.Sampel yang digunakan yaitu 12 orang ibu hamil trimester III dengan usia kehamilan 37-39 minggu dan di pilih secara purposive sampling. Data diambil dengan melakukan observasi intensitas nyeri punggung bawah sebelum dan sesudah dilakukan akupresur titik bladder 23. Responden melakukan akupresur sebanyak dua kali seminggu dengan durasi dua detik sebanyak 30 kali tekanan. Hasil intensitas nyeri punggung bawah sebelum perlakuan diperoleh nilai mean 4,17 dan setelah perlakuan berubah menjadi 2,67 dengan nilai ρ = 0,000 < α (0,05) dan nilai t (9,950). Simpulannya adalah ada pengaruh akupresur titik bladder 23 terhadap intensitas nyeri punggung bawah ibu hamil trimester III di UPTD Puskesmas I Dinas Kesehatan Kecamatan Denpasar Utara.Lower back pain in pregnancy described as pain in the lumbar region, above the sacrum which causes discomfort during pregnancy.Acupressurepoint bladder 23 is a non-pharmacological method that canreduce low back pain.This study aims to determine the effect of acupressure point bladder 23 on the low back pain level in third semester pregnant women in UPTD Puskesmas I of the Health Departement of North Denpasar. This is pre-experimental research with one group pretest-posttest design. The samples were 12pregnant women on third trimester with 37-39 weeks gestational age and were selected by purposive sampling. Data were collected byobserving the intensity of low back pain before and after treatment. Respondents did acupressure twice a week with the duration two seconds for each 30 times pressure. The results of low back pain intensity before treatment obtained a mean value of 4.17 and after the treatment there was reduce to 2.67 with a value of ρ = 0,000 <α (0.05) and t value (9,950). The conclusion is that there is an influence of acupressurepoint bladder 23 on the low back painintensityin third trimester pregnant women in UPTD Puskesmas I of the Health Departement of North Denpasar.

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Physical and psychosocial work environmental risk factors of low-back pain: protocol for a 1 year prospective cohort study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2996-z ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Rúni Bláfoss ◽

Per Aagaard ◽

Lars Louis Andersen

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Low Back Pain ◽

Back Pain ◽

Low Back ◽

Psychosocial Work ◽

Before And After ◽

Warehouse Workers ◽

Trunk Extensor

Abstract Background Musculoskeletal disorders, and in particular low-back pain (LBP), are common among blue collar workers. In the work environment, both physical- and psychosocial risk factors exist. Working in warehouses in Denmark involve large quantities of occupational lifting, high work pace and a low degree of influence at work. This study investigates both acute and long-term associations between physical- and psychosocial work environmental factors and risk of LBP in warehouse workers. The specific study aims are to investigate 1) exposure-response associations between quantity of occupational lifting and short-term (day-to-day) changes in LBP, 2) the influence of accumulated workdays and rest days during a working week on LBP, 3) long-term association between occupational lifting exposure and LBP when assessed over 1 year, and 4) the role of psychological and social factors on the above associations. Methods The present study is designed as a 1-year prospective cohort study that will examine full-time warehouse workers from up to five retail chains in Denmark. Study aims 1 and 2 will be addressed using objective data based on company records with information on weight of all the goods handled by each warehouse worker during every single workday for 3 weeks. During this period, each worker will reply to text messages received before and after every workday (also on days off work) in which study participants will score their pain in the low back, bodily fatigue and perceived mental stress (scale 0–10). Long-term pain development is assessed using questionnaire surveys before and after 1 year. Further, pressure pain threshold (PPT) will be measured for selected trunk extensor muscles in approximately 50 workers using algometry along with measurements of maximal trunk extensor strength. Associations are modelled using linear mixed models with repeated measures between variables and LBP controlled for relevant confounders. Discussion This study provides knowledge about the acute and long-term associations between physical- and psychosocial work environmental factors and LBP. The obtained data will have the potential to provide recommendations on improved design of the working week to minimize the risk of LBP among warehouse workers, and may potentially enable to identify a reasonable maximum lifting threshold per day (ton lifted/day).

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