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A comparison of analgesic prescribing among ED back and neck pain visits receiving physical therapy versus usual care.
Am J Emerg Med. 2019 07; 37(7):1322-1326.AJ

Abstract

OBJECTIVE

Physical therapy (PT) is commonly cited as a non-opioid pain strategy, and previous studies indicate PT reduces opioid utilization in outpatients with back pain. No study has yet examined whether PT is associated with lower analgesic prescribing in the ED setting.

METHODS

This was a retrospective cohort study of discharged ED visits with a primary ICD-10 diagnosis relating to back or neck pain from 10/1/15 to 2/21/17 at an urban academic ED. Visits receiving a PT evaluation were matched with same-date visits receiving usual care. We compared the primary outcomes of opioid and benzodiazepine prescribing between the two cohorts using chi-squared test and multivariable logistic regression.

RESULTS

74 ED visits received PT during the study period; these visits were matched with 390 same-date visits receiving usual care. Opioid prescribing among ED-PT visits was not significantly higher compared to usual care visits on both unadjusted analysis (50% vs 42%, p = 0.19) and adjusted analysis (adjOR 1.05, 95% CI 0.48-2.28). However, benzodiazepine prescribing among ED-PT visits was significantly higher than usual care visits on both unadjusted (45% vs 23%, p < 0.001) and adjusted analysis (adjOR 3.65, 95% CI 1.50-8.83).

CONCLUSIONS

In this single center study, ED back and neck pain visits receiving PT were no less likely to receive an opioid prescription and were more likely to receive a benzodiazepine than visits receiving usual care. Although prior studies demonstrate that PT may reduce opioid utilization in the subsequent year, these results indicate that analgesic prescribing is not reduced at the initial ED encounter.

Authors+Show Affiliations

Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America. Electronic address: howard.kim@northwestern.edu.Department of Emergency Medicine, Denver Health Hospital & Authority, Denver, CO, United States of America.Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.Department of Physical Therapy, Marquette University College of Health Sciences, Milwaukee, WI, United States of America.Department of Rehabilitation Services, Northwestern Memorial Hospital, Chicago, IL, United States of America.Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.Department of Communication Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

30528050

Citation

Kim, Howard S., et al. "A Comparison of Analgesic Prescribing Among ED Back and Neck Pain Visits Receiving Physical Therapy Versus Usual Care." The American Journal of Emergency Medicine, vol. 37, no. 7, 2019, pp. 1322-1326.
Kim HS, Kaplan SH, McCarthy DM, et al. A comparison of analgesic prescribing among ED back and neck pain visits receiving physical therapy versus usual care. Am J Emerg Med. 2019;37(7):1322-1326.
Kim, H. S., Kaplan, S. H., McCarthy, D. M., Pinto, D., Strickland, K. J., Courtney, D. M., & Lambert, B. L. (2019). A comparison of analgesic prescribing among ED back and neck pain visits receiving physical therapy versus usual care. The American Journal of Emergency Medicine, 37(7), 1322-1326. https://doi.org/10.1016/j.ajem.2018.10.009
Kim HS, et al. A Comparison of Analgesic Prescribing Among ED Back and Neck Pain Visits Receiving Physical Therapy Versus Usual Care. Am J Emerg Med. 2019;37(7):1322-1326. PubMed PMID: 30528050.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A comparison of analgesic prescribing among ED back and neck pain visits receiving physical therapy versus usual care. AU - Kim,Howard S, AU - Kaplan,Sabrina H, AU - McCarthy,Danielle M, AU - Pinto,Daniel, AU - Strickland,Kyle J, AU - Courtney,D Mark, AU - Lambert,Bruce L, Y1 - 2018/10/23/ PY - 2018/09/28/received PY - 2018/10/10/accepted PY - 2018/12/12/pubmed PY - 2020/1/22/medline PY - 2018/12/12/entrez KW - Back pain KW - Benzodiazepines KW - Opioids KW - Physical therapy SP - 1322 EP - 1326 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 37 IS - 7 N2 - OBJECTIVE: Physical therapy (PT) is commonly cited as a non-opioid pain strategy, and previous studies indicate PT reduces opioid utilization in outpatients with back pain. No study has yet examined whether PT is associated with lower analgesic prescribing in the ED setting. METHODS: This was a retrospective cohort study of discharged ED visits with a primary ICD-10 diagnosis relating to back or neck pain from 10/1/15 to 2/21/17 at an urban academic ED. Visits receiving a PT evaluation were matched with same-date visits receiving usual care. We compared the primary outcomes of opioid and benzodiazepine prescribing between the two cohorts using chi-squared test and multivariable logistic regression. RESULTS: 74 ED visits received PT during the study period; these visits were matched with 390 same-date visits receiving usual care. Opioid prescribing among ED-PT visits was not significantly higher compared to usual care visits on both unadjusted analysis (50% vs 42%, p = 0.19) and adjusted analysis (adjOR 1.05, 95% CI 0.48-2.28). However, benzodiazepine prescribing among ED-PT visits was significantly higher than usual care visits on both unadjusted (45% vs 23%, p < 0.001) and adjusted analysis (adjOR 3.65, 95% CI 1.50-8.83). CONCLUSIONS: In this single center study, ED back and neck pain visits receiving PT were no less likely to receive an opioid prescription and were more likely to receive a benzodiazepine than visits receiving usual care. Although prior studies demonstrate that PT may reduce opioid utilization in the subsequent year, these results indicate that analgesic prescribing is not reduced at the initial ED encounter. SN - 1532-8171 UR - https://www.unboundmedicine.com/medline/citation/30528050/A_comparison_of_analgesic_prescribing_among_ED_back_and_neck_pain_visits_receiving_physical_therapy_versus_usual_care_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(18)30825-8 DB - PRIME DP - Unbound Medicine ER -