The randomised trial conducted across four NSW emergency departments has resulted in up to a 24% reduction in the number of prescriptions issued for opioids to patients with acute back pain in the emergency department setting.
Published in BMJ Quality and Safety, the results could transform the way patients with back pain are treated at hospitals across Australia and help tackle the growing opioid crisis.
Led by researchers and clinicians from the Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, the trial, which included almost 4500 patients from Royal Prince Alfred, Canterbury, Concord and Dubbo hospitals, involved training about 300 clinicians in assessing, managing and referring patients with acute back pain without necessarily prescribing opioids, and providing alternatives including other medicines and heat wraps.
Real time feedback of prescription use was also provided to clinicians using Qlik Sense technology.
The trial indicated that at Canterbury Hospital, opioid use fell dramatically from 61% of patients being given prescriptions to 37% over the four-month trial. Furthermore, the was no increase in pain levels for patients, or any drop in satisfaction with care from patients despite clinicians giving out fewer opioid painkillers.
“Every year thousands of Australians are unnecessarily being prescribed opioid painkillers which can cause addiction, overdose and in some cases even death,” says lead author Dr Gustavo Machado.
“Patients turn up at emergency departments often in incredible pain and discomfort and receive a highly addictive painkiller. It’s meant to be just a short-term fix but in reality, a month later a third of patients are still taking these pills.
“Emergency departments are incredibly busy places and there is a huge pressure on clinicians to treat people as quickly as possible. Unfortunately, there is no easy fix for acute back pain but providing opioids has a lot of downsides.
“Our trial has demonstrated that there is a safer way to treat acute back pain that can easily be adopted by hospitals across the country. With back pain often being a leading reason people visit emergency departments, this new strategy could result in millions of scripts being handed out each year and help tackle the global opioid epidemic.
Key Results:
- Across the four hospitals there was a 12% decrease with opioid use – from 63% to 51%. Canterbury Hospital recorded the largest drop of 24%.
- There was no increase in pain levels for patients, or any drop in satisfaction with care from patients despite clinicians giving out fewer opioid painkillers.
“It’s clear there is a better model of care to help people with back pain, and one that does not rely so heavily on opioid painkillers. Our main aim is to make people better, and alleviate their pain, not unwittingly place them on a path to addiction, says Dr Eileen Rogan, senior emergency physician and the Director of Medical Services at Canterbury Hospital, says:
“Our physicians and nurses embraced this trial because they could see the positive results almost immediately. Patients were happy; they were receiving better care in the emergency department; getting follow-up care if needed and there was an important drop in the amount of opioid painkillers used.”
