A comparison of analgesic prescribing among ED back and neck pain visits receiving physical therapy versus usual care

Howard Kim*, Sabrina H. Kaplan, Danielle Molloy McCarthy, Daniel Pinto, Kyle J. Strickland, D Mark Courtney, Bruce L. Lambert

*Corresponding author for this work

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1322-1326
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume37
Issue number7
DOIs
StatePublished - Jul 1 2019

Fingerprint

Neck Pain
Back Pain
Analgesics
Opioid Analgesics
Benzodiazepines
Therapeutics
International Classification of Diseases
Prescriptions
Cohort Studies
Outpatients
Retrospective Studies
Logistic Models
Pain

Keywords

  • Back pain
  • Benzodiazepines
  • Opioids
  • Physical therapy

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

@article{d05903872a3748efbde5dac557d98e18,
title = "A comparison of analgesic prescribing among ED back and neck pain visits receiving physical therapy versus usual care",
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.",
keywords = "Back pain, Benzodiazepines, Opioids, Physical therapy",
author = "Howard Kim and Kaplan, {Sabrina H.} and McCarthy, {Danielle Molloy} and Daniel Pinto and Strickland, {Kyle J.} and Courtney, {D Mark} and Lambert, {Bruce L.}",
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A comparison of analgesic prescribing among ED back and neck pain visits receiving physical therapy versus usual care. / Kim, Howard; Kaplan, Sabrina H.; McCarthy, Danielle Molloy; Pinto, Daniel; Strickland, Kyle J.; Courtney, D Mark; Lambert, Bruce L.

In: American Journal of Emergency Medicine, Vol. 37, No. 7, 01.07.2019, p. 1322-1326.

Research output: Contribution to journalArticle

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T1 - A comparison of analgesic prescribing among ED back and neck pain visits receiving physical therapy versus usual care

AU - Kim, Howard

AU - Kaplan, Sabrina H.

AU - McCarthy, Danielle Molloy

AU - Pinto, Daniel

AU - Strickland, Kyle J.

AU - Courtney, D Mark

AU - Lambert, Bruce L.

PY - 2019/7/1

Y1 - 2019/7/1

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.

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