Examining Trends of Back Pain Management, Opioid Use, and ED Utilization

Back pain is one of the top pain complaints in the United States and simultaneously one of the most common reason for patient presentation in the emergency department (ED). A study presented at the American Academy of Pain Medicine’s 36th Annual Meeting explores the trends in evaluation and management of back pain in United States EDs.

Looking at data from 2007 through 2016, Peter Mullins, MD, MA, MPH, Massachusetts General Hospital, and colleagues, analyzed the National Ambulatory Medical Care Survey (NHAMCS), an annual national survey of ED visits administered by the National Center for Health Statistics.

Data was publicly accessible and deidentified for the purpose of the study.

Patients examined were at least 18-years old and back pain was defined by NHAMCS reason for visit codes. 

Dr Mullins and colleagues examined demographics, resource utilization (including laboratory testing and imaging), and medications (including opioid and nonopioid analgesics). To test for trends, the researchers used survey-weighted logistic regression.

Over the examined time period, 2007 to 2016, the data showed that ED visits for back pain increased from 8.1 million to 10.6 million, accounting for 9.1 to 9.3% of all ED visits. Admissions decreased from 6.4% to 5%. 

In terms of diagnostic tools, imaging use increased significantly throughout the observed period, 51.7% to 57.6%. Increased laboratory testing was also observed, 28.7% to 35.8%. 

“Total diagnostics performed increased significantly, as did mean number of medications,” noted the researchers. 

“Opioid utilization decreased over the study period (53.5 to 46.5%), except tramadol, which increased from 4.1 to 8.4%. Acetaminophen increased from 6.5 to 8.1%, while muscle relaxants increased from 35.5 to 38.9%. Benzodiazepine use was stable.”

“This study demonstrates continuing growth in diagnostic intensity of ED visits for back pain,” concluded Dr Mullins and colleagues, “while also demonstrating decreasing overall opioid utilization but increased use of tramadol.”  —Edan Stanley