Patient-Reported Outcomes from a National, Prospective, Observational Study of Emergency Department Acute Pain Management with an Intranasal NSAID, Opioids or Both
Charles V. Pollack Jr MA, MD, Deborah B. Dierck MD, MSc, Stephen H. Thomas MD, MPH, Nathan I. Shapiro MD, MPH, John Fanikos RPh, MBA, Sharon E. Mace MD, Zubaid Rafique MD and Knox H. Todd MD, MPH
Patient compliance and satisfaction with analgesics prescribed after Emergency Department (ED) care for acute pain are poorly understood, largely because of the lack of direct patient follow-up with the ED provider. Our objective was to compare patient satisfaction with three analgesia regimens prescribed for post-ED care—a nasally administered nonsteroidal anti-inflammatory drug (NSAID), an opioid, or combination therapy—by collecting granular follow-up on analgesic use, pain scores, side effects, work activity levels, and overall satisfaction directly from patients. We designed a prospective registry linking ED assessment and analgesic management for acute pain of specific musculoskeletal or visceral etiologies with self-reported automated telephonic follow-up daily for the four days post-ED discharge. Patients were prescribed a specific nonsteroidal anti-inflammatory drug (NSAID: SPRIX®, ketorolac tromethamine for nasal instillation) only, an oral opioid only, or both with the opioid clearly defined as rescue therapy, at the ED provider’s discretion. There were 824 evaluable subjects. Maximum pain scores improved day-to-day more effectively with a ketorolac-based approach. Self-reported rates of return to work and work effectiveness were higher with SPRIX than with opioids or combination therapy. Adverse effects of nausea, constipation, drowsiness, and abdominal pain were higher each day among patients taking an opioid; nasal irritation was more common with SPRIX. Overall satisfaction at the end of the follow-up period was higher with SPRIX-based treatment than with opioid monotherapy.
Automated telephonic follow-up of ED patients prescribed short-term analgesia is feasible. Ketorolac-based analgesia after an ED visit for many acute pain syndromes was associated with favorable patient outcomes and higher satisfaction than opioid-based therapy. SPRIX, an NSAID that is not available over-the-counter and has a novel delivery approach, may be useful for short-term post-ED outpatient analgesia.