The opioid wave sweeps across North America, increasing research curiosity. In 2019-2020, 8.1% of people who visited the emergency department in the United States were prescribed opioids.
Goal
Opioids (e.g.: morphine, oxycodone, hydromorphone, codeine) are often prescribed for acute pain to the emergency department (ED) discharged patients, but there is no actual proof of their efficacy for the treatment of pain at home. The purpose of this study was to review information regarding the efficacy of prescribed opioids compared to non-opioid analgesics for acute pain relief in ED-discharged patients.
Methodology
Raoul Daoust, David Williamson and colleagues conducted a meta-analysis, which is a quantitative study used to systematically assess the results of previous research to derive conclusions about that body of research. The research team searched several scientific databases to find all properly designed controlled studies (randomized controlled trials) investigating the efficacy of prescribed opioid for ED-discharged patients suffering from acute pain. Using these studies, they compared pain intensity scores or pain relief between patients who were treated with opioids compared to those treated with non-opioids. Researchers also compared adverse events between two groups.
Main findings
From 5,419 initially screened studies, only six studies were retained and represented 1,161 patients, all of which had acute musculoskeletal pain. There was no difference in pain intensity scores or pain relief between opioids versus non-opioids (generally anti-inflammatory drugs were used as non-opioid in the studies). But excluding studies using codeine, which is a less potent opioid than the others, opioids were more effective than non-opioids. However, there were more adverse events associated with opioids compared to non-opioids.
Take home message
For ED-discharged patients with acute musculoskeletal pain, opioids do not seem to be more effective than non-opioid analgesics in the home pain management. However, this absence of efficacy seems to be driven by codeine, as opioids other than codeine are more effective than non-opioids. Still, we should be careful with the use of opioids since they were associated with more adverse events compared to non-opioids.
