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{
    "pk": 18380,
    "title": "Opioid Treatment Is Associated with Recurrent Healthcare Visits, Increased Side Effects, and Pain",
    "subtitle": null,
    "abstract": "<p><strong>Introduction: </strong>Pain is a major driver of visits to the emergency department (ED). Clinicians must consider not only the efficacy of treatment options but also subsequent healthcare utilization and patient-centered outcomes such as side effects from prescribed medications. Our goal in this study was to determine whether there was an association between acute pain treatment regimen (opioids, intranasal non-steroidal anti-inflammatory drugs [NSAIDs], or both) and unscheduled healthcare visits following ED discharge.</p>\n<p><strong>Methods: </strong>This study was a secondary analysis of the Acute Management of Pain from the Emergency Department (AMPED) prospective, observational cohort study. We used Cox proportional hazards analysis to assess the relationship between treatment regimen and time to first unscheduled healthcare visit. Repeated measures logistic regression analyses were used to determine the relationship between treatment regimen and any unscheduled visits, and to evaluate whether this relationship was mediated by pain severity and/or medication side effects.</p>\n<p><strong>Results:</strong> Of 831 total enrolled participants, 141 (16.9%) experienced an unplanned healthcare visit within five days of ED discharge. A majority of these visits happened one day after the ED visit. Those who were treated with intranasal NSAIDs only were less likely to have an unscheduled healthcare visit compared to those who received opioids only, with an adjusted odds ratio (AOR) of 0.63. The higher odds of unscheduled healthcare visits with opioids were mediated by both the presence of side effects and higher pain levels, with AORs of 2.24 and 1.33, respectively.</p>\n<p><strong>Conclusion:</strong> Opioid treatment for acute pain is associated with increased unscheduled healthcare visits compared to those treated with intranasal ketorolac. This difference can be explained by higher levels of ongoing pain and greater medication side effects.</p>",
    "language": null,
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "emergency department"
        },
        {
            "word": "Opioid"
        },
        {
            "word": "Recurrent Healthcare Visits"
        },
        {
            "word": "acute pain"
        }
    ],
    "section": "Behavioral Health",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/08t8c9rx",
    "frozenauthors": [
        {
            "first_name": "Caroline",
            "middle_name": "E.",
            "last_name": "Freiermuth",
            "name_suffix": "",
            "institution": "University of Cincinnati, Department of Emergency Medicine, Cincinnati, Ohio; University of Cincinnati College of Medicine, Center for Addiction Research, Cincinnati, Ohio",
            "department": ""
        },
        {
            "first_name": "Jenny",
            "middle_name": "A.",
            "last_name": "Foster",
            "name_suffix": "",
            "institution": "Duke University School of Medicine, Durham, North Carolina",
            "department": ""
        },
        {
            "first_name": "Pratik",
            "middle_name": "",
            "last_name": "Manandhar",
            "name_suffix": "",
            "institution": "Duke University, Department of Biostatistics and Bioinformatics, Durham, North Carolina",
            "department": ""
        },
        {
            "first_name": "Evangeline",
            "middle_name": "",
            "last_name": "Arulraja",
            "name_suffix": "",
            "institution": "Duke University, Department of Emergency Medicine, Durham, North Carolina",
            "department": ""
        },
        {
            "first_name": "Alaattin",
            "middle_name": "",
            "last_name": "Erkanli",
            "name_suffix": "",
            "institution": "Duke University, Department of Biostatistics and Bioinformatics, Durham, North Carolina",
            "department": ""
        },
        {
            "first_name": "Charles",
            "middle_name": "V.",
            "last_name": "Pollack",
            "name_suffix": "",
            "institution": "University of Mississippi Medical Center, Department of Emergency Medicine, Jackson, Mississippi",
            "department": ""
        },
        {
            "first_name": "Stephanie",
            "middle_name": "A.",
            "last_name": "Eucker",
            "name_suffix": "",
            "institution": "Duke University, Department of Emergency Medicine, Durham, North Carolina",
            "department": ""
        }
    ],
    "date_submitted": "2023-06-22T14:20:37Z",
    "date_accepted": "2024-06-13T21:51:15.931000Z",
    "date_published": "2024-09-24T13:00:00Z",
    "render_galley": {
        "label": "Final Article",
        "type": "pdf",
        "path": "https://journalpub.escholarship.org/westjem/article/18380/galley/26474/download/"
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            "label": "Layout",
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            "path": "https://journalpub.escholarship.org/westjem/article/18380/galley/24579/download/"
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        {
            "label": "Final Article",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/18380/galley/26474/download/"
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}