Introduction and general approach to pain

Ducharme, James

doi:10.1017/cbo9780511544835.003

Cited by 1 publication

(1 citation statement)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We based the design and implementation of an opioid reduction initiative in our ED on the concept of channels/enzymes/receptors-targeted analgesia (CERTA) that focuses on patient-specific, pain syndrome-targeted pain control for a variety of acute and chronic painful conditions in the ED ( Appendix 1 ). 24 , 25 The CERTA approach promotes combinations of non-opioid analgesics as first-line treatment modalities when feasible and employs opioids judiciously and predominantly as a rescue. A pilot study of non-opioid analgesic administration conducted in our ED prior to implementation of the opioid reduction initiative demonstrated good pain relief and great patient satisfaction.…”

Section: Methodsmentioning

confidence: 99%

Analgesic Administration for Patients with Renal Colic in the Emergency Department Before and After Implementation of an Opioid Reduction Initiative

Motov

Drapkin

Butt

et al. 2018

WestJEM

View full text Add to dashboard Cite

IntroductionWe aimed to evaluate the patterns of analgesic prescribing for emergency department (ED) patients suffering from pain of renal colic before, during, and after implementation of an opioid reduction initiative. We hypothesized that this initiative based on the concept of channels/enzymes/receptors-targeted analgesia would result in overall decrease in opioid utilization in the ED and at discharge.MethodsWe performed a retrospective analysis of ED electronic medical record of patients presenting with renal colic who received analgesics in the ED and at discharge over a five-year period. Patients were divided into three groups based on the following periods: 2012–2014 (pre-implementation phase); 2014–2015 (implementation phase); and 2015–2017 (post-implementation).ResultsA total of 4,490 patients presented to the ED with renal colic over a five-year study period. Analgesics were administered to 3,793 ED patients of whom 1,704 received opioids and 2,675 received non-opioid analgesics. A total of 3,533 ED patients received a prescription for analgesic(s) upon discharge from the ED: 2,692 patients received opioids, and 2,228 received non-opioids. We observed a 12.7% overall decrease from the pre-implementation to post-implementation time period in opioid prescribing in the ED and a 25.5% decrease in opioid prescribing at discharge, which translated into 432 and 768 fewer patients receiving opioids, respectively.ConclusionImplementation of an opioid-reduction initiative based on patient-specific, pain syndrome-targeted opioid alternative protocols resulted in a reduction in opioid administration in the ED by 12.7% and at prescriptions at discharge by 25.5%. Adoption of similar ED initiatives nationwide has the potential to foster effective non-opioid analgesic practices for ED patients presenting with renal colic and to reduce physicians’ reliance on administering and prescribing opioids.

show abstract

Section: Methodsmentioning

confidence: 99%