RT Journal Article
SR Electronic
T1 Secondary analysis of the SHaPED trial: shifting away from opioids to simple analgesics for emergency care of low back pain
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 6832
DO 10.1370/afm.22.s1.6832
VO 22
IS Supplement 1
A1 Côté-Picard, Claudia
A1 Maher, Chris
A1 Machado, Gustavo
A1 Coombs, Danielle
A1 Li, Qiang
YR 2024
UL http://www.annfammed.org/content/22/Supplement_1/6832.abstract
AB Context: The SHaPED trial implemented a model of care for low back pain in emergency departments and resulted in a 12.3% reduction in the prescription of opioids (OR 0.57, 95% CI 0.38–0.95) without compromising patient outcomes. However, the original analyses did not look if the decrease in opioid use led to a greater use of the recommended analgesics (e.g. non-steroidal anti-inflammatory drugs-NSAIDs).Objective: To determine the effects of the SHaPED intervention on the use of non-opioid pain medicines in the management of low back pain in emergency departments.Study Design: This is a secondary analysis of a stepped-wedge cluster-randomised controlled trial.Setting: SHaPED was a multi-centre trial that took place in four emergency departments of NSW, Australia.Population Studied: Emergency department clinicians (physicians, nurses and physiotherapists) (n=269) and patients aged 18 years and older who presented to an emergency department with non-specific or radicular low back pain (n=4,625) were included.Intervention: The SHaPED trial used a multifaceted clinician-targeted 4-week intervention to encourage guideline-adherent care that included educational seminars and materials, provision of non-opioid pain management strategies, education on referral to outpatient services and audit and feedback.Outcome Measures: The main outcome of this secondary analysis was the proportion of low back pain episodes treated exclusively with NSAIDs, paracetamol, or a combination of the two. Secondary outcomes were the proportion of LBP presentations receiving each class of non-opioid pain medicines (paracetamol, NSAIDs, muscle relaxants, corticosteroids, benzodiazepines, antiepileptics, and antidepressants), administered alone or in combination with opioids and/or non-opioids.Results: There was a 7.1% absolute increase in the proportion of low back pain episodes treated solely with the combination of NSAIDs and paracetamol (OR 2.05, 95% CI 1.16-3.65), a 1.4% absolute increase in the use of NSAIDs alone (OR 3.05, 95% CI 1.24–7.52), and an absolute decrease of 2.3% in the prescriptions of benzodiazepines (OR 0.42, 95% CI 0.20–0.86).Conclusions: These secondary analyses of the SHaPED trial provide the first randomised evidence that a shift in the prescribing pattern of pain medicine away from opioids and towards simpler and safer analgesics for the emergency care of low back pain is possible.