title: Patient-reported Outcomes from A National, Prospective, Observational Study of Emergency Department Acute Pain Management With an Intranasal Nonsteroidal Anti-inflammatory Drug, Opioids, or Both.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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 4 days post-ED discharge. Patients were prescribed a specific 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Charles V
authors.initials: CV
authors.lastname: Pollack
authors.affiliation: Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA.
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Diercks
authors.affiliation: Department of Emergency Medicine, University of Oklahoma College of Medicine, Tulsa, OK.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Thomas
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Nathan I
authors.initials: NI
authors.lastname: Shapiro
authors.affiliation: Department of Pharmacy, Brigham and Women's Hospital, Boston, MA.
authors.forename: John
authors.initials: J
authors.lastname: Fanikos
authors.affiliation: Department of Emergency Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Mace
authors.affiliation: Section of Emergency Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Zubaid
authors.initials: Z
authors.lastname: Rafique
authors.affiliation: Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Knox H
authors.initials: KH
authors.lastname: Todd
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D020911:Ketorolac Tromethamine; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D059408:Pain Management; D010147:Pain Measurement; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D020911:Ketorolac Tromethamine