How Much Opioids Do You Need After Your Emergency Department Visit

NCT ID: NCT02799004

Last Updated: 2019-05-10

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 761 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2016-06-07
• Study Completion Date: 2018-09-30

Brief Summary

Pain is one of the most common complaints in emergency department (ED) and is still often poorly managed. A major prospective multicenter study reported that 74% of patients that had a pain complaint at ED triage are discharged in moderate to severe pain. Accordingly, physicians frequently prescribed analgesic after discharged for these patients, and opioid is given in 29% of ED visits involving pain complaints. However, few studies evaluate pain management after ED discharge: the frequency and length of opioids prescriptions, the opioids quantity taken by the patients, are the patients relieved and satisfied by these pain treatments, what are the adverse effects associated with the use of these medications, and what are the chances of developing addiction?

The primary aim of this study is to determine the required minimal opioids prescription for patients treated for acute pain after being discharge from the ED. Secondary objectives include: 1) monitor the patients' adverse events during opioids treatment; 2) evaluate the patients' level of pain relief associated with their respective opioids treatment; 3) determine the patients' level of addiction following post-ED opioids treatments.

The design of the project is a prospective observational cohort study. A cohort of consecutive ED patients aged 18 or more with an initial pain at triage of 4 or more and discharged from the ED in less than 48 hours with a prescription of opioid will be asked to participate in the study. Patients will be excluded if there is ongoing treatment for a pre-existing chronic pain condition or if they used opioid drugs in the past year. Research nurses will contact the patients by phone at three follow-up time points (1 week, 1 month, and 3 months). Follow-up phone interviews will evaluate pain intensity as well as pain treatment satisfaction (0-10 NRS), monitor adverse events, and investigate possible opioids addiction (SOWS: subjective opioid withdrawal scale). During these interviews, the nurses will also question the patients about their daily opioids usage and if they were relieved from pain.

This study will provide the base for future guidelines regarding the prescription of opioids treatment for specific pathology encountered in ED. It will also give indications on how to adjust the treatments according to adverse events and the level of addiction experienced by patients.

Conditions

Acute Pain

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

Patients in acute pain

No interventions assigned to this group

Eligibility Criteria

Inclusion Criteria

• 18 years and older
• Pain level at 4 or greater at triage
• Acute pain (2 weeks or less)
• Opioids prescription at discharge

Exclusion Criteria

• Language barrier
• Pregnancy
• Treated for chronic pain
• Hospital stay greater than 48 hours

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Centre Integre Universitaire de Sante et Services Sociaux du Nord de l'ile de Montreal

OTHER

Sponsor Role: lead

Responsible Party

Raoul Daoust

Researcher and Associate Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Raoul Daoust, MD MSc

Role: PRINCIPAL_INVESTIGATOR

Université de Montréal

Locations

Hopital du Sacre-Coeur de Montreal

Montreal, Quebec, Canada

Countries

Canada

References

Daoust R, Paquet J, Cournoyer A, Piette E, Morris J, Lessard J, Lavigne G, Chauny JM. Relationship between acute pain trajectories after an emergency department visit and chronic pain: a Canadian prospective cohort study. BMJ Open. 2020 Dec 7;10(12):e040390. doi: 10.1136/bmjopen-2020-040390.

Reference Type: DERIVED

PMID: 33293313 (View on PubMed)

Daoust R, Paquet J, Gosselin S, Lavigne G, Cournoyer A, Piette E, Morris J, Castonguay V, Lessard J, Chauny JM. Opioid Use and Misuse Three Months After Emergency Department Visit for Acute Pain. Acad Emerg Med. 2019 Aug;26(8):847-855. doi: 10.1111/acem.13628. Epub 2019 Jul 18.

Reference Type: DERIVED

PMID: 31317619 (View on PubMed)

Daoust R, Paquet J, Cournoyer A, Piette E, Morris J, Lessard J, Castonguay V, Williamson D, Chauny JM. Side effects from opioids used for acute pain after emergency department discharge. Am J Emerg Med. 2020 Apr;38(4):695-701. doi: 10.1016/j.ajem.2019.06.001. Epub 2019 Jun 3.

Reference Type: DERIVED

PMID: 31182367 (View on PubMed)

Daoust R, Paquet J, Cournoyer A, Piette E, Morris J, Lessard J, Castonguay V, Lavigne G, Chauny JM. Acute Pain Resolution After an Emergency Department Visit: A 14-Day Trajectory Analysis. Ann Emerg Med. 2019 Aug;74(2):224-232. doi: 10.1016/j.annemergmed.2019.01.019. Epub 2019 Feb 21.

Reference Type: DERIVED

PMID: 30797575 (View on PubMed)

Daoust R, Paquet J, Cournoyer A, Piette E, Morris J, Gosselin S, Emond M, Lavigne G, Lee J, Chauny JM. Quantity of opioids consumed following an emergency department visit for acute pain: a Canadian prospective cohort study. BMJ Open. 2018 Sep 17;8(9):e022649. doi: 10.1136/bmjopen-2018-022649.

Reference Type: DERIVED

PMID: 30224393 (View on PubMed)

Other Identifiers

2016-1271

Identifier Type: -

Identifier Source: org_study_id