Australian back pain trial slashes opioid use

A NSW trial has led to a 24% reduction in opioid prescribing for patients with acute back pain in emergency departments.

Led by researchers and clinicians from the Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, the randomised trial was conducted across four NSW emergency departments, with results published in BMJ Quality and Safety.

The study included almost 4500 patients from Royal Prince Alfred, Canterbury, Concord and Dubbo hospitals, and involved training about 300 clinicians in assessing, managing and referring patients with acute back pain without necessarily prescribing opioids, providing alternatives such as other medicines and heat wraps.

Real-time feedback of prescription use was provided to clinicians using Qlik Sense technology.

Across the four hospitals there was a 12% decrease in opioid use, from 63 to 51%, over the four-month trial. At Canterbury Hospital, opioid use fell from 61% of patients being prescribed opioids to 37%. No increase in patient pain levels, nor any drop in satisfaction with care, was observed, despite clinicians giving out fewer opioid painkillers.

“Every year thousands of Australians are unnecessarily being prescribed opioid painkillers, which can cause addiction, overdose and in some cases even death,” lead author Dr Gustavo Machado said.

“Patients turn up at emergency departments often in incredible pain and discomfort and receive a highly addictive painkiller. It’s meant to be just a short-term fix but in reality, a month later, a third of patients are still taking these pills.

“Emergency departments are incredibly busy places and there is a huge pressure on clinicians to treat people as quickly as possible. Unfortunately there is no easy fix for acute back pain, but providing opioids has a lot of downsides.”

Dr Machado said that the trial demonstrated a safer way to treat acute back pain that can easily be adopted by hospitals across the country, and could help tackle the global opioid epidemic.

Dr Eileen Rogan, senior emergency physician and the Director of Medical Services at Canterbury Hospital, said, “It’s clear there is a better model of care to help people with back pain, and one that does not rely so heavily on opioid painkillers. Our main aim is to make people better and alleviate their pain, not unwittingly place them on a path to addiction.

“Our physicians and nurses embraced this trial because they could see the positive results almost immediately. Patients were happy; they were receiving better care in the emergency department, getting follow-up care if needed, and there was an important drop in the amount of opioid painkillers used.”

Head of Rheumatology at Royal Prince Alfred Hospital Dr Bethan Richards added, “A key aspect of the trial was ensuring clear communication and education of patients as well as fast-track referrals to outpatient services including physiotherapy, primary care and specialist back clinics when required. This trial has significantly changed the way our staff both approach and manage people with back pain. Clinicians have a greater understanding of the unseen harms that can come from prescribing opioids in emergency departments and a new confidence that using alternatives can deliver just as effective and much safer care.”

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