Author Interviews, Emergency Care, Pain Research / 19.10.2015

Benjamin W. Friedman MD, MS Department of Emergency Medicine Montefiore Medical Center Albert Einstein College of Medicine Bronx, New YorkMedicalResearch.com Interview with: Benjamin W. Friedman MD, MS Department of Emergency Medicine Montefiore Medical Center Albert Einstein College of Medicine Bronx, New York Medical Research: What is the background for this study? What are the main findings? Dr. Friedman: Low back pain is responsible for 2.4% of visits to emergency departments resulting in 2.7 million visits annually. Pain outcomes for these patients are generally poor. One week after an ED visit in an unselected low back pain population, 70% of patients report persistent back-pain related functional impairment and 69% report analgesic use. Three months later, 48% report functional impairment and 46% report persistent analgesic use. Treatment of  Low back pain with multiple concurrent medications is common in the ED setting. Data from a national sample show that emergency physicians often prescribe NSAIDs, skeletal muscle relaxants, and opioids in combination—26% of patients receive a NSAID combined with a skeletal muscle relaxant and 26% also receive an NSAID combined with an opioid. Sixteen percent of patients receive all three classes of medication. Several clinical trials have compared combination therapy with NSAIDS + skeletal muscle relaxants to monotherapy with just one of these agents. These trials have reported heterogeneous results. The combination of opioids + NSAIDS has not been well evaluated in patients with acute low back pain. Given the poor pain and functional outcomes that persist beyond an ED visit for musculoskeletal LBP and the heterogeneity in clinical care, we conducted a randomized comparative efficacy study with the following objective. To compare pain and functional outcomes one week and three months after ED discharge among patients randomized to a ten day course of: 1) naproxen + placebo 2) naproxen + cyclobenzaprine or 3) naproxen + oxycodone/acetaminophen. (more…)
Author Interviews, BMJ, Pain Research, Rheumatology / 03.04.2015

Gustavo C Machado, PhD student The George Institute for Global Health, Sydney Medical School University of Sydney Sydney AustraliaMedicalResearch.com Interview with: Gustavo C Machado, PhD student The George Institute for Global Health, Sydney Medical School University of Sydney Sydney Australia (Editor’s note: Paracetamol isalso known as acetaminophen) MedicalResearch: What is the background for this study? What are the main findings? Response: Back pain and osteoarthritis are the two major musculoskeletal conditions affecting people worldwide, and paracetamol is the most used over the counter medicine to treat these conditions. Recent debates on the efficacy and safety of paracetamol prompted us to conduct a systematic review of literature on the efficacy of this medication. In our study we included all available clinical trials that compared paracetamol to placebo, and our conclusions are based on data from more than 5,300 patients with low back pain and hip or knee osteoarthritis. We found that paracetamol is ineffective for low back pain and provides small and not clinically important benefits to patients with osteoarthritis. (more…)
Author Interviews, Emergency Care, Pain Research / 06.02.2015

MedicalResearch.com Interview with: Erin R. Schlemmer, MPH Health Care Manager / Epidemiologist Department of Clinical Epidemiology & Biostatistics Blue Cross Blue Shield of Michigan MedicalResearch: What is the background for this study? Response: Low back pain (LBP) is a common reason for emergency department (ED) visits. Usually, uncomplicated acute LBP is a benign, self-limited condition that can be managed without the need for imaging studies. However, national data have shown that a substantial proportion of ED patients with LBP receive imaging studies, and that the use of advanced imaging has increased considerably for this population in recent years. A number of groups (including specialty societies, a consortium of health plan medical directors, and an expert panel of emergency medicine physicians) have offered recommendations for the appropriate use of imaging for Low back pain. Within these guidelines, there are a number of “red flag” conditions that serve as indications for Low back pain imaging, and it is generally accepted that most patients do not require imaging to inform treatment of their Low back pain unless they have one or more red flags. Our objective was to use claims data from a large commercial insurer to describe the imaging indications and imaging status of patients presenting to the ED with Low back pain, and to describe demographic and healthcare use characteristics associated with non-indicated imaging. MedicalResearch: What are the main findings? Response: We found that over half (51.9%) of all patients presenting to the ED with low back pain had no claims-based evidence of indications for imaging. Overall, 36.5% of patients received imaging, and 10.2% received advanced imaging (CT or MRI). Among patients with imaging indications, the most common indication was trauma (71.6%), followed by cancer (24.0%). Although nearly a third of non-indicated patients received imaging, this population had a lower prevalence of imaging compared to patients with imaging indications (30.1% vs. 43.5%), and were also less likely to have prior healthcare use (such as ED visits) in the past year. Among non-indicated patients who received imaging, 26.2% received advanced imaging (CT or MRI) and 4.3% had >1 type of imaging. (more…)