Relationship Between Pain Management Modality and Return Rates for Lower Back Pain in the Emergency Department

J Emerg Med. 2021 Jul;61(1):49-54. doi: 10.1016/j.jemermed.2021.01.022. Epub 2021 Feb 23.


Background: Emerging evidence suggests that opioid use for patients with acute low back pain does not improve functional outcomes and contributes to long-term opioid use. Little is known about the impact of opioid administration in the emergency department (ED) for patients with low back pain.

Objectives: This study compares 30-day return rates after administration of various pain management modalities for emergency department (ED) patients with low back pain.

Methods: We conducted a retrospective multicenter observational study of patients in the ED who were diagnosed with low back pain and discharged home in 21 EDs between November 2018 and April 2020. Patients were categorized based on the pain management they received in the ED and compared with the reference group of patients receiving only nonsteroidal anti-inflammatory drugs, acetaminophen, or a combination of the two. The proportions of ED return visits within 30 d for each medication category was calculated and associations between analgesia categories and proportions of return visits were assessed using logistic regression models to obtain odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Patients with low back pain who received any opioid, intravenous opioid, or intramuscular opioid had significantly increased proportions of a return visit within 30 d (32% [OR 1.78 {95% CI 1.21-2.64}]; 33% [OR 1.83 {95% CI 1.18-2.86}]; and 39% [OR 2.38 {95% CI 1.35-4.12}], respectively) when compared with patients who received nonsteroidal anti-inflammatory drugs (19%), acetaminophen (20%), or a combination of the two (8%).

Conclusions: Patients receiving opioids were more likely to return to the ED within 30 d than those receiving received nonsteroidal anti-inflammatory drugs or acetaminophen. This suggests that the use of opioids for low back pain in the ED may not be an effective strategy, and there may be an opportunity to appropriately treat more of these patients with nonopioid medications.

Keywords: analgesics; emergency; low back pain; opioids; return rates.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Analgesics, Opioid / therapeutic use
  • Emergency Service, Hospital
  • Humans
  • Low Back Pain* / drug therapy
  • Pain Management
  • Retrospective Studies


  • Analgesics, Opioid