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Older adults are at higher risk than younger adults for axial pain conditions such as neck and low back pain. A common treatment pathway for patients with axial pain is the emergency department (ED), yet a paucity of research exists on ED treatment and subsequent outcomes for older adults with axial pain. This preliminary analysis investigated the role of age in a common treatment for axial pain in the ED – opioid prescription. Included in this analysis were patients visiting a university health system ED for a new episode of axial pain between January 2013 and December 2017. Patients were categorized based on age group (younger= less than 60 years; older= 60 years and older) and if they were prescribed opioids (yes/no). Differences based on axial pain region (neck/upper back versus low back) were also assessed. Associations between age group and opioid prescription for different axial pain regions were quantified using adjusted odds ratios (OR; 95% CI) derived from logistic regression which accounted for sex and age X axial pain region interaction. A total of 22,684 patients were assessed and the opioid prescription rate was 63%. The opioid prescription rate for older age was 68% and was 62% for younger age. Among those with neck/upper back pain (n=9,809), older age was associated with opioid prescription (1.16; 1.04, 1.28). Similarly, among those with low back pain (n=12,875), older age was associated with opioid prescription (1.44; 1.30, 1.58). Study findings suggest older adults seen in the ED for axial pain may have a greater likelihood of opioid prescription compared to younger adults, particularly for those with low back pain. Future studies among older adults with axial pain seen in the ED will elucidate the influence of opioids on recovery, as well as downstream health risks. [ABSTRACT FROM AUTHOR]

Over 13% of Emergency Department (ED) visits are for musculoskeletal pain, but little is known about ED patients' expectations for pain management and pain-related functional outcomes. This cross-sectional study surveyed adults seeking care at an academic ED with a primary complaint of neck, back or extremity pain. Survey data included the previously validated Patient Centered Outcomes Questionnaire to rate pain interference with activities on a scale of 0 (none) to 100 (worst imaginable) across usual, desired, successful, and expected outcome levels, as well as patient-reported use of various pharmacological and non-pharmacological modalities for pain relief. Responses were analyzed from 106 patients, with mean age 42.4 years (SD 15.6); 52% female; 63% African American and 27% Caucasian. For primary location of pain, 46% identified back, 32% leg, 13% arm, and 11% neck. Median duration of pain was 3 days (IQR 1-7), and 36% reported previous episodes of this pain. Reported median usual pain interference with activities in the past week was 66 (IQR 40-94). Patients desired a median 100% reduction (IQR 89-100%) in interference, but considered 77% reduction successful (IQR 49-100%), and only expected a 52% reduction (IQR 9-91%) after treatment. Most patients were willing to take opioid (73%) and non-opioid (79%) pain medications, despite only 32% having taken an opioid and 55% having taken a non-opioid for pain. Most were also willing to engage in non-pharmacological treatments including direct/passive modalities such as heat, cold packs, acupuncture, and massage (84%); indirect/psychosocial modalities such as music, prayer and meditation (80%); and physical/active modalities such as yoga, exercise, and physical therapy (66%). However, current use of non-pharmacological modalities only ranged from 36-50%. This foundational data highlights an opportunity to incorporate patient perspectives in setting treatment goals and expanding treatment options for integrated, multi-modal pain management in the ED. [ABSTRACT FROM AUTHOR]