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(550) Association of Medication History With Pain Medication Administration for Abdominal Pain


Ryan Lucas, MPH – Medical Student, Rocky Vista University

Kennon Heard, MD – Professor of Emergency Medicine, University of Colorado Denver-Emergency Medicine

Kennon Heard, MD – Professor of Emergency Medicine, University of Colorado Denver-Emergency Medicine


Background and Objectives: There is significant variation in the treatment of non-specific abdominal pain in the emergency department (ED). Understanding the characteristics of patients who recieve pain medications may provide insight for better treatment. The objective of this study was to identify historical medications (HM) associated with administration of parenteral opioids to patients with abdominal pain.

Methods: A retrospective chart review including adult (age 18-60) emergency department visits with non-specific abdominal pain within a large academic health system. Cases were identified using ICD-10 codes and variables were abstracted from electronic health records. HM were categorized as : antipsychotics, antidepressants, stimulants, opioids, muscle relaxants, gabapentanoids, benzodiazepines, and non-steroidal anti-inflammatory drugs (NSAIDS). We calculated the proportions of patients who received parenteral opioids for each HM and the relative rates (RR) of parenteral opioid administration.

Results: 29,353 ED visits over the study period. The median age was 32 years (range 18-60), 64% were female. 57% were non-Hispanic White, 11% were African American and 22% were Hispanic. Of these patients, 28.3% (n = 8,304) received a parental opioid while 71.7% (n = 21,049) did not. Patients with previously documented opioid prescriptions (35.4%) were more likely to receive parenteral opioids during their ED visit than those without (26.8%; RR 1.3). The same was true for gabapentinoids (44.1% vs. 28.1%; RR 1.6), antidepressants (39.2% vs. 27.8%; RR 1.4), benzodiazepines (38.2% vs. 27.8%; RR 1.4), antipsychotics (36.5% vs. 28.3%; RR 1.3), muscle relaxants (35.2% vs. 28.1%; RR 1.3), and stimulants (33.4% vs. 28.2%; RR 1.2). NSAIDs did not show a similar increase (28.1% vs. 28.3%; RR 1.0).

Conclusion: HM are associated with an increase use of parenteral opioids. Many of these medications are used to manage chronic diseases that predispose individuals to long-term opioid use and abuse including depression, anxiety, psychosis and chronic pain. This study is limited in that there is no method to determine whether increased opioid use associated with certain HM was a result of altered response to pain, altered response to opioids, or provider prescribing bias.

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