Research suggests that opioid treatment for abdominal pain, which comprises a large
proportion of patients presenting to the emergency department (ED), may contribute
to long-term opioid use without significant benefits with regard to symptom management.
This study seeks to assess the association between opioid use for management of abdominal
pain in the ED and return ED visits for abdominal pain within 30 days for patients
discharged from the ED at initial presentation.
We conducted a retrospective, multi-center observational study of adult patients presenting
to and discharged from 21 EDs with a chief concern of abdominal pain between November
2018 and April 2020. The proportion of 30-day return visits to the ED for patients
who received opioid analgesics was compared to a reference group of patients who only
received acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), or both.
Of the 4,745 patients, 1,304 (27.5%) received opioids while 1,101 (23.2%) only received
either acetaminophen, NSAIDs, or both. Among those given opioids, 287 (22.0%) returned
to the ED for abdominal pain within 30 days, compared to 162 (14.7%) of those in the
reference group (OR 1.57 [1.27-1.95], p-value <0.001).
Patients given opioids for abdominal pain in the ED had 57% increased odds of a return
ED visit within 30 days compared to those given only acetaminophen and/or NSAIDs.
This warrants further research on the use of nonopioid analgesics in the ED, especially
in patients with anticipated discharge.