Opioid Use and Predicting Factors at the Emergency Department

Study Overview
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Brief Summary
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Background: Increasing opioid misuse is a worldwide problem. About 10% of opioid misusers are primarily exposed to opioids at the Emergency Department (ED). This study was conducted to determine the feasibility for a clinical trial investigating the effect of Virtual Reality therapy on opioid consumption at the ED. Methods: Adult patients were included when primarily seen by the Emergency Physician and presenting with a NRS pain score ≥4. Main objective was to identify the target population and evaluate outcome measures to sustain a trial incorporating the Oral Morphine Equivalent (OME) at the ED as the primary endpoint. Primary outcome was mean OME administered at the ED. Secondary outcomes included NRS pain scores, main symptoms and type of analgesics administered at the ED.

Official Title
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Opioid Use and Predicting Factors at the Emergency Department

Conditions
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Pain, Pain, Acute

Intervention / Treatment
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* Other: Usual care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient ≥16 years admitted to ED and identified by an Emergency Physician (EP) NRS pain score ≥4 Patient is willing and able to comply with the study protocol Exclusion Criteria: Patients initially treated by another physician than the EP. EMV < 14 History of dementia, seizures Severe hearing/visual impairment not corrected Headwounds or damaged skin with which comfortable and hygienic use is not possible. Presentation to ED because of chronic pain (≥3 months) exacerbation Chronic opioids use (≥3 months)

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patient with NRS pain at rest being 4 or higher<br>Patient with NRS pain at rest being 4 or higher, primarily treated by emergency physician, internist, or surgeon. All patients receive usual care, no interventions are administered. | Other: Usual care<br>* Patients received usual care<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Opioid use | Opioids use of patients during their stay at Emergency Department (yes/no) | throughout study participation, up to 8 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Oral morphine equivalent | Doses of opioids received by a patient during their stay at the ED converted to Oral morphine equivalent (OME) | throughout study participation, up to 8 hours | 
| Administered analgesics | Type and dose of all administered analgesics at Emergency Department. | throughout study participation, up to 8 hours | 
| Pain acceptability | Patient opinion on acceptability of their pain at rest upon admittance and discharge | Asked at moment of admittance and at discharge, up to 6 hours after inclusion | 
| Reason why patients finds pain acceptable | Open question | Assessed upon admittance | 
| Patients desire for analgesics | yes/no question whether patient desires analgesics | Asked at moment of admittance and at discharge, up to 6 hours after inclusion | 
| Patients openness to VR | yes/no question to explore patients willingeness to use VR in their situation | Assessed upon admittance | 
| Numaric rating score pain scores at rest | Including whether this is pre/post analgesics | Every 30 minutes until discharge of patient | 
| Numaric rating score anxiety scores | NRS anxiety scores | Every 30 minutes until discharge of patient | 
| Satisfaction with pain management | On a numaric rating scale | Asked at moment of discharge, up to 6 hours after inclusion | 
| Nurse opinion on patient adequacy of pain reporting | Categorical question: understating - adequate - exaggerating | Assessed upon admittance | 
| Duration of ED visit | Duration of ED visit | throughout study participation, up to 8 hours | 
| Analgesics prescriptions | When patient is discharged home prescribed analgesics are registered. | throughout study participation, up to 8 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Emergency Department, Pain at rest, Opioid use