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<< Pain Management in the Emergency Department

Cost Effective Strategies

Inform patients about generic options.
Many pharmacies will automatically substitute a generic drug (i.e., oxycodone/acetaminophen when Percocet™ is prescribed) while filling a prescription; however, patients may not know to look for generic brands of over-the-counter drugs. It is a common habit to refer to TylenolTM or MotrinTM when speaking to patients, but reminding them that acetaminophen and ibuprofen are the same medications can save them money when they purchase their medications.

Consider using oral medications instead of IV.
When patients are intolerant to oral medication there may be no option but to use IV or IM medications. However, if a patient can tolerate oral medications, their administration is less expensive than the parenteral routes. Additionally, it allows assessment of the effectiveness of oral pain control for discharge planning and may decrease return visits to the ED.

Consider using a traditional NSAID and GI protection instead of a COX-2 inhibitor.
It is increasingly difficult to prescribe a COX-2 inhibitor since refocoxib has been withdrawn from the worldwide market and valdecoxib has been withdrawn from the market in the United States. Celebrex™ is still available, although physicians should weigh carefully two factors before prescribing the medication. First, is it safe for this patient to use? Even though there has not been the same evidence on celecoxib increasing cardiovascular risk as has been publicized on refocoxib – the potential risks should still be strongly considered. Patients may be better served by taking a traditional NSAID and either a proton-pump inhibitor or H2-blocker for gastrointestinal protection. Secondly, physicians should also consider their own liability when prescribing a COX- 2 inhibitor, given the legal climate that has surrounded the two drugs no longer available.