Does Analgesic Choice in the ED Affect Persistent Pain After Car Crash?

Researchers carried out 284 head-to-head comparisons
Researchers carried out 284 head-to-head comparisons

The choice of analgesic given in the emergency department after a motor vehicle crash does not appear to influence the development of persistent moderate to severe pain six weeks after but it could influence continued use when opioids are prescribed.

Researchers from Brown University, RI, drew their data from a larger study conducted at eight hospitals in Florida, Massachusetts, Michigan and New York between February 2009 and October 2011. The researchers compared cases between two analgesic drug classes (non-steroidal anti-inflammatory drugs [NSAIDs] and opioids) that were as similar as possible. This entailed considering more than 50 variables, including socio-demographic characteristics, to baseline reported pain, areas of pain and patient medical history. This comparison was essential as opioids are prescribed to patients with higher levels of pain at baseline. 

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This analysis allowed for 284 cases to be compared head-to-head. They found that, after six weeks similar patients who were prescribed opioids were 7.2% (95% CI: -5.2,19.5%) more likely to report moderate to severe pain over those who were prescribed NSAIDs. A difference considered not statistically significant.

However, the researchers found a significantly larger risk (Risk Difference = 17.5% (95% CI: 5.8, 29.3%) indicating that people prescribed opioids were still using opioids after six weeks, compared to the NSAID group still using NSAIDs. In all cases patients were initially prescribed a supply of medication to last just a few days.

The authors note that although there was no significant difference in pain risk overall, individualizing treatment is important as patients in the study may have responded differently if given another treatment. Based on the data, they wrote, they could predict: "Approximately one in five individuals would not have persistent moderate or severe pain six weeks after [a crash] if they were prescribed an opioid, but they would have had moderate to severe pain had they been prescribed an NSAID. Conversely, one in four patients would have only experienced such treatment success with an NSAID."

Further research should be aimed towards identifying characteristics that may help predict the best pain therapy for patients.

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