NSAIDs, Opioids Found Similar for Chronic Pain Risk After Vehicular Accidents

http://www.painmedicinenews.com/ViewArticle.aspx?ses=ogst&d=Clinical+Pain+Medicine&d_id=82&i=August+2015&i_id=1211&a_id=33228

According this doctor and her colleagues CHRONIC MODERATE PAIN starts at “3” on the pain scale.. how many prescribers are happy with leaving pain pts with a “5” or higher on the pain scale and refusing to attempt to lower their pain any further ? So are they leaving pts in severe pain ?

There are no significant differences between giving nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids to patients in the emergency department (ED) with regard to their risk for developing chronic pain after motor vehicle accidents, a new study suggests.

Individuals presenting to EDs after vehicular accidents have a high risk for developing chronic pain from the physical and emotional trauma they experience, according to researchers from Alpert Medical School of Brown University, in Providence, R.I. The team of emergency physicians and pain specialists sought to assess whether prescriptions for opioid analgesics versus NSAIDs received on discharge affected these patients’ risk for chronic pain.

“These patients are at very high risk for development of chronic pain, likely due to the mechanics of their injury and the emotional stress involved,” said study author Francesca L. Beaudoin, MD, MS, assistant professor of emergency medicine at Alpert Medical School and Rhode Island Hospital/Miriam Hospital, also in Providence. “Some studies say that as many as 40% of patients following motor vehicle crashes will develop either persistent pain or chronic pain. Given that, there’s probably a lot more we can do in the ED to prevent onset of chronic pain.”

Dr. Beaudoin and her colleagues evaluated the effect of medication treatment for moderate or severe musculoskeletal pain (defined as a numeric rating scale score >3) at the time of ED discharge in patients six weeks after a motor vehicle accident. There were 948 adults who presented to the ED following a crash. The team was able to obtain data from 859 patients. They found that 49% of patients receiving NSAID prescriptions and 56% of patients receiving opioid prescriptions reported moderate or severe musculoskeletal pain.

The team used propensity score matched analysis to compare the odds of moderate or severe musculoskeletal pain at follow-up among patients discharged with prescriptions for opioid analgesics alone (n=198) and prescriptions for NSAIDs alone (n=338). The researchers found that there was no significant difference in moderate or severe musculoskeletal pain between the treatment groups.

“As emergency physicians, we want to know that what we’re giving people as they leave the ED has a positive effect on outcomes, and obviously that’s within the context of the ongoing debate regarding appropriate use of opioids,” Dr. Beaudoin said. “So we want to know if we are appropriately prescribing opioids, but also if whatever we are giving works.”

The findings of this study add to the growing amount of research that could be interpreted as questioning current opioid prescribing patterns. Dr. Beaudoin told Pain Medicine News that about 33% of motor vehicle crash victims in her ED receive prescriptions for opioids (alone or in combination with NSAIDs). She added that there currently seemed to be no standard approach for pain prescribing in these patients, and that “best practice” guidelines may be needed.

Lynn Webster, MD, a pain specialist and medical director of CRI Lifetree, and past president of the American Academy of Pain Medicine, agreed, noting that the study, as presented, had too many limitations for it to play any role in guiding future treatment decisions.

“It shouldn’t influence what is prescribed,” said Dr. Webster, a Pain Medicine News editorial advisory board member, who was not involved in the study. “Certainly, opioids should not be prescribed to anyone in whom an NSAID would be sufficient and safe. I don’t see how this study changes that paradigm.”

This study is supported by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. It is part of a larger research project on chronic pain following motor vehicle accidents being performed by the same team. The findings were presented at the American Pain Society’s 2015 annual meeting (abstract 412).

 

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