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    Persistent pain after motor vehicle collision: comparative effectiveness of opioids vs nonsteroidal antiinflammatory drugs prescribed from the emergency department-a propensity matched analysis

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    Authors
    Beaudoin, Francesca L.
    Gutman, Roee
    Merchant, Roland C.
    Clark, Melissa A.
    Swor, Robert A.
    Jones, Jeffrey S.
    Lee, David C.
    Peak, David A.
    Domeier, Robert M.
    Rathlev, Niels K.
    McLean, Samuel A.
    Show allShow less
    UMass Chan Affiliations
    Department of Quantitative Health Science
    Document Type
    Journal Article
    Publication Date
    2017-02-01
    Keywords
    Opioid analgesics
    Nonsteroidal antiinflammatory drugs
    Acute pain
    Persistent pain
    Chronic pain
    Motor-vehicle collision
    Causal inference
    Propensity matching
    Emergency Medicine
    Pain Management
    Pathological Conditions, Signs and Symptoms
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    Metadata
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    Link to Full Text
    https://doi.org/10.1097/j.pain.0000000000000756
    Abstract
    Each year millions of Americans present to the emergency department (ED) for care after a motor vehicle collision (MVC); the majority ( > 90%) are discharged to home after evaluation. Acute musculoskeletal pain is the norm in this population, and such patients are typically discharged to home with prescriptions for oral opioid analgesics or nonsteroidal antiinflammatory drugs (NSAIDs). The influence of acute pain management on subsequent pain outcomes in this common ED population is unknown. We evaluated the effect of opioid analgesics vs NSAIDs initiated from the ED on the presence of moderate to severe musculoskeletal pain and ongoing opioid use at 6 weeks in a large cohort of adult ED patients presenting to the ED after MVC (n = 948). The effect of opioids vs NSAIDs was evaluated using an innovative quasi-experimental design method using propensity scores to account for covariate imbalances between the 2 treatment groups. No difference in risk for moderate to severe musculoskeletal pain at 6 weeks was observed between those discharged with opioid analgesics vs NSAIDs (risk difference = 7.2% [95% confidence interval: -5.2% to 19.5%]). However, at follow-up participants prescribed opioids were more likely than those prescribed NSAIDs to report use of prescription opioids medications at week 6 (risk difference = 17.5% [95% confidence interval: 5.8%-29.3%]). These results suggest that analgesic choice at ED discharge does not influence the development of persistent moderate to severe musculoskeletal pain 6 weeks after an MVC, but may result in continued use of prescription opioids. Supported by NIAMS R01AR056328 and AHRQ 5K12HS022998.
    Source
    Pain. 2017 Feb;158(2):289-295. doi: 10.1097/j.pain.0000000000000756. Link to article on publisher's site
    DOI
    10.1097/j.pain.0000000000000756
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/29206
    PubMed ID
    28092325
    Related Resources

    Link to Article in PubMed

    ae974a485f413a2113503eed53cd6c53
    10.1097/j.pain.0000000000000756
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