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Opioids vs NSAIDs Following Motor Vehicle Collision

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Many patients with motor vehicle accidents experience acute musculoskeletal pain, which transforms to persistent pain in approximately 40% of cases.

A study comparing opioids with nonsteroidal anti-inflammatory drugs (NSAIDs) prescribed for pain following a motor vehicle collision (MVC) found that opioids do not reduce the likelihood of developing persistent pain. In addition, opioids may lead to chronic prescription opioid use after discharge from the emergency department (ED). The study results were published in Pain.1

In the United States, nearly 4 million people are treated in an ED after a MVC every year, the majority of whom are discharged.2,3 Many of these patients experience acute musculoskeletal pain, which transforms into persistent pain in approximately 40% of cases.4

Opioid or NSAID analgesics are often prescribed in the ED for post-MVC pain, but studies investigating their efficacy on persistent pain outcomes are limited. While opioids may provide greater analgesia than NSAIDs in the acute setting, patients to whom they have been prescribed may become chronic users, and experience hyperalgesia. Although the risk of hyperalgesia may be lower with NSAIDs, these drugs may not improve persistent pain outcomes.1

Francesca L. Beaudoin, MD of Brown University in Providence, Rhode Island, and colleagues examined whether opioid vs NSAID use had an impact on the development of persistent moderate-to-severe musculoskeletal pain 6 weeks following an MVC.

Of 948 patients evaluated in an ED after an MVC, follow-up data was obtained for 213 patients who were prescribed an opioid and 260 who were prescribed a NSAID.

At 6 weeks, no difference in the rates of persistent moderate-to-severe musculoskeletal pain was found between the groups.

Despite the similar risk of persistent pain in both groups, patients treated with opioids were more likely to report ongoing opioid use at 6 weeks than patients treated with NSAIDs (risk difference, 17.5%, 95% CI: 5.8%-29.3%).

Using innovative statistical techniques, the investigators predicted treatment success on an individual level based on treatment type. “We found that there appear to be individuals who would respond to one treatment and not the other, such as an NSAID over an opioid or vice versa,” Dr Beaudoin said in an interview with Clinical Pain Advisor.

Summary and Clinical Applicability

After an MVC, many patients are discharged from the ED with prescription opioids or NSAIDs for acute musculoskeletal pain. However, the effect of either treatment on the development of persistent musculoskeletal pain has not been clearly established.

Researchers found that opioid use did not improve rates of persistent pain after discharge from the ED, compared with NSAIDs, and may result in chronic opioid use. In addition, they showed that some patients are more likely to respond to one type of treatment over another.

“These findings alone are not enough to change clinical practice and to recommend one treatment over the other,” Dr Beaudoin said. “Rather, they should prompt providers to think about the individual patient when prescribing. This work begs the question: ‘What is the best treatment, who is it best for, and under what conditions?’”

Limitations

The results of this study may not be generalizable to patients receiving care after an MVC in settings other than an ED.

The effect of analgesic doses and “as needed” prescription regimens were not evaluated in this study.

References

  1. Beaudoin FL, Gutman R, Merchant RC, et al.Persistent pain after motor vehicle collision: comparative effectiveness of opioids vs nonsteroidal antiinflammatory drugs prescribed from the emergency department-a propensity matched analysis.Pain. 2017;158(2):289-295. doi: 10.1097/j.pain.0000000000000756
  2. Gopinath B, Jagnoor J, Harris IA, et al.Comparison of health outcomes between hospitalised and non-hospitalised persons with minor injuries sustained in a road traffic crash in Australia: a prospective cohort study.BMJ Open.2015;5(9):e009303. doi: 10.1136/bmjopen-2015-009303
  3. Niska R, Bhuiya F, Xu J. National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary.Natl Health Stat Report. 2010;(26):1-31.
  4. McLean SA, Ulirsch JC, Slade GD, et al.Incidence and predictors of neck and widespread pain after motor vehicle collision among US litigants and nonlitigants. Pain. 2014;155(2):309-321. doi: 10.1016/j.pain.2013.10.016

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