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Pain. 2017 Feb;158(2):289-295. doi: 10.1097/j.pain.0000000000000756.

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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aDepartment of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA Departments of bEpidemiology and cBiostatistics, Brown University, Providence, RI, USA dDepartment of Quantitative Health Science, University of Massachusetts Medical School, Worcester, MA, USA eDepartment of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI, USA fDepartment of Emergency Medicine, Spectrum Health Butterworth Campus, Grand Rapids, MI, USA gDepartment of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA hDepartment of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA iDepartment of Emergency Medicine, St Joseph Mercy Hospital, Yipsilanti, MI, USA jDepartment of Emergency Medicine, Baystate Medical Center, Springfield, MA, USA Departments of k Emergency Medicine and l Anesthesiology, University of North Carolina, Chapel Hill, NC, USA mTRYUMPH Research Program, University Of North Carolina, Chapel Hill, NC, USA.


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.

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