Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department

Abstract

clinicaltrials.gov Identifier: NCT02455518.

National Variation in Opioid Prescribing and Risk of Prolonged Use for Opioid-Naive Patients Treated in the Emergency Department for Ankle Sprains

“…Nonsteroidal anti-inflammatory drugs, rather than opioids are first-line treatment for ankle sprains 38,39 and are just as effective as opioids in pain reduction. 10 We confirmed that the majority of subsequent prescriptions were unlikely to be related to the initial ankle sprain or chronic ankle pain. This suggests that association between larger prescriptions and increased likelihood of prolonged use could be due to other factors such as patients requesting opioids as default pain control, or the development of dependence or misuse.…”

“…This is concerning because ankle sprains are a minor, self-limited condition for which there is likely to be little clinical benefit from opioids. 10 …”

“…9 Therefore, any risk of subsequent opioid misuse is likely to outweigh the treatment benefit given that non-opioid analgesics have been found to be equally effective for acute pain management. 10,11 Second, although initial opioid prescriptions written in the ED are more consistent with current prescribing guidelines than those from non-ED settings and are typically for smaller quantities, (and thus less likely to progress to long-term use), EDs remain a common source of acute opioid prescriptions. 12,13 Finally, there is still significant variability in opioid prescribing by emergency physicians and patient assignment is essentially random.…”

A target concentration strategy to determine ibuprofen dosing in children

“…An analgesic model for children given ibuprofen after tonsillectomy has been described with a maximum effect ( E MAX ) of 6.5 pain units (Visual analogue scale 0‐10), an effect site concentration ( C e50 ) of 3.95 mg/L and a Hill coefficient of 1.45 . If we assume a reasonable analgesic target effect (TE) of a pain reduction by four pain units then a target concentration (TC) can be calculated:…”

Combination of ibuprofen and acetaminophen is no different than low-dose opioid analgesic preparations in relieving short-term acute extremity pain

“…This was a blinded, randomised-controlled trial comparing single doses of four different oral analgesic preparations (non-opioid and opioid) for the treatment of acute extremity pain in the ED 4. The study was conducted in the USA at two large urban academic EDs.…”