(412) Treatment effects of opioids versus NSAIDs prescribed from the emergency department following motor vehicle collision: the impact on pain outcomes at 6 weeks

More than four million Americans present to U.S. Emergency Departments (EDs) each year after motor vehicle collision (MVC). More than 90% of these individuals have acute musculoskeletal pain (MSP), and, while less than 5% have a fracture or require hospital admission, 20-30% transition to chronic MSP. Individuals with acute MSP after MVC are most often discharged with oral non-steroidal anti-inflammatory drugs (NSAIDs) or opioid medications, however optimal medication treatments are poorly defined and the influence of acute medication choices on post-MVC pain trajectory are unknown. In this study we evaluated the effect of opioid versus NSAID medication treatment at the time of ED discharge on the presence of moderate or severe MSP (MSMSP, NRS > 3) six weeks after MVC. Data was obtained from a large prospective cohort of adult European Americans (n=948) who presented to the ED after MVC. Propensity score matched analysis was used to compare the odds of MSMSP at six week follow-up (obtained in 859/948 (91%) among patients discharged with opioid analgesics alone (198/859 (23%)) vs. those discharged with NSAIDs alone (338/859 (39%)). Participants were propensity-matched on demographic and clinical characteristics, baseline pain scores, and MVC characteristics. At 6-weeks, 49% of those receiving NSAIDS and 56% of those receiving opioids reported MSMSP. After propensity matching, there was no significant difference in MSMSP at six weeks between those discharged with opioids vs. those discharged with NSAIDS (OR=0.92; 95% CI 0.33 – 1.51). These results suggest that initial ED provider choice of NSAIDs versus opioid medication at discharge following MVC does not influence the development of MSMSP six weeks after MVC. Supported by NIAMS R01AR056328.