Opioid Analgesics for Acute Fracture Pain in Adults Discharged From the ED
Status:
Terminated
Trial end date:
2019-09-17
Target enrollment:
Participant gender:
Summary
Background: Emergency department (ED) providers are frequently challenged with how best to
treat acute pain, specifically when non-opioid analgesics are insufficient or
contraindicated. Studies have documented older patients presenting to the ED with painful
conditions are less likely to receive pain medications than younger patients, and this
inadequate pain control has been associated with increased risk of delirium and longer
hospital stays. Given the concerns for drug interactions, adverse side effects, over-sedation
and addiction; emergency physicians often report uncertainty regarding the ideal choice of
opioid analgesic in older adults. There are no guidelines informing best practice for the
management of acute pain in this population.
Objective: The primary objective is to compare the efficacy of codeine, oxycodone and
hydromorphone for acute fracture pain in patients discharged from the ED.
Methods: This will be a blinded, randomized controlled trial of adults (age ≥ 18) discharged
home from the ED with acute pain secondary to an upper extremity, lower extremity, rib,
pelvic or vertebral compression fracture. Patients will be randomized to receive a 3-day
supply of codeine, oxycodone or hydromorphone. Patients will also be given acetaminophen.
Patients will be contacted by phone or email 3 days following their ED visit. The primary
outcome will be differences in pain scores at 3 days assessed using the validated Brief Pain
Inventory (Short Form). Secondary outcomes will include side effects (ie: confusion,
constipation), adverse events (i.e, falls, healthcare visits) and pain interference with
daily activity. Patients, physicians and all research staff will be blinded to group
allocation.
Importance: All analgesics (including opioids) prescribed to adults are associated with an
increased risk of adverse events. This study seeks to inform ED providers of opioid efficacy,
side effects and patient-important, functional outcomes in this growing patient population.