Improving Pain Management and Long-Term Outcomes Following High-Energy Orthopaedic Trauma (Pain Study)

Abstract

Poor pain control after orthopaedic trauma is a predictor of physical disability and numerous negative long-term outcomes. Despite increased awareness of the negative consequences of poorly controlled pain, analgesic therapy among hospitalized patients after orthopaedic trauma remains inconsistent and often inadequate. The Pain study is a 3 armed, prospective, double-blind, multicenter randomized trial designed to evaluate the effect of standard pain management versus standard pain management plus perioperative nonsteroidal anti-inflammatory drugs or pregabalin in patients of ages 18-85 with extremity fractures. The primary outcomes are chronic pain, opioid utilization during the 48 hours after definitive fixation and surgery for nonunion in the year after fixation. Secondary outcomes include preoperative and postoperative pain intensity, adverse events and complications, physical function, depression, and post-traumatic stress disorder. One year treatment costs are also compared between the groups.

Opioid Consumption Following Foot and Ankle Surgery

“…1,6,13,17,26 A future multicentered randomized trial, examining pain management regimens with and without NSAIDs and reporting on the rates of chronic pain, opioid consumption, and nonunion, will offer valuable information that can be used to craft appropriate postsurgery pain management plans. 8 While it might prove true that NSAIDs cause higher rates of nonunions in humans when compared with opioids, the complete impact of opioids, including the more sinister potential side effects such as abuse, addiction, diversion, and even death, should be fully considered.…”

Moderate to severe acute pain disturbs motor cortex intracortical inhibition and facilitation in orthopedic trauma patients: A TMS study

“…Orthopedic trauma (OT) patients are routinely afflicted by pain and it is considered the most common and debilitating symptom reported among this population [1,2]. Optimal pain control is an OT care priority as pain interferes with trauma recovery and affects outcome [3,4].…”

Virtual structural analysis of tibial fracture healing from low-dose clinical CT scans

“…The RUST Xray scoring system evaluates visible callus at each of the four cortices to assess healing progress (Whelan et al, 2010). The RUST approach has demonstrable intra-and inter-observer reliability (Leow et al, 2016;Whelan et al, 2010), has been adapted for use in metaphyseal fractures (Litrenta et al, 2015), and has become a commonly used tool in the design of randomized controlled trials (Castillo et al, 2017). The advantage of RUST scoring is that it was designed to capture the development of external callus at the fracture site and has demonstrated utility as a tool to differentiate between united and nonunited fractures (RUST > 10 for union) in clinical studies (Bishop et al, 2012;O'Halloran et al, 2016;Van Houten et al, 2014).…”