1. A multimodal pain regimen using generic medications reduced opiate exposure and achieved adequate pain control for adults following trauma.
Evidence Level Rating: 1 (Excellent)
Effective strategies that relieve acute pain without heavy reliance on opiates are needed for patients. This unblinded, randomized, comparative effectiveness trial compared two multimodal pain regimens (MMPR). Patients with acute pain in the setting of trauma were randomized to receive either the originally developed MMPR – consisting of IV, followed by oral, acetaminophen, 48 hours of celecoxib and pregabalin followed by naproxen and gabapentin, scheduled tramadol, and as needed oxycodone – or a generic MMPR, termed MAST MMPR – consisting of oral acetaminophen, naproxen, gabapentin, lidocaine patches, and as needed opiates. The primary outcome was oral morphine milligram equivalents (MME) per day. 1,561 patients presenting to a busy, urban center with trauma were included – 787 to the MMPR regimen (median [IQR] age = 44 (29-63) years, 68% male) and 774 to the MAST MMPR regimen (median [IQR] age = 45 (28-62) years, 67% male). The patients in both cohorts did not differ significantly with regards to demographics, medical history, or presenting injury causing pain. Patients in the MAST MMPR cohort had lower daily opiate exposure when compared with the MMPR cohort (34 MME/day vs. 48 MME/day, p < 0.001). Additionally, patients in the MAST MMPR cohort had a lower total MME exposure (164 MME vs. 218 MME, p < 0.001) as well as a lower rate of opiate prescribing at discharge (62% vs. 67%, p = 0.029). Of note, there was no clinically significant difference in pain scores between the two cohorts. In all, this study demonstrated that for the management of acute pain, a dynamic pain control strategy relying on generic medications is not only opiate sparing but also reduces opiate prescribing at discharge. These data underscore the value of these widely available, opiate-sparing regimens for patients with acute pain.
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