Low-Dose Short-Term Ketorolac to Reduce Opioid Use and Pain Scores on Orthopaedic Polytrauma Patients
Abstract
Post-traumatic pain (PTP) often occurs immediately following musculoskeletal injury and can last throughout the early recovery phase. In polytrauma patients, or patients who have experienced injuries to multiple body parts and organ systems, this pain is often severe and can be difficult to manage. Opioids remain the primary treatment for PTP but, unfortunately, are associated with a number of complications, such as long-term use, addiction, dependence, and the potential risk for overdose. The overuse of opioids and the potential for abuse have led to the current opioid epidemic and the need for alternative non-addictive PTP medications that can adequately manage patients pain. The authors previously showed that the use of a low-dose nonsteroidal anti-inflammatory (NSAID), ketorolac, can reduce short and mid-term opioid use and pain. The proposed study looks to test whether this same medication can also reduce the rate of chronic opioid use. Additionally, this study will look to address whether inpatient NSAID treatment improves the functional response to pain. Therefore, the proposed study addresses the fiscal year 2022 PRORP Focus Area Retention Strategies, with an emphasis on rehabilitation and return to duty within one year of injury. Patients from two busy trauma hospitals who have sustained polytraumatic orthopaedic injuries will be recruited over a three-and-a-half-year period to participate in this study. The last half-year will be used to interpret and gather the remaining data. Half of the patients will be randomized to receive ketorolac (treatment group), and the other half (control group) will receive the same volume and frequency of treatment without ketorolac. The endpoints of interest will include inpatient 24-hour morphine dose equivalence scores; short- and long-term opioid use; and multiple patient-reported outcome scores that measure pain, ability to return to work, and ability to return to activities of daily living. Even if the ketorolac treatment does not decrease chronic opioid use or improve patient reported outcomes, a mediation analysis will be performed and can help understand the reasons why the intervention did not have the intended effects. The authors hypothesize that the treatment group will have decreased short- and long-term opioid use with improved pain control and better ability to return to activities of daily living and work. Military and civilian personnel who sustain polytrauma can have significant PTP that limits prompt rehabilitation and further delays one s return to work. Patients can become heavily reliant on opioid medication, with a higher likelihood of developing chronic PTP. Defining other pain management modalities that can better treat PTP, decrease opioid dependence, and hasten recovery time is critical. This study has the potential to address the challenging issue of PTP, while minimizing acute and chronic opioid intake. It may also improve patients ability to return to duty and shorten recovery time following their polytraumatic injuries. Therefore, this study has the potential to change the overall pain management landscape, allowing for shorter hospital length of stay, mitigating delays in rehabilitation, decreasing opioid dependence, and improving our knowledge as we strive to help patients return to duty.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310413
Entities
People
- Arun Aneja
Organizations
- United States Army
- University of Kentucky