Researchers Identify Pain Management Strategy That Reduces Opioid Exposure

A study conducted by physician researchers the University of Texas Health Science Center at Houston has found that a new pain management regimen for trauma patients that uses mostly over-the-counter medications reduces opioid exposure while providing a comparable level of pain control as other forms of treatment.

Findings of the study were published last week in the Journal of American College Surgeons.

The study, which involved 1,561 patients, was conducted at the Red Duke Trauma Institute at Memorial Hermann-Texas Medical Center. The patients were divided into groups to assess the effectiveness of two separate combinations of non-opioid pain relievers. The “original” combination, developed in 2013, included intravenous and oral acetaminophen, celecoxib, pregabalin, gabapentin, tramadol and, as needed, oxycodone. While the strategy reduced opioid exposure by 31%, the use of tramadol made not opioid-minimizing.

For the second study group, researchers created a Multi-Modal Analgesic Strategies in Trauma (MAST) regimen that included more affordable and generic medications, including oral acetaminophen, naproxen, gabapentin, lidocaine patches and, as needed opioids.

The MAST group was found to:

• Receive less opioid exposure (34 morphine milligram equivalents vs. 48 for the original group)
• Be more likely to be discharged without an opioid prescription
• Report pain scores that had no clinically significant difference vs. the original group

“Our first hypothesis was that the original regimen would provide better acute pain control because those medications theoretically should have performed better,” John Harvin, MD, MS, associate professor in the Department of Surgery at UTHealth’s McGovern Medical School and the study’s first corresponding author, said in a news release.

“We thought if we could control acute pain better upfront then we could use less narcotics overall, but the MAST regimen achieved equal levels of pain control and overall reduced opioid exposure, likely because it only included opioids as needed. Narcotics do not need to be the first line of therapy for acute pain control.”