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Medicine use during acute and chronic postinjury periods in whiplash-injured individuals

Ritchie, Carriea,b,*; Hollingworth, Samantha A.c; Warren, Jacellea,b; Sterling, Michelea,b

doi: 10.1097/j.pain.0000000000001460
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Medicine use as part of multimodal management for whiplash-associated disorders (WAD) is common: neck pain is the cardinal symptom, mental health conditions are common, and some individuals may have neurological signs and symptoms. Almost half of the individuals with WAD have ongoing pain and disability. However, medicine use during acute and chronic recovery periods for WAD management is unknown. We analysed medicine use during acute (<12 weeks) and chronic (12 weeks to 2 years) postinjury periods in adults claiming compensation for WAD in the no-fault jurisdiction of Victoria, Australia (n = 2871). Compared with males, females were more likely to have only nonopioid analgesic and/or NSAID claims during the acute postinjury period (odds ratio = 1.35 [95% confidence interval: 1.08-1.68]). However, high medicine use was more likely in males (1.39 [1.16-1.67]), middle-aged claimants (35-44 years) (1.74 [1.12-2.56]), and claimants with a common law claim (2.96 [2.38-3.68]). During both acute and chronic postinjury periods, over half of the pharmaceutical claimants were prescribed NSAIDs and weak opioid medicines, and over one quarter were prescribed benzodiazepines. Antidepressant use was high during the chronic period. The proportion of strong opioid claimants quadrupled between 2000/2001 (5.5%) and 2012/2013 (23.4%). Opioid consumption, expressed as oral morphine equivalent, was double in males than in females (z = −5.4, P < 0.001), and higher in middle-aged than in younger or older claimants (χ2 = 13.9, P < 0.001). The high opioid, benzodiazepine, and antidepressant medicine use in this study is concerning and highlights the need for pharmaceutical approaches that balance pain management while minimising risk.

The high opioid, benzodiazepine, and antidepressant medicine use in acute and chronic whiplash management highlights the complexity of medicine use in these individuals.

aRecover Injury Research Centre, The University of Queensland, Herston, Queensland, Australia

bNational Health and Medical Research Council (NHMRC), Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Queensland, Australia

cSchool of Pharmacy, The University of Queensland, Herston, Queensland, Australia

Corresponding author. Address: Recovery Injury Research Centre, The University of Queensland, Level 7, Oral Health Centre, 288 Herston Rd, Herston, Queensland 4006, Australia. Tel.: +617 33464781. E-mail address: c.ritchie@uq.edu.au (C. Ritchie).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received August 22, 2018

Received in revised form November 27, 2018

Accepted December 04, 2018

© 2019 International Association for the Study of Pain
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