Fiore M, Nasto LA, McCaffery E, Barletta F, Visconti A, Gargano F, Pola E, Pace MC. Pain management in acute musculoskeletal injury: Effect of opioid vs nonopioid medications. World J Orthop 2024; 15(9): 882-890 [DOI: 10.5312/wjo.v15.i9.882]
Corresponding Author of This Article
Marco Fiore, MD, Doctor, Lecturer, Professor, Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza Miraglia 2, Naples 80138, Italy. marco.fiore@unicampania.it
Research Domain of This Article
Orthopedics
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Sep 18, 2024; 15(9): 882-890 Published online Sep 18, 2024. doi: 10.5312/wjo.v15.i9.882
Pain management in acute musculoskeletal injury: Effect of opioid vs nonopioid medications
Marco Fiore, Luigi Aurelio Nasto, Eleni McCaffery, Fannia Barletta, Angela Visconti, Francesca Gargano, Enrico Pola, Maria Caterina Pace
Marco Fiore, Maria Caterina Pace, Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
Luigi Aurelio Nasto, Enrico Pola, Department of Orthopaedics, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
Eleni McCaffery, Department of Emergency Medicine, New York Presbyterian-Brooklyn Methodist Hospital, New York, NY 11215, United States
Fannia Barletta, Department of Anesthesia and Intensive Care, “San Carlo” Hospital, Potenza 85100, Italy
Angela Visconti, Department of Anaesthesia, "San Giuliano” Hospital, Giugliano 80014, Italy
Francesca Gargano, Unit of Anesthesia and Intensive Care, The Fondazione Policlinico Universitario Campus Bio-Medico, Rome 00128, Italy
Author contributions: Fiore M designed the study and wrote the manuscript; Barletta F and Visconti A evaluated the eligible studies via initial screening; Gargano F prepared the manuscript; McCaffery E performed the English language check; and Nasto LA, Pola E, and Pace MC supervised the research; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest. They did not receive any funding for the work undertaken.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marco Fiore, MD, Doctor, Lecturer, Professor, Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Piazza Miraglia 2, Naples 80138, Italy. marco.fiore@unicampania.it
Received: June 30, 2024 Revised: July 19, 2024 Accepted: August 5, 2024 Published online: September 18, 2024 Processing time: 73 Days and 14.9 Hours
Abstract
BACKGROUND
The use of opioids for pain is linked to an increased risk of developing opioid use disorder, and has resulted in the emergence of the opioid crisis over the last few years.
AIM
The systematic review question is “How does the use of opioid medications in pain management, compared with non-opioid medications, affect pain intensity over the short, intermediate, and long-term in adults with acute traumatic pain?”.
METHODS
The protocol was prospectively registered on the International Prospective Register of Systematic Reviews: CRD42021279639. Medline and Google Scholar were electronically searched for controlled peer-reviewed studies published in full, with the PICO framework: P: Adult patients with traumatic injuries, I: Opioid medications, C: Non-opioid medications, O: A minimum clinically important difference (MCID) in pain.
RESULTS
After full-text screening, we included 14 studies in the qualitative synthesis. Of these 14 studies, 12 were randomized clinical trials (RCTs) and 2 were pseudo-RCTs with a total of 2347 patients enrolled. There was heterogeneity in both medication utilized and outcome in these studies; only two studies were homogeneous regarding the type of study conducted, the opioid used, its comparator, and the outcome explored. The MCID was evaluated in 8 studies, while in 6 studies, any measured pain reduction was considered as an outcome. In 11 cases, the setting of care was the Emergency Department; in 2 cases, care occurred out-of-hospital; and in one case, the setting was not well-specified. The included studies were found to have a low-moderate risk of bias.
CONCLUSION
Non-opioids can be considered an alternative to opioids for short-term pain management of acute musculoskeletal injury. Intravenous ketamine may cause more adverse events than other routes of administration.
Core Tip: Opioid use is linked to an increased risk of developing opioid use disorder. This systematic review question is “How does the use of opioid medications in pain management, compared with non-opioid medications, affect pain intensity over the short, intermediate, and long-term in adults with acute traumatic pain?”. The search was performed using Medline and Google Scholar. We included 14 studies in the final synthesis [12 were randomized clinical trials (RCTs) and 2 were pseudo-RCTs]. Most retrieved studies on the use of non-opioids concluded that non-opioid drugs are non-inferior to opioids for the control of acute pain in acute musculoskeletal injury.
