Effect of NSAID Use on Pain and Opioid Consumption Following Distal Radius Fracture

Study Overview
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Brief Summary
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Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are excellent medications for providing pain control in certain patients. There is some data to suggest that NSAIDs can be used to reduce postoperative pain and narcotic use in patients who had undergone carpal tunnel release. There are mixed results about the effect of bone healing in adult patients with broken bones. The investigators hypothesize that NSAID administration in the acute phase of distal radius fracture healing will be non-inferior for pain control and decrease the use of opioid analgesics compared to patients who take acetaminophen for pain control during this same time period. Furthermore, the investigators hypothesize that patients will have similar or better patient reported outcomes, range of motion, and strength with the administration of NSAIDs.

Detailed Description
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In the United States, drug overdose deaths and opioid-involved deaths continue to increase, quadrupling since 1999; six out of ten drug overdose deaths involve an opioid. Overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths. The amount of prescription opioids sold to pharmacies, hospitals, and doctors' offices has drastically risen, yet there had not been an overall change in the amount of pain that Americans reported. Deaths from prescription opioids-drugs like oxycodone, hydrocodone, and methadone-have more than quadrupled since 1999. Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to control both postoperative pain and pain associated with some orthopaedic injuries in children and adults with certain orthopaedic injuries. Further, the use of NSAIDs for pain control has been shown to lessen the use of narcotic pain medications, the adverse effects of which are well known. With the current opioid epidemic, more research is needed to determine strategies to reduce opioid use in patients with orthopaedic injuries. Chapman et al. showed that NSAIDs can be used effectively to reduce postoperative pain and narcotic use in patients who had undergone carpal tunnel release. Although distal radius fractures are one of the most common fractures, no studies have examined the effect of NSAIDs on distal radius fracture pain. The purpose of this study is to compare pain and narcotic pain medication use in patients who have had distal radius fractures in patients who use NSAIDs to those who do not. To the authors' knowledge, there have been no clinical prospective, randomized studies to evaluate the effect that NSAIDs have on patients with distal radius fractures. The investigators hypothesize that NSAID administration in the acute phase of distal radius fracture healing will be non-inferior for pain control and decrease the use of opioid analgesics compared to patients who take acetaminophen for pain control during this same time period. Furthermore, the investigators hypothesize that patients will have similar or better patient reported outcomes, range of motion, and strength with the administration of NSAIDs.

Official Title
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Effect of NSAID Use on Pain and Opioid Consumption Following Distal Radius Fracture: A Prospective, Randomized Study

Conditions
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Distal Radius Fracture

Intervention / Treatment
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* Drug: Ibuprofen
* Drug: Acetaminophen


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 Distal radius fracture Exclusion Criteria: Contraindication to NSAID use (cannot tolerate, gastritis, ulcers, chronic kidney disease stage 4 or higher, bleeding disorders/thrombocytopenia) Inability to take breakthrough medications Regular use of NSAIDs Regular use of Narcotics Open fracture Other orthopaedic injuries (polytrauma) Pathologic fracture Previous injury to the bone Pregnant or plan to become pregnant Unable to sign informed consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Non-operative Acetaminophen<br>Acetaminophen will be given to participants for pain control following their injury. | Drug: Acetaminophen<br>* Control Group - will be administered acetaminophen for pain control with dose and frequency of 325mg 1-2 tablets q4-6h hours as needed, Maximum dose 1000mg. Maximum amount per day: 3g/day.<br>* Other names: tylenol;|
| Active Comparator: Operative Acetaminophen<br>Acetaminophen will be given to participants for pain control following their surgery for arm fracture. | Drug: Acetaminophen<br>* Control Group - will be administered acetaminophen for pain control with dose and frequency of 325mg 1-2 tablets q4-6h hours as needed, Maximum dose 1000mg. Maximum amount per day: 3g/day.<br>* Other names: tylenol;|
| Experimental: Non-operative NSAID<br>Ibuprofen will be given to participants for pain control following their injury. | Drug: Ibuprofen<br>* NSAID Group - will be administered ibuprofen 400-800 mg, up to three times a day as needed for pain control<br>* Other names: Advil;|
| Experimental: Operative NSAID<br>Ibuprofen will be given to participants following their surgery for arm fracture. | Drug: Ibuprofen<br>* NSAID Group - will be administered ibuprofen 400-800 mg, up to three times a day as needed for pain control<br>* Other names: Advil;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intensity of pain: Visual Analog Scale (VAS) | The patient will be asked to report their pain on a scale of 0 - 10 using the Visual Analog Scale with 0 being no pain and 10 being the worst pain the patient can imagine. | 2 weeks | 
| Number of oxycodone tablets | The number and dosing of oxycodone tablets taken per participant for breakthrough pain will be recorded. | 2 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Extent of Wrist Range of Motion (ROM) | The patient will be asked to move their wrist and their ROM will be measured with a goniometer. | 3 month | 
| Quality of Pinch and Grip Strength | The patient will be asked to grip and pinch a dynamometer to measure grip and pinch strength. | 3 months | 
| Quality of Pinch Strength | The patient will be asked to pinch a dynamometer to measure pinch strength. | 3 months |