Narcotic Versus Non-narcotic Medication for Pain Management After Wrist/Hand Fractures

Narcotic Versus Non-narcotic Medication for Pain Management After Wrist/Hand Fractures: a Randomized Controlled Trial

The purpose of this study is to evaluate two drug options for pain control in patients following wrist injury. Participants will be randomized to one of the 2 pain relief treatments to determine what treatment provides the most effective pain relief

The purposes of this noninferiority randomized clinical trial are to determine whether: 1. the most commonly used non-narcotic analgesic (ibuprofen 600 mg + acetaminophen 500 mg) provides pain relief that is not unacceptably worse than the most commonly prescribed narcotic (hydrocodone 5 mg + acetaminophen 500 mg) in patients with a hand or wrist fracture. 2. the following covariates affect pain outcomes: sex/gender, age, gender-related pain expectations, paid/unpaid work roles, comorbid health status, baseline pain intensity, and employment status.

Inclusion Criteria:

• All patients 18 and older undergoing non-operative management of a hand or wrist fracture will be considered eligible.
• Able to read and speak English

Exclusion Criteria:

• pain exceeding 7/10 on numeric rating scale or 35/50 on PRWE pain scale at enrollment
• nerve injury
• surgeon decision that surgery is required
• history of chronic opioid use
• documented or suspected substance abuse
• individuals currently on daily use of ibuprofen, acetaminophen or other pain-altering medication including medications like Neurontin (gabapentin) and Ultram (tramadol)
• individuals with documented or suspected chronic pain syndrome, reported allergy or adverse reaction to hydrocodone, acetaminophen, or ibuprofen
• history or symptoms of serious medical problem in the last year (i.e., arrhythmia, impaired cardiovascular function, gastrointestinal bleeding, liver disease, renal disease)
• patients with active peptic ulcer disease (history of severe heartburn)
• symptoms of infection
• pregnant or lactating women
• diagnosis of cognitive impairment
• unable to provide informed consent
• unable or unwilling to fill out the forms
• prior fracture in same hand
• on Coumadin or Plavix
• other medical or psychological health conditions that preclude them from receiving either intervention
• or unable to return for follow-up visits