New research published in the Annals of Internal Medicine found that nearly 12 percent of individuals diagnosed with an ankle sprain get a prescription for opioids within seven days of diagnosis, but there’s more to this story than just the headline.
For the study, a team of researchers analyzed medical data from nearly 600,000 patients who were diagnosed with an ankle sprain between 2008 and 2016. They found that 11.9 percent of that group filled a prescription for opioids within the first seven days after being diagnosed. Other findings from the study include:
- More than 75 percent of patients were categorized as opioid-naive, or not currently on opioids prior to their ankle sprain diagnosis.
- Of the opioid-naive group, 8.3 percent filled an opioid prescription within seven days of diagnosis.
- Of the opioid-naive group, 8.4 percent became classified as opioid-persistent, using opioids for between 90-180 days post-diagnosis.
- The most commonly prescribed opioids were hydrocodone, tramadol, and oxycodone (62.3, 15.6, and 11.5 percent, respectively).
- Prescriptions were mainly provided by physicians and advanced practice providers (77.4 and 18.9 percent, respectively) in emergency medicine and primary care settings (38.2 and 31.6 percent, respectively).
Dr. Silverman Chimes In
Even an academic center known to have reputable people can put out misleading and incomplete literature. The reality is that most ankle sprains aren’t bad. They don’t need narcotic management for pain control. Generally, Tylenol and anti-inflammatories work just fine, as well as the classic measures of PRICE described in previous posts.
However, some ankle sprains are significant. For example, Grade 3 sprains which are dislocations often involve bony contusions. X-rays of these injuries are negative, which seems to throw these study authors into a fantasy world where the injury couldn’t have been that bad. Ample MRI evidence has been performed and show nondisplaced fractures in these injuries. These injuries are very painful, and I suspect the authors have never suffered such an injury and therefore they have no idea what it might be like to have fractured foot in five places. It doesn’t change the initial non-surgical management, but it most certainly does change the indications for management. Opioids play a crucial role in pain management at the outset of these types of less common sprains.
In my opinion, this is a very irresponsibly performed study. We’re living in a PC world of telling everyone that opioids are all bad. The acute use of opioids in the first few days following such a severe ankle injury is not only indicated, it would be literally cruel not to provide, but that bit of information has been conveniently left out of the study or the conclusions. Instead, we’re fed more rhetoric that opioids are bad and doctors and patients are abusing them.
This pendulum of opioid use needs to swing back to a reasonable position. I agree opioid prescriptions that exceed one week are incredibly rarely needed, as most only need 2-3 days for severe injures. But to imply through a study that all ankle sprains don’t need it further disrespects the soft tissues of the body and does a disservice to the patients who sustain soft tissue injuries where x-rays are negative. Let’s stop picking and choosing our data points to push our narrative and simply work on furthering our understanding of the entire scope of the issue at hand.