IHO043

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Synopsis

Road traffic injury (RTI) incurs a huge and rapidly increasing worldwide burden. Most RTIs are musculoskeletal, principally neck pain and upper back pain (whiplash). 50% of people with whiplash RTI do not recover, contributing significantly to the Australian burden of chronic pain. Preventing chronic pain has been recognised as an unmet medical need in Australia and internationally. Recommended treatments (advice, exercise, simple analgesics) do little to reduce chronic pain after RTI. Inappropriate prescription of opioids is common. Pregabalin, approved in Australia for neuropathic pain and epilepsy, is increasingly used off-label for acute whiplash. This is despite the lack of supporting evidence and concerns about side effects. Pregabalin blocks the development of pain central sensitization, features of which are associated with poor recovery after whiplash RTI. We recently completed a randomised controlled feasibility trial of pregabalin for acute whiplash initiated within 48 hours of injury in the hospital Emergency Department. The trial was feasible and pregabalin had promising and sustained effects over placebo to prevent chronic pain. Repurposing pregabalin for use in acute injury is a novel approach to prevent chronic pain. We propose a double-blind parallel randomised placebo controlled trial to definitively test whether short term pregabalin prevents chronic pain after acute whiplash injury. Safety and cost-effectiveness of the intervention will be determined. A mixed methods process evaluation to provide detailed understanding of implementation and mechanisms of effect (mediators) will be conducted. We have included consumers and end-users (clinicians, policy makers) in the refining and piloting of the treatment and they will play a central role throughout the project. Any treatment that can prevent chronic pain after injury will have a profound and significant effect on public health and cost of Australia and the world’s most burdensome condition.