Medicine use during acute and chronic post-injury periods in whiplash injured individuals.

Medicine use as part of multimodal management for whiplash-associated disorders (WAD) is common: neck pain is the cardinal symptom, mental health conditions are common, and some individuals may have neurological signs and symptoms. Almost half of WAD individuals have on-going pain and disability. However, medicine use during acute and chronic recovery periods for WAD management is unknown. We analysed medicine use during acute (<12 weeks) and chronic (12 weeks - 2 years) post-injury periods in adults claiming compensation for WAD in the no-fault jurisdiction of Victoria, Australia (n=2871). Compared with males, females were more likely to have only non-opioid analgesics and/or NSAIDs claims during the acute post-injury period (odds ratio = 1.35 [95% confidence interval, 1.08 to 1.68]). Whereas, high medicine use was more likely in males (1.39 [1.16 to 1.67]), middle-aged claimants (35-44 years) (1.74 [1.12-2.56]), and claimants with a common law claim (2.96 [2.38 to 3.68]). During both acute and chronic post-injury periods, over half of pharmaceutical claimants were prescribed NSAIDs and weak opioid medicines, and over one quarter were prescribed benzodiazepines. Antidepressant use was high during the chronic period. The proportion of strong opioid claimants quadrupled between 2000/2001 (5.5%) and 2012/2013 (23.4%). Opioid consumption, expressed as oral morphine equivalent, was double in males than females (z=-5.4, p<.001), and higher in middle aged than younger or older claimants (χ=13.9, p<.001). The high opioid, benzodiazepine, and antidepressant medicine use in the present study is concerning and highlights the need for pharmaceutical approaches that balance pain management while minimising risk.