title: Long-term pain prevalence and health-related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomised controlled trial.
abstract: BACKGROUND
  Improved early pain control may affect the longer-term prevalence of persistent pain. In a previous randomised, controlled trial, we found that the administration of ketamine on hospital arrival decreased pain scores to a greater extent than morphine alone in patients with prehospital traumatic pain. In this follow-up study, we sought to determine the prevalence of persistent pain and whether there were differences in patients who received ketamine or morphine.
  
  
  METHODS
  This study was a long-term follow-up study of the prehospital, prospective, randomised, controlled, open-label study comparing ketamine with morphine in patients with trauma and a verbal pain score of >5 after 5 mg intravenous morphine. Patients were followed-up by telephone 6-12 months after enrollment, and a questionnaire including the SF-36 (V.2) health-related quality of life survey and the Verbal Numerical Rating Scale for pain was administered.
  
  
  RESULTS
  A total of 97/135 (72%) patients were able to be followed-up 6-12 months after enrollment between July 2008 and July 2010. Overall, 44/97 (45%) participants reported persistent pain related to their injury, with 3/97 (3%) reporting persistent severe pain. The prevalence of persistent pain was the same between study groups (22/50 (44%) for the ketamine group vs 22/47 (46%) for the morphine group). There was no difference in the SF-36 scores between study arms.
  
  
  CONCLUSIONS
  There is a high incidence of persistent pain after traumatic injury, even in patients with relatively minor severity of injury. Although decreased pain scores at hospital arrival are achieved with ketamine compared with morphine, this difference does not affect the prevalence of persistent pain or health-related quality of life 6 months after injury. Further larger studies are required to confirm this finding.
  
  
  BACKGROUND
  Australian and New Zealand Clinical Trials Registry (ACTRN12607000441415).
authors.affiliation: Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Ambulance Victoria, Melbourne, Victoria, Australia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Jennings
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Cameron
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Ambulance Victoria, Melbourne, Victoria, Australia The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bernard
authors.affiliation: Ambulance Victoria, Melbourne, Victoria, Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Walker
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Damien
authors.initials: D
authors.lastname: Jolley
authors.affiliation: Ambulance Victoria, Melbourne, Victoria, Australia The Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Fitzgerald
authors.affiliation: Ambulance Victoria, Melbourne, Victoria, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Masci
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D004635:Emergency Medicine / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology; D059408:Pain Management / Q000379:methods; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult
chemical_list: D000700:Analgesics; D007649:Ketamine; D009020:Morphine
keywords: Trauma; analgesia/pain control; emergency ambulance systems