title: Impact of morphine use in reducing the need for CT scan in patients with cervical spine trauma: a double blinded randomized clinical trial.
abstract: BACKGROUND
  Cervical spine trauma occurs mostly among young males due to falls and car accidents. The CT scan technology is replacing radiography in many medical clinics as it is very capable in detecting subtle cervical spine injuries. However, the use of CT scan for routine screening in patients with cervical spine trauma remains controversial due to its radiation risks and relatively high cost.
  
  
  OBJECTIVE
  The focus of this research was on using morphine in patients with cervical spine trauma. The objective was to determine the ability of morphine to reduce the number of patients in need of CT scans.
  
  
  METHODS
  This double-blinded randomized clinical trial study was conducted from April 2014 to March 2015 in Hasheminejad Hospital in Mashhad, Iran. We enrolled 67 patients with cervical spine trauma and normal radiography in the study. They were divided randomly into two groups (groups A and B), where group A received intravenous morphine, and group B received a placebo. We measured the pain scores in both groups before giving the medication and 10 minutes afterwards using a visual analog scale (VAS).
  
  
  RESULTS
  As a result of receiving morphine, the patients in group A had significantly lower pain than group B (p-value < 0.001). The average pain score in group A was reduced by 43% versus 23% in group B. However, the most pain reduction was in those in group A with a normal CT scan. The pain score of these patients dropped by 52%.
  
  
  CONCLUSIONS
  The findings of this study suggest that patients with a normal radiography may be discharged with a cervical collar without a need for a CT scan if morphine reduces their pain. This is because the pain in these patients stem from the muscles and non-bony structures in the cervical spine area.
  
  
  BACKGROUND
  The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2013100214872N1.
  
  
  BACKGROUND
  The authors received no financial support for the research or for the publication of this article.
authors.affiliation: M.D of Emergency Medicine, Associate Professor, Department of Emergency, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Mohammad Davood
authors.initials: MD
authors.lastname: Sharifi
authors.affiliation: M.D of Emergency Medicine, Assistant Professor, Department of Emergency, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Hamid Zamani Moghadam
authors.initials: HZ
authors.lastname: Doloo
authors.affiliation: M.D of Emergency Medicine, Associate Professor, Department of Emergency, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Amir Masoud
authors.initials: AM
authors.lastname: Hashemian
authors.affiliation: M.D of Emergency Medicine, Assistant Professor, Department of Emergency, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Javad Tootian
authors.initials: JT
authors.lastname: Tourghabe
authors.affiliation: M.D of Emergency Medicine, Assistant Professor, Department of Emergency, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Behrang Rezvani
authors.initials: BR
authors.lastname: Kakhki
authors.affiliation: M.D of Emergency Medicine, Department of Emergency, Valieasr Hospital, Birjand University of Medical Sciences, Birjand, Iran.
authors.forename: Sasan Johari
authors.initials: SJ
authors.lastname: Teimoori
authors.affiliation: M.D of Emergency Medicine, Assistant Professor, Department of Emergency, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Niaz Mohammad Jafari
authors.initials: NM
authors.lastname: Chokan
authors.affiliation: M.D of Radiology, Assistant Professor, Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Noroozi
keywords: CT scan; Cervical spine; Morphine; Trauma