PRioRTI: PReventing chronic pain after Whiplash Road Traffic Injury Project

Vision and Aim

Our VISION for this project is to develop evidence-based targeted treatments to prevent chronic pain and revolutionise the early management of musculoskeletal injury.

Funded by a Medical Research Future Fund grant awarded to Professor Michele Sterling and team, this project aims to trial the use of pregabalin for use in acute injury resulting from musculoskeletal spinal (neck and/or back) pain following non-catastrophic road traffic injury (RTI).

Purpose

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.

The aim of this project is to conduct a randomised controlled trial to:

1. Determine the clinical and cost-effectiveness of a short course of pregabalin commenced in the Emergency Department and transitioned to primary care on clinical outcomes at 6 weeks, 3-, 6-, and 12-months post‑whiplash injury in patients ‘at-risk’ of poor recovery.

2. Conduct a mixed methods process evaluation to provide detailed understanding of barriers/facilitators to implementation from perspectives of patients and clinicians and mechanisms of effect (mediators).