Research Supervisor Connect
Back pain is the 5th most common presentation to Australian emergency departments. Overuse of strong opioids medicines like oxycodone (50% stronger than morphine) is a problem. Current back pain trials do not examine the effects of non-opioid analgesics such as ibuprofen or muscle relaxants in this setting. We propose a trial across five large, diverse emergency departments in NSW and QLD testing multiple non-opioid treatments against the most used opioid to manage back pain in Australia. This trial is funded by an MRFF Acute Care Grant ($3.2 million, CIA Machado).
Camperdown - School of Public Health
Back pain is a major health issue and one of the most common presentations to Australian emergency departments. The challenge is to provide rapid pain relief to relieve patient distress and avoid delays in discharge and unnecessary hospitalisations. The problem is that potentially harmful opioids like oxycodone remain widely used and we lack relevant trial data to guide emergency clinicians’ choice of pain medicines.
We propose a multi-arm multi-stage, non-inferiority, randomised trial including 520 participants with moderate-severe back pain across five emergency departments in NSW and QLD. In ADAPT-ED, we are testing the comparative effectiveness of five active analgesic medicines for back pain in the emergency department. We will randomly allocate participants to receive three days of regular doses of paracetamol 1g plus naproxen 500mg (twice per day), regular doses of naproxen 500mg alone (twice per day), regular doses of prednisolone 25mg (twice per day), or as-needed doses of oxycodone 5mg (maximum 30mg per day).
The primary outcome is change in pain intensity assessed on an 11-point numeric rating scale (NRS) in which 0 denotes no pain and 10 denotes worst imaginable pain, measured from the time of emergency triage (baseline) to two hours after ingestion of study medicine (primary time point). Our team has extensive experience in back pain and emergency medicine trials and will work closely with consumers and partners to deliver this project.
Dr Gustavo Machado is an NHMRC Investigator (EL2) and Robinson Fellow at the Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District. He has published extensively on topics related to musculoskeketal pain, physiotherapy, emergency and pre-hospital care, and public health.
The work he has led is published in top ranking general medical (eg BMJ) and specialist journals (eg Lancet Rheumatology). His papers have been cited over >4800 times (h-index=28), published with editorials, summarised in leading journals (eg NEJM), featured in major media (eg The New York Times), changed guideline recommendations (eg NICE), and awarded prizes and awards, including the 2019 NSW Health Award for Value Based Health Care, the 2022 ANZMUSC Trial of the Year Award, and the 2023 Research Australia Health Services Research Award.
He sits on the Board of the Faculty of Medicine and Health, is a core member of the Emergency Care Institute Research Advisory Committee, member of the RPA Virtual Hospital Research Steering Committee, and member of the Sydney Local Health District Human Research Ethics Committee (HREC). He is also a member of the Health Services Research Association for Australia and New Zealand and has contributed to Early-Mid Career Research Committees from the School of Public Health and the Faculty of Medicine and Health.
The opportunity ID for this research opportunity is 3461