867 The Effect of Financial Reward on Opioid Use After Thermal Injury to the Upper Extremity

Abstract Introduction The widespread use of opioids for the treatment of pain has come under progressive scrutiny in an attempt to address multiple unintended consequences. Despite multiple psychological, social, biological, and legal factors that contribute to pain management strategies, narcotics remain a mainstay for the treatment of burn-pain. As efforts are underway to test novel methods for mitigating pain, it is essential to clearly define models for testing these tools and strategies. This study examines the impact of financial incentives alone on the use of opioids at a single center. Methods Patients with thermal injury to the upper extremity, managed as outpatients, no more than three days from the date of injury and were prescribed the state-encouraged narcotic dosage of no more than 4 tablets (oxycodone, 5mg) per day for no more than 7 days were included. Enrolled patients (n=33) then answered a series of descriptive questions, completed the QuickDASH and had grip strength measurements of each hand. Patients were randomized to one of two groups. Both groups were offered a financial incentive to return a completed pill diary. One group (Incentivized- IC) was offered the possibility of additional financial incentive for each unused oxycodone tablet returned at one week follow up. Only patients who presented a completed pill diary were included in analysis (n=23). Results The Unincentivized (UIC)(n=13) and IC (n=10) were similar age, gender race, ethnicity, mean burn size (1.72% TBSA) and completed level of education. Mechanism of injury was predominantly scald burns (17 scalds, 5 flame injuries, 1 contact injury). Mean difference in grip strength between hands was similar between study groups at enrollment for both UIC and IC patients (-16.60 ±15.92lbs p=0.32,-16.45 ± 12.681lbs p=0.21). The initial QuickDASH scores (15.6lbs, SD 24.6 vs. 7.3lbs SD±10.4 p=0.01) were significant between groups. At one week follow up the difference between grip strength in each hand had improved similarly in each group (-13.16 ±19.71lbs p = 0.51vs. 3.07 ±19.44 lbs, p=0.87 and the increase in QuickDASH score was similar (34.83 SD 23.90 vs.46.09 SD 30.67 p=0.33). The UIC group used a mean of 2.5 tablets/day (±1.5 tab/day) versus the IC group used 2.1 tablets/day (±1.5 tab/day), p=0.46. Conclusions Modest financial incentives do not appear to alter opioid use for acute pain from thermal injury involving the upper extremity. These results support the use of financial rewards, which may encourage participation in future studies without independently affecting opioid use. Finally, it also appears that our state’s encouragement of more stringent prescription practices is appropriate for this mechanism of injury. Applicability of Research to Practice Ongoing research is needed to identify the best tools to decrease use of opioids in acute injury.