Pain Medication Trends Examined for Ankle Sprain Treatment in the ED

Overall, opioids were found to have accounted for the majority of medications used in the ED and prescribed at discharge.

The majority of patients who present to the emergency department (ED) for treatment of an ankle sprain generally receive at least 1 medication, according to the findings of a record-based cohort study.

While evidence indicates that the treatment of an ankle sprain in the ED typically involves the prescribing of multiple medications, little is known about the exact identity of the agents used. “The primary purpose of this study was to document the type of medication, number of doses, and number of encounters given a prescription at discharge or instructions to take over-the-counter medication,” the authors explained. The study also aimed to assess whether the proportion of encounters for each type of medication varied based on age, gender, race, and year.  

Electronic medical records (n=1740) were retrospectively reviewed of encounters reported to a southeast academic level 1 trauma center that included an ankle sprain diagnosis between 2013 and 2017. Data relevant to nonsteroidal anti-inflammatory drug (NSAIDs), muscle relaxants, opioids, and nonopioid analgesics were extracted.

Findings revealed that during more than half of these encounters (n=1008), patients received at least 1 dose of medication in the ED. Results of the analysis also showed that at discharge, 28% of patients (n=479) received a prescription, while 54.5% (n=948) were counseled to use over-the-counter medications.

Overall, opioids were found to have accounted for the majority of medications used in the ED (44%) and prescribed at discharge (49%); however, there was a decline in annual rates from 2013 to 2017. NSAIDs were reported to be the second most common medications given in the ED (40%) and prescribed at discharge (47%).

The authors also noted that age was predictive in determining which medication was prescribed, as the majority of patients younger than 15 years of age received NSAIDs or nonopioid analgesics, while patients over 15 years were more likely to receive an opioid medication. Additionally, a relationship between race and medication administration was observed, with white patients receiving opioid treatment in the ED more frequently than nonwhite patients.

“Our data, which demonstrate that prescription opioids were being given occasionally to patients with an acute ankle sprain, support the need for future research to review current practices,” the authors concluded. “Reviewing current practices can help identify barriers and enhance the implementation of clinical practice guidelines and improve quality in health care.”


Koski KB, Bowers LC, Hoch MC, et al. Pain medication administered and prescribed to patients with an ankle sprain treated in an emergency department: A record-based cohort study. J. Emerg. Nurs. 2021; doi:

This article originally appeared on MPR