Healing With Venlafaxine After Injury (HELP)

Inclusion Criteria: * Between the ages of 18 and 59 * Presents to ED within 24 hours of MVC * ED axial pain score greater than or equal to 4 (0-10 NRS) * Clinically sober * Willing to provide a blood sample * Has a telephone * Has regular access to Internet and an email address * Able to speak and read English * Permanent US citizen or has a green card * Blood pressure reading(s) in ED that, when considered in the context of patient past and current history, in the investigator's judgment does not exceed acceptable level Exclusion Criteria: * Axial pain score greater than 0 in the past month (0-10 NRS) * Clinically unstable * Fracture (other than fracture of the phalanges) * Substantial soft tissue injury * Hepatic failure (acute or chronic) * Renal failure (acute or chronic) * Coronary artery disease, including previous MI, Angina, PCTA, etc. * History of glaucoma * Previous congestive heart failure * History of seizure disorder * History of mania or psychotic disorder * History of suicidal ideation * Prisoner * History and behavior indicates, in the investigator's judgment, that the participant would likely be noncompliant with the study * Any other condition that, in the investigator's judgment, would indicate that the patient in unsuitable for the study (e.g. might interfere with the study, confound interpretation, or endanger patient) * Currently taking a monoamine oxidase inhibitor * Currently taking medication with substantial interaction with venlafaxine, or which could confound interpretation of study results * Breastfeeding * If female, either not postmenopausal (having menses within past year), or, if childbearing potential, positive pregnancy test prior to randomization and not using a medically acceptable form of contraception * Exceeds acceptable chronic daily opioid use prior to MVC * Previously on venlafaxine * Previous allergic reaction to venlafaxine * Antidepressant use within 2 weeks of study start (4 week if Prozac)