Over-the-counter painkillers treat injuries as well as opioids: study
In the opioid epidemic sweeping North America, there have been many paths to addiction. For some, it started with a fall or a sports injury, a trip to a nearby emergency room and a prescription for a narcotic pain reliever that seemed to work well in the ER.
New research underscores how tragically risky — and unnecessary — such prescribing choices have been.
In a new study of patients who showed up to an emergency department with acute pain in their shoulders, arms, hips or legs, researchers found that a cocktail of two non-addictive, over-the-counter drugs relieved pain just as well as — and maybe just a little better than — a trio of opioid pain medications widely prescribed under such circumstances.
The epidemic of opiate addiction, which has left more than two million North Americans addicted to narcotic painkillers, has claimed more than 183,000 lives since 1999, according to the U.S. Centers for Disease Control and Prevention.
Emergency-department prescribing decisions have played a key role in fuelling that crisis. One study found that between 2001 and 2010, the share of U.S. emergency department visits that resulted in a prescription for an opioid analgesic rose by nearly 50 per cent, to 31 per cent from 21 per cent.
Not everyone who gets narcotic pain medication will become addicted. But a report released in July by the U.S. National Academies of Sciences, Engineering and Medicine found that, among patients prescribed opioid pain relievers, at least eight per cent develop “opioid use disorder,” and 15 per cent to 26 per cent engage in problematic behaviours that suggest they have become dependent.
And a 2015 study found that, among Colorado ER patients who had never taken opioids, but filled such a prescription to treat a short-term pain condition, 17 per cent were still taking a narcotic pain reliever a year later.
The report published Tuesday in the Journal of the American Medical Association suggests that much of this misery could have been avoided.
The trial included 416 patients who showed up to Montefiore Medical Center’s Emergency Department in the Bronx borough of New York City with such injuries as a sprained ankle, a dislocated shoulder or a banged-up knee. Patients were evenly assigned to one of four groups. One group got a combination ibuprofen/acetaminophen tablet, containing the medications found in Advil and Tylenol. The other groups got a drug that contained a prescription narcotic, such as Percocet (a combination of oxycodone and acetaminophen), Vicodin (hydrocodone and acetaminophen) or Tylenol No. 3 (codeine and acetaminophen).
Researchers asked patients to rate their pain upon arrival and two hours after they got their medication.
Patients who got the acetaminophen/ ibuprofen treatment reported pain relief just as substantial as did the patients who got one of the opioid painkillers.
ER patients who got the over-the-counter pain cocktail reported an average decline in pain of 4.3 points on a 10-point scale. By comparison, those who got Percocet reported an average decline of 4.4 points, those who received Vicodin reported an average decline of 3.5 points and those who took Tylenol No. 3 reported an average decline of 3.9 points.
The differences among the four pills were statistically insignificant. In other words, all the treatments performed essentially the same.
The trial suggests that many patients who were first exposed to an opioid in the ER could have treated their injury without risk of addiction. And when they went home, they could have been given instructions to take 400 mg of ibuprofen (two regular-strength pills) and 1000 mg of acetaminophen (two extra-strength tablets) at a time.
(Acetaminophen has a safe daily dosing limit of 4,000 mg for adults. For ibuprofen, the limit is 3,200 mg per day.)
The authors of the new study, led by Dr. Andrew K. Chang of Albany Medical College in New York, noted that their findings are in line with mounting evidence that the combination of ibuprofen and acetaminophen — two pain relievers that work by different means — outperforms opioids in a variety of patients.