As the over prescribing of opioid pain medications has become a major public health concern, health care providers have been paying more attention to over-the counter-drugs that could be used instead, without the risk of addiction. A new study published in the Journal of the American Medical Association (JAMA) has confirmed that OTC meds ibuprofen and acetaminophen are just as effective as prescription opioids at reducing acute pain caused by common injuries.
It is one of the few “real world” studies that has made the comparison.
A team of researchers led by Andrew Chang, M.D. of Albany Medical College, studied 411 patients (aged 21 to 64) who had sought medical care at two urban emergency departments after having sprained, strained or broken an arm or leg. (About 20 percent of the patients had fractures.)
The patients were randomly assigned to one of four groups. One group received a pill for their acute pain that contained a combination of ibuprofen and acetaminophen, the ingredients in Advil and Tylenol. The other groups were given a pill for their pain that contained a prescription opioid as well as acetaminophen, either oxycodone and acetaminophen (Percocet), hydrocodone and acetaminophen (Vicodin), or codeine and acetaminophen (Tylenol No. 3).
All the patients were asked to rate their pain immediately before taking the pain medication and again both one and two hours afterward (before they left the emergency department). The assessments were done using an 11-point scale (0 = no pain; 10 = worst possible pain).
The study found that the intensity of pain was similar among all four groups before they took the medication, with a mean score of 8.7 on the scale. The pain then declined over time in all four groups — and by similar levels: 4.3 points in the ibuprofen/acetaminophen group, 4.4 points in the oxycodone/acetaminophen group, 3.5 in the hydrocodone/acetaminophen group and 3.9 in the codeine/acetaminophen group.
The researchers said the major limitation of the study is that it had the patients assess their pain only while they were in the emergency department. The study did not evaluate how the ibuprofen/acetaminophen combination would work in comparison to opioids once the patients went home. Also, the participants had a specific type of acute pain — from sprained or broken arms and legs.
“Preventing new patients from becoming addicted to opioids may have a greater effect on the opioid epidemic than providing sustained treatment to patients already addicted to opioids, in whom it may take many years to achieve recovery,” Dr. Demetrio Kyriacou, a senior editor at JAMA and a professor of emergency medicine at Northwestern University, wrote in an accompanying editorial.
Kyriacou says “stemming the opioid addiction crisis will … require reexamination of the long-standing assumptions that opioids are superior to non-opioids in most clinical situations requiring management of moderate to severe pain.”
Studies have shown that nearly one-third of adult patients seeking care at U.S. hospital emergency departments are given prescriptions for opioid painkillers, even if their visit was not pain-related. That is a dangerous practice, since some individuals can become addicted even after only taking opioid pain meds for a few days. One study found that one in five people given a 10-day supply of opioid painkillers became long-term users.
Don Teater, M.D., medical adviser of the non-profit National Safety Council, says doctors need more education to understand the drawbacks of prescribing opioids. “Doctors get a lot of training in the physical aspects of health, but not the mental aspects,” says Teater, a family physician in North Carolina whose practice focuses on treatment of pain and the treatment of opioid use disorder.
“We don’t get training in addiction. Often, a doctor will start a patient on opioid pain medication and continue it for awhile. Then if the doctor feels the patient is asking for too much medication, the doctor will cut them off, and abandon them. There needs to be a greater understanding of the emotional component to pain. We also need to have a better understanding of the disease of addiction.”
According to a white paper from the Council, there is little evidence that opioids are helpful when used for chronic pain. “In fact, some evidence shows they may be detrimental and increase risk of addiction and premature death,” the paper says.