Researchers analyzed four combinations of pain relievers to determine which combination provides the greatest relief to patients with acute pain.
Prescription opioid misuse has become more prevalent in recent times. This has led to a substantial increase in cases of addiction and death in the community, thereby creating a public health concern. To help combat this epidemic, a review of current pain management protocols is beneficial. Prescribing practices play a significant role in the presence of these medications in the community. Patients who visit the emergency department with acute pain tend to get prescribed opioid analgesics such as oxycodone. While this class of pain relievers provides relief, it is important that medications with little or no addiction potential are also considered as first line in pain management.
A research news article published in the British Medical Journal reviewed the findings on research conducted by Andrew Chang and his team. The study enrolled patients admitted to two emergency departments in New York, with acute pain in the upper or lower limbs. The randomized double-blind trial comprised 416 patients over a 13-month period. Each patient received one of four combinations of pain relievers. These combinations are 400mg ibuprofen and 1000mg acetaminophen; 5 mg oxycodone and 325mg acetaminophen; 5mg hydrocodone and 300mg acetaminophen; or 30mg codeine and 300mg acetaminophen.
The main outcome measured was pain reduction after two hours of medication administration. This was measured using an 11-point numerical scale. The results of the study showed no significant difference in pain reduction between the four groups of pain relievers. However, the study did not monitor pain levels past two hours. The study also did not document side effects. Therefore, we do not have a comparison on the duration of pain relief and adverse events of the various combinations.
This important study indicates that non-opioid pain relievers may be just as effective as opioid pain relievers for certain types of pain. If studies show that non-opioid pain relievers can be as effective as opioid pain relievers, physicians may be less likely to prescribe opioids. This could go a long way in alleviating the opioid epidemic in the US. Non-opioid pain relievers can be considered as the first line in the management of pain in the emergency department. Opioid analgesics may be required in some patients, based on pain severity. More research is required to assess the effects of the study’s limitations on prescribing practices.
Written by Anuolu Bank-Oni, Pharm.D, CDE
(1) Wise, J. No difference in efficacy of opioids and non-opioid analgesics for arm or leg pain. BMJ 2017.
(2) Chang A, Bijur P, Esses D, et al. Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department. A randomized clinical trial. JAMA 2017.