If you have a lot of pain in your leg or arm, you might be expecting (and hoping!) that your doctor will give you a powerful pain reliever like codeine or oxycodone. That would likely be a mistake.
A new study published today in JAMA (Journal of American Medical Association) shows that opioids don’t work any better than a combination of ibuprofen and acetaminophen, and opioids create significantly higher concern in the medical community.
Just over 400 patients who arrived in the ER complaining of bad pain in a leg or arm were randomly given acetaminophen and either ibuprofen, oxycodone, hydrocodone or codeine. Patients were asked to assess their pain on a 1 (no pain) to 10 (worst possible pain) scale just before receiving the meds and again 2 hours later. Most of the patients arrived with a sprain/strain or a fracture.
After 2 hours, pain dropped in every group:
From 8.9 average pain to 4.6 for ibuprofen and acetaminophen
From 8.7 average pain to 4.3 for oxycodone and acetaminophen
From 8.6 average pain to 5.1 for hydrocodone and acetaminophen
From 8.6 average pain to 4.7 for codeine and acetaminophen
About 18% of the patients needed “rescue” pain relievers (more pain relief), and they were given either oxycodone, morphine or tramadol.
Conclusion? There were “no statistically significant or clinically important differences in pain reduction at 2 hours” according to the study authors.
So we ask, why take the big guns of opioids? Why expose yourself to the risks and side effects of these powerful drugs when acetaminophen and ibuprofen will help just as much?
There were some limitations to the study: The follow-up was limited to 2 hours — there might have been greater differences over a longer period of time. Also, no side-effect information was gathered, so while the expectation is that the nonprescription drugs would have fewer side effects, it was not proven.
The doctors reported that they had no conflicts of interest and the funding came from the NIH (National Institutes of Health).