![]() The upshot is that doctors need better research to guide their decisions about opiate prescribing, according to Dr. To many, it is now considered a fateful moment in the run-up to the current crisis. The WHO document was published six years after a letter in the New England Journal of Medicine asserted that “the development of addiction is rare in medical patients with no history of addiction.” Although the five-sentence letter was based on a rudimentary analysis of patients from a single hospital, it was nevertheless widely cited as evidence that narcotic painkillers were safe. Depending on the intensity of pain, that WHO “pain ladder” recommends starting with a combination of ibuprofen and acetaminophen, and then, as necessary, escalating to such “mild opioids” as codeine en route to stronger ones, including hydrocodone and oxycodone. That idea may also stem from a 1986 document drafted by the World Health Organization, Chang and his coauthors wrote. Chan School of Public Health and was not involved in the JAMA study. Barnett, who studies opioid prescribing patterns at Harvard University’s T.H. Patients often believe that prescription medications - costlier, harder to get and quite often riskier - must be better than what’s in their own medicine cabinets, said Dr. So why does the impression persist among patients and even some physicians that opioids are better medicine for acute pain? 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. And pain is, after all, a key reason that people go to an emergency room. That’s fair: Because they have been on the front lines of treating overdoses and spotting addicted patients seeking drugs, emergency physicians belong to an especially chastened medical specialty.īut it can take years for the dangers of narcotic painkillers to reach every emergency department. Many emergency department doctors will protest that it’s been years since they blithely handed out narcotic prescriptions. “The fact that investigators thought the question needed to be answered is sort of an indicator of how oriented we are to using opioids for pain, even when simpler and safer approaches might work just as well.” “I would have thought that people who came to an ER with pain that could be managed with just pills wouldn’t be given opioids,” said Clark, who was not involved in the new research. David Clark said that the findings of this simple, head-to-head comparison “could shape practice really very profoundly.” At the same time, Clark acknowledged that he was surprised such a trial had never been done before. For ibuprofen, the limit is 3,200 mg per day.) (Acetaminophen has a safe daily dosing limit of 4,000 mg for adults. 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. ![]() 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. ![]() In other words, all the treatments performed essentially the same. The differences among the four pills were statistically insignificant. 3 reported an average decline of 3.9 points. 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. Those who scoff at the modest effects of over-the-counter pain relievers may be surprised by the results: Patients who got the acetaminophen/ibuprofen treatment reported pain relief just as substantial as did the patients who got one of the opioid painkillers.ĮR patients who got the over-the-counter pain cocktail reported an average decline in pain of 4.3 points on a 10-point scale. Researchers asked patients to rate their pain upon arrival and two hours after they got their medication. 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. One group got a combination ibuprofen/acetaminophen tablet, containing the medications found in Advil and Tylenol. Upon arrival, all of these patients were evenly assigned to one of four groups. ![]()
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