Opioids & Non-opioids

I’m a turmeric, magnesium powder, lipoic acid, vitamin B12, vitamin D, arnica and omega-3 krill oil type of person when it comes to pain.
I see great results when anybody in pain is empowered to make some decisions based on their expectations, rather than be told what they need, without adequate explanations of the range of adverse effects that accompany the treatment.
Some interesting research about opioids versus non-opioids is of some comfort to patients who have been caught up in the hysteria over codeine.

A study reported in JAMA, titled “Effect of a Single Dose of Oral Opioid and Non-Opioid Analgesics on Acute Extremity Pain in the Emergency Department” shows that there’s little difference in the outcomes here.

For adults coming to the emergency department for arm or leg pain due to strain, sprain or fracture, there was no difference in pain reduction after two hours with ibuprofen-paracetamol versus three comparison opioid-paracetamol combinations.

As we know, but seem to ignore, we are facing a prescribed and over-the-counter opioid epidemic.
Despite the epidemic, opioid analgesics seem to remain a first-line treatment for moderate to severe acute pain in the emergency department.

The combination of ibuprofen and paracetamol can represent an effective non-opioid alternative.

The study included 416 patients aged 21 to 64 years, with moderate to severe acute extremity pain in two urban emergency departments were randomly assigned to receive:

  • 400mg ibuprofen and 1000mg of paracetamol

  • 5mg oxycodone and 325mg paracetamol

  • 5mg hydrocodone and 300mg paracetaol or

  • 30mg codeine and 300mg paracetamol

The study measures the between-group difference in decline in pain two hours after taking the study drugs.

This was an RCT.

After two hours, the pain was less in all participants, without any important differences in effect between the four groups.

This research is obviously reassuring to the patient who is obsessed with codeine for pain.

It’s all about engagement here, and might I suggest some lifestyle interventions and nutritional options to get your patient involved?

My cynical colleagues will say though, “why bother with suggestions from the list above”?
My response is “why not ask your patient who is in pain”?

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