No good reason for the opioid epidemic: Clinical trial showed no “significant difference” in pain relief for treating arm or leg pain using opioids vs non-opioids
12/20/2017 // Cassie B. // Views

There is a lot of finger-pointing going on when it comes to the cause of the opioid epidemic. The pharmaceutical companies making these drugs often get the bulk of the blame, with the doctors who prescribe them following closely behind in the culpability leaderboard. To be fair, some opioid addictions start out fairly innocently, with doctors trying to help alleviate their patients’ pain. However, a new clinical trial is showing just how unnecessary these dangerous drugs are for relieving certain types of pain.

In the study, researchers from Northwestern University’s Feinberg School of Medicine looked at 416 people between the ages of 21 and 64 who visited New York emergency rooms with moderate to severe pain in their arms or legs due to fracture, sprain or strain. Around a fifth of them had bone fractures, while others had problems like dislocated shoulders or sprained ankles. Opioid analgesics are a first-line method of treatment for this type of pain in ERs, and the researchers wanted to see if there were safer alternatives that would work just as well.

The patients were asked to assess their pain on a scale from 0 to 10. In the randomized clinical trial, the patients were assigned to one of four groups to receive either 400 mg ibuprofen and 1,000 mg acetaminophen; 5 mg hydrocodone and 300 mg acetaminophen; 5 mg oxycodone and 325 mg acetaminophen; or 30 mg codeine and 300 mg acetaminophen.

After two hours, the pain in each patient was measured to determine how much it had dropped. The scientists found that there was no important difference in the pain reduction noted after two hours between those who took the ibuprofen-acetaminophen combinations and those who took the opioid-acetaminophen combinations. This would suggest that ibuprofen-acetaminophen combo pills are acceptable alternatives to opioids when it comes to managing the acute pain in extremities that can be caused by strains, fractures, and sprains.


The study’s lead author, Dr. Andrew K. Chang, said: “Some docs will reflexively give an opioid to anyone with a fracture. But if we can give the non-opioid and show the patient that it works, we can help with this ongoing opioid problem.”

Could the opioid epidemic have been prevented?

The Los Angeles Times reports that the opioid epidemic is now claiming an average of 91 lives every day, and many people start down this deadly path after experiencing the types of injuries studied in the trial and receiving narcotics in the emergency room. According to the CDC, more than 183,000 people have died since 1999 at the hands of these painkillers, and around two million Americans are believed to be addicted.

During the time period from 2001 to 2010, the percentage of ER visits in the nation that resulted in an opioid prescription rose by almost half from 21 percent to 31 percent. While not everyone will become addicted, at least eight percent will go on to develop what is known as “opioid use disorder” and as many as 26 percent will show signs of becoming dependent.

A study carried out in 2015 found that 17 percent of ER patients in Colorado who were given opioids for the first time to treat short-term pain conditions were still taking the drugs one year later.

It’s disheartening to think that this tragic epidemic could have been avoided to some extent by giving patients a combination of Advil and Tylenol. While these painkillers are not without their set of side effects, they are not addictive. How many lives could potentially be saved by such a simple change in practice?

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