OTC Pain Relievers Matched Opioids in ER

The opioid crisis in the US has sparked a number of new studies looking to address patient access to the drugs, and how unnecessary exposure could be prevented in the first place. One such study – published in the Journal of the American Medical Association – found that over-the-counter (OTC) painkillers – including Motrin and Tylenol – were as effective as opioids at reducing pain in ER patients.

While patients who are admitted to the emergency room with broken bones, and other causes of acute severe pain, are often given opioids, these recent findings could change this standard of care. As many patients are first exposed to opioids in the ER, reducing their use in this setting could cut the number of people who eventually become dependent on the drugs.

“Preventing new patients from becoming addicted to opioids may have a greater effect on the opioid epidemic than providing sustained treatment to patients already addicted,” said Dr. Demetrios Kyriacou, an emergency medicine specialist at Northwestern University.

In all, 411 adult patients were included in the study, which took place between July 2015 and August 2016. Two emergency departments at hospitals in the Bronx, New York were the focus of the randomized clinical trial.

Adult patients presenting with moderate to severe acute extremity pain were randomly assigned to receive one of four drug regimens for pain: 400 mg of ibuprofen and 1000 mg of acetaminophen; 5 mg of oxycodone and 325 mg of acetaminophen; 5 mg of hydrocodone and 300 mg of acetaminophen; or 30 mg of codeine and 300 mg of acetaminophen. Two hours after the pain medication was administered, each patient’s pain intensity was assessed using an 11-point numerical rating scale.

The study investigators found no statistically significant or clinically important difference in pain reduction between the treatment groups. According to Dr. Andrew Chang, an emergency medicine professor at Albany Medical College, since ibuprofen and acetaminophen have different modes of action, their combined use may offer a more effective way to manage pain.

While the study suggests that opioids may not always be necessary for managing acute pain in a hospital setting, it did not look at how patients treated their pain after being discharged from the hospital.