As epidemic rages, ER study finds opioids no better than Advil and Tylenol
arstechnica.com
arstechnica.com
On example that made an impression on me: a couple of years ago, I had arthroscopic surgery on a knee. When the surgery was done and I was being discharged, a nurse came to me with a percocet script and told me to take one every xx hours. Having taken percocet in the past and being familiar with the aforementioned side-effects, I asked her if she wanted me to take it for pain management, or if there was another reason to take it (blocking the formation of blood clots for example). I'm fairly pain-tolerant, so if it was a pain management thing, I wasn't going to take it. Her response was "just take the pills." That was not helpful. If doctors and nurses are just shoving these things down patients' throats it's not surprising there is a problem out there.
Did the script say "P.R.N?" PRN means "as needed" in medical terms. It's an abbreviation for "pro re nata." Just for future reference.
I've also found that, for me, naproxen (Aleve) works much better than opioids. Opioids just make me feel very, very sick (from nausea). If they do help with the pain relief I can't tell over the nausea and vomiting.
But, yeah, YMMV.
There's a fairly big camp of people both online and in real life that is strongly against questioning medical authority. I've encountered it before.
For example (and I know this is purely anecdotal), after doing a few hours of extensive research and photography comparisons online I came to the conclusion that my sister had shingles. I mentioned this to the doctor when I took her and he dismissed it and said that it is unlikely since she is so old. I mentioned this on a subreddit that I frequent and a bunch of people jumped on me and told me to stop doing my own research and to let medical authorities do their job without me pestering them. However, after taking her to a different doctor, he immediately recognized it as shingles and prescribed her the appropriate medicine.
On the one hand, I get why doctors don't want the "ignorant masses" doing their own research and coming op with cockamamie theories, but on the other hand, doctors can only hold so much information in their heads whereas the internet has vastly more information available and I can become an expert in one tiny little niche fairly quickly.
the UK has had a campaign recently around sepsis where people are being trained to ask these questions.
If the doctor hadn't been so sure of his diagnosis, this would have been caught years earlier. I'd specifically asked, more than once, about the possibility.
A lot of scrambling on their part, that day, to get me a same-day appointment for consult with a well-regarded surgeon.
Yes doctor, no doctor, I don't think so doctor, yes doctor also my left foot. => He thinks I have a sprained ankle, I think I'm not sleeping well (or whatever) and I'll mention what my guess is at the end (not before) and ask him why my guess is (presumably) wrong.
Of course if you think there's something unusual or your symptoms are severe then of course go to the doctor without delay, but it's also helpful to get a bit of a personal education when you've got time with a specialist.
I have a lot of medical knowledge and I try not to be a wise ass with my doctors. Sometimes though, it pays to pay attention.
Digestive problems are so common with long-term use that some doctors think that they should co-prescribed with omeprazole and other agents to head them off. (Long-term omepraloze will give you B-12 deficiency if you don't supplement; it is an unusual side effect, but I can't sleep if I take omeprazole.
Cardiovascular risk from Vioxx was enough to pull the drug from the market; risk is also seen with Celebrex and other COX-2 selective NSAIDS. The risk with non-selective NSAIDS is less understood but still present.
My doc does not want me taking acetaminophen because she thinks it causes me to get elevated liver enzymes.
Like opioids there are problems when people don't "use as directed". My grandmother used to take Bufferin by the handful and one day at the dinner table we saw her throwing up blood like something out of a horror movie and she was subsequently hospitalized..
Acetaminophen overdoses can easily destroy your liver and are one of the most common forms of fatal poisonings.
The verdict is that we don't have truly 'safe and effective' medicines for pain in 2017.
It doesn't just go away like alcohol either. If I drink too much and throw up, I feel better within a few minutes. For cannabis I remain high afterwards, so I've become pretty hesitant about it.
That being said, it is very likely less addictive and has far fewer side-effects for those who it helps. For that reason I am extremely positive about legalizing it and studying it further. :)
PS: Not to defend Cannabis, it can trigger Heart Attacks and is associated with a host of Lung issues. I just never heard of those symptoms.
On the bright side, at dispensaries you can know precisely what you’re getting, so at least I can say “this weed will pleasantly reduce my anxiety and pain, that weed will blast me unwillingly into space” which is an option I never had before.
Doctors and I were convinced he was not telling the truth or his stuff was laced. Ended up that he was telling the truth and was clean other than pot. Sad thing was he would keep using pot which ended up messing with his health.
I never see why people care to be sedated emotional. Worst thing about pot to me. They miss out on so much emotionally.
Sorry to pick on you, but people should realize that if all they want to do is try cannabis for pain management, they shouldn't let a dislike for the recreational effects deter them because the two can absolutely be separated.
FWIW, I manage my pain with meditation techniques and it's the only form of pain management that I recommend whole-heartedly, so I'm not recommending anyone try CBD. But I know people who take CBD for pain and I think people should, at least, understand how cannabis is used medicinally before saying negative things about it.
It's legal where I live and the handful of times I have used during the week, I can't remember what I did the day before as well, or what my tasks for the day are. My performance at work noticeably degrades. I'm also more tired the day after, despite generally getting more sleep.
It's great for the weekend when I can just sleep it off or my only tasks are to go for a hike and get groceries though. Better than alcohol at least.
That being said, I may have exaggerated the memory issues. It isn't like full blown amnesia. More so it just takes longer than usual to remember things. I'd compare it to a cache miss. Smoking clears my brain's cache the next day and I end up feeling like I am pulling short-term thoughts and memories from colder storage.
(Unless by 'safe and effective' you mean NEVER have side effects, in which case we probably don't have any 'safe and effective' medications.)
Chronic pain is difficult to deal with and wasn't addressed in this study. Generally opiates are not recommended, but its tough to find other alternatives that are consistently safe. Opiates often end up being used and... epidemic. (... == long complicated story)
https://en.wikipedia.org/wiki/NSAID_hypersensitivity_reactio...
NSAIDs-exacerbated respiratory disease
N.E.R.D.
I found out that (scientifically speaking) I am a NERD (or have NERD, whatever)
Paracetamol/Acetaminophen has an incredible safety profile - in people who use it responsibly and don't have liver disease.
It is, after all and as you are obviously well aware, responsible for the highest number of ED presentations for overdose, and it does kill a number of people each year. But that's a mental health issue, and you can overdose on Water (or food, as I indicate in opening paragraph), and die. For people who take it responsibly and without intent for suicide, it is incredibly safe and effective.
Same with ibuprofen - although with the proviso of Do not take for more than several days. But, the same could also be said of opiates - safe for short periods. it's chronic use that will cause problems in lots of cases (ie. add in benzos as well)
An uncle and some other older physicians who are on long-term measured acetaminophen usage reported supplementing their regimen with n-acetyl cysteine (NAC) with no apparent diminution in analgesic effect. WebMD has a description of the chemical mechanism:
https://www.webmd.com/vitamins-supplements/ingredientmono-10...
As an aside it's also the primary antitoxin for the treatment of acetaminophen poisoning in veterinary medicine:
http://orrongpharmacy.com/content/s_vet/vet_poisoning.htm
So it might be useful to bring this possibility up with your personal physician.
I stopped after the first one.
I have enough addictive behaviors, I don't need to add a chemical one.
The problem isn't the extreme cases, it's the every day ones. Opiates are being massively over-prescribed in cases where OTC medicine or a shot of whiskey would suffice, and this over-prescription is a driving force behind the addiction epidemic.
Not sure if you said it in jest or not but alcohol is also highly addictive, prone to abuse, and harmful to your health and IMO would really not be a step in the right direction.
edit: I almost added to my comment "It's almost taboo in our society to mention this fact" but didn't. I was almost immediately down voted so I guess maybe I'm not wrong...
A while back I was talking to a course tutor who in the UK gave the "dealing with staff with serious addiction problems" course - he commented its when you find 3 or 4 stashes of vodka hidden in the office that you know you have a problem
I did get a big script for norco when I was discharged, but their instructions were to take it if the pain became distracting.
The nursing and medical staff at the hospital (CPMC Davies) overall seemed great, so it may just be the difference between staff that listens/tries and staff that doesn't.
I switched over to the default over the counter dose of ibuprofen, and it worked better than the combination of those two "heavy duty" prescription drugs.
I will say, though, that doctors in the U.S. have been damned cavalier about ibuprofen. One doctor with a popular radio show would cite the nickname, "Vitamin I", and routinely tell people to use it non-stop for a month or two.
I've found that now, a few days on it will make me rather lethargic. My cardio strength and sometimes rhythm feels impaired. And lo, there are studies now coming out that indicate it may carry as much risk as Vioxx and the like.
(Incidentally, a doctor prescribed me Vioxx a month or two before it was yanked from the market. I questioned this, remarking on recent news I'd read indicating it had problems. He had no clue and told me it was perfectly safe. Sure, it was still on the market, then, but he appeared to have no clue about the looming controversy.)
With any medicine, it really seems TANSTAAFL. You have to carefully weigh the benefit against known as well as suspected risks. And the U.S. medical system completely falls down in not fully informing not just patients but also doctors to the existence and nature of these.
1) Well, that urgent care experience -- a new facility opened by the premier area hospital -- was itself a horrible experience. Deserted facility, by all appearances, yet it took about 2.5 hours to see a doctor. Who gave me no neck brace; family took me to their chiropractor, the next day, who DID give me a neck brace -- which provided the first real relief and stopped me from constantly retriggering the injury with every movement.
To be clear, I refuse to have my neck cracked. And the chiropractor wouldn't have, at that point, anyway, given my severe spasming. But at least he had the sense to immobilize my neck. (Then he provided some ongoing care to encourage the release and healing of the spasming. To whatever extent this may have helped, that initial immobilization was key. WTF was wrong with that fully credentialed MD serving the urgent care's rather extensive ER facility?)
A slight distinction that might not matter sometimes, but i often wonder how many antibiotics/pain killers I've taken prescribed from urgent cares that were possibly overkill.
That ER doctor just gave me the prescriptions and sent me off. No follow-up care. I guess you'd have had to see my level of discomfort. My family was equally surprised and disappointed.
I take your point. And much of the U.S. health care system keeps pushing patients towards urgent care and "the doctor at hand". Not that there aren't good urgent care staff; nonetheless, it doesn't exactly promote medical management.
Also, I've delayed some care because I've been uncertain of the approach and awaited more information and perhaps improved procedures and techniques. This might well be called a conservative approach -- and these days, so much of the U.S. rhetoric is about the need to be "conservative". Well, much of that is actually "Conservative", which is actually a rather different ideology.
Yet, insurance keeps worsening by the year. Patients who might otherwise be inclined to be conservative and await better knowledge as well as what would normally be lower costs (in most other industries, "product" costs decline with age and with technical improvements and growing marketshare). Well, in U.S. health care, patients can feel compelled to "act now", because while technology and standards of care may improve, next year's insurance may well not cover it or cover it enough for it to be affordable ($5000 deductible? $7500?), if one even has insurance next year.
Had you continued the muscle relaxant (the problem was an involuntary muscle spasm), you possibly could have avoided further treatment (the neck brace).
If I suffer a muscle spasm that can't be massaged out, then a muscle relaxant + ibuprofen serves well for 1-2 days and, after that, only ibuprofen.
IMO muscle relaxants + narcotics is not a useful combination, their purposes(muscle relaxation vs pain-reduction) being orthogonal, except in cases of severe injury where near-immobilization is required.
I was on the muscle relaxant for a full day, and I was no better. Any time I moved, I was retriggering the spasm.
The neck brace stopped that. I still had to be careful, but at least I could walk around and sit and such without constantly re-spasming (which I suspect was actually exacerbating the injury).
I do agree in concept with the concern about combining such an injury / muscle relaxant with strong pain killers. The pain is warning you as to damage; numbing it seems like it might well promote furthering that damage and/or hindering healing.
In my case, once I was braced and stopped retrigging -- and possibly worsening -- the spasming, the remaining pain was entirely tolerable. Of course, the limited effective activity was another aspect requiring coping. That included sleeping: Getting into bed, and keeping things immobilized in bed, was a bit of effort. I learned how to sleep with a neck brace on, and I "trained" myself quickly not to roll from side to side -- despite my allergies that promote frequent shifting.
Took Percocet after a shoulder surgery, I just slept through the pain. I also understand now why people get addicted.
I get raging migraines, Excedrine is the only thing that works for that.
True story, when my daughter was in the hospital (cancer) we overheard a nurse and doctor discussing what to give a child (also with cancer) for tooth pain... "morphine". The nurse was like "for a tooth? can't we tell the mother to give him Tylenol?"
Also, true story Tylenol is not "formulaic" (I may be saying that wrong) at many hospitals. Meaning THEY DON'T KEEP IT IN THE PHARMACY (the one that fills orders for internal use). I was very surprised to learn this.
God do I hate medical professionals like that. It's as if they don't want you to steal any of their elite knowledge or that you as a patient are beneath them. How dare one of us ask a semi-intelligent question!
https://jamanetwork.com/journals/jama/article-abstract/26615...
I'd like to note that their p-value was awfully close to the statistically significant differences in pain reduction, so a larger study is definitely warranted.
We've known for a while that IV acetaminophen is just as effective at pain reduction in acute pain compared with IV morphine, as well. See this study, there are more similar to this:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608332/
For those of you that think that a few doses of opioids can't cause addiction, think again. This study found that even after 10 days supply of opioids, 20% of patients had a dependence lasting up to a year.
https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm#F1_up
Here's an arstechnica link that is more digestable: https://arstechnica.com/science/2017/03/with-a-10-day-supply...
I've seen patients get 30 day supply for appendectomy regularly, and my dentist friends have prescribed up to 50 at a time in the past.
We need to do these studies, and discuss them, and make them better, so that patients get the best care that they can. What we absolutely cannot do is rely on anectodal evidence to make clinical decisions.
The study did not find that. The study looked for long-term opioid use, not addiction, and not dependence. Long term use, addiction, and dependence (and tolerance) are all separate things.
Long-term use: simply using a thing consistently for a long time Addiction: compulsive seeking, not noted in any of your links Dependence: something bad happens when use is discontinued Tolerance: more use is required to get the same effects
However, the study noted a few things that lead me to believe that this long-term opioid use is not intentional by prescribers. The study excluded patients with cancer, which is a common reason to be prescribed long term opioids. Additionally, they note that most of the patients were not provided long-acting opioids at the start, suggesting that the prescribers did not intend to start these patients on long-term opioid therapy.
At the very least, the data is suggestive of an increase in dependence in patients prescribed a 10-day or greater supply of opioids, as we know that when patients are on opioids for too long, you must slowly discontinue lest you initiate withdrawal.
Also, the CDC guidelines state that opioids are recommended when other treatments fail (regardless of the underlying condition). That key facet was excluded from this article. Ugh.
Apologies, this is a bit of a rant. I have a very painful chronic neurological condition that often requires powerful opioid pain medication to get out of bed (and not commit suicide). Please keep in mind that there are legitimate use cases for opioids. I don’t like them, but combined with biofeedback, PT, mindfulness and relaxation techniques, I’m able to survive until my condition gets better (if it does).
We all understand that opioids should be avoided when possible. Addiction is horrific. I don’t think anybody is arguing that. But please help stop making life exponentially harder for people with legitimate problems that effectively require opioid medications as part of a treatment plan. We have it tough enough already.
The only way out of the current situation is to develop drugs that are at least as effective as opioids, but not addictive (and ideally not psychoactive). I’ve tried everything (yes, an NSAID + acetaminophen, and even intrathecal Ziconotide), but we just aren’t there yet. I hope we get there soon, because I’m sick of the mental cloudiness and health risks of opioids. I want my life back, and I’m sick of fighting just to maintain an acceptable level of pain management.
I'm not sitting around, popping pills to get high. And, you can't magically get addicted to opoids if you never take increasing doses (read: follow the prescription). The longer you take them, the high rapidly goes away (drug addicts "chase" it by increasing doses) while the pain relief stays usable for a _much much_ longer period.
After six years, I've gone down on dosages slowly. The relief works fine. And I get zero high. It's like taking a Tylenol for me except it actually helps my pain.
Meanwhile, for 6 to 9 months when I lost my insurance I was stuck with over the counter medicine. I destroyed my gastrointestinal tract and almost my kidneys, just trying to take enough medicine to not commit suicide from the pain.
Are opoids being over perscribed? Yes. duh.
Does treating anyone who takes opoids into an addict, help anyone? NO.
People need to get off their high horses (ha, pun.) and realize pills are pills. You can argue for reduced perscriptions but the second you start villifing actual patients by telling them "you're pain isn't real. just take some Tylenol" you're now apart of the problem. You're not stopping a single person from getting high. You're just helping oppress people who are already so !@$!@ed up that they barely have the energy to keep going, let alone defend themselves from the public's armchair warrior researched lynching.
I've moved plenty of times. I've seen literally dozens of doctors. And almost every single one of them agreed with my diagnosis that I should be on this medicine. What makes you think reading a bloody internet magazine article about a single study makes you think you know better than the doctors who are trying to save my life?
So while yes, I think most people here are more reluctant to be as judgey--and I thank you for it--there are still plenty of people abusing sources to make their soap box point. They think opiods are automatically evil. They're not. They're the "right tool for the right job." end of story. And just because one research study says they're not useful for specific scenario, doesn't mean all scenarios are some secret conspiracy to get healthy people high.
I don't "want" to be an ANY of these medicines. Every single one is a potential liability. I have to keep them with me when I go places. I have to keep them safe from thieves (!!!) at home. I have to monitor how many each I take a day. At 25 years old, I had two 7 day pill counters just a 85 year old man. We don't _want_ to be on these medicines and deal with their side-effects upon side-effects. We're taking them because we have to and the other option is to simply roll over and die.
So forgive me if I sound emotional, when literally one of the tools that keep me alive, is being threatened by both conservative and democrats looking to grandstand to their constituents while nobody actually does anything to stop the abuser.
You can't imagine what it's like when you see someones face (nurse, doctor, police officer) completely change and withdraw the second they find out you're on an opoid. It's unreal. The entire room "goes cold." I dare you to try telling someone that. They stop talking to you and talk _at_ you. I've literally had a cop lie on a police report when he found out I take a medicine that I'm 100% legally prescribed. I've had receptionists not forward my calls to the doctor. I've had people scout out and follow me home.
All because I chose to put a pill in my mouth that a doctor told me to.
I could write an entire book on this stuff by now. I've considered building a YouTube channel about it. As a scientist, I can tell you, it's like walking into another world.
Then when his prescribing doctor got arrested, he ended up detoxing involuntarily at first, and then voluntarily, and he found that he didn't have any pain after he managed to make it through withdrawal.
I honestly think a lot of people with chronic pain that they're treating with opiates are actually treating withdrawal with opiates.
I was rushed to the ER with an excruciating condition, and i popped quite a bit of ibuprofen at home before going to the hospital (i think 4-6?). Nothing.
In the triage room or whatever, that morphine drip (plus saline IV to replace all fluid i vomited up due to pain) made the 8/10 pain reduce to a 2-3/10, allowing me to bear with it until i was put under general anesthesia for surgery.
But the morphine at the hospital was like magic. And the dose low enough I didn't really feel any other effects.
That said, when it was time for discharge, the doc told me to alternate tylenol and advil every 2 hours (4 hour cycles each), as needed.
It wasn't news to me. I've followed the protocol before. I wasn't really in much pain by the time I was discharged, so I didn't bother with it this time and can't really compare.
EDIT: also, this is pretty much what Excedrin is (aspirin instead of ibuprofen, but NSAID + acetaminophen, plus also caffeine)
The best treatments, for me, directly address whatever underlying issue.
I agree that directly addressing underlying causes like stress, noise, sleep, and diet are better than a pill.
I had no idea the labels said otherwise.
I believe the study, but I've also taken opioids for pain and for me personally there's no comparison. Not even close. Placebo?
>and usually advised against on the labels of both drugs.
I've never seen this.
The label you refer to advises against using other medicines that contain acetaminophen, as many cold and allergy medicines do (Excedrin, NyQuil, Robitussin).
The thing you want to look out for are not doubling up acetaminophen, and not taking any combination of aspirin + naproxen + ibuprofen.
Anyone doubting the merits of opioids in pain control should take a look at https://en.wikipedia.org/wiki/Equianalgesic - many of the voices in this debate will sorely regret their remarks if they ever experience real pain, which most people will at some point.
They tested medicine combinations (400mg of ibuprofen and 1,000mg of acetaminophen), not ibuprofen alone.
Extremity pain (arms and legs) was tested only, not pain in general.
They only tested medications delivered orally, not intravenously. That distinction is very, very important as intravenously administered medications have a much higher placebo effect than orally administered medications. In fact, I'd love to see a comparison of orally administered opioids vs intravenously administered NSAIDs.
Obviously that is a bad use case for them and you would be crazy to use them for chronic pain.
1) https://www.ncbi.nlm.nih.gov/pubmed/26497567
2) https://www.statnews.com/2016/07/15/chronic-pain-opioids-pat...
You couldn't take that acetaminophen dosage for more than 8 hours with 2 hour dosing without hitting your daily maximum. I'm skeptical that opioid alternative with such a low dosage over such a short period of time has any real chance of being addition forming.
My point is I don't see that replacing opioids in this case is really useful. I'm happy to admit I don't know the answer here but I'm skeptical that people going to the hospital and getting a single 5mg percocet/vicodin or even a 3-4 over ~8-12 hours are really at risk of addiction.
For 24/7 dosing that acetaminophen/ibuprofen combo is only safe once every 6 hours which from my experience is way too long for acetaminophen. Even on every 4 hours I find the last 1 hour is definitely very noticeable.
I only slept 3 hours a night for 2 month. My neurosurgeon said - "When you've reached your pain limit call me and we'll schedule surgery". That was 2 months.
I'm very grateful for both the narcotics and the neurosurgeon. Surgery was the last resort and thankfully it reduced my pain 95% (micro discectomy).
Some years later I was umpiring and tripped and fell right on my ribs (I'm 230 lbs) - crackity crack. Breathing would not have been possible without a good dose of Percocet - a limited, appropriate amount.
So not sure exactly what's going on with this study (and I think the hysterical press has some factor) but I'd debate the results.
An opiod hits the mental half in a way the others do not. If you are in hospital with a compound fracture (bone sticking out of you) then you aren't just in severe pain but are also absolutely terrified. Opiods work in such cases. Within a minute you will be very happy. Advil might help with the physical pain but it won't put your mind in the same place.
That said, I think Bayer (manufacturer of Aspirin) being a German company could have something to do with that, on the other hand seeing the immense money spent on lobbying by Opioid companies in the US really says a lot. IIRC Purdue even paid university professors to downplay risks of Oxy in front of their students so they would get a biased view on them already.
The times when my wife and I have received Opioids: broken ankles, back injuries from weight lifting, and after c-sections. I didn't receive them when I broke my collarbones (I've broken both, on separate occasions).
> I think Bayer (manufacturer of Aspirin) being a German company...
Tylenol is produced by a huge American company: Johnson and Johnson. Advil is produced by another huge American company: Pfizer.
There as needed and I can go months between refilling the script sometimes but it's still for headaches
You are very uninformed obviously. As far as i know for my town, Paderborn (NRW), we have about 1.000 people receiving opioid replacement drugs under government supervision (~90.000 city population).
US: 0.000160 %
Germany: 0.0000226415 %
US death rate is 7 times higher than the German, while population is only 4 times bigger. That said, a look at the opioid users in Germany (160k) and US (2M+600k) is way clearer. We are talking about 16 times the abuse rate in the US compared to Germany. So yeah, Germany doesn't have an opioid problem, compared to the US.
So while Germany has heroin addicts, the US actually has a drug addict training program running. In the US there are 290M opioid prescriptions per year. [4] And while Germany doesn't have those outstanding numbers, Big Pharma is pushing for change in Germany [5 (German)]
[0]: https://www.asam.org/docs/default-source/advocacy/opioid-add...
[1]: http://www.dw.com/en/medication-abuse-a-growing-concern-in-g...
[2]: http://www.emcdda.europa.eu/system/files/publications/4528/T...
[3]: https://www.cdc.gov/drugoverdose/index.html
[4]: https://addiction.surgeongeneral.gov/surgeon-generals-report...
[5]: http://www.spiegel.de/gesundheit/diagnose/oxycodon-fentanyl-...
Whoa, that's an outsized proportion - entire Germany has 77k people in methadone substitution: http://www.bfarm.de/SharedDocs/Downloads/DE/Bundesopiumstell...
Also, the numbers are 500 methadone substituters (of total ~1k opiate users) in Paderborn (http://www.nw.de/lokal/kreis_paderborn/paderborn/paderborn/1...). What would interest me is the background why ~1% of the population are opiate abusers, though.
In veterinary medicine it's slightly different, because we can't use ibuprofene for dogs and cats, but something similar. Still, opioids are a good idea perioperatively, and addiction is at worst a transient problem. The dog can't go out and score some heroin, for instance.
I was hospitalized with a huge abscess that was damaging my leg and hitting my sciatic nerve. The pain was as acute as I would imagine is possible. The morphine drip that I had did nothing. It was very frustrating. Sometimes the pain would re-occur before I was allowed to get more morphine, and the duration/severity of the pain was comparable.
At the time, I thought that the morphine only managed to make me tired after the pain had subsided, but maybe taking a nap after that kind of pain was normal anyways?
Edit: I just wanted to point out there are different degrees of “acute extremity pain”. There’s “I bumped my toe against a chair leg” kind, and then there’s “I can’t breathe because I’m in shock” kind. Opioids are appropriate for the latter.
Class of injury is very important too: limb injuries producing acute pain are more likely to be a type where time, even just 2 hours, will have a leveling effect on pain, while one class or combination of drugs might provide better instant relief.
Finally, we have these short term acute pain examples and long term chronic pain, but medium term acute pain in the range of days to weeks might be a primary area of risk for new addictions where a patient requires more than a few doses but doesn't ask the patient to shift their outlook on how they deal with pain and adjust to it that chronic pain patient may have to do, with or without opiods. If the pain is short term in this way, the potent opioid pills can be seen as a quick fix that doesn't take as much effort as rethinking "acceptable" levels of pain.
The dosages contain very little of each opiod. Based on Googling "normal dose of oxycodone" 5mg is the smallest available dose of oxycodone and half the size of the smallest dose of it under the brand name Oxycotoin. In addition each opiod cocktail contains less acetaminophen than in the non-opiod control.
It's worth noting that the standard pain scale goes from zero to ten and that a mean of 8.7 across 411 patients is very high: closer to "Excruciating Unbearable" than "Utterly Horrible" [1]. Reducing it to 4.3 is to take it down between "Distressing" and "Very Distressing".
None of the treatments reduced the pain to "Tolerable" (level 3). One might say that the study shows that an inadequate cocktail of opoids is no better than an inadequate cocktail without them.
[1]: https://previews.123rf.com/images/sunshinearts/sunshinearts1...
The headline here says the study "finds opioids no better", but what actually happened is that the study was too small to reach statistical significance on any of its endpoints.
More importantly, the study chose the top of the recommended dose range for the ibuprofen+acetaminophen group but the bottom of the recommended dose ranges for the oxycodone+acetaminophen, hydrocodone+acetaminophen, and codeine+acetaminophen groups. This strongly suggests that the study designers knew what outcome they wanted, and arranged subtle details of the study (which are hidden behind a paywall!) to make sure they got it.
The study compared the following doses: — 400 mg ibuprofen and 1,000 mg acetaminophen — 5 mg oxycodone and 325 mg acetaminophen — 5 mg hydrocodone and 300 mg acetaminophen; or — 30 mg codeine and 300 mg acetaminophen
https://media.jamanetwork.com/news-item/no-significant-diffe...
So, the study is comparing high doses of ibuprofen/acetaminophen to low doses on opiates/acetaminophen.
It is an interesting outcome for mild pain and suggest that for mild pain it might be better to pass on low dose opiates but in no way does this show that opiates are not needed for severe pain.
I call BS on this. Maybe if you have an unresolved underlying chronic pain, this could be true. But many people get a hydrocodone prescription after surgery or dental work and do not go on to become addicts.
And no, Tylenol is not great for acute pain. It does very little for me in fact. Ibuprofen or aspirin work better in my experience.
My cousin got addicted in his late 20s after shoulder surgery.
My friend got addicted in his late teens after knee surgery.
>According to the large, annually repeated and representative National Survey on Drug Use and Health, 75 percent of all opioid misuse starts with people using medication that wasn’t prescribed for them—obtained from a friend, family member or dealer. And 90 percent of all addictions—no matter what the drug—start in the adolescent and young adult years.
>A Cochrane review of opioid prescribing for chronic pain found that less than one percent of those who were well-screened for drug problems developed new addictions during pain care; a less rigorous, but more recent review put the rate of addiction among people taking opioids for chronic pain at 8-12 percent.
Are you thinking of a different study?
1. https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm#F1_up
Why would drug companies sell us over priced, dangerous drugs, when the over the counter drugs work almost better?
Overprescribed, yes. Comparable to OTC? Absolutely fucking not. Claiming that ibuprofen is as effective as diluadid or morphine is completely disingenuous.
They only tested drug combinations as well, not a single medication.
I presume, from your comment, you also weren't given the 400mg of ibuprofen and 1,000mg of acetaminophen combination first and then an opioid only because that wasn't enough pain relief.
And while we are swapping anecdotes, I was given hydrocodone for an acute extremity injury (leg) and the only noticeable thing it did for me was make me feel really, really nauseous. If it did help with the pain it was hard to tell because of the nausea.