Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

As epidemic rages, ER study finds opioids no better than Advil and Tylenol

arstechnica.com

Post reply on HN
Print view View original

11–20 of 161 posts

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#11

Post by dna_polymerase »

I don't get the US stance on opioids. In Germany they are heavily regulated and can't be obtained without special prescription giving them an rather exclusive aura. No German doctor would prescribe them for headaches and people only really get them after serious surgery for a really short term. Advil (Ibuprofen) and Aspirin (ASS) are far more common here and used for pain management at a far broader extent than in the US. And frankly so, Germany doesn't have an opioid problem.

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.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#12

Post by contingencies »

dajohnson89 wrote: post #4

Agreed that opiods are overprescribed, but for acute pain there's no comparison. At least in my experience. 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, allo…

Watch out popping ibuprofen in large quantities, it is hepatoxic.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#13

Post by astura »

dajohnson89 wrote: post #4

Agreed that opiods are overprescribed, but for acute pain there's no comparison. At least in my experience. 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, allo…

>In a randomized, double-blind clinical trial—the gold standard of trials—a combination of ibuprofen (Advil) and acetaminophen (Tylenol) was just as effective at treating patients with acute pain in an extremity as three other pain-killer combinations containing opioids.

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.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#14

Post by bryanlarsen »

derefr wrote: post #9
dajohnson89 wrote: post #4

Agreed that opiods are overprescribed, but for acute pain there's no comparison. At least in my experience. 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, allo…

They didn’t say opioids are no better than either acetaminophen or ibuprofen; they said that opioids are no better than the combination of ibuprofen with acetaminophen — something very rarely prescribed (and usually advised against on the labels of both drugs.)

counter-anecdote: my doctor told me to use precisely that combination for severe pain. She said you cannot combine multiple NSAID's (ibuprofen, naproxen, ASA), but you can combine an NSAID with acetaminophen.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#15

Post by JPKab »

1jojojo wrote: post #10

Yeah, look, I staggered into the ER with a shattered collar-bone and a shitload of missing skin, and 10 mg of oxy had me feeling pretty much FINE while a nurse took a coarse sponge to scrub the asphalt out of my wounds. Overprescribed, yes. Comparable to OTC? Absolutely fucking not. Claiming that ibuprofen is as effective as diluadid or morphine is completely disingenuous.

Acute pain from injury? Give me opioids. Post-surgical pain while in hospital? Opioids. Released from hospital? Opioids probably shouldn't be prescribed.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#16

Post by [deleted] »

1jojojo wrote: post #10

Yeah, look, I staggered into the ER with a shattered collar-bone and a shitload of missing skin, and 10 mg of oxy had me feeling pretty much FINE while a nurse took a coarse sponge to scrub the asphalt out of my wounds. Overprescribed, yes. Comparable to OTC? Absolutely fucking not. Claiming that ibuprofen is as effective as diluadid or morphine is completely disingenuous.

[deleted]

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#17

Post by astura »

1jojojo wrote: post #10

Yeah, look, I staggered into the ER with a shattered collar-bone and a shitload of missing skin, and 10 mg of oxy had me feeling pretty much FINE while a nurse took a coarse sponge to scrub the asphalt out of my wounds. Overprescribed, yes. Comparable to OTC? Absolutely fucking not. Claiming that ibuprofen is as effective as diluadid or morphine is completely disingenuous.

Your anecdote is irrelevant - the study only tested extremity pain, a collar bone is not an extremity.

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.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#18

Post by jedmeyers »

dna_polymerase wrote: post #11

I don't get the US stance on opioids. In Germany they are heavily regulated and can't be obtained without special prescription giving them an rather exclusive aura. No German doctor would prescribe them for headaches and people only really get them after serious surgery for a really short term. Advil (Ibuprofen) and Aspirin (ASS) are far more common here and used for pain management at a far broader extent than in th…

Bayer is the original manufacturer and trademark holder for Heroin, so I imagine they could have entered the opioid game if they wanted to. However, they might still remember the 100 years old lesson of what comes from marketing opioids to the general population.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#19

Post by epmaybe »

All the commenters thus far seem to think they know more than a randomized clinical trial that was double blinded looking at oral (not IV morphine) combination doses of opioids like codeine, hydrocodone, and oxycodone with tylenol vs ibuprofen+acetaminophen (tylenol). Here's the actual study if you would like to read more...

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.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#20

Post by throwaway30yo »

dajohnson89 wrote: post #4

Agreed that opiods are overprescribed, but for acute pain there's no comparison. At least in my experience. 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, allo…

I suspect that there is no comparison to opioids for chronic pain either.

Obviously that is a bad use case for them and you would be crazy to use them for chronic pain.

Post reply on HN