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

arstechnica.com

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

#41

Post by jordibunster »

bryanlarsen wrote: post #14
derefr wrote: post #9

Earlier quoted context omitted.

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.

I take that for every tension headache (which isn't often, I mostly get migraines and clusters): 3 ibuprofen and 2 tylenol.

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?

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

#42

Post by sandworm101 »

"Pain" is a very difficult thing to nail down. It is a physical thing but also a psychological issue. The same physical pain, an identical injury, can manifest completely differently according to the patient's mental state. That's why VR games reduce pain in children undergoing painful treatments. That's why someone with severe chest pain can see it suddenly diminish once the doc rules it's not heart attack.

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.

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

#43

Post by maccard »

ams6110 wrote: post #2

an initial prescription of just a few days' worth of pills can trap patients into using the highly addictive, often deadly drugs for a year or more 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…

Can you link to the studies that you've performed that demonstrate this? Because there havebeen multiple discussions on this site where studies have proven that people _do_ get addicted over short term, unnecessary high doses.

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

#44

Post by SheepSlapper »

Anechoic wrote: post #27

Of course while YMMV, I've found the same thing - I've been prescribed opioids for pain, and I found that Advil worked just as well, without the side effects. I do understand that opioids have their place - for example I was told that Advil was not safe to take before surgery so I was stuck with the prescription meds. On example that made an impression on me: a couple of years ago, I had arthroscopic surgery on a kne…

Agreed, I've been lucky and only required a few surgeries in my life. Every time I get handed a jug full of opiates, and end up taking ibuprofen instead. Personally the pain management I get from ibuprofen is similar (definitely less, but sufficient) to the opiates but without the side effects.

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

#45

Post by strictnein »

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…

Your view looking into the US may be a little flawed, to be honest. Opioids are also regulated in the US. No one gets them for headaches. Doctors recommend Tylenol and Advil for most aches and pain.

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.

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

#46

Post by mjcl »

Anechoic wrote: post #27

Of course while YMMV, I've found the same thing - I've been prescribed opioids for pain, and I found that Advil worked just as well, without the side effects. I do understand that opioids have their place - for example I was told that Advil was not safe to take before surgery so I was stuck with the prescription meds. On example that made an impression on me: a couple of years ago, I had arthroscopic surgery on a kne…

I had a slightly different experience, luckily, I guess. When I was in recovery after having a brain tumor removed, I was first being given fentanyl once every hour or two. I found that for the few minutes I was lucid (before the next dose), I really didn't have much pain and asked for something less strong. They moved me to norco, which still seemed too strong. After another request for something less, they moved me to plain tylenol.

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.

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

#47

Post by aclonedsheep »

epmaybe wrote: post #19

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…

In my limited experience, IV acetaminophen is never available to use because of cost which seems incredibly unfortunate.

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

#48

Post by testvox »

PaulHoule wrote: post #38
Anechoic wrote: post #27

Of course while YMMV, I've found the same thing - I've been prescribed opioids for pain, and I found that Advil worked just as well, without the side effects. I do understand that opioids have their place - for example I was told that Advil was not safe to take before surgery so I was stuck with the prescription meds. On example that made an impression on me: a couple of years ago, I had arthroscopic surgery on a kne…

NSAIDS are not benign. 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 see…

Cannabis works pretty well and has minimal side effects, at least compared to those you describe.

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

#49

Post by srinivgp »

epmaybe wrote: post #19

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…

> 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.

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

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

#50

Post by SheepSlapper »

shams93 wrote: post #40
Anechoic wrote: post #27

Of course while YMMV, I've found the same thing - I've been prescribed opioids for pain, and I found that Advil worked just as well, without the side effects. I do understand that opioids have their place - for example I was told that Advil was not safe to take before surgery so I was stuck with the prescription meds. On example that made an impression on me: a couple of years ago, I had arthroscopic surgery on a kne…

This is not the case when you suffer major 3rd degree burns. When you need morphine in the case of say regrowing nerve endings in a damanged limb advil will not cut it, not even medical cannabis will cut it, there are still cases where giving a patient morphine is appropriate.

The discussion around opiate abuse isn't about the extreme cases. Yes, if I get 3rd degree burns then I want to be as out of it as possible until the pain goes away.

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.

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