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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

#61

Post by astura »

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…

The topic at hand is acute pain management in the ER, you seem to be talking about chronic pain management, which is another (more complicated) topic altogether.

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

#62

Post by joshgel »

nimos wrote: post #55

Those opioid doses are all super low, roughly equivalent to a single Tylenol 3. The alternative is a super high dose of acetaminophen. 1/4 your daily recommended maximum. At roughly 3x the acetaminophen + the fairly high dose ibuprofen I don't think there is anything really surprising about this. You couldn't take that acetaminophen dosage for more than 8 hours with 2 hour dosing without hitting your daily maximum. I…

These are standard doses of all these medications. Its the dose of tylenol often used in the hospital and wasn't dosed every 2 hours it was dosed once. For the opiates we either give 1 or 2 pills, here they gave 1. Perfectly reasonable.

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

#63

Post by hughw »

Toradol (NSAID) is the most effective pain killer I've experienced. I broke a rib and could barely move. ER injected me with Toradol, and for a brief few hours I could move normally. I call that the best high I've ever had -- not a buzz -- just absence of pain. Unfortunately it's so bad for your stomach they won't give you two shots and won't let you take it orally more than a few days.

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

#64

Post by ejstronge »

maccard wrote: post #43
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.

The study that most people reference in this setting[1] simply associates days of opioid usage to likelihood of using opioids in the long term. A simple (and very likely) explanation is that people who need opioids for ten days are likely suffering from chronic pain.

Are you thinking of a different study?

1. https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm#F1_up

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

#65

Post by jbattle »

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…

I had some bad reactions to NSAIDs (asthma attacks & bad headaches). I was never sure if I was having an attack come on and thus took aspirin, or if the aspirin was causing it. Eventually I went to a doctor and it turns out there's a allergy-like sensitivity to these things that some people have.

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)

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

#66

Post by vrtx0 »

The title of this link is frustrating and misleading. The article clarifies a bit, but I take issue with Ars linking to the specific study with text stating the methodology is the gold standard. That doesn’t mean the conclusion will hold up to scrutiny, or that “extremity pain” is a meaningful dimension. The type of injury (eg. compound fractures, sprains, etc.) could be more meaningful than where the injury is. There’s no control for injury location.

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.

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

#67

Post by immutate »

throwaway30yo wrote: post #20
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.

No, you wouldn't be crazy. You'd simply be following medical advice/what's best for your situation. For some chronic pain sufferers opioids are one of the only options (or is something that is used in addition to other methods/things to alleviate pain). For instance, many people with connective tissue disorders use opioids in addition to other physical methods (surgical, splints, etc)[1], and removing something like an opioid can make life untenable, and amounts to torture [2]

1) https://www.ncbi.nlm.nih.gov/pubmed/26497567

2) https://www.statnews.com/2016/07/15/chronic-pain-opioids-pat...

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

#68

Post by Footkerchief »

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…

Yup -- requesting an edit of the link title to clarify that it's about oral analgesics only, not IV analgesics, since this has indeed been a major point of confusion for several commenters.

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

#69

Post by learc83 »

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.)

NSAIDS + acetaminophen are very common. Excedrin is acetaminophen + aspirin (and caffeine).

>and usually advised against on the labels of both drugs.

I've never seen this.

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

#70

Post by vrtx0 »

testvox wrote: post #48
PaulHoule wrote: post #38

Earlier quoted context omitted.

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.

It may help to note that THC and CBD are two active components which can treat different symptoms. I find CBD extraordinarily effective at treating my essential tremor. CBD and THC combined provide mild help for my pain, but THC makes me anxious and spacey. The side effects don’t quite outweigh the benefits for me, personally. But I cannot recommend CBD enough, and agree both are worth trying.
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