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

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

#121

Post by walshemj »

sliverstorm wrote: post #56
randlet wrote: post #52

Earlier quoted context omitted.

> or a shot of whiskey would suffice 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...

Yeah, but what is it, 1/8 Americans are already alcoholics, so 12% of the time you're not making things any worse!

As on expat UK-> USA said if you have a pint for lunch people start leaving AA leaflets on your desk.

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

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

#123

Post by pilsetnieks »

saas_co_de wrote: post #82

This is a highly misleading presentation of the study. 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 opi…

400 mg ibuprofen and 1000 mg acetaminophen aren't high doses, at least when taken separately, they're pretty standard adult doses (I think those are also the most common pill dosages.)

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

#124

Post by ramses0 »

ythn wrote: post #36
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…

> Her response was "just take the pills." 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…

I always like to come to a Dr's appointment with a "sealed envelope" ... what I think the problem is, but not to mention it until they get through with their diagnosis.

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.

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

#125

Post by 659087 »

I guarantee many of you who advocate for basically getting rid of opiates completely as an option for pain management, will be singing an entirely different tune if you ever end up in real pain and realize that "tylenol and advil" isn't going to cut it.

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

#126

Post by brudgers »

Researchers then randomly assigned the patients to get one of four pain-pill combinations: 400mg of ibuprofen and 1,000mg of acetaminophen; 5mg of oxycodone and 325mg of acetaminophen; 5mg of hydrocodone and 300mg of acetaminophen; or 30mg of codeine and 300mg of acetaminophen. Each of the pill combinations looked identical to the patients—three opaque capsules.

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...

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

#127

Post by nrb »

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.)

Acetaminophen and ibuprofen are safe and effective together.

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.

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

#128

Post by brudgers »

joshgel wrote: post #62
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.

The median pain level after treatment was above "Distressing" (Pain level 4). That's not reasonable. It is unethical. And probably why the study was run in the Bronx rather than someplace like Manhattan where people are far more likely to have the means to get what they want and to do something about shoddy treatment.

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

#129

Post by leroy_masochist »

I'm sure this is true for the pain associated with the various ailments that bring most people to the ER, but opioids are massively more effective for serious trauma. Motrin does very little for people who've been shot. Fentanyl lollipop on the other hand....

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

#130

Post by fapjacks »

leroy_masochist wrote: post #129

I'm sure this is true for the pain associated with the various ailments that bring most people to the ER, but opioids are massively more effective for serious trauma. Motrin does very little for people who've been shot. Fentanyl lollipop on the other hand....

Right. When you get your legs blown off, Ibuprofen ain't gonna cut it. That's why Army medics carry morphine.
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