Over-the-counter pain relievers work as well as opioids

Advil and Tylenol are as effective at relieving pain as opioids, according to a recent study in the journal JAMA that explored which combination of four oral analgesics provided more effective reduction of moderate to severe acute extremity pain.

Researchers conducted a randomized clinical trial at two urban emergency departments (EDs) in The Bronx, New York. They studied 416 patients aged 21 to 64 years old between July 2015 to August 2016 who arrived at the ED with a mean pain score of 8.7 on a scale of 0-10. They reported acute pain in their shoulders, arms, hips or legs. About 20 percent of trial participants were diagnosed with a bone fracture. The rest suffered injuries such as a sprained ankle, a dislocated shoulder or a banged-up knee.

Participants were randomly and equally distributed into one of four groups and prescribed one of the following drug combinations:

  • 400 mg of ibuprofen and 1000 mg of acetaminophen,
  • 5 mg of oxycodone and 325 mg of acetaminophen,
  • 5 mg of hydrocodone and 300 mg of acetaminophen, or
  • 30 mg of codeine and 300 mg of acetaminophen.

“For patients presenting to the ED with acute extremity pain, there were no statistically significant or clinical important differences in pain reduction at 2 hours among single-dose treatment with ibuprofen and acetaminophen or with three different opioid and acetaminophen combination analgesics,” they concluded.

In other words, all the treatments performed essentially the same. But, the acetaminophen and ibuprofen combination avoids the risk of addiction, suggesting a viable over-the-counter pain treatment plan.

The trial suggests that many patients who were first exposed to an opioid in the ED could have treated their pain with over-the-counter drugs and without risk of addiction. 


Topics: Clinical , Clinical Leadership