Could High-Dose Acetaminophen Be a Good Alternative to Opioids for Acute Pain?

In trying to fight the ongoing, nationwide opioid crisis, researchers are working to find new options that will ease patients’ pain without putting them at risk for addiction. The most recent effort was a study, published in the Annals of Emergency Medicine, of adult emergency room patients who were given either 1 mg intravenous hydromorphone or 1 g intravenous acetaminophen for acute pain. The primary outcome of this prospective, randomized, clinical trial was between-group difference in change in numeric rating scale from baseline to 60 minutes after receiving the study medication. Secondary outcomes included the difference in the proportion of patients who declined additional analgesia at 60 minutes, those who received additional medication before 60 minutes, and those who developed nausea, vomiting, or pruritus. While both drugs provided clinically significant reductions in pain, hydromorphone did so to a greater extent in the same time period, with fewer patients accepting more medication when it was offered. The mean decrease in numeric rating scale pain score at 60 minutes was 5.3 in the hydromorphone group and 3.3 in the acetaminophen group. More patients in the hydromorphone arm also declined additional analgesia at 60 minutes (65% vs 44%).  However, significantly more subjects in the hydromorphone group developed nausea (19% vs 3%) and vomiting (14% vs 3%).