Don’t Assume Opioids Are Necessary for Acute Extremity Pain; Here’s Why

The opioid crisis in the United States has moved many healthcare facilities, providers, and governing bodies to consider just how often (and for how long) it’s really necessary to prescribe narcotics for acute pain. If new data just published in the Journal of the American Medical Association are any indication, the correct answer may be, “not very often.” In this study, researchers compared three different opioids vs one opioid-free analgesic for relief of severe, acute extremity pain in 411 emergency room patients. Starting from a baseline of 8.7 on an 11-point scale, mean pain scores dropped by 4.3 points with ibuprofen and acetaminophen; by 4.4 points with oxycodone and acetaminophen; by 3.5 points with hydrocodone and acetaminophen; and by 3.9 points with codeine and acetaminophen. The authors concluded that for “adult ED patients with acute extremity pain, there were no clinically important differences in pain reduction at 2 hours with ibuprofen and acetaminophen or three different opioid and acetaminophen combination analgesics.” Use these new data to inform your own prescribing decisions, but also to educate urgent care patients who come in believing that only an opioid medication can relieve their pain.