Opioid vs. non-opioid pain relief in the ER

The U.S. is in the midst of an opioid epidemic as nearly half a million people have died from opioid overdoses since 2000.

Now, a new study is looking at how pain medication is delivered in the emergency department.

The study looked at 416 individuals between the ages of 21 and 64 who came to the emergency department with an injury to their extremities, such as a broken arm.

One group of patients were given an opioid and acetaminophen combination for pain relief. The other group were not given opioids, but rather a combination of ibuprofen and acetaminophen.

Researchers found that after two hours, patients in both groups reported about the same reduction in pain.

Cleveland Clinic’s Baruch Fertel, M.D., did not take part in the study, but said the results show that opioids do not necessarily bring more pain relief than other medications.

“What we’re seeing from studies such as this, is despite people thinking that opiates are a stronger or a better pain medication, it’s not really the case when done in a randomized controlled trial,” said Dr. Fertel.

Dr. Fertel said a large number of emergency department visits involve pain, so it’s important for doctors to not only be able to help people manage their pain, but to do so safely - and opioids do not come without risks.

He said opioids can be addictive in nature and that often times addiction starts with a legitimate prescription from a doctor.

“Opiates are not necessarily your best choice in the emergency department,” said Dr. Fertel. “Opiates can even cause harm, both in the short term and the long term. We now know that even one prescription could potentially cause harm and could put someone on the pathway to addiction.”

Dr. Fertel said it’s important to manage pain, but it’s also important for people to be realistic about their pain level. He said sometimes having a goal of ‘zero’ pain is unrealistic and even dangerous.

He believes that learning how to deal with pain through other measures is ultimately the safest course. Complete results of the study can be found in JAMA.

SOURCE: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2017.16190

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