Researchers provide more evidence that not all pain needs to be treated with powerful and potentially addictive opioids.
With the opioid epidemic only continuing to grow — more than 500,000 people have died from drug overdoses since 2000, many from opioid overdoses — doctors are struggling to find better ways to manage pain. And now, a new study confirms what doctors and policymakers have been saying for some time: that opioids are overprescribed, and that for some types of pain, simple, non-opioid alternatives may work just as well.
“The results did surprise me,” says study author Dr. Andrew Chang, professor of emergency medicine at Albany Medical Center. “Most physicians reflexively give opioids to patients with fractures or broken bones. This study lends evidence that opioids aren’t always necessary even in the presence of fractures.”
In the new paper published in JAMA, scientists investigated whether alternative pain killers could be effective in treating pain in emergency departments. The group studied more than 400 people who came to two emergency rooms in the Bronx, New York, for arm or leg strains, sprains of fractures. They were randomly assigned to receive either non opioid pain killers — a combination of ibuprofen and acetaminophen (Tylenol) — or one of three variations of opioid-based pain killers. After two hours, the doctors asked the people to rate their pain on an 11-point scale and compared their responses.
Chang did not find much difference between the pain ratings among those who were given the non-opioid pain relievers and the opioid-based ones. That’s a revelation, especially given that studies have shown that even short term use of opioids can lead to long term addiction, and that nearly 19% of people leave emergency rooms with an opioid prescription.
Chang stresses that the study only looked at one type of pain — that caused by arm or leg injuries, but that it highlights possible ways that opioid prescriptions can be reduced.
The study only assessed people’s pain after two hours, but that’s when pain from sprains or fractures can be acute. Still, he plans to extend the study to see if people who leave the emergency department with non-opioid pain relievers continue to report similar pain relief compared to those who use opioids.
Chang says the results have already changed the way he prescribes painkillers. Now, when he sees people with bone fractures, he has a discussion with them about starting with non opioid options and then moving to opioids only if the pain is too severe and doesn’t respond to the other medications. “I also have a discussion with them about the risks of addiction because we know that a certain percentage of patients exposed to opioids are going to become addicted,” he says. “One way to help decrease the epidemic is to decrease the number of people exposed. And changing physician prescribing practices is also an important way to control the epidemic.”