
As epidemic rages, ER study finds opioids no better than Advil and Tylenol - rbanffy
https://arstechnica.com/science/2017/11/as-epidemic-rages-er-study-finds-opioids-no-better-than-advil-and-tylenol/
======
Anechoic
Of course while YMMV, I've found the same thing - I've been prescribed opioids
for pain, and I found that Advil worked just as well, without the side
effects.  I do understand that opioids have their place - for example I was
told that Advil was not safe to take before surgery so I was stuck with the
prescription meds. 

On example that made an impression on me: a couple of years ago, I had
arthroscopic surgery on a knee.  When the surgery was done and I was being
discharged, a nurse came to me with a percocet script and told me to take one
every xx hours.  Having taken percocet in the past and being familiar with the
aforementioned side-effects, I asked her if she wanted me to take it for pain
management, or if there was another reason to take it (blocking the formation
of blood clots for example).  I'm fairly pain-tolerant, so if it was a pain
management thing, I wasn't going to take it.  Her response was "just take the
pills."  That was not helpful.  If doctors and nurses are just shoving these
things down patients' throats it's not surprising there is a problem out
there. 

~~~
PaulHoule
NSAIDS are not benign. 

Digestive problems are so common with long-term use that some doctors think
that they should co-prescribed with omeprazole and other agents to head them
off. ( Long-term omepraloze will give you B-12 deficiency if you don't
supplement; it is an unusual side effect, but I can't sleep if I take
omeprazole. 

Cardiovascular risk from Vioxx was enough to pull the drug from the market;
risk is also seen with Celebrex and other COX-2 selective NSAIDS.  The risk
with non-selective NSAIDS is less understood but still present. 

My doc does not want me taking acetaminophen because she thinks it causes me
to get elevated liver enzymes. 

Like opioids there are problems when people don't "use as directed".  My
grandmother used to take Bufferin by the handful and one day at the dinner
table we saw her throwing up blood like something out of a horror movie and
she was subsequently hospitalized..

Acetaminophen overdoses can easily destroy your liver and are one of the most
common forms of fatal poisonings. 

The verdict is that we don't have truly 'safe and effective' medicines for
pain in 2017. 

~~~
testvox
Cannabis works pretty well and has minimal side effects, at least compared to
those you describe. 

~~~
chucky_z
Cannabis has pretty awful side-effects for me.  It gives me absolutely
incredible nausea, to the point where I've tried it ~10 times in varying
doses, thinking my dosage was an issue, and out of those I was violently ill 4
of the times.  The other 6 times were simply unenjoyable. 

It doesn't just go away like alcohol either.  If I drink too much and throw up,
I feel better within a few minutes.  For cannabis I remain high afterwards, so
I've become pretty hesitant about it. 

That being said, it is very likely less addictive and has far fewer side-
effects for those who it helps.  For that reason I am extremely positive about
legalizing it and studying it further. :) 

~~~
baldfat
I never touched the stuff, but I would end up having to take my friend to the
ER.  For some reason at different times it would cause an allergic reaction and
he would act like he was in septic shock and have dementia. 

Doctors and I were convinced he was not telling the truth or his stuff was
laced.  Ended up that he was telling the truth and was clean other than pot. 
Sad thing was he would keep using pot which ended up messing with his health. 

I never see why people care to be sedated emotional.  Worst thing about pot to
me.  They miss out on so much emotionally. 

~~~
pbhjpbhj
If you don't understand why people would avoid the full force of their
emotional response to life then you apparently have had great fortune in your
emotional experiences.  I note you don't have to want it for yourself to
understand why others would want it. 

------
epmaybe
All the commenters thus far seem to think they know more than a randomized
clinical trial that was double blinded looking at _oral_ (not IV morphine)
combination doses of opioids like codeine, hydrocodone, and oxycodone with
tylenol vs ibuprofen+acetaminophen (tylenol).  Here's the actual study if you
would like to read more...

[https://jamanetwork.com/journals/jama/article-
abstract/26615...](https://jamanetwork.com/journals/jama/article-
abstract/2661581?&utm_source=BHClistID&utm_medium=BulletinHealthCare&utm_term=110817&utm_content=MorningRounds&utm_campaign=BHCMessageID)

I'd like to note that their p-value was awfully close to the statistically
significant differences in pain reduction, so a larger study is definitely
warranted. 

We've known for a while that IV acetaminophen is just as effective at pain
reduction in acute pain compared with IV morphine, as well.  See this study,
there are more similar to this:

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608332/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608332/)

For those of you that think that a few doses of opioids can't cause addiction,
think again.  This study found that even after 10 days supply of opioids, 20%
of patients had a dependence lasting up to a year. 

[https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm#F1_up](https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm#F1_up)

Here's an arstechnica link that is more digestable:
[https://arstechnica.com/science/2017/03/with-a-10-day-
supply...](https://arstechnica.com/science/2017/03/with-a-10-day-supply-of-
opioids-1-in-5-become-long-term-users/)

I've seen patients get 30 day supply for appendectomy regularly, and my
dentist friends have prescribed up to 50 at a time in the past. 

We need to do these studies, and discuss them, and make them better, so that
patients get the best care that they can.  What we absolutely cannot do is rely
on anectodal evidence to make clinical decisions. 

~~~
srinivgp
> For those of you that think that a few doses of opioids can't cause
> addiction, think again.  This study found that even after 10 days supply of
> opioids, 20% of patients had a dependence lasting up to a year. 

The study did not find that.  The study looked for long-term opioid use, not
addiction, and not dependence.  Long term use, addiction, and dependence (and
tolerance) are all separate things. 

Long-term use: simply using a thing consistently for a long time Addiction:
compulsive seeking, not noted in any of your links Dependence: something bad
happens when use is discontinued Tolerance: more use is required to get the
same effects

~~~
epmaybe
You're right, thank you for the clarification and I apologize for misleading. 
This study did not look at addiction. 

However, the study noted a few things that lead me to believe that this long-
term opioid use is not intentional by prescribers.  The study excluded patients
with cancer, which is a common reason to be prescribed long term opioids. 
Additionally, they note that most of the patients were not provided long-
acting opioids at the start, suggesting that the prescribers did not intend to
start these patients on long-term opioid therapy. 

At the very least, the data is suggestive of an increase in dependence in
patients prescribed a 10-day or greater supply of opioids, as we know that
when patients are on opioids for too long, you must slowly discontinue lest
you initiate withdrawal. 

------
vrtx0
The title of this link is frustrating and misleading.  The article clarifies a
bit, but I take issue with Ars linking to the specific study with text stating
the methodology is the gold standard.  That doesn’t mean the conclusion will
hold up to scrutiny, or that “extremity pain” is a meaningful dimension.  The
type of injury (eg.  compound fractures, sprains, etc.)  could be more
meaningful than where the injury is.  There’s no control for injury location. 

Also, the CDC guidelines state that opioids are recommended when other
treatments fail (regardless of the underlying condition).  That key facet was
excluded from this article.  Ugh. 

Apologies, this is a bit of a rant.  I have a very painful chronic neurological
condition that often requires powerful opioid pain medication to get out of
bed (and not commit suicide).  Please keep in mind that there are legitimate
use cases for opioids.  I don’t like them, but combined with biofeedback, PT,
mindfulness and relaxation techniques, I’m able to survive until my condition
gets better (if it does). 

We all understand that opioids should be avoided when possible.  Addiction is
horrific.  I don’t think anybody is arguing that.  But please help stop making
life exponentially harder for people with legitimate problems that effectively
require opioid medications as part of a treatment plan.  We have it tough
enough already. 

The only way out of the current situation is to develop drugs that are at
least as effective as opioids, but not addictive (and ideally not
psychoactive).  I’ve tried everything (yes, an NSAID + acetaminophen, and even
intrathecal Ziconotide), but we just aren’t there yet.  I hope we get there
soon, because I’m sick of the mental cloudiness and health risks of opioids.  I
want my life back, and I’m sick of fighting just to maintain an acceptable
level of pain management. 

~~~
katastic
I was about ready to chime in the same thing.  I've been on opiods for six
years (not by simple choice).  I'm also on a literal 15 other medicines.  I take
around 30+ pills a day I've had multiple back surguries.  I've got on average 3
doctor visits a month (those co-pays add up fast!)...  for six years.  And this
all started in my prime... at 25 years old where I went from starting a Ph. D
program... to fighting with every ounce of my strength and mental fortitude to
keep from being homeless. 

I'm not sitting around, popping pills to get high.  And, you can't magically
get addicted to opoids if you never take increasing doses (read: follow the
prescription).  The longer you take them, the high rapidly goes away (drug
addicts "chase" it by increasing doses) while the pain relief stays usable for
a _much much_ longer period. 

After six years, I've gone down on dosages slowly.  The relief works fine.  And
I get zero high.  It's like taking a Tylenol for me except it actually helps my
pain. 

Meanwhile, for 6 to 9 months when I lost my insurance I was stuck with over
the counter medicine.  I destroyed my gastrointestinal tract and almost my
kidneys, just trying to take enough medicine to not commit suicide from the
pain. 

Are opoids being over perscribed?  Yes.  duh. 

Does treating anyone who takes opoids into an addict, help anyone?  NO. 

People need to get off their high horses (ha, pun.)  and realize pills are
pills.  You can argue for reduced perscriptions but the second you start
villifing _actual patients_ by telling them "you're pain isn't real.  just take
some Tylenol" you're now apart of the problem.  You're not stopping a single
person from getting high.  You're just helping oppress people who are already
so ! @$!@ed up that they barely have the energy to keep going, let alone defend
themselves from the public's armchair warrior researched lynching. 

I've moved plenty of times.  I've seen literally dozens of doctors.  And almost
every single one of them agreed with my diagnosis that I should be on this
medicine.  What makes you think reading a bloody internet magazine article
about a single study makes you think you know better than the doctors who are
trying to save my life? 

So while yes, I think most people here are more reluctant to be as judgey--and
I thank you for it--there are still plenty of people abusing sources to make
their soap box point.  They think opiods are automatically evil.  They're not. 
They're the "right tool for the right job."  end of story.  And just because one
research study says they're not useful for specific scenario, doesn't mean all
scenarios are some secret conspiracy to get healthy people high. 

I don't "want" to be an ANY of these medicines.  Every single one is a
potential liability.  I have to keep them with me when I go places.  I have to
keep them safe from thieves (!!!)  at home.  I have to monitor how many each I
take a day.  At 25 years old, I had two 7 day pill counters just a 85 year old
man.  We don't _want_ to be on these medicines and deal with their side-effects
upon side-effects.  We're taking them because we have to and the other option
is to simply roll over and die. 

So forgive me if I sound emotional, when literally one of the tools that keep
me alive, is being threatened by _both conservative and democrats_ looking to
grandstand to their constituents while nobody actually does anything to stop
the abuser. 

You can't imagine what it's like when you see someones face (nurse, doctor,
police officer) completely change and withdraw the second they find out you're
on an opoid.  It's unreal.  The entire room "goes cold."  I dare you to try
telling someone that.  They stop talking to you and talk _at_ you.  I've
literally had a cop lie on a police report when he found out I take a medicine
that I'm 100% legally prescribed.  I've had receptionists not forward my calls
to the doctor.  I've had people scout out and follow me home. 

All because I chose to put a pill in my mouth that a doctor told me to. 

I could write an entire book on this stuff by now.  I've considered building a
YouTube channel about it.  As a scientist, I can tell you, it's like walking
into another world. 

~~~
empath75
I have a very good friend with a similar story about long term back problems. 
He was on oxycontin for literally 10 years along with other medications. 
Multiple back surgeries. 

Then when his prescribing doctor got arrested, he ended up detoxing
involuntarily at first, and then voluntarily, and he found that he didn't have
any pain after he managed to make it through withdrawal. 

I honestly think a lot of people with chronic pain that they're treating with
opiates are actually treating _withdrawal_ with opiates. 

------
dajohnson89
Agreed that opiods are overprescribed, but for acute pain there's no
comparison.  At least in my experience. 

I was rushed to the ER with an excruciating condition, and i popped quite a
bit of ibuprofen at home before going to the hospital (i think 4-6?).  Nothing. 

In the triage room or whatever, that morphine drip (plus saline IV to replace
all fluid i vomited up due to pain) made the 8/10 pain reduce to a 2-3/10,
allowing me to bear with it until i was put under general anesthesia for
surgery. 

~~~
derefr
They didn’t say opioids are no better than _either_ acetaminophen or
ibuprofen; they said that opioids are no better than the _combination_ of
ibuprofen with acetaminophen — something very rarely prescribed (and usually
advised against on the labels of both drugs.) 

~~~
bryanlarsen
counter-anecdote: my doctor told me to use precisely that combination for
severe pain.  She said you cannot combine multiple NSAID's (ibuprofen,
naproxen, ASA), but you can combine an NSAID with acetaminophen. 

~~~
apendleton
Agreed; I've been prescribed that combination more than once by different
doctors.  It's very common, and often the recommendation is to stagger them. 
NSAIDs are metabolized by the kidneys and acetaminophen is metabolized by the
liver, so they can be safely combined. 

EDIT: also, this is pretty much what Excedrin is (aspirin instead of
ibuprofen, but NSAID + acetaminophen, plus also caffeine)

~~~
ianai
As a migrainer, excedrin really only works part of the time.  Though, opioids
really only succeed in making me not care about the pain.  I’m still in pain
with them. 

The best treatments, for me, directly address whatever underlying issue. 

~~~
mturmon
Drifting off-topic, but have you tried sumatriptan ("Imitrex")?  It seems to
have a near-total effectiveness on my ~monthly migraines.  Neither
acetaminophen nor NSAIDs ever did anything for my migraines. 

I agree that directly addressing underlying causes like stress, noise, sleep,
and diet are better than a pill. 

~~~
GordonS
I was about to say the same thing - sumatriptan works _amazingly_ well for my
migraines.  I'm in the UK though, and I seem to recall someone on HN saying it
was very expensive in the US. 

~~~
mturmon
It might have once been expensive ("Imitrex" (R)(TM)) but there is a generic
now.  I understand there are also non-pill delivery systems, like nasal or
patches, and other permutations that may still be under patent.  The pills seem
to work for me. 

~~~
ianai
Triptans work for me as well, but they’re too hard on my body.  It’s aftually
pretty scary how they work. 

~~~
GordonS
Can I ask what side effects it is you get?  Just curious since there don't
appear to be any negative effects at all for me. 

~~~
ianai
It works by causing your muscles tissues to dialate or something like that.  My
doctor explained taking too many in too short a time could cause a stroke or
heart attack, forget which exactly.  One side effect i get is my skin becoming
highly sensitive to heat.  We’re talking luke warm shower water feeling
something like scalding hot.  It’s not that exactly either, very weird
sensation.  Other times my throats tensed up similar to when you eat something
highly sour. 

------
nimos
Those opioid doses are all super low, roughly equivalent to a single Tylenol
3.  The alternative is a super high dose of acetaminophen.  1/4 your daily
recommended maximum.  At roughly 3x the acetaminophen + the fairly high dose
ibuprofen I don't think there is anything really surprising about this. 

You couldn't take that acetaminophen dosage for more than 8 hours with 2 hour
dosing without hitting your daily maximum.  I'm skeptical that opioid
alternative with such a low dosage over such a short period of time has any
real chance of being addition forming. 

~~~
joshgel
These are standard doses of all these medications.  Its the dose of tylenol
often used in the hospital and wasn't dosed every 2 hours it was dosed once. 
For the opiates we either give 1 or 2 pills, here they gave 1.  Perfectly
reasonable. 

~~~
nimos
I'm not saying they are unreasonable doses but they are definitely low as far
as opioid doses go.  Apart from T1/T2s you can't get lower afaik. 

My point is I don't see that replacing opioids in this case is really useful. 
I'm happy to admit I don't know the answer here but I'm skeptical that people
going to the hospital and getting a single 5mg percocet/vicodin or even a 3-4
over ~8-12 hours are really at risk of addiction. 

For 24/7 dosing that acetaminophen/ibuprofen combo is only safe once every 6
hours which from my experience is way too long for acetaminophen.  Even on
every 4 hours I find the last 1 hour is definitely very noticeable. 

~~~
empath75
The more casually people treat opiates and the more that are on 'the market',
the more that are going to be diverted.f

------
SpikeDad
Well lets take some of these folks and give them a herniated disk like I had. 
Advil?  Tylenol?  Sure - like Skittles.  Even high doses of Hydrocodone only kept
the debilitating pain away for a couple of hours. 

I only slept 3 hours a night for 2 month.  My neurosurgeon said - "When you've
reached your pain limit call me and we'll schedule surgery".  That was 2
months. 

I'm very grateful for both the narcotics and the neurosurgeon.  Surgery was the
last resort and thankfully it reduced my pain 95% (micro discectomy). 

Some years later I was umpiring and tripped and fell right on my ribs (I'm 230
lbs) - crackity crack.  Breathing would not have been possible without a good
dose of Percocet - a limited, appropriate amount. 

So not sure exactly what's going on with this study (and I think the
hysterical press has some factor) but I'd debate the results. 

~~~
vita17
There’s no worse pain than passing a kidney stone.  Ibuprofen + acetaminophen
works better than anything I’ve ever been prescribed.  If it hasn’t worked for
you, you might not have taken enough.  Ask your doctor about the dosage.  It’s
safe to take more than what is recommended on the bottle. 

------
sandworm101
"Pain" is a very difficult thing to nail down.  It is a physical thing but also
a psychological issue.  The same physical pain, an identical injury, can
manifest completely differently according to the patient's mental state. 
That's why VR games reduce pain in children undergoing painful treatments. 
That's why someone with severe chest pain can see it suddenly diminish once
the doc rules it's not heart attack. 

An opiod hits the mental half in a way the others do not.  If you are in
hospital with a compound fracture (bone sticking out of you) then you aren't
just in severe pain but are also absolutely terrified.  Opiods work in such
cases.  Within a minute you will be very happy.  Advil might help with the
physical pain but it won't put your mind in the same place. 

------
dna_polymerase
I don't get the US stance on opioids.  In Germany they are heavily regulated
and can't be obtained without special prescription giving them an rather
exclusive aura.  No German doctor would prescribe them for headaches and people
only really get them after serious surgery for a really short term.  Advil
(Ibuprofen) and Aspirin (ASS) are far more common here and used for pain
management at a far broader extent than in the US.  And frankly so, Germany
doesn't have an opioid problem. 

That said, I think Bayer (manufacturer of Aspirin) being a German company
could have something to do with that, on the other hand seeing the immense
money spent on lobbying by Opioid companies in the US really says a lot.  IIRC
Purdue even paid university professors to downplay risks of Oxy in front of
their students so they would get a biased view on them already. 

~~~
tunichtgut
"And frankly so, Germany doesn't have an opioid problem." 

You are very uninformed obviously.  As far as i know for my town, Paderborn
(NRW), we have about 1.000 people receiving opioid replacement drugs under
government supervision (~90.000 city population). 

~~~
mschuster91
> As far as i know for my town, Paderborn (NRW), we have about 1.000 people
> receiving opioid replacement drugs under government supervision (~90.000
> city population). 

Whoa, that's an outsized proportion - entire Germany has 77k people in
methadone substitution:
[http://www.bfarm.de/SharedDocs/Downloads/DE/Bundesopiumstell...](http://www.bfarm.de/SharedDocs/Downloads/DE/Bundesopiumstelle/SubstitReg/Subst_Bericht.pdf?__blob=publicationFile&v=6)

Also, the numbers are 500 methadone substituters (of total ~1k opiate users)
in Paderborn
([http://www.nw.de/lokal/kreis_paderborn/paderborn/paderborn/1...](http://www.nw.de/lokal/kreis_paderborn/paderborn/paderborn/11184250_Netzwerk-
hilft-1.000-Drogensuechtigen.html)).  What would interest me is the background
why ~1% of the population are opiate abusers, though. 

------
bayesian_horse
The title is misleading, because opioids clearly are better at treating severe
pain.  I'm not familiar with the particular combination researched here, but
Ibuprofene alone certainly doesn't cut it in many instances.  On the other
hand, I can't understand why doctors in the US are so happy to prescribe
opioids. 

In veterinary medicine it's slightly different, because we can't use
ibuprofene for dogs and cats, but something similar.  Still, opioids are a good
idea perioperatively, and addiction is at worst a transient problem.  The dog
can't go out and score some heroin, for instance. 

------
ceedan
Some more anecdotal evidence

I was hospitalized with a huge abscess that was damaging my leg and hitting my
sciatic nerve.  The pain was as acute as I would imagine is possible.  The
morphine drip that I had did nothing.  It was very frustrating.  Sometimes the
pain would re-occur before I was allowed to get more morphine, and the
duration/severity of the pain was comparable. 

At the time, I thought that the morphine only managed to make me tired after
the pain had subsided, but maybe taking a nap after that kind of pain was
normal anyways? 

------
0xbear
As someone who actually ended up in ER with a badly broken ankle once, I beg
to differ.  After surgery, Percocet was the only reason I could sleep for the
first few days.  I got off it as soon as I could, though. 

Edit: I just wanted to point out there are different degrees of “acute
extremity pain”.  There’s “I bumped my toe against a chair leg” kind, and then
there’s “I can’t breathe because I’m in shock” kind.  Opioids are appropriate
for the latter. 

------
AdmiralAsshat
The other fun thing is that opioids are often cut with ibuprofen or
acetaminophen.  So even if you _are_ taking an opioid for chronic pain, you
might still be getting a long-term dose of Tylenol, which can damage your
liver. 

------
ineedasername
Would like to have seen an opioid-ibuprofen combo in the mix.  Or ibuprofen and
acacetamenophine each alone.  For the class of injury described, swelling and
inflamation will be very common, and ibuprofen is better suited than
acetamenophine for this. 

Class of injury is very important too: limb injuries producing acute pain are
more likely to be a type where time, even just 2 hours, will have a leveling
effect on pain, while one class or combination of drugs might provide better
instant relief. 

Finally, we have these short term acute pain examples and long term chronic
pain, but medium term acute pain in the range of days to weeks might be a
primary area of risk for new addictions where a patient requires more than a
few doses but doesn't ask the patient to shift their outlook on how they deal
with pain and adjust to it that chronic pain patient may have to do, with or
without opiods.  If the pain is short term in this way, the potent opioid pills
can be seen as a quick fix that doesn't take as much effort as rethinking
"acceptable" levels of pain. 

------
659087
I guarantee many of you who advocate for basically getting rid of opiates
completely as an option for pain management, will be singing an entirely
different tune if you ever end up in real pain and realize that "tylenol and
advil" isn't going to cut it. 

------
brudgers
_Researchers then randomly assigned the patients to get one of four pain-pill
combinations: 400mg of ibuprofen and 1,000mg of acetaminophen; 5mg of
oxycodone and 325mg of acetaminophen; 5mg of hydrocodone and 300mg of
acetaminophen; or 30mg of codeine and 300mg of acetaminophen.  Each of the pill
combinations looked identical to the patients—three opaque capsules._ 

The dosages contain very little of each opiod.  Based on Googling "normal dose
of oxycodone" 5mg is the smallest available dose of oxycodone and half the
size of the smallest dose of it under the brand name Oxycotoin.  In addition
each opiod cocktail contains less acetaminophen than in the non-opiod control. 

It's worth noting that the standard pain scale goes from zero to ten and that
a mean of 8.7 across 411 patients is very high: closer to "Excruciating
Unbearable" than "Utterly Horrible" [1].  Reducing it to 4.3 is to take it down
between "Distressing" and "Very Distressing". 

None of the treatments reduced the pain to "Tolerable" (level 3).  One might
say that the study shows that an inadequate cocktail of opoids is no better
than an inadequate cocktail without them. 

[1]:
[https://previews.123rf.com/images/sunshinearts/sunshinearts1...](https://previews.123rf.com/images/sunshinearts/sunshinearts1508/sunshinearts150800025/43529275-Faces-
pain-rating-scale-Comparative-pain-scale-chart-Pain-assessment-tool--Stock-
Vector.jpg)

------
jimrandomh
The study abstract: [https://jamanetwork.com/journals/jama/article-
abstract/26615...](https://jamanetwork.com/journals/jama/article-
abstract/2661581) .  This study appears to be too new for sci-hub to have it;
it is extremely unlikely that the Ars Technica writer read the study at all. 

The headline here says the study "finds opioids no better", but what actually
happened is that the study was too small to reach statistical significance on
any of its endpoints. 

More importantly, the study chose the top of the recommended dose range for
the ibuprofen+acetaminophen group but the bottom of the recommended dose
ranges for the oxycodone+acetaminophen, hydrocodone+acetaminophen, and
codeine+acetaminophen groups.  This strongly suggests that the study designers
knew what outcome they wanted, and arranged subtle details of the study (which
are hidden behind a paywall!)  to make sure they got it. 

------
saas_co_de
This is a highly misleading presentation of the study. 

The study compared the following doses: — 400 mg ibuprofen and 1,000 mg
acetaminophen — 5 mg oxycodone and 325 mg acetaminophen — 5 mg hydrocodone and
300 mg acetaminophen; or — 30 mg codeine and 300 mg acetaminophen

[https://media.jamanetwork.com/news-item/no-significant-
diffe...](https://media.jamanetwork.com/news-item/no-significant-difference-
pain-relief-opioids-vs-non-opioid-analgesics-treating-arm-leg-pain/)

So, the study is comparing high doses of ibuprofen/acetaminophen to low doses
on opiates/acetaminophen. 

It is an interesting outcome for mild pain and suggest that for mild pain it
might be better to pass on low dose opiates but in no way does this show that
opiates are not needed for severe pain. 

~~~
pilsetnieks
400 mg ibuprofen and 1000 mg acetaminophen aren't high doses, at least when
taken separately, they're pretty standard adult doses (I think those are also
the most common pill dosages.) 

~~~
iliketosleep
Maximum single does of standard release acetaminophen is 1000 mg.  Make no
mistake, that is a high dose and it's terrible for your liver.  That's why in
recent years, there are more and more 325 mg preparations (where an adult
takes 2 x 325) rather than the traditional 2 x 500 mg. 

------
ams6110
_an initial prescription of just a few days ' worth of pills can trap patients
into using the highly addictive, often deadly drugs for a year or more_

I call BS on this.  Maybe if you have an unresolved underlying chronic pain,
this could be true.  But many people get a hydrocodone prescription after
surgery or dental work and do not go on to become addicts. 

And no, Tylenol is not great for acute pain.  It does very little for me in
fact.  Ibuprofen or aspirin work better in my experience. 

~~~
maccard
Can you link to the studies that you've performed that demonstrate this? 
Because there havebeen multiple discussions on this site where studies have
proven that people _do_ get addicted over short term, unnecessary high doses. 

~~~
bobcostas55
Take a look at this: [https://blogs.scientificamerican.com/mind-guest-
blog/opioid-...](https://blogs.scientificamerican.com/mind-guest-blog/opioid-
addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/)

>According to the large, annually repeated and representative National Survey
on Drug Use and Health, 75 percent of all opioid misuse starts with people
using medication that wasn’t prescribed for them—obtained from a friend,
family member or dealer.  And 90 percent of all addictions—no matter what the
drug—start in the adolescent and young adult years. 

>A Cochrane review of opioid prescribing for chronic pain found that less than
one percent of those who were well-screened for drug problems developed new
addictions during pain care; a less rigorous, but more recent review put the
rate of addiction among people taking opioids for chronic pain at 8-12
percent. 

------
hughw
Toradol (NSAID) is the most effective pain killer I've experienced.  I broke a
rib and could barely move.  ER injected me with Toradol, and for a brief few
hours I could move normally.  I call that the best high I've ever had -- not a
buzz -- just absence of pain.  Unfortunately it's so bad for your stomach they
won't give you two shots and won't let you take it orally more than a few
days. 

------
vinniejames
This can’t be true. 

Why would drug companies sell us over priced, dangerous drugs, when the over
the counter drugs work almost better? 

------
autarch
Personally I'd rather take the opiates.  I have GERD and other GI problems. 
Ibuprofen is likely to lead to extreme pain and discomfort.  I've taken a
variety of opiates in the past.  They did work for reducing pain but I couldn't
wait to stop.  I hate the dopey feeling. 

------
leroy_masochist
I'm sure this is true for the pain associated with the various ailments that
bring most people to the ER, but opioids are massively more effective for
serious trauma.  Motrin does very little for people who've been shot.  Fentanyl
lollipop on the other hand....

~~~
fapjacks
Right.  When you get your legs blown off, Ibuprofen ain't gonna cut it.  That's
why Army medics carry morphine. 

------
Buttes
I find that really hard to believe.  Maybe for some kinds of pain OTC meds or
marijuana will cut it, but when I have really bad back pain nothing works as
well as opiates, not muscle relaxers, not tylenol, not even _close_.  Opiates
work like _magic_. 

------
beebmam
I broke my arm a decade or so ago.  The doctor wasn't able to set my bone
without relaxing my extremely tight muscles.  Morphine worked great for that.  I
sincerely doubt that an NSAID could have done this, or even something like a
Soma (Carisoprodol). 

~~~
aarbor989
Same thing happened when I dislocated my shoulder last year.  No NSAID could
have done what that morphine did.  They tried for about 10min to do it without
the morphine but it was just simply not happening.  After the morphine they
actually had to put my shoulder back in twice since it popped right back out
after the first attempt. 

------
hamilyon2
Isn't it well-known?  It is written on ketorolak informational sheet.  edit: oh,
I see, article is about ibuprofen and acetaminophen.  The point stands, non-
opioid paikillers have same effectiveness

------
trisimix
Yeah they cause bleeding though so dont expect advil if you come in with a
bullet wound.  Hopefully we can stop giving opioids for non bleeding injuries
with this study. 

------
devmunchies
Would a TCH infused candy not be good for acute pain or is it mainly
beneficial for chronic pain?  Its less addictive than opioids. 

~~~
fhood
Sorry, TCH? 

~~~
neaden
I assume he meant THC aka a marijuana edible. 

------
nickthemagicman
I've had Advil, I've had morphine.  There is zero comparison. 

------
1jojojo
Yeah, look, I staggered into the ER with a shattered collar-bone and a
shitload of missing skin, and 10 mg of oxy had me feeling pretty much FINE
while a nurse took a coarse sponge to scrub the asphalt out of my wounds. 

Overprescribed, yes.  Comparable to OTC?  Absolutely fucking not.  Claiming that
ibuprofen is as effective as diluadid or morphine is completely disingenuous. 

~~~
JPKab
Acute pain from injury?  Give me opioids.  Post-surgical pain while in hospital? 
Opioids.  Released from hospital?  Opioids probably shouldn't be prescribed.