In a recent study published in the Journal of the American Medical Association, physicians compared the efficacy of alternative pain killers to opioids for acute pain conditions. The study looked at 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.

According to the principal investigator, Dr. Andrew Chang, there was very little difference between the pain scores among those who were given the non-opioid pain relievers and those who received opioid-based ones. There are multiple studies that illustrate the dangers of short term opioid use. Considering that almost 19% of people leave emergency rooms with an opioid prescription, this new research should lead emergency room physicians and prospective patients to consider all their options for managing acute traumatic pain.

“For patients… with acute extremity pain, there were no statistically significant or clinically important differences in pain reduction at 2 hours among single-dose treatment with ibuprofen and acetaminophen or with 3 different opioid and acetaminophen combination analgesics.”

It is important to note that this research only looked at pain caused by arm or leg injuries, and that other injuries may require very strong analgesics like opioids to properly manage a patient’s pain. Nonetheless this research highlights possible ways that opioid prescriptions can be reduced in an emergency room setting.

These results have already changed the way Dr. Chang prescribes opioid painkillers and prompts him to have a discussion with patients about 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.”

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