In a randomized clinical trial, researchers discovered no significant statistical or clinical difference in acute pain reduction between patients receiving either Tylenol and Advil or Tylenol and an opioid.
The study included 416 male and female emergency room patients, presenting with moderate to severe pain in their extremities, from injuries such as sprains and fractures.
They randomly assigned them to an oral dose of acetaminophen (Tylenol) with either ibuprofen (Advil) or the opioids oxycodone, hydrocodone or codeine. Two hours later, they questioned them using an 11-point pain scale.
Lead author Dr. Andrew K. Chang said in general, non-opioids work just as well even for severe pain, though he added individual patients may find opioids more effective.
The average score was 8.7 before taking medicine. That score decreased 4.3 points with ibuprofen and Tylenol, 4.4 with oxycodone and Tylenol, 3.5 with hydrocodone and Tylenol, and 3.9 with codeine and Tylenol. In other words, there was no significant difference, either statistically or clinically, among any of the four regimens. The study is in JAMA.
There are clear implications for the continuing U.S. opioid crisis:
“Some docs will reflexively give an opioid to anyone with a fracture,” Dr. Chang said. “But if we can give the non-opioid and show the patient that it works, we can help with this ongoing opioid problem.”