The opioid crisis has taken the lives of thousands of people in our country. In fact, according to the CDC, opioid overdose deaths hit over 100,000 for the first time in the 12-month period ending this past January. That is a devastating number.
Many of those people first received an opioid drug, not from a drug dealer, but from a doctor, prescribing it in good faith to treat pain. The question is: are opiates good for treating pain that is not from cancer. The latest research says, “No.”
Researchers from Australia randomized two groups of patients who had 1 or more bone fractures that required surgery to receive either oxycodone — what they called a “strong” opioid — or acetaminophen and codeine (aka “Tylenol #3) to treat pain after they were discharged to the hospital.
They found no significant difference in pain between each group, despite the fact that the oxycodone group had a 6-fold higher opioid dose. The study authors concluded, “These findings suggest that ongoing first-line strong opioid use after discharge from the hospital should not be supported” in those patients who had a surgically managed bone fracture.
This is an important study. It further strengthens the recommendation that strong opioids such as oxycodone should not be used for noncancer-related pain. In fact, when thinking about a bone fracture, the mechanism of the pain after surgery has nothing to do with the opioid receptors in the body, and they are more likely due to the inflammation after the fracture and the surgery to fix it.
In fact, the absolute best pain medicine I’ve used to treat the surgical pain of patients recovering from heart surgery — and this was confirmed to me by a physician colleague who had the surgery himself — has been ketorolac, which is an NSAID like ibuprofen. The only thing is, NSAIDs such as ketorolac can cause serious complications like bleeding and kidney failure (which I’ve seen in my practice).
Still, even though opioids are ubiquitously used for post surgery pain, they really are not good drugs for the pain. This also goes for pain after dental surgery and procedures. As clinicians, we need to use less of them.
Of course, it is not our fault if we prescribe an opioid for pain in good faith and our patients abuse the medication. At the same time, we need to heed the science about opioids for noncancer pain. The literature increasingly suggests that opioids are not effective and can lead to abuse and complications. Thus, we should prescribe less of these medications as much as possible.
