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Opioids vs. Common Painkillers

Posted 5/18/2018 by UHBlog

If your insurance and workers comp data indicates a lot of missed days due to employees' chronic pain issues, it's time to look at the occupational health measures you have in place. We can help.

Close up of a doctor’s and patient’s hands while discussing medical records after health examination

A recent study suggests that common painkillers – like Tylenol – are just as effective in reducing pain as opioid medications, according to findings in the Journal of the American Medical Association (JAMA). Meanwhile, primarily as a response to today's opioid overdose crisis, doctors are prescribing less narcotic pain medications than before.

The JAMA study has some limitations, such as a relatively small patient sample of 240 participants, who were all Veterans Administration patients and didn't necessarily reflect the general population, observes occupational medicine specialist Mundeep Chaudhry, MD. The study also looked at pain control a year after the medication was started.

In the long term, Dr. Chaudhry says, there may be no difference in opioids versus acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) for treating pain, but opioids may have short-term benefits right after an injury. However, he generally agrees that non-narcotic painkillers are as effective – and safer – than opioids.

“In occupational medicine, we try to stay away from opioids as much as possible,” Dr. Chaudhry says. “They should be used only when it is absolutely necessary.”

In fact, he reveals, the University Hospitals occupational health system writes only about 20 to 30 opioid prescriptions annually.

Opioids like methadone, oxycodone and fentanyl are synthetic drugs engineered to mask pain sensations. They act similarly to opiates, natural products like morphine and heroin that are derived from the opium poppy. Numerous states and municipalities have sued opioid manufacturers, claiming that they misled doctors and the public about the addiction risks of opioids.

The U.S. Food and Drug Administration (FDA) says reducing the number of Americans who are addicted to opioids and cutting the rate of new addictions may be achieved by ensuring that opioids are prescribed only to patients for whom they would be most appropriate. Additionally, the FDA recommends that the prescriptions are for durations and doses that properly match the clinical reason for which the drug is being prescribed.

“Before we prescribe an opioid medication, we first consider whether there are other options,” Dr. Chaudhry says. “If we find that an opioid is the best choice for a particular patient who, for example, has a herniated disc in his or her back, or a broken bone, we prescribe it for as short a period as possible – usually for a week or less – to lower the risk of addiction. If you control pain for the first few days after an injury, the body starts to heal and the pain goes down to where the patient can tolerate it better.”

Instead, says Dr. Chaudhry, the preferred options include over-the-counter or prescription doses of anti-inflammatory medications, like ibuprofen and naproxen (such as Advil or Aleve) and steroids, as well as acetaminophen (such as Tylenol).

“If the pain is in a joint, we want to keep the patient active,” he says. “Limited activity and mild movement is better than non-activity to reduce pain. Other modalities, if a patient isn't improving after a week, are things like physical therapy and massage.”

Cortisone injections, says Dr. Chaudhry, also can be effective in reducing pain, but are best left to physicians who are experienced in giving joint injections, such as orthopedists and physical medicine and rehabilitation physicians.

“Like opioids, non-narcotic painkillers should not be abused,” he says. “Overdoing it can cause damage to the liver and kidneys. High doses of anti-inflammatory medications can cause ulcers, bleeding in the stomach and kidney failure. You shouldn't exceed the recommended doses of common pain medications without consulting with your doctor.”

There are also non-pharmacological approaches to pain, which is the topic of University Hospitals Connor Integrative Health Network's upcoming symposium on Friday, September 14, from 7:30 a.m. – 5 p.m. at Hilton Cleveland Downtown. The symposium is in response to the opiates crisis and the millions of Americans suffering from chronic pain.

The day-long conference is offered to clinicians and non-clinicians, such as employers, human resources managers and others who want to learn about readily available, evidence-based therapies that can help reduce pain, build resilience and improve outcomes. For more information and list of speakers, log into https://case.edu/medicine/cme/courses-activities/conferences and click on ‘conferences.’ Scroll down to September events until you see, “Transforming Healthcare: The Non-Pharmacologic Approach to Pain / Clinician Well-Being.” You can also call 216-983-1239 for information.

To learn more about University Hospitals' occupational health and safety services, connect with University Hospitals Employer Solutions for more information.

Mundeep Chaudhry, MD is an occupational medicine specialist for University Hospitals Occupational Health. You can request an appointment with Dr. Chaudhry or any other doctor online.

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