This week I want to highlight two articles that address the treatment of pain. The first article examines different types of medications and how they treat different types of pain. The second article examines results from a study about pain trends and treatment in adults across the U.S. Below you’ll find these articles and my thoughts on their implications.
Disclaimer: The views and opinions expressed below are those of Mark Pew, Senior Vice President of Product Development and Marketing, and do not necessarily reflect the views of Preferred Medical.
It is commonly thought that opioids are powerful painkillers, much more effective than over-the-counter drugs such as Ibuprofen or acetaminophen. However, after examination and evidence-based reviews, this series of articles reports that depending on the type of pain you have those over-the-counter drugs could be just as effective. In summary, when evaluating the effectiveness and harmful side effects, opioids should not always be the first choice for treatment of pain.
This is an excellent series of articles by my friend Linda Van Dillen regarding opioids. Back in 2016 she published “Is Tylenol better than opioids?” then “What is number needed to treat (NNT)?” then “The medication with the lowest NNT for acute pain?” then “Which pain medication is best for a specific type of pain?” I suggest you read them all, in sequence, as the objective measurement of NNT is a great way to compare the various options. Her conclusion? “When they <opioids> are as effective as NSAIDs and acetaminophen, they cause more harmful side effects. Even if you ignore the societal issues created by chronic use of opioids, the lack of superior effectiveness demonstrates that opioids should not be the first line choice for pain relief.” Spoiler alert (but please read Linda’s articles anyway). The best treatment for pain after wisdom tooth extraction is the combination of ibuprofen and acetaminophen. For back pain, the data shows opioids aren’t the best option. And for severe pain—in this example, renal colic (kidney stones)—NSAIDs and opioids offer similar relief but opioids cause more adverse side effects. So the winner of NNT? “It was Ibuprofen 200 mg + acetaminophen 500 mg: The combination of these two OTC medicines provided the best pain relief of all, with an NNT of 1.6!” Two of my past blogposts might be helpful additional reading:
- “Good parent (!) – Bad dentist (?)” on August 14, 2017
- “The “good stuff” may not be what you think…” on June 27, 2018
A recent study provides insights into pain trends in adults across the United States. The findings conclude that 178 million adults in the U.S. have at least one painful health condition and 10.5 million adults use prescription opioids for pain management. This National Institutes of Health study shows small and large trends in health and pain management that can help policymakers, providers and patients make better choices.
This is somewhat dated info (only thru 2014) but the trends outlined are important. The doubling of Rx opioids in the report does not represent the current state. Opioid prescriptions started to decline in 2012, accelerated their decline in 2014 and has continued that downward trend ever since. But the number of people in non-cancer pain (“at least one painful health condition”) has continued to climb “from 120.2 million (32.9 percent) in 1997/1998 to 178 million (41 percent) in 2013/2014.” And in 2019 that trend probably continues. Why are an increasing number of people in pain? So many potential factors that it’s cause is probably unknowable, but for whatever reason chronic pain is becoming more prevalent. Are somehow humans in more pain in 2019 than in past years, decades, centuries? Are we better at identifying pain (thanks to the now-controversial Pain as the Fifth Vital Sign added in the mid-1990’s)? Are we better at reporting pain (thanks to more data analysis, organizations focused on pain, and social media)? Or are we less able to manage pain (i.e. less resilient)? Again, the reason behind this increase in pain is likely unknowable. But as long as we deal more with symptoms (pain) than root causes (physical, psychological, emotional) then this trajectory will probably continue in the wrong direction.
To read everything on my mind this past week, please visit me on LinkedIn at https://www.linkedin.com/pulse/marks-musings-february-25-mark-rxprofessor-pew/.
Until next week,