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CHICAGO — Emergency rooms are where many patients are first introduced to powerful opioid painkillers, but what if doctors offered over-the-counter pills instead? A new study tested that approach on patients with broken bones and sprains and found pain relievers sold as Tylenol and Motrin worked as well as opioids at reducing severe pain.

The results challenge common ER practice for treating short-term, severe pain and could prompt changes that would help prevent new patients from becoming addicted.

The study has limitations: It only looked at short-term pain relief in the emergency room and researchers didn’t evaluate how patients managed their pain after leaving the hospital.


But given the scope of the U.S. opioid epidemic — more than 2 million Americans are addicted to opioid painkillers or heroin — experts say any dent in the problem could be meaningful.

Results were published Tuesday in the Journal of the American Medical Association.


Long-term opioid use often begins with a prescription painkiller for short-term pain, and use of these drugs in the ER has risen in recent years. Previous studies have shown opioids were prescribed in nearly one-third of ER visits and about 1 out of 5 ER patients are sent home with opioid prescriptions.

“Preventing new patients from becoming addicted to opioids may have a greater effect on the opioid epidemic than providing sustained treatment to patients already addicted,” Dr. Demetrios Kyriacou, an emergency medicine specialist at Northwestern University, wrote in an accompanying editorial.

The study involved 411 adults treated in two emergency rooms at Montefiore Medical Center in New York City. Their injuries included leg and arm fractures or sprains. All were given acetaminophen, the main ingredient in Tylenol, plus either ibuprofen, the main ingredient in Motrin, or one of three opioids: oxycodone, hydrocodone or codeine. They were given standard doses and were not told which drug combo they received.

Patients rated their pain levels before taking the medicine and two hours later. On average, pain scores dropped from almost 9 on a 10-point scale to about 5, with negligible differences between the groups.

Ibuprofen and acetaminophen affect different pain receptors in the body so using the two drugs together may be especially potent, said Dr. Andrew Chang, an emergency medicine professor at Albany Medical College in upstate New York, who led the study.

He noted that a pill combining ibuprofen and acetaminophen is available in other countries; his findings echo research from Canada and Australia testing that pill against opioids for pain relief.

— Lindsey Tanner

  • Absolute nonsense. If you buy any of this I got a Bridge to sell ya!
    If the Pain Meds did not work I guess the entire use of them could stop immediately — fortunately for those who know – opiate meds do work. We (the USA) have just been Bcrapped by bigPharma starting with Oxycontin and Purdue (as they admitted as much is lawsuit, $600 million fine.

    But, they ran all the way to the Bank with Billions (yes B as in Billions) of dollars ($$$).

    So, how about doing a story about the real pain med crisis starting with them?

    — Here is a fact: Chronic Pain Patients (who treat successfully with opiates) are NOT O’Ding – heroin addicts are. Heroin is illegal. Sure, perhaps they liked (which is probably genetic) a pain pill when they got Wisdom teeth pulled, and YES, they should never have gave patients 30-60 opiate meds afterwards – better to give 3-5 and say call if your in severe pain when they are gone .

    I have chronic pain. I remember Dr. Death. Humans cannot tolerate severe pain 24/7 for much time before thinking suicide is better (it’s not, OK). This rush to cut off chronic pain patients from opiates is misguided and mass medical (punishment) treatment.

    So the question is: WHY IS THIS HAPPENING ? It simple, chronic pain patients get opiates, so cut them off. BUT, when they do this and Heroin Addicts are still ODing (which they will) – what then? Cut off Diabetics from Insulin, see if that will work?

    The entire problem is the (so-called) War on Drugs, and stupidity in trying to treat (genetically based) addictions with some 12 step program. It is a brain disease and will need life long treatment.

    Heck Our Governement will not even PROPERLY fund the VA for our Great Veterans who many have horrific injuries because when the Country called, they answered — lets treat them properly (and what makes you think they if the Senate/House will NOT fund the VA when they praise Veterans, what makes you think they will even do 10% funding for addiction treatment — the entire medical payments system needs redone and take the profit out of it.

    If you do not add value, you have no place in the medical field. Look at other Western Countries — surely not perfect, but why not pick the best from each and any of them ?

    First thing need done is ban all lobbyists as they will not let it happen (did’t Trump say He was going to do that “day one?”).

    Lives are at stake, it is no place for Politics (or idiots who rail against long proven and working treatment methods – pain meds work, but they can hook those who are genetically pre-disposed, and probably any one if not done carefully and telling them pain free is NOT possible, pain reduce from 9 to 4 is the best we can probably do — being addicted is worse than 4 out of 10 pain so BE DARN CAREFUL and use other modes to deal with your pain – I use every mode known — I had to it was that or suicide (read above, Humans cannot handle severe pain 24/7 for more than a few hours or days — they will commit suicide, ask Dr. Death).

  • This headline is misleading. Also, other media have chosen to run this article selectively: They cut out certain statements to make it sound as if Tylenol can replace opiates in all cases for pain (and gee, the headline matches). You should be ashamed of yourself, AP.

  • Hmmm… so they tested max dose of ibuprofen and acetaminophen against the lowest recommended dose of opioids. Sounds like academic dishonesty at its finest. Shame on you stat and Lindsey tanner, you should be ashamed of yourself

  • It is actually not surprising to me that ibuprofen plus acetaminophen worked as well or better for sprains or broken bones than an opiate plus acetaminophen in adults. In other studies, NSAIDs were equal to or more effective than opiates for fracture pain in children (Poonai CMAJ 2014; Clark Pediatrics 2007). Adding codeine to acetaminophen plus ibuprofen led to no improvement in dental pain in another new study (J Oral Maxillofac Surg. 2017 Oct;75(10):2063-2069). We are abandoning the use of codeine for pain in children because of the risks. I hope the day will come when we abandon codeine in adults as well. Although the average pain scores in this study (and others) suggest some analgesia, we need to bear in mind that 1 in 10 patients (poor metabolizers of CYP 2D6) gets no pain relief with codeine because they do not metabolize it to its active metabolite, morphine. Anyone taking a drug that strongly inhibits CYP 2D6 like Prozac (fluoxetine) or Paxil (paroxetine) is also unlikely to have adequate pain relief with codeine. Then there is the risk of fatal morphine toxicity after taking a normal dose of codeine if you are an ultra-rapid metabolizer of CYP 2D6. If codeine were a new drug under consideration by the FDA for approval today, would it pass? I hope not.

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