Are Opioids Better at Treating Pain Than Over-the-Counter Medicines?

By Martha McLaughlin

Pain exists to serve as a warning signal. In an ideal world, we experience pain, quickly identify the underlying problem and easily correct it. Unfortunately, sometimes it’s not possible to decipher the message our pain is trying to send or to fix the issue quickly once it’s been identified. Sometimes, the efforts to correct a problem, such as surgery, can cause an increase in pain themselves, at least temporarily.

The importance of safe pain management has become increasingly apparent as the crisis of opioid addiction and overdose has engulfed the nation. Many people become addicted to opioids after being legitimately prescribed painkillers after surgery or for an ongoing medical condition. Often, teenagers looking to experiment with drugs start with prescription opioids, both because they’re legal – and therefore erroneously believed to be safe – and because they’re easily obtained at home.

Young woman holding pill

How Do Opioids Work Differently Than Other Painkillers?

There are various types of medicinal painkillers, and they work in different ways and have different risks. Painkillers that can be bought over the counter include acetaminophen (found in Tylenol) and nonsteroidal anti-inflammatory drugs, collectively known as NSAIDS. Some common NSAIDS include aspirin, ibuprofen (found in Advil and Motrin) and naproxen (in Aleve and Naprosyn). The primary prescription painkillers are opioids, like oxycodone (found in OxyContin, Tylox, Percodan and Percocet) and hydrocodone (in Vicodin, Lorcet and Norco).

Some differences between types of painkillers include the following:

  • NSAIDS – Non-steroidal anti-inflammatories work by lowering the amount of prostaglandins made by the body. Prostaglandins are hormone-like chemicals that affect inflammation, among other things. Lowering inflammation can lower pain, because inflammation tends to stimulate nerve endings. When NSAIDS are used in high amounts or for long periods of time, they can potentially cause bleeding in the stomach or digestive tract. Their use also appears to raise the risk of heart attack or stroke.4
  • Acetaminophen – Experts don’t agree on how exactly acetaminophen relieves pain. Some believe that it lowers prostaglandins in much the same way that NSAIDS do, but through inhibiting a different enzyme system. Others believe that it blocks the same enzymes, but in different parts of the body. The risks associated with high-dose and long-term use of acetaminophen include the potential for serious liver damage.5
  • Opioids – Opioids differ from over-the-counter painkillers in that they don’t work directly on the site of the pain. Instead, they block pain signals from reaching the brain. The addiction risk is high, and fatal overdoses can occur because the drugs lower the breathing and heart rate.6

Are Opioids Effective Compared to Other Options?

The conventional wisdom has long been that opioids are stronger and more effective pain relievers. Recent research, however, is causing that assumption to be re-evaluated. A year-long study reported in the Journal of the American Medical Association followed patients with moderate to severe back, hip or knee pain. Some were treated with opioid and some with non-opioid medications.

The study looked at pain-related function, the intensity of pain and adverse effects from the drugs. Opioids didn’t prove superior in any category. There was no significant difference in pain-related function, and the group that took non-opioid painkillers actually reported lower pain intensity. Opioids were also associated with more adverse symptoms related to the drugs themselves.1

The study, which examined the treatment of chronic pain, follows one reported in the same journal that looked at the role of opioids for acute pain, such as when it’s used in an emergency room. The study compared the effectiveness of four drug combinations in treating emergency room patients. Three of the combinations included opioids and one was opioid-free. The degree of pain relief after two hours was similar for all patients, with no significant differences seen. The combination of ibuprofen and acetaminophen worked as well as the combinations including opioid medications.2

What Are the Best Non-Opioid Treatments for Pain?

There’s no one-size-fits-all answer to pain relief for either acute or chronic conditions. Fortunately, there are many options, including non-drug approaches. A review of clinical trials examined the safety and effectiveness of drug-free methods for dealing with the pain of osteoarthritis, fibromyalgia, migraines, severe headaches, and pain in the back or neck. The review concluded that relief could be found using acupuncture, yoga, tai chi, massage therapy and relaxation techniques.3 Sometimes non-opioid prescriptions like corticosteroids, anti-seizure medications or even some anti-depressants can be helpful for pain, as well as herbal and enzyme formulations.

Opioids have their place in the tool kit of pain relief options, but it’s becoming increasingly clear that their risks outweigh their benefits in many circumstances. It’s important for all patients and doctors to do their homework, and to know the risks of any medications they deal with. No one wants to experience pain, but it’s also not wise to trade one problem for another.


Sources

1 Krebs, Erin E., et al. “Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial.” Journal of the American Medical Association, March 6, 2018.

2 Chang, Andrew K., et al. “Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department: A Randomized Clinical Trial.” Journal of the American Medical Association, November 7, 2017.

3Nondrug approaches effective for treatment of common pain conditions, review suggests.” Science Daily, September 1, 2016.

4 Sufka, Paul. “NSAIDs (nonsteroidal anti-inflammatory drugs).” American College of Rheumatology, March, 2017.

5 Drahl, Carmen. “How Does Acetaminophen Work? Researchers Still Aren’t Sure.Chemical and Engineering News, July 21, 2014.

6 Katz, Josh. “Short Answers to Hard Questions About the Opioid Crisis.” The New York Times, August 10, 2017.


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