Mild painkillers match opioids for treating fracture pain: study

Painkiller addiction is on the rise in Australia. For many, their first experience with opioids comes after major surgery when they are prescribed to help with recovery.

What initially starts as a much-needed health tool can quickly become a crutch of dependence. But conventional wisdom says these drugs are necessary for people to withstand high levels of pain, and that they are worth the potential costs.

The effectiveness of strong opioids such as oxycodone and fentanyl as painkillers is undeniable, but are they the best choice for every type of surgery?

Researchers from The Daffodil Centre have demonstrated in a study that for patients recovering from surgery to treat bone fractures, a milder combination of codeine and paracetamol can provide pain relief equal to that from oxycodone hydrochloride tablets.

Read: Common anti-inflammatory drugs linked to serious health concerns

The study examined 120 patients undergoing surgery for orthopaedic fractures at a leading Sydney hospital. The researchers compared pain relief in the first week after being discharged.

Half the group was prescribed oxycodone hydrochloride 5mg or 10mg (one or two tablets, depending on severity of injury), while other half was given a combination tablet of acetaminophen 500mg and codeine 8mg (or 1000mg and 16g if taking two tablets). Tablets were to be taken four times per day.

They found that differences in pain levels experienced by the two groups were not statistically significant, despite the oxycodone tablets delivering an opioid dose six times higher than the combination tablet.

“Patients with surgically managed fractures are commonly, if not routinely, discharged home from hospital with a strong opioid prescription in Australia,” the study’s lead author, Dr Deanne Jenkin, told The Guardian.

Read: Drugs ‘wildly over-prescribed’ for dementia, study finds

“Clinicians should consider a less-is-more-approach for pain management upon hospital discharge following fracture surgery.

“It makes good sense to avoid medications that can cause harm if they provide no greater benefit as was the case here – no better pain outcomes for the strong opioid group.”

Along with the potential for addiction, the risk of overdosing on opioids is high. In Australia, it’s estimated that three people die from misuse of prescription opioids, and nearly 150 are hospitalised, every day.

At the same time, opioids are being prescribed at higher and higher rates in Australia, jumping more than 30 per cent between 2009 and 2014.

Read: Drugs limit; fears for aged

Those over 65 are the most likely age group to be prescribed opioids, with women 1.5 times more likely than men. Pharmaceutical opioids are now responsible for far more deaths and hospitalisations in Australia than illegal opioids such as heroin.

Earlier this year, the federal government launched the National Strategic Action Plan For Pain Management (NSAPFPM) aimed at reframing the way the Australian health system deals with pain as a whole.

Features of the plan include rescheduling codeine as a prescribed drug (meaning it is no longer available over the counter) and the introduction of real-time prescription monitoring.

One of the plan’s key outcomes is to reduce the number of opioid prescriptions in Australia, particularly in rural areas.

It pointed to the Australian Commission on Safety and Quality in Health Care, which revealed that opioid medications were being prescribed in some regional areas at 10 times the rate of other areas and recommended action on pain and opioid management in rural areas.

Have you ever been prescribed opioids for pain relief? What was your experience? Let us know in the comments section below.

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Written by Brad Lockyer