Opioids No Better than Tylenol for Pain?

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I’ve never been a fan of narcotic/opioid medications. Fifteen years ago, when sales reps for pharma companies descended on our office to extoll the virtues of prescribing high-dose narcotics to our pain patients, I thought these folks were crazy. Obviously, the whole thing turned into a mess of gargantuan proportions, with opioids killing many patients and leaving others addicted for life. Now new research suggests that the whole opioid epidemic may have been based on a scam that these medications were effective for pain. Let me explain.

Opioids in the Headlines

You’re probably familiar with opioids, at least by name, because they have been a hot topic in the headlines in recent years. Opioids are prescription narcotic drugs (e.g., oxycodone, morphine, Percocet, Lorcet, Demerol, hydrocodone, etc.) that doctors prescribe to patients for pain. The problem is that they are dangerous drugs that are highly addictive, and, according to the CDC, overdoses due to prescription opioids are rampant. Just how addictive are they? According to a recent study, one in five patients becomes addicted to certain opioids after a ten-day prescription (one in ten with a standard five-day prescription).

Another problem research is uncovering is that some opioids aren’t even relieving pain and, in fact, may be creating chronic pain in the process by amplifying pain signals and causing inflammation. This ties into another study I covered showing that taking opioids (even as little as one prescription) at any point within two years prior to a knee replacement increases the risk of more pain after the surgery. Another study found that one reason some opioids may not be relieving pain for everyone is due to a protein called NK1R that is a master at hiding from the pain-relieving effects of the drugs.

So if we are going to risk our lives to attempt to relieve our pain, are opioids at least better at doing this than the milder and much less risky pain-relieving stuff? Let’s take a look at acetaminophen, which was tested against opioids in today’s feature study.

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Acetaminophen (e.g., Tylenol): Can It Hold Its Own Against Opioids?

Tylenol is a popular acetaminophen brand (also known as Paracetamol in Europe) that’s used to treat mild pain, and it comes in either a prescription form or you can buy it right off of your drug-store shelf. You can also find it in combo medications, like Excedrin, which also contains aspirin (an NSAID) and caffeine. Tylenol is not good at relieving inflammation, and this is what makes it different from nonsteroidal anti-inflammatory drugs (NSAIDs), which are both anti-inflammatories and pain relievers.

Acetaminophen, however, isn’t without its side effects as well. Tylenol has been associated with brain fog symptoms and it appears to have a negative effect on emotions.  But, at this point, acetaminophen does appear to be the lesser of many pain-reliever evils.

Opioids vs Tylenol for Pain: Tylenol Relieved Pain as Well as or Better than the Dangerously Addictive Opioids

The purpose of the new study was to investigate whether opioid drugs (e.g., oxycodone, morphine, etc.) provide better pain relief than nonopioid pain-relieving drugs (e.g., acetaminophen, aspirin, ibuprofen, etc.).  The study consisted of 240 patients with either back pain or knee or hip arthritis pain. The patients were randomized into two separate groups: an opioid group and a nonopioid group.

The results? Pain severity levels were slightly higher on average in the opioid group (on a scale of 0–10, the opioid group scored 4.0, while the nonopioid group scored 3.5). The medication’s effect on functional activities (e.g., sleep, work, etc.) after a year was, better in the nonopioid group compared to the opioid group (61% and 59% respectively). Researchers concluded that for chronic back pain or pain due to knee or hip arthritis, opioids were not  “superior” to nonopioids for pain relief or function, and that these results do not support opioid treatment for these types of pain.

Yikes! Think about that for a second. The pharma companies, by spending hundreds of millions pushing narcotic medications to physicians through advertising, sales reps, dinners, and trips have likely caused between 500,000 and 1 million preventable deaths. If the results of this study hold up, that means that these deaths were predicated on a scam that the medications were needed because they were more powerful pain relievers.

The upshot? As I always say, you just can’t make this stuff up! I still remember that day I kicked the Oxycontin rep out of my office and told him never to return. That was based on the empirical evidence before me of the new narcotic addicts I saw his drug create. That was back when many of my medical colleagues had bought his song and dance that Oxycontin wasn’t addictive. What if all of that human carnage was for nothing? What if all of those expensive drugs that could easily kill you weren’t any better than a ten-cent Tylenol pill? Regrettably, you just can’t make this stuff up…

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Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile

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