Movement is Medicine: Opioid Crisis, Tylenol and Ibuprofen
We can all agree the opioid crisis is real. According to the CDC, the sales of prescription opioids in the US nearly quadrupled from 1999 to 2014 despite no change in the overall amount of pain Americans have reported. The supply of prescription opioids remains high and an estimated 1 out of 5 patients are prescribed the medication in office-based settings.
A study in 2016 reported that 3.3 billion opioid pills were left over from prescriptions. Nine out of 10 patients in this study were prescribed an average of 85 pills, and 1 in 5 reported sharing their medication with someone else. We have also seen opioid overdoses increase by 30 percent from July 2016 to Sept 2017.
In March the Journal of American Medical Association (JAMA) released a study that compared the effectiveness of opioid and non-opioid medications in treating chronic pain. The results of the yearlong study found that opioids were NOT superior to pain relievers like acetaminophen (Tylenol) and ibuprofen for treating chronic knee, hip, or back pain caused by osteoarthritis.
The news media went wild in reporting the results of this one study, with headlines such as: “Opioids don’t treat chronic pain any better than ibuprofen,” “Opioids don’t beat other medications for chronic pain,” and “Opioids no better than common painkillers for treating chronic pain.”
We are desperately looking for a way out of the opioid epidemic, however we must not lose sight of the nuances and complexity of the issue, and not rush to judgment on what to do and how to change it.
One nuance that has become apparent is that patients who are taking opioids to manage pain and are productive members of society are being frowned upon or even called addicts. What if this patient has tried everything else and this is the only thing that works and allows them lead a productive and functional life?
The JAMA study suggesting that Tylenol or ibuprofen were as good as or slightly better than opioids for chronic pain, forgets to mention that each of those medications have their own set of side effects especially when taken over long periods of time and at high doses. Too much Tylenol can potentially result in liver injury and the potential increases if the individual regularly drinks alcohol. Approximately 15,000 people die per year and another 100,000 are hospitalized related to non-steroidal anti-inflammatories (NSAID) such as Ibuprofen, prescribed NSAIDs and aspirin.
Treating pain is challenging. It is complex and it is not black and white. Pain is a unique experience for each individual and each persons response will differ based on their own beliefs and experiences.
How do we move forward?
1. Discuss your individual issue with your doctor. He/she knows you and they can best advise you on your situation.
2. Ask for non-medication options first. If your pain is related to an orthopedic issue try ice or heat, or positioning. Go see your physical therapist for an evaluation.
3. Consider non-prescription medications like Tylenol and ibuprofen. Discuss with your doctor the dosing and length of time that is safe for you to take the medication based on your individual health.
4. Understand that opioids may be necessary to manage pain after an acute injury or surgery. Again the most important point here is to work with your doctor.
Yes, we have an opioid crisis; how we manage it will require a healthy and balanced approach.
