Risk-Benefit of Opioids, Other Analgesics Prescribed in ED Unclear

Emergency-room-entrance
Opioids were no more effective than NSAIDs or local, systemic anesthetics for musculoskeletal pain and may carry higher risk for harm.

HealthDay News — The balance of risks and benefits is unclear for opioids compared with placebo, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and local or systemic anesthetics prescribed for musculoskeletal pain in the emergency department setting, according to a review published online Oct. 18 in the Annals of Internal Medicine.

Caitlin M.P. Jones, from the University of Sydney in Australia, and colleagues examined the comparative effectiveness and harms of prescribing opioids for musculoskeletal pain in the emergency department setting in a review of randomized controlled trials of any opioid analgesic compared to placebo or a nonopioid analgesic administered to adults. Data were included for 42 articles, with 6,128 participants.

The researchers found that opioids were statistically but not clinically more effective for short-term pain reduction compared with placebo and acetaminophen, but were no more effective than NSAIDs or local or systemic anesthetics in the emergency department. Compared with placebo, acetaminophen, or NSAIDs, opioids may carry higher risks for harms, although the evidence is uncertain. No evidence of difference in harms associated with local or systemic anesthetics was seen.

“Opioids may have pain outcomes equivalent to those of NSAIDs, but evidence on comparisons of harms is very uncertain and heterogeneous,” the authors write. “There is an urgent need for more studies on opioids prescribed in the emergency department and upon discharge.”

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