McMaster scientists in Hamilton show codeine is less effective for post-op pain

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The containment of the COVID-19 pandemic means hospitals will gradually start tackling backlogs of elective surgeries. And, almost on cue, a new research study affirms that patients do not need to take opoiods to manage pain, since ibuprofen works better any way.

McMaster University scientists in Hamilton recently published an analysis in the Canadian Medical Association Journal that shows that ibuprofen, and other NSAIDs (non-steroidal anti-inflammatory drugs) are more effective than codeine. The team’s research looped in 40 randomized controlled trials on more than 5,100 adults to compare pain levels and safety between using NSAIDs and using  medications  containing the opioid codeine, such as Tylenol 3.

Their analysis found that patients who took NSAIDs had lower pain scores at six and 12 hours after treatment, compared with those taking codeine. Researchers also found fewer adverse effects such as dizziness, drowsiness, headache, nausea and vomiting.

We evaluated patient global assessments and found moderate-to high-quality GRADE evidence that NSAIDs were statistically and clinically superior to codeine at all time points,” write the authors, who include Dr. Matthew Choi (associate professor of surgery), Dr. Li Wang (assistant professor, anesthesia), Dr. Christopher J. Coroneos (asst. prof., surgery), Dr. Sophocles H. Voineskos (asst. prof., surgery) and Dr. James Paul (professor, anesthesia).

The study’s main focus was on patients who are coming off of  dental, orthopedic and plastic surgery procedures. The authors say that NSAIDs are “statistically and clinically superior to codeine at all time points.”

The authors also say that prescribing codeine can be counterproductive, since many patients develop a reluctance to take it due to the aforementioned side effects.

All of (those common side effects) reduce compliance and increase rescue medication usage,” they write.

Canada has had some 9,000 opoiod-related deaths since 2016. The authors suggested that less prescribing of codeine could give a boost to a long-running public health issue.

Management of pain and potential opioid misuse is important across all medical and dental specialties,” they write.

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