Can NSAIDs and Acetaminophen Effectively Replace Opioid Treatment Options for Acute Pain?

ABSTRACT

Introduction

Opioid analgesia for acute painful conditions has come under increasing scrutiny with the public health crisis of opioid overdose, leading clinicians to seek nonopioid alternatives, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (paracetamol).

Areas Covered

This perspective evaluates recent clinical trials of nonopioids, opioids, and combination therapy for use in acute pain. Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) often provide adequate analgesia, although these agents are not without risks. Combination therapy using a small amount of opioid together with a nonopioid pain reliever has been shown effective and reduces opioid consumption.

Expert opinion

The short-term use of opioids under close clinical supervision, such as in-hospital use of opioid analgesics for postoperative pain, may be appropriate, but even here, combination therapy or nonopioid therapy may be preferred. The use of opioids even for acute pain of short duration has been questioned. The ideal analgesic has yet to be developed, but effective pain control pharmacological regimens for acute pain are available.

KEYWORDS:

• Acetaminophen
• acetaminophen toxicity
• acute pain
• chronic pain
• dental pain
• dexketoprofen
• gout
• ibuprofen
• ketamine
• ketoprofen
• ketorolac
• meloxicam
• migraine
• morphine
• multi-mechanistic pain
• multimodal therapy
• musculoskeletal pain
• naproxen
• nefopam
• nonsteroidal anti-inflammatory drugs
• opioid-associated side effects
• opioids
• patient-controlled analgesia
• postsurgical pain
• subacute pain
• tapentadol

Article highlights

• Pain is a heterogenous condition and to some extent, treatments have to be individualized; the role of opioids for acute pain is coming under increasing scrutiny

• Acute pain can be effectively treated with multimodal therapy, combining a relatively small amount of opioids with nonopioid pain relievers such as acetaminophen or NSAID

• The dental pain model often used for acute analgesia has found that nonopioids can be safe and effective for a single dose or short course of treatment

• Acute musculoskeletal injury may often be treated effectively with NSAIDs or acetaminophen

• All analgesics carry both risks and benefits; the patient should be informed about these risks and analgesics should be used at the lowest effective dose for the shortest period of time possible

This box summarizes key points contained in the article.

Declaration of interest

JV Pergolizzi, JA LeQuang, R Taylor and C Wollmuth are all employees of NEMA Research Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One referee has received research funding to study ibuprofen, diclofenac and other NSAID formulations, which was provided to the Trustees of the University of Pennsylvania. Furthermore, the referee has, in the past, also received consultancy fees from Johnson and Johnson (makers of Tylenol and ibuprofen products), Pfizer Consumer Healthcare (make of ibuprofen products) and Bayer (maker of naproxen products). Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This manuscript was not funded.