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‘Regular painkillers work as well as opioids for fractures,’ but is this new information?

Rating

3 Star

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Regular painkillers work as well as opioids for sprains, strains and fractures

Our Review Summary

The news story reports on the findings of a recent study published in JAMA, which evaluated the effectiveness of four painkillers in addressing acute arm or leg pain in emergency room patients. One of the painkillers was a combination of the over-the-counter medications acetaminophen and ibuprofen; the other three painkillers were combinations of acetaminophen and an opioid (oxycodone, hydrocodone or codeine). The study found that — within the two-hour window being evaluated — there was no statistical significant difference in the effectiveness of the four drugs, indicating that acetaminophen/ibuprofen is a viable alternative to opioids for addressing acute pain.

The story is exceptionally concise — a news brief rather than a feature — but does a good job of describing the study and placing it in the context of the “opioid crisis” in the U.S. But much like a related news release, which we also reviewed, the story fails to place the findings in context with previous research on the relative efficacy of opioid and non-opioid painkillers.

 

Why This Matters

The story does a lot of things well, particularly given its brevity. It describes the study well and makes clear that the study is important because of the ongoing opioid crisis in the United States. As we noted when reviewing a news release on this study, the American Society of Addiction Medicine reports that at least 2 million Americans had an addiction to prescription painkillers in 2015 — and more than 20,000 people died from prescription painkiller overdoses in the same year. And data from the National Institute of Drug Abuse show that this problem is on the rise.

However, any story about research findings will be stronger if it explains how new findings are consistent with or differ from previous research in the field. That may be especially true here. If this story aimed to highlight the finding that non-opioid painkillers are comparable in effectiveness to opioid painkillers, it could have mentioned any of several studies (cited in the journal article) that had similar findings in post-surgical settings.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Cost isn’t addressed. As we noted when reviewing the news release, the costs of ibuprofen and acetaminophen are fairly low — but the relevant opioids are also relatively inexpensive. For the relevant dosages, the costs would be more or less comparable, with the hydrocodone/acetaminophen combination likely being the most expensive.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The story does a nice job here. It offers some quantification of the benefit without delving into statistically insignificant distinctions. In short, it makes clear that there was no practical difference in the effectiveness of the painkillers.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story does not delve into potential harms — but it does note that the study itself did not collect information on side effects. In a case like this one, simply reminding readers that there are potential side effects for all the drugs studied, and that the study did not address them, is sufficient for a Satisfactory rating.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story squeaks by on this one for explaining, albeit very briefly, that the study was randomized and that there were caveats to the data.

Does the story commit disease-mongering?

Satisfactory

No disease mongering here.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

There are no independent sources cited in the story, nor does the story address potential conflicts of interest. We get that this story is part of a series that aims to present brief “snapshots” of recent research findings that are interesting or important — little news nuggets you can read in the amount of time it takes you to wait for the elevator.

But we think getting outside input is sort of a threshold issue for journalism, and perhaps especially so for health care journalism. It could simply be a sentence from an independent source noting whether this is valuable information for clinical decision-making in emergency rooms. Are opioids regularly prescribed to patients with these types of injuries?

Likewise, there don’t appear to be any conflicts of interest related to the paper. A few words to that effect would have been very welcome.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story (and the study itself) are focused on the comparison of alternatives.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

While the story doesn’t explicitly state that the relevant drugs are clinically available, acetaminophen and ibuprofen are both sufficiently well-known over-the-counter painkillers that the writer can assume most readers are familiar with their availability. Opioid drugs, meanwhile, are generally much harder to access and tightly regulated in many states.

Does the story establish the true novelty of the approach?

Not Satisfactory

This is the weakest point of the story. It was also the weakest point of a news release on the work, and we’ll make the same observation here that we did there. First, here’s a key quote from the JAMA article: “Relatively few ED [emergency department] studies have compared the efficacy of the 3 most commonly used opioid analgesics in the ED and none has compared them in a single study. Although opioids are considered to provide stronger analgesia than nonopioid analgesics, 1 ED-based study found that adding combination oxycodone and acetaminophen to naproxen did not improve pain relief at 1 week in patients with acute low back pain. Several postsurgical studies have found combination nonopioids to be as effective as a combination of codeine and acetaminophen.” This is really useful information. Among other things, it tells us that previous studies have found similar results — but not in the context of addressing acute pain in the emergency room. In other words, it makes clear how this study builds on and is different from earlier research. That’s important. What’s more, as we noted in the “Why This Matters” section at the top of the page, the studies cited in the JAMA paper had comparable findings. This is not the first time someone has found that non-opioids are comparable to opioids. If you’re trying to tell people that there may be a way for doctors to meaningfully address one contributing factor to the opioid crisis, you should point to all of the supporting information — not just the most recent.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story included information that was not found in the release.

Total Score: 6 of 10 Satisfactory

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