Ibuprofen in the age of opioids
My mom, age 84, and I don’t always have the easiest time. She doesn’t like me telling her what to do. I don’t like her dropping hints on how to raise kids. For sure, she missed the AARP memo on simplifying life after retirement.
Months ago, in a freak accident mowing grass, Mom went airborne. I saw her in the ER, bruised and stitched. Two ribs and left elbow broken; left shoulder dislocated and broken.
Before I opened my mouth, she said, “Why the face? I’m not dead!”
Two month after her injury, she started painting her backyard fence. I asked how it went.
She said, “I hurt all over.”
“What pain med are you on?”
Her doctor prescribed piroxicam, a once-daily, nonsteroidal anti-inflammatory drug (NSAID), which she took – as needed.
“The drug works, Mom,” I said. “But you’re doing it wrong.”
NSAIDs (ibuprofen, naproxen, etc.) have been around in one form or another for thousands of years. The Egyptians, Greeks and Chinese brewed and chewed beans, peas, jasmine and willow bark to treat fever, joint and labor pain.
Somehow opioids have taken on a mythical image as stronger pain killers than NSAIDs. But are they really?
Since 2000 almost half a million people have died from drug overdoses; we need to revisit that question.
In this month’s JAMA, a study looked at patients who presented to ER with acute extremity pain. They were given four different analgesics: three opioids (codeine, hydrocodone and oxycodone) were pitted against ibuprofen.
The result: a wet blanket for the opioid myth.
Even at a modest dose of 400mg (200mg is the OTC dose), ibuprofen provides pain relief equal to the opioids. With fewer side effects.
NSAIDs are relatively safe, work very well at relieving acute pain and have the added advantage of reducing inflammation, which opioids don’t do. NSAIDs are frontline drugs in treating gout, dental pain, migraine headaches and certain postsurgical pain.
Is one NSAID better than another?
For pain relief, not much. A higher dose works better. I prefer ibuprofen because of its fast onset and low cost.
Piroxicam, for example, takes hours to reach peak blood level, days to reach steady state.
Meanwhile, ibuprofen takes minutes to kick in, an hour to reach peak blood level and is mostly eliminated in hours.
The price difference: a month of piroxicam costs $38.45 (retail: $110.11) on GoodRx; a month of ibuprofen equivalent starts at $4.
Who cannot take NSAIDs?
I worry most about patients with heart conditions or strokes and those prone to stomach ulcers.
But for anybody who takes NSAIDs long term (more than two weeks), let your doctor know. Maybe there’s a better choice. Celecoxib, for example, is designed to protect against ulcers.
I told – no, I suggested – that Mom take ibuprofen before she started painting, another in four hours if she still hurt. Today, her fence is dancing with dolphins and mermaids.
Regrettably, I wasn’t gifted with my pretty, high-spirited mom’s artistic gene (or her prettiness), but I pray I’ve got her nine lives.