NSAID painkillers less harmful, just as effective as opioid drugs, studies show

Aug. 17 (UPI) -- Non-steroidal anti-inflammatory drugs, or NSAIDs, are just as effective as opioids at reducing pain from common injuries like strains and sprains, two analyses published Monday by the Annals of Internal Medicine found.

People taking NSAIDs also are less likely to experience the potentially harmful risks associated with opioid use, including abuse and addiction, researchers from McMaster University in Canada said.

The findings come as the United States is still dealing with an "opioid epidemic" fueled by misuse and abuse of used prescribed pain medications, according to the researchers.

"Although there are many treatment options available for addressing acute pain from musculoskeletal injuries, only a limited number of pharmacologic options are currently supported by moderate-to-high certainty evidence," study co-author Dr. Jason Busse told UPI.

"Specifically, topical NSAIDs [and] oral NSAIDs ... show the most convincing and attractive benefit-harm ratio, and no opioid provided benefit greater than that of NSAIDs," said Busse, an associate professor of anesthesia at McMaster.

Despite the risks associated with opioid use, some 25% of people who suffer acute ankle sprains are prescribed these drugs, Busse said.

For the first of their new studies, which focused on the scope of opioid prescribing, Busse and his colleagues reviewed data from 13 other studies with 13.3 million participants.

Twenty-seven percent of people in "high-risk" populations, such as those with histories of substance use disorders, were prescribed opioids following acute injuries, compared to 6% of those in the general population, the data showed.

Older adults and those with underlying health problems were also more likely to engage in prolonged use of opioid pain relievers.

In the second study, the researchers reviewed data from 207 clinical trials with a total of 33,000 participants that evaluated 45 therapies. Among the injuries of participants in these trials were sprains, whiplash, muscle strains, non-surgical fractures and contusions.

Topical NSAIDs -- the researchers did not identify specific drugs -- as well as oral NSAIDs and acetaminophen had the "most convincing and attractive benefit-to-harm ratio" -- based on pain relief, physical function, side effects and patient satisfaction -- for people with acute pain.

The findings from the two studies "informed" new recommendations for treating musculoskeletal injuries pain management that appear in the same issue of Annals of Internal Medicine, Busse said.

"[Our] findings support avoiding prescription of opioids for acute pain from non-low back musculoskeletal injuries," he said. "Patients can use the findings from our review to decline the use of opioids for [these injuries]."