Comparative Analgesic Efficacy of Oxycodone/Acetaminophen vs Codeine/Acetaminophen for Short‐Term Pain Management Following ED Discharge

• Published in: Pain medicine (Malden, Mass.) Vol. 16; no. 12; pp. 2397 - 2404
• Main Authors: Chang, Andrew K., Bijur, Polly E., Lupow, Jason B., Gallagher, E. John
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.12.2015
• Subjects: Acetaminophen - administration & dosage; Adult; Analgesics; Analgesics, Non-Narcotic - administration & dosage; Analgesics, Opioid - administration & dosage; Codeine - administration & dosage; Codeine/Acetaminophen; Drug Therapy, Combination - methods; Emergency Department; Emergency Service, Hospital - statistics & numerical data; Female; Humans; Hypotheses; Male; Middle Aged; New York - epidemiology; Oxycodone - administration & dosage; Oxycodone/Acetaminophen; Pain; Pain - diagnosis; Pain - drug therapy; Pain - epidemiology; Pain management; Pain Management - methods; Pain Management - statistics & numerical data; Pain Measurement - drug effects; Pain Measurement - statistics & numerical data; Patient Discharge; Patient satisfaction; Patients; Prevalence; Risk Factors; Treatment Outcome; Oxycodone/Acetaminophen; Pain; Codeine/Acetaminophen; Emergency Department
• ISSN: 1526-2375; 1526-4637; 1526-4637
• DOI: 10.1111/pme.12830

Objective To test the hypothesis that oxycodone/acetaminophen provides analgesia superior to codeine/acetaminophen following emergency department (ED) discharge. Design Prospective, randomized, double‐blind, trial. Setting Adult inner city ED. Subjects ED patients with acute extremity pain who were discharged home. Methods Patients randomized to oxycodone/acetaminophen (5 mg/325 mg) or codeine/acetaminophen (30 mg/300 mg). The primary outcome, obtained via telephone one day after ED discharge, was the between‐group difference in improvement in numerical rating scale (NRS) pain scores over a 2‐hour period following the most recent ingestion of study drug. Secondary outcomes included proportion of patients with >50% pain reduction, side‐effect profile, and patient satisfaction. Results Two hundred and forty patients were enrolled. Mean baseline NRS scores were 7.9 in both groups. Mean decrease over 2 hours was 4.5 NRS units in the oxycodone/acetaminophen group vs 4.2 NRS units in the codeine/acetaminophen group, for a clinically and statistically nonsignificant difference of 0.2 NRS units (95% CI −0.4–0.9 NRS units). Similarly, 66% vs 61% achieved >50% pain relief for a nonsignificant difference of 5% (95% CI −8% to 17%). Side‐effect profile and patient satisfaction were similar. Conclusion Our hypothesis that oxycodone/acetaminophen provides analgesia superior to codeine/acetaminophen was rejected. Although pain within each group was reduced by more than half, the between‐group difference was not significant. Pending independent validation, these unexpected findings suggest that codeine/acetaminophen, a Schedule III agent, may be a clinically reasonable outpatient opioid alternative to oxycodone/acetaminophen, a more tightly restricted Schedule II agent thought to be more prone to misuse.