Research & Discovery

September 11, 2019 | Sheila Foran - School of Pharmacy

Study Shows Opioids Not the Only Option for Pain Management

UConn researchers studied the effectiveness of opioid and nonopioid analgesics in treating moderate to severe pain in prehospital settings.

Diana Sobieraj and William Baker outside the UConn School of Pharmacy.

Diana Sobieraj and William Baker outside the UConn School of Pharmacy. (UConn photo/Karin Burgess)

What to do when a patient is in pain?  While adequate pain relief can minimize anxiety and cardiac complications associated with acute pain, it is estimated that as many as 43% of adults and 83% of pediatric patients have insufficient prehospital pain relief. With increased concern about the negative consequences of opioid use, healthcare providers may face a real conundrum when prescribing meds.

In an article published in the Journal of Prehospital Emergency Care titled ‘Comparative Effectiveness of Analgesics to Reduce Acute Pain in the Prehospital Setting,’ lead author Diana Sobieraj, Pharm.D., FCCP, BCPS, Assistant Professor of Pharmacy Practice, and her co-authors, report on the effectiveness and drawbacks of opioids compared to nonopioid analgesics when treating moderate to severe acute pain in the prehospital setting.

The study, funded through the Agency for Healthcare Research and Quality (AHRQ) and sponsored by the National Highway Traffic and Safety Administration (NHTSA), involved a systematic review of 52 randomized controlled trials and 13 observational studies with the goal of synthesizing the available data.

William Baker, 02 (Pharm.D.), FCCP, FACC, FAHA, Associate Professor in the Department of Pharmacy Practice explained the value of such a study in light of current concerns about safe administration of pain medications. He said, “We identified a general lack of data in the prehospital setting with most previously published studies performed in the Emergency Department. Given the focus of the medical community on appropriate pain management in the current era, we felt that prehospital pain research should be given greater funding priority.”

Among the study’s key findings was that nonsteroidal anti-inflammatory drugs provide similar pain relief to opioids and may cause fewer overall side effects and less drowsiness. Acetaminophen may also provide similar pain relief to opioids and may cause fewer side effects overall, including less dizziness. Importantly, most analgesics were dosed intravenously and acetaminophen was dosed as 1 gram, more than the typical over-the-counter tablet.

In comparing ketamine to opioids, results show similar pain relief. However, ketamine may cause more dizziness or overall side effects, while opioids may cause more respiratory depression. The latter is a potentially fatal complication when opioids are used for either acute or chronic pain management.

Combining an opioid with ketamine may be more effective in reducing pain compared with opioids alone. In addition, if morphine does not adequately relieve pain, changing to ketamine may be more effective and quicker at reducing pain than if additional morphine is given.

In reviewing study results, lead author Sobieraj said, “Our research suggests that acute pain in the prehospital setting can be managed effectively with non-opioid options as well as opioids, although the side effect profiles differ. This knowledge can be applied to personalize analgesic selection in the prehospital setting and is an important contribution to patient care in the face of current concerns of opioid overdose in this country.”

The authors suggest that future research is needed to address pain management through formal studies set in the prehospital environment. This would involve evaluation of subgroups, including patient and drug regimen characteristics and EMS personnel training and how these characteristics may modify comparative effectiveness and harms of different analgesics.