Q: I am 74 years old, have arthritis in my knees and spine, and the last time I saw my doctor, she talked about switching my medication from Vicodin (combination of hydrocodone and acetaminophen) to something called an NSAID. Aside from some constipation, the Vicodin seems to be working well so far; why the proposed change?
A: Chronic pain has been one of the main problems prompting doctor visits for centuries and the discovery of narcotic pain meds (referred to, by physicians, as “opioids”, of which hydrocodone is one) has certainly allowed many chronic pain patients to be more comfortable and functional for far longer than prior to their discovery.
However, opioids come with very high risks of side effects, such as constipation, tolerance (where higher and higher doses are required to get pain relief), adverse interactions with many other medications, addiction, and worst of all, death from overdose, especially when mixed (intentionally or accidentally) with other medications.
A study published recently in the Journal of the American Medical Association (JAMA), showed that a combination of acetaminophen (generic form of Tylenol) and any of a number of different NonSteroidal Antiinflammatory Drugs (NSAID) worked significantly better for chronic pain than opioids, with none of the same risks as opioids, such as the constipation you’ve reported, but particularly addiction and overdose death.
In addition, the generic forms of all of the NSAIDs are covered by all major insurances and a regimen using them is far less expensive that any prescription opioid regimen. In fact, generic forms of 2 NSAIDs (ibuprofen and naproxen) are even available without a prescription, though it is best to consult your pharmacist if you plan to try such a regimen, for review of your entire medication regimen to determine if starting it might pose problems, such as the drug interactions mentioned above.
To learn more about this and many other health topics, visit the American Academy of Family Physicians’ website familydoctor.org, where you can click on the Search box in the upper right corner of the website, and enter your topic of interest.
I want to thank Darryl Y. for his question. If you have a topic you would like to hear about, message me at paulmdake@gmail.com.
Dr. Paul Dake, a Newberry native, is a retired family physician. He lives in Pinconning, Michigan.
