Are Strong Opioids Really Needed for Severe Acute Pain Management?

The strength of opioids used to manage severe acute pain has increased several-fold during the past 20 years. In this double-blind Australian trial, researchers enrolled patients undergoing surgical fixation of long bone, pelvic, or foot fractures to compare a strong opioid and a mild opioid for acute pain management. A total of 120 patients (mostly men; mean age, 37) were randomized to outpatient oxycodone (5–10 mg) or acetaminophen with codeine (500–1000 mg/8–16 mg) administered four times daily. Patients had been managed with oxycodone postoperatively in the hospital before randomization.

Pain was assessed with a standard 0-to-10 pain scale at discharge and through 3 weeks of follow-up. The mean baseline pain score for the entire group wa…