Jeffrey A. Singer and Josh Bloom
A decade ago, most people thought of Tylenol (acetaminophen) as a medicine for fever, malaise and minor aches and pains. Nobody imagined that it would become the go-to drug for treating moderate, let alone severe, postoperative pain.
But this is just what has happened. Thanks to pressure from lawmakers, government agencies and policymakers who inserted themselves into the patient-doctor relationship, patients became the victims of the never-ending war on drugs.
Now, doctors frequently offer only acetaminophen to treat painful conditions despite the drug’s inability to remedy them.
Doctors pressured to avoid pain medication
Policymakers’ exaggerated fear of opioids has pressured hospitals, doctors and dentists to switch to acetaminophen, no matter how severe the patient’s pain. Sometimes, the drug is given intravenously in high doses as part of “opioid-sparing protocols.” We believe using the drug in this way is ill-advised, cruel and borders on malpractice.
Lawmakers believed they had to do something about the opioid overdose crisis, which has grown exponentially since the 1970s. The crisis was driven by a growing population of nonmedical drug users accessing drugs from the black market.
States dictate rules on prescriptions
Now, nearly 40 states have passed laws dictating the maximum number and dose of opioids that doctors are permitted to prescribe to their patients, all based on the misguided notion that medical use of prescription pain pills caused the crisis.
But what’s really fueling overdose deaths is drug prohibition and the dangerous black market that it creates. The Centers for Disease Control and Prevention got into the act by guiding doctors in treating pain, an area not in the agency’s wheelhouse.
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The evidence clearly shows that acetaminophen alone is a poor choice for treating most types of pain. Multiple literature reviews show that the drug has limited analgesic utility. Several Cochrane systematic reviews, which are highly regarded, evidence-based analyses that carefully evaluate the quality of data in numerous studies, have questioned its ability to relieve pain caused by a variety of conditions. With few exceptions, it fails miserably.
For example, studies reveal that acetaminophen effectively reduces fever in children. But, while the drug is frequently recommended for headache pain, its efficacy is mostly imaginary. A 2016 Cochrane review examined 23 studies, including more than 8,000 people with tension headaches. While 59% of the participants experienced relief within two hours, so did 49% of the group that received a placebo.
The authors concluded, “Only 10% people with tension-type headaches get a benefit from (acetaminophen).”
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A 2013 Cochrane review found the drug inferior to ibuprofen for reducing dental pain at all doses studied.
Perhaps most telling is a 2021 review that included 36 systematic studies of 44 painful conditions. It concluded that acetaminophen provided modest pain relief for one of them, osteoarthritis of the hip and knee. There was no sound evidence of the drug’s ability to treat any other painful condition.
Yet now, some doctors give it intravenously for postsurgical pain, a cruel and unethical practice if there ever was one.
Patients suffer agonizing pain
The government promulgates an erroneous fear of opioids that makes patients often endure agonizing postoperative pain they never would have experienced a decade ago, a violation of basic medical standards.
Yet, contrary to politicians’ beliefs, data show that the addiction rate of medically used opioids has been about 1%. Government data also show no correlation between the volume of opioids prescribed and the rate of abuse or addiction.
The treatment and management of acute and chronic pain involve the same nuanced medical decision-making as treating hypertension, diabetes, infectious diseases and psychiatric disorders. Just as it is wrong for the government to dictate how doctors treat those conditions, it should butt out when doctors treat pain.
Doctors take an oath to ease suffering and do no harm. Government meddling is causing doctors to violate their professional credo.
Dr. Jeffrey A. Singer practices general surgery in Phoenix and is a senior fellow at the Cato Institute. Josh Bloom is director of chemical and pharmaceutical science at the American Council on Science and Health.
Story Credit: usatoday.com