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Oxycodone Oxycodone with acetaminophen (Percocet, Tylox, Roxicet), plain oxycodone (Percodan), and extended release oxycodone (Oxycontin) are popular forms of the highly addictive oxycodone. The FDA has approved yet another powerful oxycodone narcotic (Combunox) which is oxycodone combined with ibuprofen. Virtually all of the pain relieving effect comes from the ibuprofen. Oxycodone is a very poor pain reliever. Oxycontin and the others are widely available on the street. Also, a large percentage of oxycodone addicts became addicts thanks to negligent physicians giving them this highly dangerous medication for some legitimate pain condition. Oxycontin is an extremely addictive and deathlier version of the highly addictive narcotic oxycodone. Both are dangerous narcotics with no place in medical care. In double-blind studies comparied oxycodone to non-narcotic pain relievers, oxycodone did worse in twelve studies against ibuprofen (3), indoprofen, bromfenac, Bextra, Vioxx, Arcoxia, lumiracoxib, and bupivacaine. In one study, oxycodone plus acetaminophen did as well, but it caused significantly more side-effects. In five studies, oxycodone or oxycodone plus acetaminophen did as well as non-narcotic controls. In only one lower quality, 20-year-old study did oxycodone do slightly better than an NSAID named Voltaren, but it caused many more side-effects, so I ruled the results a tie. Oxycodone's record is 0 wins, 13 losses, and 6 ties. Oxycodone is a loser! In two more studies, adding oxycodone to ibuprofen had little or no added benefit. Oxycontin should never have been approved by the FDA for usage in humans. Oxycontin tablets contain large amounts of narcotic which is supposed to be gradually released, but if chewed is released in an immediate and powerful surge of narcotics. Oxycontin serves no purpose that previously available medications did not serve and yet it has unleashed a huge wave of physical addiction, drug abuse, and death in our country. It is killing thousands of people, being the primary factor in huge numbers of drug overdose deaths every year. And the abuse rates are still climbing rapidly each year. I hope to be adding to this page as I find time. Clearly, the FDA should immediately withdraw it from the market. But since the current FDA is strongly influenced by the drug industry, the chance of this happening is zero. Oxycodone itself is a very addictive narcotic giving little added pain relief that is not obtainable with non-narcotic alternatives. Putting patients with chronic pain on the narcotic merry-go-round appears very destructive. Despite the myths perpetrated by pharmaceutical giants and their paid physicians, narcotics are not powerful pain relievers and almost all of their pain relieving benefits can be achieved as well or better with other alternatives. The small possible added benefit in a minority of cases is clearly outweighed by the dangers of addiction and abuse. Despite claims by narcotic prescribing doctors, narcotic addiction and abuse is very common amoung medical patients and one-quarter of all heroin addicts get their start from a doctor giving unsolicited narcotics for some pain condition. Tens of thousands of good Americans are turned into drug addicts each year by their physicians. The pain clinic industry bring out their poorly designed research and false statistics to try to claim that pushing opiates is good medicine. While it does make them billions of dollars, the research definitely does not support this practice. In repeated studies looking at the impact of single doses of pain killing medications, opiates have been shown to be poor pain killers. In studies looking at multiple doses, the large majority of the benefit of opiates is not the relief of pain but the relief of drug withdrawal caused by the opiates themselves. The Rush Limbaugh case is typical in which a highly addictive medication is given without any real need and turns a previously law-abiding and healthy person into a criminal drug addict. The pain physician community and their drug companies conveniently pass this off claiming that its not their fault, but the fact that the patients were not following directions and were just drug addicts. However, it appears clear that malpractice is occurring on a massive scale with the approval of the FDA and harming tens of thousands of citizens directly every year and harming us all financially. We should be careful not to blame the practicing physicians who is misled by the physicians working for pharmaceutical companies. In fact, the research on opiate pain relievers is that they make very poor pain relievers and should rarely, if ever, be used. After just one or two doses, withdrawal effects start to play an increasingly prominent role. So, the relief from pain that the patient is experiencing is increasingly a relief of the pain of withdrawal and not relief of the initial pain that the patient started with. It may feel like the same pain, but it is magnified by the drug withdrawal. The vast majority of so-called research isn't scientific research at all. It's only the drug pushing doctors saying that once patients are started on heavy duty narcotics, that most keep taking them. One thing I have noted about the "bogus" studies listed below is how many are not connected with medical school, but are done by private physician corporations. I guess being drug pushers is not good for your image. Another thing is that it is the anesthesiologists who are the big promoters of narcotics. Their field has long been insensitive to the disasterous effects that narcotics have on society and their role in this. Most of the current uses of opiates have never been research except against other opiates or against placebo. I have yet to find a single study in which opiates do better than non-opiates and I have found many in which they are markedly inferior. The phlegmatic Bush FDA allowed narcotic salesman Endo Pharmaceuticals to introduce two more addictive strengths of Percocet in January, 2000. Percocet 5/325 was joined by 7.5/325 and 10/325. If a doctor wants to give you oxycodone, print out this webpage and give it to him. If he still insists on giving you a narcotic, get another doctor. If a doctor gave you oxycodone and you became addicted and suffered some unfortunate consequence, the doctor and the narcotic manufacturer could be liable for malpractice. Also, consider whether you should report the doctor to the state licensing board. In view of the research, prescribing oxycodone is or at least should be ruled malpractice. Doctors are responsible for knowing whether or not narcotics are necessary. This research is readily available to anyone with a computer and an internet connection. Just go to Pubmed, and enter "oxycodone and double-blind." Oxycontin Killing Thousands: Of the 919 drug abuse cases, the vast majority (96.7%) were multiple drug abuse deaths in which there was at least one other plausible contributory drug in addition to oxycodone. The most prevalent drug combinations were oxycodone in combination with benzodiazepines, alcohol, cocaine, other narcotics, marijuana, or antidepressants. Using the DAWN definitions, drug abuse cases were further categorized as drug-induced or drug-related. A total of 851 (92.6%) cases met the criteria for classification as being drug-induced, and the remaining 68 (7.4%) cases were categorized as drug-related. Oxycodone involvement in drug abuse deaths: a DAWN-based classification scheme applied to an oxycodone postmortem database containing over 1000 cases. Cone EJ, Fant RV, Rohay JM, Caplan YH, Ballina M, Reder RF, Spyker D, Haddox JD. J Anal Toxicol. 2003 Mar;27(2):57-67; discussion 67 Oxycontin Abuse Skyrocketing; Leading Hundreds of Thousands into Narcotics: Non-medical OxyContin use in the United States, based on data from the 1999, 2000, and 2001 Substance Abuse and Mental Health Services Administration National Household Survey on Drug Abuse has been doubling every year. Reported lifetime non-medical OxyContin use in the United States increased from 0.1% to 0.2% to 0.4% in 1999, 2000, and 2001. Compared to those reporting non-medical use of prescription analgesics other than OxyContin, non-medical OxyContin users were more likely to show a pattern of more serious drug abuse: they used multiple drugs, used needles for drug injection, and had higher rates of abuse and dependence. 17% of non-medical OxyContin users reported having never used illicit drugs or other prescription medications non-medically prior to their first non-medical use of prescription analgesics. J Pain Palliat Care Pharmacother. 2005;19(2):13-23. Ed: The authors of this report pooh-pooh concerns about prescription pain relievers leading people into drugs. 17% doesn't sound "rare" to me. As single agent, the controlled release (CR) oxycodone's market in the USA grew from 10% in 1996 to 53% in 2000 and it has become a leading opioid in the United States. Minerva Anestesiol. 2005 Jul-Aug;71(7-8):451-60. Drug Pushers Dominant at WHO: "Cancer pain treatment should follow the recommendations of the World Health Organisation. Treatment should be with oral application, regular application times and following the analgesic step-ladder. Nonopioids such as dipyrone or nonsteroidals are used for slight to moderate pain, step-2 opioids such as tramadol or tilidine/naloxone for moderate pain and step-3 opioids such as morphine, oxycodone or hydromorphone for severe pain. Transdermal application of fentanyl or buprenorphine offer a non-invasive parenteral alternative for patients with stable pain syndromes. Cannabinoids such as tetrahydrocannabinol offer a valuable add-on option for cancer patients with refractory pain, spasticity, nausea or appetite loss." Palliative pain therapy, cannabinoids. Radbruch L, et al. Klinik fur Palliativmedizin, RWTH Aachen, Germany. Ed: Research is clear that cannabinoids are of no objective benefit whatsoever for spasticity and of little benefit for nausea or appetite with numerous alternatives available and preferred by the large majority of physicians. It is also crazy to consider opiates higher in pain relief. In fact, they are inferior pain relievers and have very little place in the practice of medicine. 31% Oxycontin Addicts in Treatment Started on Opiates with an OxyContin Prescription: Of 48 patients admitted for in-patient detox for abusing OxyContin, 31% first obtained their OxyContin from a physician for a real medical aliment. None of these had a history of prior opioid misuse. They were more likely than illicit CR oxycodone users to report prior detoxifications (P<0.03) as well as a lower mean age of first alcohol use (11.7 versus 14.7, P<0.05) and first illicit drug use (12.8 versus 15.8, P<0.05). Substance use histories in patients seeking treatment for controlled-release oxycodone dependence. Potter JS, et al. McLean- Harvard. . Drug Alcohol Depend. 2004 Nov 11;76(2):213-5. Ed: Obviously, doctors in Massachusetts aren't being very careful to whom they prescribe OxyContin. At the University of Kentucky, 187 OxyContin addicts admitted for detox used an average dose of 184 milligrams of OxyContin per day. They made up 31% of all Addictive Disease Unit admission and 61% of opiate admissions. The OxyContin dependent individuals tended to show a progression from p.o. use to either snorting or i.v. use. J Addict Dis. 2004;23(4):1-9. Medical Use Pushing Up Non-Medical Abuse: Fentanyl, hydromorphone, morphine, and oxycodone usage have markedly increased in medical usage between 1997 and 2002. in the same time period, opioid analgesics increased from 5.75% to 9.85% of all drug abuse (J Pain Symptom Manage. 2004 Aug;28(2):176-88). While pain clinics blossom and rake in the money, insurance costs skyrocket, pain doesn't decrease, and junkies, legal and illegal, are multiplying rapidly. Cost: OxyContin 20 mg costs $3.10 a pill with the generic $2.80; 40 mg costs $5.27 a pill with a generic available for $4.80; 80 mg costs $9.91 a pill with the generic $7.14; 160 mg. pills are available for $15.25 each. Walgreens.com 9/25/05. University of Pittsburgh Prescribing Huges Doses of OxyContin: In a chart review of 128 chronic pain management clinic patients on stable doses of sustained-release oxycodone for at least 6 months, only 33% were being prescribed their Oxycontin for twice daily dosing, usually 80 mg bid ($600/month). An incredible 63% were prescribed OxyContin 3 times daily, usually 60 mg tid. And 4% were prescribed a totally unbelievable 120 mg 4 times daily ($1300/month). In addition to this, still more regularly scheduled, daily supplemental short-acting opioids were used by 47% of patients prescribed twice daily OxyContin and 21% for those prescribed greater than twice daily dosing. Sustained-release oxycodone dosing survey of chronic pain patients. Marcus DA et al. Department of Anesthesiology, University of Pittsburgh. . Clin J Pain. 2004 Sep-Oct;20(5):363-6. Ed: These huge dosages are living proof that OxyContin is a poor pain reliever. Most Long-Acting Opioid Patients Exceed Manufacturer Guidelines: In a study of chronic nonmalignant pain management from 6 outpatient pain clinics of patients on either transdermal fentanyl (Duragesic) or oxycodone HCl controlled-release (Oxycontin) for at least 6 weeks. The manufacturer's package inserts say to use OxyContin every 12 hours and to change transdermal fentanyl patches every 72 hours. Of 690 patients, 63% received OxyContin and 37% transdermal fentanyl. The average interval between administrations of OxyContin was only 7.8 hours, not the planned 12 hours. The average daily dose was 155.6 mg, i.e., quite high. Among OxyContin patients, only 17.5% had an average interval between administrations of 12 or more hours. Transdermal fentanyl patients reported wearing the patch, on average, for 2.5 days. Only 41% reported wearing the patch for at least 3 days, and only 14% reported the duration of pain relief as at least 3 days. The probability that OxyContin patients had higher oral morphine equivalents was 83%. Patient-reported utilization patterns of fentanyl transdermal system and oxycodone hydrochloride controlled-release among patients with chronic nonmalignant pain. Ackerman SJ, et al. Gaithersburg, MD. . J Manag Care Pharm. 2003 May-Jun;9(3):223-31. Bogus Research Arizona: Oxycodone at Most Minor Benefit for Diabetic Neuropathic Pain; No Non-Narcotic Control; No Report of Effectiveness of Blinding: In a 6-week DB PC study of 159 diabetics with neuropathy pain, only CR oxycodone and placebo were compared. Doses could be increased every 3 days to a maximum of 60 mg CR oxycodone every 12 hours. At an average dose of 37 mg per day, CR oxycodone patients reported less pain than placebo (p= 0.002). From days 28 to 42, overall average daily pain intensity, rated in subject diaries on a numeric scale of 0 (no pain) to 10 (pain as bad as you can imagine), was 4.1 in subjects given CR oxycodone and 5.3 in placebo-treated subjects. Adverse events were typical of opioid-related side effects. Controlled-release oxycodone for pain in diabetic neuropathy: a randomized controlled trial. Gimbel JS, et al. Arizona Research Center, LLC, Phoenix. Neurology. 2003 Mar 25;60(6):927-34. Ed: While I applaud randomized, double-blind studies, in fact, to the extent that the double-blind doesn't work, bias will creep into the study. Patients will be disappointed that they were given sugar pills instead of "powerful pain relievers," doctors will hear patients complain that the medicine has no effect and guess that patients are on the placebo or vice versa be happy to learn that their patient might have gotten the real thing. That will inevitably effect the doctors judgements. What percentage of people can tell the difference between a powerful narcotic and a sugar pill? None of the dozens of studies I have seen have reported on the success of the blinding in their study. All good studies should do this. This study is obviously bogus for its lack of a non-narcotic pain reliever, almost all of which have been shown to be more effective than any narcotic. However, the researchers did nicely document that the actual pain relief from oxycodone in this study was quite minor. Arizona: OxyContin Pushes for Simple Arthritis Based on Only Placebo Control Study: Roth SH, Arthritis Center Ltd, Phoenix, Ariz. Arch Intern Med. 2000 Mar 27;160(6):853-60. Ed: How many arthritis patients take nothing for their pain. Come on, use an active control like ibuprofen. In fact, use glucosamine and chondroitin for long-term benefits. It's much better than any narcotic for arthritis. There are many other treatments besides narcotics. Don't turn us senior citizens into drug addicts. Brazil: Misleading Study Promotes OxyContin: In this very small, 22-patient study starting with an open-label, randomised titration phase to achieve stable pain control for 7 days, followed by a double-blind, crossover phase in two periods, 14 days each, controlled-release morphine was compared to controlled release oxycodone plus controlled release morphine. At any point, patients were allowed to use oral immediate-release morphine (IRM) as needed. Pain, satisfaction, adverse effects and number of daily rescue morphine tablets were assessed. The rescue morphine analgesic consumption was 38% higher in patients receiving only morphine, compared to patients receiving both morphine and oxycodone. The authors claim that the combination gives a better analgesia profile. Comparison of sustained-release morphine with sustained-release oxycodone in advanced cancer patients. Lauretti GR, et al. University of Sao Paulo, Brazil. . Br J Cancer. 2003 Dec 1;89(11):2027-30. Ed: This study would lead one to believe that these are good pain relievers, but there is no non-narcotic control and non-narcotic pain relievers almost always do as well or better. Also, total narcotic consumption may have been similar in both groups. Canada: University of Toronto Pushing OxyContin for Diabetic Leg Pain on Bogus Research: In a poorly designed DB study of 36 diabetics with neuropathy pain of at least 3 months, patients underwent washout from all opioids 2-7 days before randomization to 10 mg CR oxycodone or active placebo (0.25 mg benztropine) q12h. The dose was increased to 40 mg q12h CR oxycodone or 1 mg q12h benztropine, with crossover to the alternate treatment after a maximum of 4 weeks. Acetaminophen was provided as rescue. CR oxycodone resulted in lower (P=0.0001) mean daily pain (21.8 vs. 48.6 mm VAS), with similar decreases in steady pain, brief pain, skin pain, and total pain and disability. The authors conclude, "CR oxycodone is effective and safe for the management of painful diabetic neuropathy." Controlled-release oxycodone relieves neuropathic pain: a randomized controlled trial in painful diabetic neuropathy. Watson CP, et al. University of Toronto. . Pain. 2003 Sep;105(1-2):71-8. Ed: Patients already on opioids should never be allowed in a study of chronic pain because they will already be primed to prefer the opiate. In this study, they would have been at the height of opiate withdrawal pains when the oxycodone was started. Benztropine is also a terrible placebo, since it causes a significant number of side-effects. No non-narcotic pain medicine was included, no carnitine, no lipoic acid, no nortriptyline or SSRI, no thiamine, no pregabalin or other anti-convulsant. All of these have been proven helpful for helpful for diabetic neuropathy pain with the carnitines actually resulting in some nerve growth and healing. In a non-narcotic is as good or better than OxyContin, then OxyContin is not safe and not reasonable. Detroit Falsely Claims That Their Study Shows That OxyContin is a Rational Alternative for Moderate Cancer Pain: In a DB study of 100 cancer patients given OxyContin or controlled-release morphine every 12 h for up to 12 days, pain intensity (0=none to 3=severe) decreased from baseline equally within each group, from 1.9 to 1.3, mean (SE) with OxyContin, and from 1.6 to 1.0 with controlled-release morphine. Authors falsely claim that, "Controlled-release oxycodone provides a rational alternative to controlled-release morphine for the management of moderate to severe cancer-related pain." Controlled-release oxycodone compared with controlled-release morphine in the treatment of cancer pain: a randomized, double-blind, parallel-group study. Mucci-LoRusso P, et al. Karmanos Cancer Institute, Detroit. Eur J Pain. 1998;2(3):239-49. Ed: This study has no non-narcotic control group. Since in virtually every one of dozens of pain studies, non-narcotic pain relievers are more effective than narcotics, how can an extremely addictive narcotic be proven a rational alternative without considering much less expensive and non-addictive alternatives. This study is bogus. Florida: Extremely Bogus Research on Chronic Back Pain: In an irresponsible study undoubtly funded by the manufacturer, 213 chronic low back pain patients "requiring opioid therapy" (i.e. already had received opioids or currently on opioids) were randomized to oxymorphone ER (10 to 110 mg) or oxycodone CR (20 to 220 mg) every 12 hours during a 7- to 14-day dose-titration phase. Patients achieving "effective analgesia" at a stable opioid dose entered an 18-day double-blind treatment phase and either continued opioid therapy or received placebo. With stable dosing throughout the treatment phase, oxymorphone ER (79.4 mg/day) and oxycodone CR (155 mg/day) were superior to placebo for change from baseline in pain intensity as measured on a visual analog scale. However, use of rescue medication was still 20 mg per day. The authors claim, "Oxymorphone ER and oxycodone CR were generally safe and effective for controlling low back pain." Efficacy and safety of oxymorphone extended release in chronic low back pain: results of a randomized, double-blind, placebo- and active-controlled phase III study. Hale ME, et al. Gold Coast Research, LLC, Weston, FL. . J Pain. 2005 Jan;6(1):21-8. Ed: Oh boy! These "researchers" have proven that switching someone already receiving opioids to a placebo makes them feel uncomfortable. This isn't research. It's propaganda. Florida: Extremely Bogus Research on Chronic Arthritis Pain: In what appears an industry funded study, 167 adults with moderate to severe osteoarthritis pain despite regular use of nonsteroidal antiinflammatory drugs were given immediate release oxycodone four times a day for 30 days. Then, 107 of this in a DB PC study were given 30 days of placebo, controlled release oxycodone, or immediate release oxycodone-APAP. Authors report that pain decreased during the open trial period, but of course this was not a scientific study and is of no value to answering the question of how much benefit, if any, was due to oxycodone. The authors then claim, "Pain intensity and quality of sleep were significantly improved in both active groups compared with the placebo group (p< or =0.05) during the double blind trial." Treatment of osteoarthritis pain with controlled release oxycodone or fixed combination oxycodone plus acetaminophen added to nonsteroidal antiinflammatory drugs: a double blind, randomized, multicenter, placebo controlled trial. Caldwell JR, Hale ME, Boyd RE, Hague JM, Iwan T, Shi M, Lacouture PG. Gainesville Clinical Research Center, Florida 32605, USA. J Rheumatol. 1999 Apr;26(4):862-9. Ed: This study is bogus because the patients put on placebo where all being thrown into drug withdrawal after being on a powerful narcotic for 30 days. Of course, they aren't going to be feeling very comfortable or sleeping very well. The design of this study was intentionally or accidentally rigged to make oxycodone look worthwhile. Germany: More Bogus Research: This One for Retinal Pain: In a 24-hour German DB study supposed to measure the clinical efficacy and tolerance of OxyContin 10 mg every 12 hours, comparing it with IV 100 mg tramadol combined with 1 g metamizol IV every 4 h until 24 h postoperatively, patients rated pain relief somewhat higher in the CRO Group than in the TM Group 8 h (p = 0.048), 16 h (p = 0.009) and 24 h (p = 0.001) postoperatively. However, there was no statistical difference in AUC for pain scores between groups (p = 0.205). The CRO Group experienced significantly less nausea (p = 0.012). Controlled-release oxycodone is better tolerated than intravenous tramadol/metamizol for postoperative analgesia after retinal-surgery. Kaufmann J, et al. Department of Anesthesiology, University of Cologne, Germany. Curr Eye Res. 2004 Apr;28(4):271-5. Ed: This study had no non-narcotic pain relief control group. Since there is no evidence that tramadol relieved pain, and since OxyContin did no better on actual pain scores, there can be no evidence that OxyContin relieved pain either. Study after study has shown that narcotics are poor pain relievers. If you deny this, please send me your double-blind studies with non-narcotic active pain reliever controls. The emperor is wearing no clothes. Germany: Bogus Research from the University of Cologne on Women After Best Surgery: In a small DB PC study of 40 women undergoing breast surgery for cancer, OxyContin 20 mg or a placebo was given before surgery and 12 hours later. All patients had access to opioid rescue medication via an IV patient-controlled analgesia (PCA) device. IV PCA opioid consumption was lower with OxyContin (p = 0.01). There was no significant difference for pain scores on movement (p = 0.103) and for quality of analgesia (p = 0.139). The authors misleadingly claim, "Controlled release oxycodone is effective in preventing pain after breast surgery." Clinical efficacy of controlled-release oxycodone 20 mg administered on a 12-h dosing schedule on the management of postoperative pain after breast surgery for cancer. Kampe S, et al. University of Cologne, Germany. . Curr Med Res Opin. 2004;20(2):199-202. Ed: There is no non-narcotic active control group. This study would lead doctors and patients to think that OxyContin was a good choice for women undergoing such surgery. However, dozens and dozens of studies show that the non-addictive and much less costly non-narcotic pain relievers are clearly better for pain. Japan: Bizarre Claims of Efficacy for Cancer Patients: In this bizarre open-label report by 16 authors of just 22 cancer patients who had not received opioids in the previous two weeks ("opioid-naive" (sic)), oxycontin was started at 5 mg twice a day. The authors proclaim a 90% effectiveness (18 of 20 in the "efficacy group") after an average of just 1.2 days! No controls. No measurements reported. Efficacy and tolerability of cancer pain management with controlled-release oxycodone tablets in opioid-naive cancer pain patients, starting with 5 mg tablets. Koizumi W, et al. Kitasato University, Kanagawa, Japan. . Jpn J Clin Oncol. 2004 Oct;34(10):608-14. Harvard: Bogus "Research" Promotes Oxycontin: In a randomized, but open (not double-blind) report on just 36 patients with back pain, all participants had their narcotic medications discontinued and underwent a 4-week washout period of no opioid medication before being randomly assigned to one of three treatment regimens for 16 weeks: 1) naproxen only, 2) set-dose oxycodone, or 3) titrated-dose oxycodone and sustained-release morphine sulfate. Weekly reports during the experimental phase showed the titrated-dose group to have less pain (P < 0.001) and less emotional distress (P < 0.001) than the other two groups. Both opioid groups were significantly different from the naproxen-only group. On the basis of this very poorly designed study, the authors proclaim that opioid therapy has a positive effect on pain and mood and that opioid therapy for chronic back pain is without significant risk of abuse. They discourage stopping opiates. Opioid therapy for chronic noncancer back pain. A randomized prospective study. Jamison RN, et al. Harvard. Spine 1998 Dec 1;23(23):2591-600. Ed: This bizarre and very small study with only 11 patients on naproxen was used in May, 2006, in the Canadian Medical Association Journal as strong proof that opiates are better for chronic pain. Obviously, most or all of these patients were suffering from opiate withdrawal pain during the four week wash-out and those put back on their narcotic pain medication had a relief of this pain, but those on naproxen did not. Also, since it was an open trial, many naproxen patients may have been biased by their narcotic cravings. Massachusetts: Highly Addictive Narcotics for Simple Knee Surgery with no Non-Narcotic Pain Control: Postoperative analgesia with controlled-release oxycodone for outpatient anterior cruciate ligament surgery. Reuben SS, et al. Baystate Medical Center and Tufts University School of Medicine, Springfield, Mass. . Anesth Analg. 1999 Jun;88(6):1286-91. Ed: I had this surgery 20 years ago. The central Illinois surgeon urged ibuprofen. I took a few doses, but never had much pain. I recall another dermatologic surgery with laser cautery in which the dermotologist gave me a script for aspirin with codeine and encouraged me to get it filled. I thought that was crazy. I wasn't even in pain yet. I never had to use any pain reliever. These days, doctors, especially anesthesiologists, throw narcotics around like candy. Pennsylvania: Trash Science From Pain Medicine Journal and the Drug Industry Pushing Narcotics for Low Back Pain: The authors claim the purpose of their report is "To evaluate the analgesic effectiveness/safety of the new oxycodone 7.5- and 10-mg/acetaminophen 325-mg (Percocet)" which has more high potency narcotic in each tablet. Their study has no controls, no randomization, no blinding of patients or staff, and all of the biases of an industry-funded study by industry employees. Only 33 adults with chronic low back pain were included. The report presents all of the trappings of statistical analysis. Patients had their narcotics stopped at the beginning of the study, meaning that some were probably having narcotic withdrawal pains. Effectiveness and safety of new oxycodone/acetaminophen formulations with reduced acetaminophen for the treatment of low back pain. Gammaitoni AR, et al. Endo Pharmaceuticals Inc., Chadds Ford, Pennsylvania. . Pain Med. 2003 Mar;4(1):21-30. Ed: This report is the most outrageous. You can't test effectiveness with an open trial. This is even more true for a highly addictive substance and primarily subjective symptoms. Studies have proven that open trials are extremely sensitive to bias. Shame on the journal of Pain Medicine and its reviewers for publishing the report. Narcotics for chronic low back pain is extremely controversial. Toledo: Ignorant Physicians Publish Irresponsible Study; Claim Oxycodone and Hydrocodone "Potent" Pain Relievers for Teen and Adult Fracture Pain: In a DB randomized study of emergency room patients with fractures, 73 patients as young as 13 received orally either oxycodone (5 mg) with acetaminophen, or hydrocodone (5 mg) with acetaminophen. There was no difference in pain between the patients treated with oxycodone and hydrocodone at 30 or 60 minutes. The authors claim, "These results suggest that oxycodone and hydrocodone have similarly potent analgesic effects in the first hour of treatment for ED patients with acute fractures." Comparison of oxycodone and hydrocodone for the treatment of acute pain associated with fractures: a double-blind, randomized, controlled trial. Marco CA, et al. St. Vincent Mercy Medical Center, Toledo, OH. . Acad Emerg Med. 2005 Apr;12(4):282-8. Ed: In fact, this study provides absolutely no evidence that opiates help fracture pain at all, much less that they are "potent." Without at least an active, non-narcotic control, such conclusions are impossible. Even a group receiving acetaminophen alone, or ibuprofen, diclofenac, etc., would have provided a scientific study of efficacy of the narcotic components. All that can be said is that in this small study, oxycodone and hydrocodone were equal in effect, if any effect existed. This study is very embarassing to me, since my mother and father both trained at St. V's and my father and my uncle both practiced there. Real Research BACKGROUND: Opiates, acetaminophen, nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), and cyclooxygenase-2-selective inhibitors such as rofecoxib are used in the treatment of acute pain because of their anti-inflammatory and/or analgesic properties. Rofecoxib has demonstrated an improved gastrointestinal safety profile compared with nonselective NSAIDs. OBJECTIVE: The aim of this study was to compare the analgesic efficacy and tolerability profile of rofecoxib 50 mg with those of the centrally acting, nonsalicylate, opiate/nonopiate analgesic combination oxycodone/acetominophen 5/325 in patients with pain after dental surgery. METHODS: In this randomized, double-blind, placebo- and active comparator-controlled study, patients experiencing moderate to severe postoperative pain after extraction of > or =2 third molars (including > or =1 mandibular impaction) received a single oral dose of rofecoxib 50 mg, oxycodone/acetaminophen 5/325 mg, or placebo. End points included total pain relief over 6 hours (TOPAR6, the primary end point) and 4 hours (TOPAR4), patient's global assessment of treatment at 6 hours (GLOBAL6) and 24 hours (GLOBAL24), summed pain intensity difference over 6 hours (SPID6), onset of analgesic effect (time to perceptible/meaningful pain relief, using a 2-stopwatch method), peak pain relief (PEAKPR), peak pain intensity difference (PEAKPID), and duration of analgesic effect (time to use of rescue analgesia). RESULTS: Two hundred twelve patients (63% female, 37% male; 76% white, 24% other; mean [SD] age, 20.9 [4.4] years; age range, 16-41 years) were enrolled in the study and received a single oral dose of rofecoxib 50 mg (n = 90), oxycodone/acetaminophen 5/325 mg (n = 91), or placebo (n = 31). The analgesic effect of rofecoxib was significantly greater than that of oxycodone/acetaminophen at P < 0.001 for TOPAR6, TOPAR4, GLOBAL6, GLOBAL24, and SPID6; at P < 0.010 for PEAKPR and PEAKPID; and at P < 0.001 for median time to use of rescue analgesia. Significantly fewer patients in the rofecoxib group (72.2%) took rescue analgesia within 24 hours postdose compared with the oxycodone/acetaminophen group (94.5%; P < 0.001) and the placebo group (96.8%; P < 0.02). Both active treatments were similar with respect to onset of analgesic effect. Both were generally well tolerated; the overall incidence of adverse experiences in the rofecoxib, oxycodone/acetaminophen, and placebo groups was 51.1%, 64.8%, and 48.4%, respectively. Rofecoxib was associated with a significantly lower incidence of nausea (18.9% vs 39.6%; P < 0.001) and vomiting (6.7% vs 23.1%; P < 0.001) compared with oxycodone/acetaminophen. CONCLUSIONS: In study patients with moderate to severe pain after dental surgery, rofecoxib 50 mg had a greater analgesic effect than oxycodone/acetaminophen 5/325 mg and was associated with less nausea and vomiting. Comparison of rofecoxib and oxycodone plus acetaminophen in the treatment of acute pain: a randomized, double-blind, placebo-controlled study in patients with moderate to severe postoperative pain in the third molar extraction model. Korn S, et al. Merck Research. . Clin Ther 2004 May;26(5):769-78. Surgery: Abdominal or Pelvic: Ibuprofen Much Better than Oxycodone; Oxycodone Adds Minor Benefit: In a 6-hour DB PC study of 456 women 14-48 hours after abdominal or pelvic surgery and suffering from moderate to severe pain, a single-dose combination tablet containing oxycodone 5 mg/ibuprofen 400 mg was compared to either agent alone and to placebo. The total pain relief at 6 hours on a 0-24 scale was the combination 11.75, ibuprofen alone 10.03, oxycodone alone 8.56, placebo 6.41. Patients' global ratings of analgesic efficacy were significantly higher in the combination-treatment was slightly better than ibuprofen (P < 0.044) and much better than oxycodone alone or placebo (both P < 0.001). Combination oxycodone 5 mg/ibuprofen 400 mg for the treatment of pain after abdominal or pelvic surgery in women: a randomized, double-blind, placebo- and active-controlled parallel-group study. Singla N, et al. Huntington Memorial Hospital, Pasadena, California. . Clin Ther. 2005 Jan;27(1):45-57. Ed: Two of the 3 authors are employees of the manufacturer and the first author was paid by a grant from the manufacturer. Pain relief in the ibuprofen group could easily have been increased by the addition of caffeine, or by the addition of acetaminophen. Besides each of these proven techniques, many more are available. There is absolutely no need to push highly addictive narcotics with minor pain relief benefits. While the study is a good design, the conclusions are highly irresponsible and corrupt. Manfacturers, especially of highly addictive narcotics, should not be allowed to be co-researchers or have any influence of the study design or its publication. Cancer Pain: Oxycodone No Better Than Non-Addictive Zomepirac, Even for Severe Pain: In a single-dose, DB crossover study of 40 patients with moderate to severe chronic pain due to advanced cancer, zomepirac 100 mg (Zomax), did as well as oxycodone with APC (Percodan) on all assessments of pain intensity and pain relief. The authors state, "Zomepirac sodium, 100 mg, appears to be an acceptable alternative to narcotic combinations such as oxycodone with APC in the management of moderate to severe cancer pain." Analgesic efficacy of zomepirac sodium in patients with pain due to cancer. Stambaugh JE Jr, et al. J Clin Pharmacol. 1981 Nov-Dec;21(11-12 Pt 1):501-7. Dental Surgery: Oxycodone/Acetaminophen (Percocet) Much Inferior to Etoricoxib (Arcoxia): In a 24-hour DB PC study of 225 adults having extractions of 3rd molars, a single dose of etoricoxib 120 mg was much more effective for pain relief than oxycodone/acetaminophen 10/650 mg, or placebo at 6 hours (P < 0.001). Oxycodone/acetaminophen was 5 minutes faster, its only advantage. Etoricoxib patients experienced a longer analgesic duration, had a smaller percentage requiring rescue opioids during 6 and 24 h, and required less rescue analgesia during 6 and 24 h. Oxycodone/acetaminophen treatment resulted in more frequent side-effects, especially nausea, and vomiting. The analgesic efficacy of etoricoxib compared with oxycodone/acetaminophen in an acute postoperative pain model: a randomized, double-blind clinical trial. Chang DJ, et al. Merck & Co. Inc, West Point, PA, USA. Dental Surgery: Oxycodone (Percodan) No Better Than Placebo; Oxycodone/Ibuprofen (Combunox) Added Very Little to Intermediate Dose of Ibuprofen, But Boston University and University of Maryland Falsely Praise the Highly Addictive Narcotic: In a DB PC study of 498 adults within 5 hours of extraction of 2 or more wisdom teeth, single doses of oxycodone 5 mg/ibuprofen 400 mg, ibuprofen 400 mg, oxycodone 5 mg, or placebo were compared. Oxycodone 5 mg/ibuprofen 400 mg did non-significantly better than ibuprofen 400 mg in pain relief (13.3 vs. 12.2) while oxycodone 5 mg by itself was no better than placebo (4.3 vs. 4.2). the authors proclaim, "A single dose of oxycodone 5 mg/ibuprofen 400 mg was fast-acting, effective, and well tolerated in subjects with moderate to severe pain after dental surgery." Combination oxycodone 5 mg/ibuprofen 400 mg for the treatment of postoperative pain: a double-blind, placebo- and active-controlled parallel-group study. Thomas Van Dyke (Boston University), Leonard Litkowski (University of Maryland), Theodore Kiersch (Cranial Pain Research, Tucson), and Hongjie Zheng and Kenneth Newman (Forest Pharmaceuticals, Jersey City). Clin Ther. 2004 Dec;26(12):2003-14. Ed: Despite a massive study, the narcotic distributor, Forest Labs, who funded this study and who had two employees among the authors, was unable to prove that a very powerful and extremely addictive narcotic was of any significant value whatsoever for the relief of acute dental pain. Of course, these hired "spin doctors," instead of noting that this powerful narcotic has no place in the treatment of dental pain, proclaimed it "fast-acting and effective." The FDA has given Forest the green light, i.e., they can call the combination a new drug, show it's better than placebo, and push it down the throats of the American public by paying off the physicians with free dinners, speaking engagements, etc. Dental Surgery: Oxycodone/Acetaminophen (Percocet) High Dose No Better Than Valdecoxib (Bextra): In a DB PC study of 406 adults having extractions of 3rd molars, a single oral dose of valdecoxib (20 or 40 milligrams), did as well at pain relief over 6 and 24 hours as a combination of oxycodone 10 mg/acetaminophen 1,000 mg and better than placebo. Valdecoxib had a tolerability profile superior to that of oxycodone/acetaminophen. The analgesic efficacy of valdecoxib vs. oxycodone/acetaminophen after oral surgery. Daniels SE, et al. SCIREX Corp., Austin, Texas. J Am Dent Assoc. 2002 May;133(5):611-21. Dental Surgery: Oxycodone/Acetaminophen (Percocet) Inferior to Cox-2 Etoricoxib (Arcoxia) for Dental Impaction Pain: In a 24-hour DB PC study of 302 adults with acute dental impaction pain, single doses of Cox-2 inhibitor etoricoxib 120 mg, oxycodone/ acetaminophen 10 mg/650 mg and codeine/ acetaminophen 60 mg/600 mg were compared. Etoricoxib had greater pain relief (TOPAR6) (13.2 units) versus oxycodone/acetaminophen (10.2 units); and codeine/acetaminophen (6.0 units); p < 0.001 for all. Etoricoxib (24 h) had a significantly longer lasting analgesic effect than oxycodone/acetaminophen (5.3 h), codeine/acetaminophen (2.7 h), and placebo (1.7 h) (p < 0.001 for all). Etoricoxib patients experienced fewer clinical adverse experiences than patients on oxycodone/acetaminophen and codeine/acetaminophen, especially less nausea. The analgesic effect of etoricoxib relative to that of cetaminophen analgesics: a randomized, controlled single-dose study in acute dental impaction pain. Malmstrom K, et al. Merck Research Laboratories, Rahway, NJ. Curr Med Res Opin. 2005 Jan;21(1):141-9. Dental Surgery: Oxycodone/Acetaminophen (Percocet) Inferior to Rofecoxib (Vioxx) for Dental Pain: Many studies have shown that opiate pain relievers are inferior for acute pain to non-addictive alternatives. In a single dose DB PC study of Rofecoxib (Vioxx) 50 mg (n=90), Oxycodone/Acetaminophen 5/325 mg (Oxy/APAP) (n=91) and placebo (PBO) (n=31), patients with moderate to severe pain following extraction of at least 2 third molars rated pain intensity and pain relief better with at prescribed times over 24 hours better with Vioxx on all measures. Compared to Oxy/APAP, ROF had significantly greater overall and peak analgesic effect, significantly longer duration of analgesic effect, and similar time to onset of analgesic effect. Compared to Oxy/APAP, ROF patients had significantly fewer episodes of nausea (19% vs. 40%) and vomiting (7% vs. 23%). Conclusion: Rofecoxib 50 mg was more effective than Oxycodone/Acetaminophen 5/325 mg for relief of dental pain. ROFECOXIB COMPARED TO OXYCODONE/ACETAMINOPHEN FOR POSTOPERATIVE DENTAL PAIN. James Fricke, Theodore Vassil, Paul Kotey, Scott Korn, Merck Research Laboratories. Pain Med. 2002 Jun;3(2):185-186. Ed: Doctors, brainwashed by drug companies, have turned millions of Americans into narcotic addicts without good research to support the practice. In fact, opiates are not good pain relievers, but they are extremely addictive. While Vioxx is off the market, the evidence still stands that oxycodone is inferior to NSAIDs for acute pain. Dental Surgery: Oxycontin Inferior to Rofecoxib (Vioxx) for Dental Pain: In a 212-patient DB PC study, patients with moderate to severe postoperative pain after extraction of two or more third molars using a single oral dose of rofecoxib 50 mg, oxycodone/acetaminophen, significantly fewer patients in the rofecoxib group (72.2%) took rescue analgesia within 24 hours postdose compared with the oxycodone/acetaminophen group (94.5%) and the placebo group (96.8%). Both active treatments were similar with respect to onset of analgesic effect. Both were generally well tolerated; the overall incidence of adverse experiences in the rofecoxib, oxycodone/acetaminophen, and placebo groups was 51.1%, 64.8%, and 48.4%, respectively. Rofecoxib was associated with a significantly lower incidence of nausea (18.9% vs 39.6%) and vomiting (6.7% vs 23.1%) compared with oxycodone/acetaminophen. Comparison of rofecoxib and oxycodone plus acetaminophen in the treatment of acute pain: A randomized, double-blind, placebo-controlled study in patients with moderate to severe postoperative pain in the third molar extraction model. Korn S, Vassil TC, Kotey PN, Fricke JR Jr. Merck drug company. Clin Ther. 2004 May;26(5):769-78. Dental Surgery: Oxycodone/Acetaminophen (Percocet) Inferior to Rofecoxib (Vioxx): In a 24-hour DB PC study of 271 patients have extractions of impacted molars, a single dose of rofecoxib 50 mg was somewhat better than a single dose of oxycodone/acetaminophen 10/650 mg over 6 h as well as with a multidose regimen of oxycodone/acetaminophen 10/650 mg followed by oxycodone/acetaminophen 5/325 mg over 24 h. Rofecoxib-treated patients achieved pain relief over the first 6 hours more effectively than oxycodone/acetaminophen patients (12.9 vs 11.3, p = 0.059). Patients also rated a single dose of rofecoxib as better than multidose oxycodone/acetaminophen over 24 h on pain intensity although the difference did not quite reach statistical significance (21.9 vs 18.1; p = 0.122). Patients treated with oxycodone/ acetaminophen had a shorter time to onset of analgesia than patients treated with rofecoxib (24 vs 35 min, p < 0.05). Fewer rofecoxib than oxycodone/acetaminophen patients experienced adverse events (48 vs 76%, p < 0.001), including nausea (19.0 vs 42.5%, p < 0.001), vomiting (9.9 vs 24.2%, p < 0.01), and dizziness (7.4 vs 31.7%, p < 0.001). Comparison of rofecoxib and a multidose oxycodone/ acetaminophen regimen for the treatment of acute pain following oral surgery: a randomized controlled trial. Chang DJ, et al. Merck & Co, Inc, West Point, PA. Curr Med Res Opin. 2004 Jun;20(6):939-49. Dental Surgery: Oxycodone Added Nothing to Ibuprofen Pain Relief Except at Highest Dose Which Caused Drowsiness and Vomiting: In a 6-hour DB PC study of patients ungoing oral surgery, a dose of 400 mg ibuprofen was compared with 400 mg ibuprofen with oxycodone in doses of 2.5, 5, or 10 mg. Ibuprofen plus 10 mg oxycodone produced somewhat greater pain relief compared with the other three groups from 15 minutes after drug administration up to the 2-hour observation. All four treatments were similar from 3 to 6 hours. Neither the 2.5-mg nor the 5-mg oxycodone dose provided any additive pain relief over ibuprofen at any point. The oxycodone caused more side-effects with significantly greater drowsiness and vomiting at the 10-mg dose. Additive analgesic effects of oxycodone and ibuprofen in the oral surgery model. Dionne RA. National Institute of Dental and Craniofacial Research, Bethesda, MD. . J Oral Maxillofac Surg. 1999 Jun;57(6):673-8. I rule this one a tie at the highest dose. Dental Surgery: Oxycodone Adds Very Little to Ibuprofen; No Better than Placebo: In a large DB PC single dose study of 498 patients with moderate to severe pain following dental surgery, the total pain relief at 6 hours using the combination of oxycodone 5 mg with ibuprofen 400 mg was 13.3, ibuprofen alone 12.2, oxycodone alone 4.2, and placebo 4.3. Van Dyke T, et al. Combination oxycodone 5mg/ibuprofen 400 mg for for the treatment of postoperative pain: a double-blind, placebo- and active controlled parallel group study. Clin Ther 2004;26:2003. Musculoskeletal Pain: Oxycodone with Acetaminophen (Percocet) a Little Worse than Valdecoxib (Bextra) for Acute Pain: In a small 51-patient DB study with no placebo control, the COX-2 inhibitor, oral valdecoxib 40 mg did non-significantly better than an oxycodone(10 mg)-acetaminophen(650 mg) combination for acute musculoskeletal pain seen in the emergency department (p = 0.32). Patients treated with valdecoxib were less likely to experience sedation/dizziness (15% vs. 44%, p = 0.03) and to require rescue medications within the next 24 hours (44% vs. 74%, p = 0.04). Comparison of valdecoxib and an oxycodone-acetaminophen combination for acute musculoskeletal pain in the emergency department: a randomized controlled trial. Lovell SJ, et al. Stony Brook University, NY. Ed: The author is wrong in claiming the oral opioids are potent analgesics. However, the study is acceptable although it is too small to detect anything other than large differences, and is of no benefit for determining how much pain relief came from the acetaminophen and whether oxycodone was of any benefit at all. Valdecoxib is probably not as good as ibuprofen 400 mg with acetaminophen 500 mg and caffeine. Renal Colic: Oxycodone No Better Than Indomethacin for Renal Colic: In a DB, cross-over study of 61 patients with acute renal colic, indomethacin 50 mg IV did just as well as oxycodone-papaverine 5 mg + 50 mg IV. For those patients requiring a second injection the drugs were reversed. The intensity of pain was evaluated before and 20 min after each injection according to an analogue visual scale 0 to 100. Both drug regimens provided comparable and significant pain relief; a pain score of less than 20 appeared to be satisfactory and was achieved in almost all cases. Intravenous indomethacin and oxycone-papaverine in the treatment of acute renal colic. A double-blind study. Jonsson PE, et al. Br J Urol. 1987 May;59(5):396-400. Renal Colic: Oxycodone Worse Than Indoprofen: In a DB study of 94 patients with severe acute renal colic pain, Intravenous indoprofen (400 mg), did better than intramuscular oxycodone 10 mg with papaverine (20 mg). More patients required additional treatment in the oxycodone than in the indoprofen group (19 v. 10). At 2-5 min after injection, pain reduction was greater with indoprofen, and more patients in this group had pain relief after 3-5 hours. Side effects were less frequent with indoprofen than with oxycodone (1 v. 20 patients), in particular from the central nervous system. This difference probably was related to indoprofen's slow and poor penetration of the blood-brain barrier. Comparison of a narcotic (oxycodone) and a non-narcotic anti-inflammatory analgesic (indoprofen) in the treatment of renal colic. Persson NH, et al. Acta Chir Scand. 1985;151(2):105-8. Surgery: Abdominal Gynecologic: Oxycodone/Acetominophen Not as Good as Bromfenac But More Side-Effect: In a DB PC study of 238 women with pain due to abdominal gynecologic surgery, they received single oral doses of bromfenac (50 or 100 mg), acetaminophen 650 mg/oxycodone 10 mg, ibuprofen 400 mg, or placebo. Then, in the multiple-dose phase, 204 patients received bromfenac, acetaminophen/oxycodone, or ibuprofen for up to 5 days. In the single-dose phase, both bromfenac doses produced peak pain relief equivalent to acetaminophen/oxycodone, but the responses to bromfenac were longer lasting. Bromfenac produced significantly better overall (8-hour) analgesic summed scores than acetaminophen/oxycodone. Ibuprofen was less efficacious than the other analgesics. The remedication rate was lower in both bromfenac groups than in the other treatment groups. The acetaminophen/oxycodone group reported more somnolence and vomiting. Bromfenac sodium, acetaminophen/oxycodone, ibuprofen, and placebo for relief of postoperative pain. Johnson GH, et al. Latter Day Saints Hospital, Salt Lake City. Clin Ther. 1997 May-Jun;19(3):507-19. Surgery: C-Section: Severe Pain Treated at Least as Well with Ketoprofen (Orudis) as with Oxycodone/Acetaminophen with Fewer Side-Effects and No Addiction Risk: In a DB PC study of 240 women with severe postop pain after C-section, single doses of 100 mg or 50 mg ketoprofen, the combination of 650 mg acetaminophen plus 10 mg oxycodone hydrochloride, 650 mg acetaminophen, or placebo found both ketoprofen doses superior to acetaminophen and placebo, the 100 mg dose better than the 50 mg, and ketoprofen 100 mg at least as good as the narcotic with its effect lasting longer although not quite as strong during the first hour. There were more side-effects with the narcotic. The study was continued for 7 days comparing ketoprofen 100 mg or 50 mg or oxycodone 5mg/acetominophen 325 mg as needed. Fewer doses of the ketoprofen were needed. Ketoprofen, acetaminophen plus oxycodone, and acetaminophen in the relief of postoperative pain. Sunshine A, et al. New York University Medical Center. Clin Pharmacol Ther. 1993 Nov;54(5):546-55. Surgery: Shoulder: Bupivacaine Better than Oxycodone for Pain: In a DB study of 42 patients after shoulder surgery with general anesthesia, those receiving 10 ml of 0.5% bupivacaine in the subacromial bursa did just as well for pain reduction as those given 5 mg of oxycodone in 10 ml of saline over the first 24 hours. Those receiving 5 mg of oxycodone intramuscularly did do as well, consuming more total perioperative fentanyl for complaints of pain (1.61 mg vs. 0.97 for bupivacaine and 1.23 for intrabursal oxycodone). Comparison of the analgesic effects of intrabursal oxycodone and bupivacaine after acromioplasty. Muittari PA, et al. Turku University Hospital, Finland. J Clin Anesth. 1999 Feb;11(1):11-6. Ed: Please note that there was absolutely no evidence that the narcotic fentanyl was needed. It is virtually certain that a non-narcotic pain reliever such as ketorolac or diclofenac would have worked better as a far lower cost and no danger of increasing the future risk of addiction. Surgery: Cholescystectomy: Oxycodone No Better than Paracetamol (Acetominophen): In a DB study of 20 women undergoing a cholecystectomy for gallstones, either 10 mg oxycodone, or 1000 mg paracetamol was given orally. Oxycodone resulted in more pre-operative sedation. Post-operative pain was not significantly different by patient report or by a visual analog. No significant differences were noted for side effects or canalization. Oxycodone versus paracetamol in oral premedication in cholecystectomy. Speranza R, et al. Ospedale Bassini, Milan, Italy. Minerva Anestesiol. 1992 Apr;58(4):191-4. Surgery: Oxycodone Very Slightly Better than Diclofenac (Voltaren) for Post-Surgical Pain, But More Shots and Four Times the Side-Effects: In a DB study of 85 patients after various operations, patients requesting an analgesic were given either 75 mg of diclofenac or 10 mg of oxycodone as an intramuscular injection. The onset of analgesic effect averaged 13 min with oxycodone vs. 16 min with diclofenac. The analgesic effect of diclofenac was slightly weaker than that of oxycodone (on a pain scale of 1-4, 1.6/2.1 after 0.5 h and 1.5/1.8 after 1 h). The patients again asked for an analgesic after an average of 4.6 h in the oxycodone group vs. 6.1 h in the diclofenac group. The average number of injections requested until the first postoperative morning was 2.5 in the oxycodone group and 1.8 in the diclofenac group. Side-effects: 21 patients in the oxycodone group reported a total of 39 side-effects and eight patients in the diclofenac group a total of 10 side-effects. Diclofenac and oxycodone in treatment of postoperative pain: a double-blind trial. Nuutinen LS, et al. Acta Anaesthesiol Scand. 1986 Nov;30(8):620-4. Ed: This study is double-blind but is of lower quality than most. Of course, it is a much older study. The pain was also quite mild in any case. I called this study a tie. Surgery: Varicose Vein Surgery: Oxycodone No Better than Lysine Acetylsalicylate: Lysine acetylsalicylate (LAS) is a soluble salt of acetylsalicylic acid and can be given parenterally. LAS 12.5 mg/kg and 25 mg/kg were compared with oxycodone 0.15 mg/kg in the treatment of pain after operation in 60 patients undergoing varicose vein surgery. Both treatments almost completely relieved moderate to severe pain for the 3-h observation period. The time until the peak of action was longer after LAS (60-90 min) than after oxycodone (30-60 min). No significant differences were found between the smaller and larger doses of LAS. Comparison of i.m. lysine acetylsalicylate and oxycodone in the treatment of pain after operation. Korttila K, et al. Br J Anaesth. 1980 Jun;52(6):613-7. Surgery: Lumiracoxib Better than Oxycodone for Headaches, Orthopedic, and Dental Surgery: Lumiracoxib is a highly selective COX-2 inhibitor. In single- and multiple-dose well designed trials in patients with acute pain associated with primary dysmenorrhea, dental or orthopedic surgery or tension-type headache, lumiracoxib 100-800 mg once daily was more effective in relieving acute pain than placebo or controlled-release oxycodone 20 mg, and was at least as effective as selective COX-2 inhibitors or nonselective NSAIDs. Lumiracoxib. Lyseng-Williamson KA, et al. Adis International Limited, Auckland, New Zealand. . Drugs. 2004;64(19):2237-46 Oxycontin Use in High School Skyrocketing: Asked whether they had used tranquilizers, barbiturates or sedatives for nonmedical use in the last year, 14% of high school seniors, 11% of 10th graders, and 7% of 8th graders said yes, according to the Monitoring the Future study, which the federal government considers the best benchmark of teenage drug use. Among high school seniors, 7.2 percent had used sedatives without a prescription in the last year, up from a low of 2.8 percent in 1992, and a level not reached since 1979, when 7.5 percent of seniors reported using them. And 5.5% of seniors reported using Oxycontin, a potent pain killer, up from 4% in 2002, when the survey first asked about the use of the drug. "If you told me heroin use was at 5 percent, most people would be very concerned," said Lloyd Johnston, the principal investigator of the study and a professor at the University of Michigan, which conducts the survey for the National Institute on Drug Abuse. "I'm not sure it's a whole lot less dangerous that Oxycontin use is at that level. This is a drug that has great potential for overdose and for creating dependence." 1% of high school seniors reported using heroin. The study, conducted since 1975, surveys a nationally representative sample of about 50,000 students in 400 public and private schools. 12/20/05 Trends in abuse of Oxycontin and other opioid analgesics in the United States: 2002-2004. |