NSAIDs vs. Opioids

by Christina Lasich, MD Health Professional

Ladies and gentlemen, welcome to the Heavyweight Pain Reliever Championship Match. In the blue corner, weighing in at 200 mg's is the most common NSAID (non-steroidal anti-inflammatory) found anywhere, ibuprofen. In the red corner, weighing in at a small, but mighty, 10 mg's is the most popular, most commonly prescribed opioid, hydrocodone. Today's match promises to be a real bell ringer. Who is the fastest? Who lasts the longest? Who can go the distance? Who packs the biggest punch? This decisive match will determine whether or not NSAIDs or opioids are the best pain relievers on the planet.

ROUND 1: Both the NSAID and the opioid are off to a fast and furious pace; their analgesic onset is roughly equivalent in speed. Within the half hour, both have started to provide pain relief. At just a little over one hour, both appear to be at full strength and hitting equally hard. This fight should be one for the record books folks. Ding. Ding.

ROUND 2: With round 1 being indecisive, we look to round 2 to help us determine who will last the longest. With the pain relief from both in full swing, ibuprofen and hydrocodone come out swinging. Hour two, hour three, hour four, both are still working. But wait, wait... ibuprofen is starting to show some signs of weakness. Yes, yes, this NSAID does not appear to have the same duration of effectiveness found with hydrocodone. Hour five, hour six, ibuprofen has worn out and hydrocodone is still able to fight the pain. Hour six, hour seven, yes.. yes.. maybe even hour eight, hydrocodone is the clear winner of this round. Ding. Ding.

ROUND 3: Time for another dose, who can go the distance over the long-haul? The main thing to look for in this round is safety, especially safety of long-term use. Ibuprofen has his work cut-out for him because his previous predecesors, Vioxx and Bextra, have fallen due to causing more harm over good in the long-haul.

Can this anti-inflammatory prove a better safety record? No, don't let the myths fool you. Fans of this NSAID continue to be rushed to the emergency room with bleeding ulcers and perforated bowels. Some members of the NSAID cheering section have been diagnosed with kidney problems. Ibuprofen is not having a good round.

How is Mr. Opioid doing in this round? Not much better, but at least his fans are not ending-up in the hospital with life-threatening problems (at least those who are not overdosing). Sure, there are still long-term problems with long-term opioid use particularly hormonal problems that affect testosterone, cortisol, and thyroid hormones, just to name a few. These risks are livable. For many fans of opioids, the benefit of pain relief is worth some fatigue, drowsiness, erectile dysfunction, insomnia, sweating, and other potential adverse effects from long-term use. Ding. Ding. Ding. Hydrocodone has won this round of safe, long-term use.

But who has won the match, the NSAID or the opioid? You be the judge. You make the call.

Christina Lasich, MD
Meet Our Writer
Christina Lasich, MD

Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.