Hydrocodone/APAP vs. Codeine/APAP in Acute Extremity Pain
Hydrocodone/acetaminophen (APAP) failed to provide clinically or statistically superior pain relief compared to codeine/APAP in the treatment of acute extremity pain after emergency department (ED) discharge, according to results presented at the 30th Annual Meeting of the American Academy of Pain Medicine.
Researchers compared a 3-day supply of hydrocodone/APAP (5mg/500mg) vs. oral codeine/APAP (30mg/300mg) in a prospective, randomized, double-blind clinical trial of ED discharged patients with acute extremity pain. Patients were called 24 hours after being discharged.
The study's primary outcome was the difference in improvement in numeric rating scale (NRS) pain scores at 2 hours following the most recent ingestion of the study drug relative to the time of phone contact. The NRS pain score prior to the most recent dose after ED discharge was 7.6 for both groups. The mean decreases in NRS pain scores 2 hours after the pain medication dose were 3.9 in the hydrocodone/APAP arm vs. 3.5 in the codeine/APAP arm, for a difference of 0.4 (95% CI -0.3 to 1.2 NRS units). Both treatments lowered pain scores by approximately 50% but hydrocodone/APAP did not prove to be clinically or statistically superior in pain relief than codeine/APAP.
With the DEA proposing to reclassify hydrocodone as a Schedule II narcotic, researchers suggest codeine/APAP may be a clinically reasonable Schedule III substitute for hydrocodone/APAP. Regarding the proposal, members of the public are invited to submit comments or request a hearing through Regulations.gov through April 27, 2014.
For more information visit the American Academy of Pain Medicine website.