Some Painkillers Safer Than Others, Study Finds


"The biggest impact for the average physician should be increased awareness of the problems with opioids in older adults," said Collins. "We have previously thought there were no risks other than sedation, which does increase the risk of falls."

Still, experts noted that the reports have their limitations. The study's design did not permit researchers to compare patients based on pain diagnosis, pain severity or known use of over-the counter medications.

FDA Scrutinizing Painkillers

In recent years, the FDA has issued warnings on the dangers of opioids because of their addictive nature and the questionable safety of their long-term and short-term use. Last February, the FDA issued a proposal that tried to limit the growing misuse of opioid drugs.

In November, the FDA requested that propoxyphene's maker, Xanodyne, remove the drug from shelves after clinical data found that the drug put patients at serious risk for heart arrhythmias.

So what are patients in pain to do?

Cope said it's important to note that patients taking painkillers need to be carefully educated on the risks and benefits of these medications. She says they also need individualized evaluation and treatment.

"It would be a backward step in medical care if pain medicines were limited and prescribed based on mean group data rather than assessing each patient as an individual based on his or her pathology, function, pain status and a wide array of options," said Cope.

Pain: The Fifth Vital Sign

That being said, Dr. Gunnar Andersson, professor and chairman of the department of orthopedic surgery at Rush University Medical Center in Chicago, said doctors and patients must be careful not to overinterpret these results.

"In the right patient, these drugs are invaluable," said Andersson. "We just need to remind ourselves that musculoskeletal pain and headaches rarely require narcotics, particularly not for extended periods of time."

Despite the value of narcotics for some patients, Andersson said he worries about the preoccupation with pain these days. As the fifth vital sign, doctors must regularly document their patients' pain levels, and no patient is supposed to have any pain and go without treatment.

"This encourages oversubscription and overuse, and there is no evidence that the individual with noncancer pain actually gets more benefit than complications," continued Andersson. "We need a debate, which I hope these manuscripts will stimulate."

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