October 2, 2013
Over-The-Counter Painkillers Just As Effective As Prescription Drugs For Tonsillectomy Pain
April Flowers for redOrbit.com - Your Universe Online
After having your tonsils removed, traditional wisdom says you should eat all the ice cream you want and take a prescription pain killer. A new study from the Henry Ford Hospital, however, reveals how an over-the-counter pain reliever is just as effective.
The study, presented at the 2013 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) annual meeting in Vancouver, BC, shows over-the-counter ibuprofen manages post-surgery tonsillectomy pain for children and adults as well as prescription pain medications acetaminophen with hydrocodone or with codeine, which is no longer recommended for use in children.
"Based on this study and the FDA warning about the risks of children taking any medication with codeine, we recommend that children receive over-the-counter ibuprofen after a tonsillectomy," says Robert T. Standring, MD, with the Department of Otolaryngology-Head & Neck Surgery at Henry Ford.
"Ibuprofen appears to be the safest alternative that still provides adequate pain control for children," he says.
Tonsil removal is the second most common out-patient surgery for children under 15, with an estimated 662,000 children undergoing a tonsillectomy each year.
Following a tonsillectomy, pain is the primary source of illness. Pain causes dehydration, difficulty and painful swallowing, and weight loss -- all of which can lead to increased post-operative visits and hospital readmission.
The FDA recommended in 2012 children not be given medication with codeine due to associated risks. In 2011, the AAO-HNS also published a clinical Practice Guideline on tonsillectomy in children, recommending a weight-based pain regimen be given based on pain scores of the patient.
These changes prompted the Henry Ford researchers to investigate a safe and effective oral post-operative pain regimen for both children and adults following tonsillectomy.
Dr. Standring, and his colleague Kathleen Yaremchuk, MD, recruited 91 patients of varying age from June 2011 to August 2013. All of the patients, ranging from age 3 to 38, underwent the same surgical procedure to remove their tonsils. Before surgery, the patients were given a packet, randomly assigning them to one of three pain regimens. Each regimen -- ibuprofen, acetaminophen with hydrocodone, or acetaminophen with codeine -- was appropriately dosed by the patient's weight.
The assignment packet also included a post-operative evaluation form. Patients and/or their families were asked to rate their pain twice a day for ten days on a scale of 1 to 10 using a validated pediatric pain scale.
The study participants were also asked to record the amount of pain medication given, as well as the amount of liquid or food consumed, as well as listing the day that they returned to work or school, and any complications with the procedure or the medication.
Twenty-five out of the 91 patients completed the post-operative package. Twelve were on ibuprofen, while eight were on acetaminophen with hydrocodone, and five took acetaminophen with codeine. The research team stopped enrolling children in the codeine arm of the study after the FDA warning was issued.
The research team found no significant difference in pain control when comparing all three patient groups. All three pain relievers showed a significant decrease in pain scores over time. There was also no significant difference in the time it took for patients to return to work or school, as well as their regular diet and activities.
At certain points, however, the research team noticed acetaminophen with codeine showed a significant improvement in pain.