No Difference Between Oxycodone/Acetaminophen and Hydrocodone/Acetaminophen for Acute Extremity Pain


Am Fam Physician. 2016 Mar 1;93(5):411.

Clinical Question

How effective is oxycodone/acetaminophen compared with hydrocodone/acetaminophen in the management of acute extremity pain in adults, including sprains/strains and fractures?

Bottom Line

This study found no significant difference in the management of acute musculoskeletal extremity pain, including fractures, with oxycodone/acetaminophen vs. hydrocodone/acetaminophen. Adverse events, including nausea and dizziness, occurred significantly more often with oxycodone/acetaminophen (number needed to treat to harm = 10). (Level of Evidence = 1b)


It is commonly believed that oxycodone/acetaminophen provides better pain relief than hydrocodone/acetaminophen for adults with acute pain. These investigators identified adults (N = 240), 21 to 64 years of age, who presented to an urban emergency department with acute musculoskeletal extremity pain of less than seven days' duration. Extremity was defined as distal to and including the shoulder and hip joint. Exclusion criteria included a history of chronic pain, previous narcotic abuse, or current use of opioid pain medications. Eligible consenting patients randomly received (concealed allocation assignment) a three-day course of oxycodone/acetaminophen (5 mg/325 mg) or identically appearing hydrocodone/acetaminophen (5 mg/325 mg), one dose every four hours as needed for pain. Individuals masked to treatment group assignment assessed outcomes using a standard validated pain scoring tool two hours after the study medication was given and approximately 24 hours after emergency department discharge. Complete follow-up occurred for 92% of patients at 24 hours.

The final diagnosis of the acute musculoskeletal extremity pain included approximately 65% fractures, 40% sprains and strains, and 5% other. Using intention-to-treat analyses, no significant group differences occurred in mean pain score reduction between baseline and follow-up. Approximately 60% of patients in both groups reported at least a 50% decrease in pain. All patients were also equally satisfied with their analgesic management. Adverse reactions, including nausea and dizziness, occurred significantly more often in patients who received oxycodone/acetaminophen than in patients who received hydrocodone/acetaminophen (number needed to treat to harm = 10). The study was 80% powered to detect a predetermined clinically significant difference in pain scores between the two treatment groups.

Study design: Randomized controlled trial (double-blinded)

Funding source: Foundation

Allocation: Concealed

Setting: Emergency department

Reference: Chang AK, Bijur PE, Holden L, Gallagher EJ. Comparative analgesic efficacy of oxycodone/acetaminophen versus hydrocodone/acetaminophen for short-term pain management in adults following ED discharge. Acad Emerg Medicine. 2015; 22( 11): 1254– 1260.

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP,search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.



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