Pain relief in older adults minimal, incomplete with hydromorphone, acetaminophen drips

In the management of acute severe pain in older patients in the emergency department (ED), hydromorphone provides only nonclinically significant greater effect than acetaminophen, with pain relief being minimal or incomplete regardless of the medication received, according to a study.

The study included 162 patients aged ≥65 years from two urban EDs who experienced acute pain that was severe enough to warrant intravenous opioids. They were randomized to receive 1,000 mg of intravenous acetaminophen (n=81) or 0.5 mg of intravenous hydromorphone (n=81).

The primary outcome was an improvement in pain on a 0–10 scale (minimum clinically important difference was 1.3) at 60 minutes after treatment administration, while secondary outcomes included the need for additional analgesic medication and adverse events that were attributable to the investigational medication.

At baseline, the median pain score was 10 in both groups. This score decreased by 3.6 in the acetaminophen group and by 4.6 in the hydromorphone group (difference, 1.0, 95 percent confidence interval [CI], 0.1–2.0).

Additional analgesic medications were required for 37 (46 percent) patients on acetaminophen and 31 (38 percent) of those on hydromorphone (rounded difference, 7 percent, 95 percent CI, −8 percent to 23 percent).

Six patients in the acetaminophen group and 10 in the hydromorphone group experienced adverse events (difference, 5 percent, 95 percent CI, −4 percent to 14 percent). The most common adverse events were dizziness, drowsiness, headache, and nausea.