Hydrocodone Is Better Than Oxycodone for Post-Operative Pain
/By Pat Anson
When it comes to treating post-operative pain, hydrocodone works better than oxycodone in relieving pain and does it with smaller doses, according to a new study that compared the effectiveness of the two opioids.
A team of researchers evaluated health data for 663 patients who had elective joint arthroplasty on their hips or knees, a major surgical procedure where a damaged or arthritic joint is removed and replaced with an artificial one. About a third of the patients took oxycodone for post-operative pain, while the rest received hydrocodone.
Nearly 1.25 million joint arthroplasty procedures are performed annually in the US, and many patients experience significant pain during recovery. Oxycodone is generally considered more potent than hydrocodone, and is typically prescribed more often for post-operative pain.
The study findings, published in JAMA Network Open, show that patients on hydrocodone had slightly lower pain scores 10 days after surgery than those who took oxycodone.
They also needed significantly less morphine milligram equivalents (MMEs) over the course of their post-op recovery (93.2 MME for hydrocodone vs 134.8 MME for oxycodone).
“We observed that patients prescribed hydrocodone had lower composite pain scores over the 10-day postoperative period, and their total opioid consumption (in MME) was significantly lower, compared with patients prescribed oxycodone. Therefore, we rejected our initial hypothesis that oxycodone provides better pain control than hydrocodone,” wrote lead author Julie Johnson, PharmD, Director of the Clinical and Translational Science Institute at The Ohio State University.
It’s important to note that all of the participants in this study had the CYP2D6 gene, which makes them normal metabolizers (NMs) of opioids. Had they had a variation of the gene, oxycodone may have performed better, according to researchers. About 10% to 15% of individuals have those variants.
“Our findings have practical implications for postoperative pain management, especially in the context of personalized medicine and opioid-sparing strategies. For patients who are CYP2D6 NMs, a multimodal approach with hydrocodone appears to be a safe and effective option for managing acute post–total joint arthroplasty pain, achieving pain relief that was comparable to or better than oxycodone, with a lower MME,” Johnson wrote.
The hydrocodone and oxycodone formulations used in the study contained acetaminophen. Both groups also utilized other pain relievers, such as NSAIDs, nerve blocks and tramadol during their recovery. There were no significant differences in mobility, anxiety, and depression between the hydrocodone and oxycodone groups.
