A patient is offered Vicodin (an opioid) at an E.R. for a sprained ankle and level 5 pain. Proponents of the war on drugs (which isn’t winnable) contend that this is inappropriate because of lack of efficacy and the risk of addition/tolerance. As one physician stated (without citing any studies): “Narcotics have no anti-inflammatory properties and are no more efficacious for even moderate or severe pain than anti-inflammatories.”
First, note that Rest-Ice-Compression-Elevation (RICE) is the primary treatment for most soft-tissue injuries (although it does not include pain management) absent complications. Ice addresses the anti-inflammatory part of treatment, and does provide some (very temporary) measure of pain relief
As for the appropriateness of opioids for pain management, your truly, actively engaged in the war on pain (which *is* winnable) posit that:
The strongest NSAIDs are evaluated at 3.5 effectiveness; Vicodin is given a 5. That’s a 70% increase in efficacy. Although opioids are not as effective for neuropathic pain, they are quite effective for acute pain, such as a torn ligament.
The complications most often experienced by patients on narcotics are nausea and lack of gut motility. The threat of addiction/tolerance while healing from an acute injury is small. Certainly treating pain risks feeding addiction, but to what extent should that risk affect pain treatment?
Are there moral hazards for denying opioids to those likely to benefit from them? David Morris, in The Culture of Pain, asserts that denying pain medication to a sufferer is the moral equivalent of inflicting pain upon them.