ABSTRACT
In the management of acute pain and cancer pain, stepped levels of treatment intensity are recommended. The initial treatment is usually a nonopioid analgesic, such as aspirin, salicylate salt, acetaminophen, or a nonsteroidal anti-inflammatory drug (NSAID) (1). If this treatment, at the recommended doses is inadequate, simply increasing the dose will not result in a proportional increase in analgesia (2). Furthermore, the risk of adverse effects increases with these higher doses. Therefore, the addition of a low-dose opioid is recommended (1). The combination can be given as two individual doses or in a combination tablet or capsule. Oral narcotic-acetaminophen or narcotic-aspirin combinations represent a large category of drugs currently available in the United States for treating acute and chronic pain. Their popularity is due to the ease of prescribing the combination product, the minimization of abuse of the opioid alone, and the considerable marketing effort for the combinations. The currently marketed analgesic combinations for pain in the United States are mixtures of either codeine, hydrocodone, oxycodone, or propoxyphene with aspirin, acetaminophen, or ibuprofen. Ibuprofen at 200 mg has an analgesic efficacy equal to or greater than aspirin or acetaminophen 650 mg. Ibuprofen at 400 mg is widely considered to have a higher level of analgesic activity than aspirin or acetaminophen at 650 mg (3,4). Hence, it is reasonable that a 400-mg ibuprofen combination with a low-dose opioid would undoubtedly have greater efficacy than a combination of 650 mg of aspirin or acetaminophen with the same amount of the opioid.
