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Researchers say ibuprofen was more effective than codeine at managing pain after surgery. Arno Masse/Getty Images
  • Researchers say it appears ibuprofen is more effective than codeine for managing pain after surgery.
  • They add that ibuprofen also appears to have fewer side effects than codeine, which is an opioid.
  • Experts say ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) do not pose the potential for dependence as codeine may.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen offer better pain management and fewer side effects than codeine following surgery.

That’s according to research published today in the Canadian Medical Association Journal.

Researchers said they found that people who took NSAIDs had lower pain levels at 6 and 12 hours after surgery compared with their counterparts who took codeine.

“In all surgery types, subgroups and outcome time points, NSAIDs were equal or superior to codeine for postoperative pain,” the study authors wrote.

“We found that patients randomized to NSAIDs following outpatient surgical procedures reported better pain scores, better global assessment scores, fewer adverse effects, and no difference in bleeding events, compared with those receiving codeine,” they added.

The researchers reviewed 40 randomized control trials (RCTs) of more than 5,100 adults to compare the safety of medications containing codeine and NSAIDs as well as their efficacy in reducing pain.

“We found high-quality evidence that outpatient postoperative adults taking NSAIDs reported less pain at 6 and 12 hours than those taking codeine in a meta-analysis of RCTs,” the researchers wrote.

Dr. Sean Mackey, chief of the Division of Stanford Pain Medicine at Stanford University in California, said the results of the study aren’t surprising.

“I’m not particularly surprised, but it’s nice to see some data coming out corroborating it,” he told Healthline. “Postoperative pain is really nothing more than a controlled injury, and part of the injury is inducing an inflammatory response. NSAIDs are anti-inflammatory. They’re going to reduce swelling and pain. They’re going to be a good analgesic. I can readily see where NSAIDs can be an effective analgesic for many types of surgeries.”

Codeine belongs to a group of medications called opioids. Opioids work by altering how the nervous system and brain respond to pain.

“It’s a weak opioid. We don’t use it much in the United States for postoperative pain at all,” Mackey explained.

NSAIDs work by blocking an enzyme in the body that makes prostaglandins. Prostaglandins are chemicals in the body that can play a role in inflammation and pain. Reducing the prostaglandins created in the body can help reduce inflammation and pain.

“What we frequently do in pain management, in postoperative pain management, is that we’ll combine these types of medications. So, we’ll use a little bit of an NSAID and a little bit of an opioid,” Mackey said.

Both NSAIDs and codeine have potential side effects.

In the Canadian study, the researchers found that those who took NSAIDs following surgery had fewer adverse effects than those who took codeine.

“The benefits of codeine are that it’s a pain reliever, though a rather weak pain reliever. The downside of it being an opioid is that it has all the potential side effects of being an opioid. Opioids cause constipation. They can cause itching, nausea, and vomiting. In susceptible people, they can cause a decrease in your breathing,” Mackey said.

“Then there’s always the [misuse] potential of being on an opioid. Exposure to an opioid does put one at risk for future misuse or [misuse]. It’s rare, but it can occur,” he added.

NSAIDs also carry risks, but Mackey said they are typically safe.

“The obvious upside is there is zero abuse or addiction potential. You simply cannot become addicted to an NSAID. They are generally safe, but they do have some potential downsides. Those downsides include increased risk of bleeding because they also inhibit your platelets from sticking together, so the clotting function after surgery can be impaired by an NSAID,” he said.

NSAIDs may also cause stomach irritation and long-term use can also cause kidney damage, increased blood pressure, and an increase of cardiovascular events.

Although the Canadian study concluded that NSAIDs offer better pain management and fewer side effects postoperatively than codeine, Mackey said the results do not imply the same could be said for other opioids.

“You’re comparing [NSAIDs to] one opioid here only. You can’t make a gross generalization to morphine, hydrocodone, hydromorphone, fentanyl… any of those,” he noted.