Smart drug choices

• In the research analyzed by the OSU College of Pharmacy, Flector demonstrated efficacy over placebo for strains or contusions ranging from mild to moderate when used less than 14 days in only two of four studies.
• The difference in pain relief over placebo was not considered clinically meaningful by one FDA clinical reviewer.
• Flector is systemically absorbed and thus carries the same black-box warnings for cardiovascular and gastrointestinal risk. There is no evidence that Flector offers a safety advantage.
• The patch delivery system brings with it a five percent risk of site reactions and variable absorption associated with heat or flushing. 
• Ibuprofen (600-800mg three times daily) or naproxen (250-500mg two times daily) or diclofenac (50 mg three times daily) have strong evidence of efficacy over placebo at a much lower cost. Numerous other generic NSAIDs also provide cost-effective alternatives for patients that do not tolerate ibuprofen, naproxen, or diclofenac.

We recognize that that every injured worker's care is individualized. We appreciate your review of this evidence and consideration of a less costly, medically appropriate alternative.

• Many patients with intermittent chronic pain (e.g. back pain present only with activity) don't require continuous pain therapy.ⁱ  Evidence suggests long- and short-acting oxycodone are equally effective at equivalent doses.ⁱⁱ
• Long-acting (LA) opioids are indicated for continuous pain or pain present for more than 12hrs in a 24 hour period.¹  Available evidence has not established a superior LA opioid in terms of efficacy or safety.²
• Side effects (e.g. nausea, vomiting, somnolence, thought impairment) are common for all opioids, and often wane over time or are easily treated with slow dose titration and dose adjustments. Constipation often persists and prescribers should consider the addition of a scheduled laxative regimen for all LA opioid patients.
• OxyContin is not available generically and is more expensive than generic LA-morphine.
• Methadone is very inexpensive but should only be prescribed by an experienced clinician aware of its accumulation potential and drug interactions.^{iii, iv}

We recognize that that every injured worker's care is individualized. We appreciate your review of this evidence and consideration of a less costly, medically appropriate alternative.

• Zolpidem, Sonata and Lunesta have similar efficacy for sleep latency and total sleep time when used for <=4 weeks.¹
• Withdrawals due to adverse events were similar.¹
• Long-term use (>4 weeks) is discouraged because epidemiological data and recent FDA warnings suggest there are significant risks associated with long-term sedative use. ^{2, 3, 4}