{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T05:55:35Z","timestamp":1771998935093,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2014,3,13]],"date-time":"2014-03-13T00:00:00Z","timestamp":1394668800000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2014,3]]},"abstract":"Abstract<\/jats:title>Objectives<\/jats:title>The objective was to test the hypothesis that hydrocodone\/acetaminophen (Vicodin [5\/500]) provides more efficacious analgesia than codeine\/acetaminophen (Tylenol #3 [30\/300]) in patients discharged from the emergency department (ED<\/jats:styled-content>). Both are currently Drug Enforcement Administration (DEA<\/jats:styled-content>) Schedule III<\/jats:styled-content> narcotics.<\/jats:p><\/jats:sec>Methods<\/jats:title>This was a prospective, randomized, double\u2010blind, clinical trial of patients with acute extremity pain who were discharged home from the ED<\/jats:styled-content>, comparing a 3\u2010day supply of oral hydrocodone\/acetaminophen (5\u00a0mg\/500\u00a0mg) to oral codeine\/acetaminophen (30\u00a0mg\/300\u00a0mg). Pain was measured on a valid and reproducible verbal numeric rating scale (NRS<\/jats:styled-content>) ranging from 0 to 10, and patients were contacted by telephone approximately 24\u00a0hours after being discharged. The primary outcome was the between\u2010group difference in improvement in pain at 2\u00a0hours following the most recent ingestion of the study drug, relative to the time of phone contact after ED<\/jats:styled-content> discharge. Secondary outcomes compared side\u2010effect profiles and patient satisfaction.<\/jats:p><\/jats:sec>Results<\/jats:title>The median time from ED<\/jats:styled-content> discharge to follow\u2010up was 26\u00a0hours (interquartile range [IQR<\/jats:styled-content>]\u00a0= 24 to 39\u00a0hours). The mean NRS<\/jats:styled-content> pain score before the most recent dose of pain medication after ED<\/jats:styled-content> discharge was 7.6 NRS<\/jats:styled-content> units for both groups. The mean decrease in pain scores 2\u00a0hours after pain medications were taken were 3.9 NRS<\/jats:styled-content> units in the hydrocodone\/acetaminophen group versus 3.5 NRS<\/jats:styled-content> units in the codeine\/acetaminophen group, for a difference of 0.4 NRS<\/jats:styled-content> units (95% confidence interval [CI<\/jats:styled-content>]\u00a0=\u00a0\u20130.3 to 1.2 NRS<\/jats:styled-content> units). No differences were found in side effects or patient satisfaction.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Both medications decreased NRS<\/jats:styled-content> pain scores by approximately 50%. However, the oral hydrocodone\/acetaminophen failed to provide clinically or statistically superior pain relief compared to oral codeine\/acetaminophen when prescribed to patients discharged from the ED<\/jats:styled-content> with acute extremity pain. Similarly, there were no clinically or statistically important differences in side\u2010effect profiles or patient satisfaction. If the DEA<\/jats:styled-content> reclassifies hydrocodone as a Schedule II<\/jats:styled-content> narcotic, as recently recommended by its advisory board, our data suggest that the codeine\/acetaminophen may be a clinically reasonable Schedule III<\/jats:styled-content> substitute for hydrocodone\/acetaminophen at ED<\/jats:styled-content> discharge. These findings should be regarded as tentative and require independent validation in similar and other acute pain models.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.12331","type":"journal-article","created":{"date-parts":[[2014,3,13]],"date-time":"2014-03-13T22:25:35Z","timestamp":1394749535000},"page":"227-235","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Randomized Clinical Trial of Hydrocodone\/Acetaminophen Versus Codeine\/Acetaminophen in the Treatment of Acute Extremity Pain After Emergency Department Discharge"],"prefix":"10.1111","volume":"21","author":[{"given":"Andrew K.","family":"Chang","sequence":"first","affiliation":[{"name":"The Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Medical Center Bronx NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Polly E.","family":"Bijur","sequence":"additional","affiliation":[{"name":"The Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Medical Center Bronx NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin G.","family":"Munjal","sequence":"additional","affiliation":[{"name":"The Department of Emergency Medicine Mount Sinai Medical Center New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"John Gallagher","sequence":"additional","affiliation":[{"name":"The Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Medical Center Bronx NY"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,3,13]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2007.64"},{"key":"e_1_2_8_3_1","first-page":"1","article-title":"National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary","author":"Niska R","year":"2010","journal-title":"Natl Health Stat Report"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1197\/j.aem.2004.12.005"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(05)81383-6"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e3181850ca3"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1875-9114.1994.tb02800.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2005.04.010"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0149-2918(00)80060-0"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0149-2918(02)85007-X"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2012.06.013"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-720X.2005.tb00543.x"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2003.tb01355.x"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1442-2026.2003.00499.x"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(96)70226-3"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.1609"},{"key":"e_1_2_8_17_1","first-page":"40","article-title":"Guidelines for scheduling drugs under the controlled substances act [proceedings]","volume":"17","author":"Kartzinel R","year":"1981","journal-title":"Psychopharmacol Bull"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f1012"},{"key":"e_1_2_8_19_1","unstructured":"State of New York Department of Health.Frequently asked questions Part C Chapter 447 Laws of 2012 (Controlled Substance Schedule Changes). 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