Ibuprofen Is Viable for Pain Treatment In Emergency Departments
Ibuprofen and acetaminophen reduced pain within 2 hours after ingestion in patients with acute extremity pain, according to a recent study.
The randomized clinical trial included 416 patients with severe acute extremity pain admitted to 2 urban emergency departments (ED) in New York City. Patients were divided evenly into 4 groups and received either 400 mg of ibuprofen and 1000 mg of acetaminophen, 5 mg of oxycodone and 325 mg of acetaminophen, 5 mg of hydrocodone and 300 mg of acetaminophen, or 30 mg of codeine and 300 mg of acetaminophen.
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An 11-point numerical rating scale (NRS) was used to assess pain intensity. The researchers compared the decline in pain 2 hours after ingestion between the 4 treatment groups, with a predefined minimum clinically important difference of 1.3 on the NRS, but did not assess adverse events.
The final analysis included 411 patients (mean age 37 years, 48% women, 60% Latino) and the mean baseline NRS pain score was 8.7.
After 2 hours, the mean NRS pain score decreased by 4.3 among patients who received ibuprofen and acetaminophen, by 4.4 among those who received oxycodone and acetaminophen, by 3.5 among those who received hydrocodone and acetaminophen, and by 3.9 among those who received codeine and acetaminophen.
“For patients presenting to the ED with acute extremity pain, there were no statistically significant or clinically important differences in pain reduction at 2 hours among single-dose treatment with ibuprofen and acetaminophen or with 3 different opioid and acetaminophen combination analgesics.” the researchers concluded. “Further research to assess adverse events and other dosing may be warranted.”
—Melissa Weiss
Reference:
Chang AK, Bijur PE, Esses D, Barnaby DP, Baer J. Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department: a randomized clinical trial [published online November 7, 2017]. JAMA. doi:10.1001/jama.2017.16190.