Non-Opioid Meds Compared to Opioids for Acute Extremity Pain

A total of 416 patients between 21 and 64 years of age with moderate to severe acute extremity pain were enrolled
A total of 416 patients between 21 and 64 years of age with moderate to severe acute extremity pain were enrolled

For adults visiting the emergency department (ED) with extremity pain, no clinically important differences in pain reduction at 2 hours were seen between patients who received ibuprofen-acetaminophen and those who received an opioid combination analgesic. The findings comes from a randomized clinical trial (RCT) conducted at 2 EDs in New York City. 

A total of 416 patients between 21 and 64 years of age with moderate to severe acute extremity pain were enrolled. Each analgesic combination group contained 104 individuals. They received either:

  • ibuprofen 400mg and acetaminophen 1000mg
  • oxycodone 5mg and acetaminophen 325
  • hydrocodone 5mg and acetaminophen 300mg; or
  • codeine 30mg and acetaminophen 300mg

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Results at 2 hours demonstrated that the mean 11-point numerical rating scale (NRS) pain scores decreased by 4.3 (95% CI, 3.6 to 4.9) in the ibuprofen and acetaminophen group compared to 4.4 (95% CI, 3.7 to 5.0) in the oxycodone and acetaminophen group; 3.5 (95% CI, 2.9 to 4.2) in the hydrocodone and acetaminophen group; and by 3.9 (95% CI, 3.2 to 4.5) in the codeine and acetaminophen group (P=.053). The minimum clinically important difference was defined as 1.3 on the NRS.

The authors concluded, “The findings suggest that ibuprofen-acetaminophen is a reasonable alternative to opioid management of acute extremity pain due to sprain, strain, or fracture, but further research to assess longer-term effect, adverse events and dosing is warranted.” They noted also how the results were limited in that they only applied to pain after 2 hours and 1 in 5 patients required additional medication to control their pain.

The full findings were published in JAMA.

For more information visit Jamanetwork.com.