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.

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