Also Noted

Which pain medication (acetaminophen, ibuprofen, or codeine) provides the best analgesia for children with musculoskeletal injuries? This question was investigated by a randomized, controlled trial of children age 6 to 17 years who presented to the emergency department with pain from a musculoskeletal injury sustained in the previous 48 hours. Children were randomized to receive 1 oral dose of acetaminophen 15 mg/kg, ibuprofen 10 mg/kg, or codeine 1 mg/kg. Using a visual analog scale, children rated their own pain. At 30 minutes, there was no statistical difference between pain scores in the 3 groups. However, at 60 or more minutes, patients who had received ibuprofen exhibited significantly greater improvement in pain scores compared with those in the acetaminophen or codeine groups. In addition, more patients in the ibuprofen group had achieved adequate analgesia compared with the other 2 groups (52% vs 36% and 40%; P < .001; NNT = 7 and 9, respectively). Ibuprofen appears to be more effective than acetaminophen or codeine in the treatment of acute musculoskeletal pain, particularly if a fracture is present. However, ibuprofen alone often provides inadequate pain control.