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Hesitance to use opioids is a barrier to effective treatment of pain in children. In this study, researchers randomized a convenience sample of 66 children (age range, 5–17 years) with acute traumatic extremity pain (pain scores ≥5 on a 1–10 verbal numeric scale) to receive ibuprofen (10 mg/kg to a maximum dose of 400 mg) or acetaminophen-codeine (1 mg/kg as codeine to a maximum dose of 60 mg). Using the validated color analog scale, children rated their pain before administration of the study drug and 20, 40, and 60 minutes after administration. Both groups had similar and clinically significant improvement in pain scores at all time points, with minimal adverse effects.
Friday JH et al. Ibuprofen provides analgesia equivalent to acetaminophen–codeine in the treatment of acute pain in children with extremity injuries: A randomized clinical trial. Acad Emerg Med 2009 Aug; 16:711.
Comment
These findings should encourage the use of ibuprofen to treat acute traumatic extremity pain in children. This study also serves as a reminder that codeine is a poor analgesic and that an effective opioid, such as hydrocodone or oxycodone, should be considered for children with moderate-to-severe pain that is not effectively relieved by ibuprofen or acetaminophen.