Acetaminophen plus Ibuprofen Noninferior to Low-Dose Oral Opioids for Acute Extremity Pain

In the midst of the opioid crisis, we are all looking for reasons not to use opioids. Investigators conducted a double-blind, randomized, controlled trial to compare efficacy of four oral analgesic regimens in adult emergency department patients with acute extremity pain. The four regimens were ibuprofen 400 mg plus acetaminophen 1000 mg, oxycodone 5 mg plus acetaminophen 325 mg, hydrocodone 5 mg plus acetaminophen 300 mg, and codeine 30 mg plus acetaminophen 300 mg. Pain was measured on an 11-point numeric rating scale before and 2 hours after administration of the medications.

Among 411 patients, the mean pain score before administration was 8.7. At two hours, there were no statistically significant differences in pain reduction among trea…