Does Adding Ibuprofen and Codeine to Oral Acetaminophen Improve Pain Control?

Opioids and nonsteroidal anti-inflammatory drugs (NSAIDS) are often used to treat acute pain even though evidence suggests that acetaminophen or NSAIDS alone are just as effective. To determine whether NSAIDs and codeine provide additive pain relief to oral acetaminophen, researchers at a single emergency department in New Zealand enrolled 119 adults with acute limb or trunk injuries and at least moderate pain. All patients received 1 gram of acetaminophen and were then randomized to receive either 400 mg ibuprofen and 60 mg codeine or matching placebos. Patients with open injuries, renal or hepatic insufficiency, pregnancy, or intoxication were excluded. The primary outcome was improvement in pain at rest at 60 minutes.

Mean baseline pain s…