Rethinking Combination Analgesia for Pediatric Musculoskeletal Pain

Ibuprofen is a first-line treatment for acute musculoskeletal pain in children, yet many experience incomplete pain relief. Clinicians may add acetaminophen or opioids to improve analgesia, despite limited supporting evidence. Two recent double-blind, placebo-controlled trials provide further data.

The studies involved 699 children (ages, 6–17) presenting at emergency departments with acute limb injuries and moderate-to-severe pain (mean score, 6.4 on a 0–10 scale). Researchers then randomized these pediatric patients to receive ibuprofen alone or ibuprofen plus acetaminophen or hydromorphone.