Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain

in the Emergency Department: A Randomized Clinical Trial

  1. Calliope
    Study Author(s):
    Andrew K. Chang, MD, MS; Polly E. Bijur, PhD; David Esses, MD; et al
    Journal Name:
    JAMA. 2017;318(17):1661-1667.
    Publication Date:
    November 2017
    Question Do any of 4 oral combination analgesics (3 with different opioids and 1 opioid-free) provide more effective reduction of moderate to severe acute extremity pain in the emergency department (ED)?

    Findings In this randomized clinical trial of 411 ED patients with acute extremity pain (mean score, 8.7 on the 11-point numerical rating scale), there was no significant difference in pain reduction at 2 hours. Mean pain scores decreased by 4.3 with ibuprofen and acetaminophen (paracetamol); 4.4 with oxycodone and acetaminophen; 3.5 with hydrocodone and acetaminophen; and 3.9 with codeine and acetaminophen.

    Meaning For adult ED patients with acute extremity pain, there were no clinically important differences in pain reduction at 2 hours with ibuprofen and acetaminophen or 3 different opioid and acetaminophen combination analgesics.