A Non-Opioid Alternative for Pain in the ER

By Jane Farrell

A combination of ibuprofen and acetaminophen proved as good as opioids in treating arm or leg pain for adults coming to the emergency department, new research shows.

According to a release from the JAMA Network Journals, in the randomized clinical trial researchers analyzed 416 patients, aged 21 to 64 years, in two urban emergency departments. The patients came to the ER with moderate to severe acute extremity pain (arms and legs) from sprains, strains or fractures. They were randomly assigned one of the following:

• 400 mg ibuprofen and 1,000 mg acetaminophen
• 5 mg oxycodone and 325 mg acetaminophen
• 5 mg hydrocodone and 300 mg acetaminophen
• 30 mg codeine and 300 mg acetaminophen

After two hours, the pain was less in all participants, without any important difference in effect among the four groups of remedies.

However, the release acknowledged, there were certain limitations to the study: It measured pain for only two hours after patients took the medicine, and about one in five required additional medication for pain.

According to the news release, the findings suggest that ibuprofen-acetaminophen is a reasonable alternative to opioid management of acute extremity pain due to sprain, strain, or fracture, but further study is needed to assess longer-term effect, adverse events and dosing.

The research is important because the United States is facing an opioid epidemic, with almost 500,000 individuals dying from opioid overdoses since 2000. Despite the epidemic, opioid analgesics remain a first-line treatment for moderate to severe acute pain in the emergency department. The combination of ibuprofen and acetaminophen may represent an effective non-opioid alternative.

Authors of the study were Andrew K. Chang, M.D., M.S., of Albany Medical College, Albany, New York, and colleagues from the Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.