No Significant Difference in Pain Relief for Opioids vs Non-Opioid Analgesics for Treating Arm or Leg Pain



Media advisory: To contact corresponding author Andrew K. Chang, M.D., M.S., email Sue Ford Rajchel at The full study is available on the For The Media website.

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Bottom Line: For adults coming to the emergency department for arm or leg pain due to sprain, strain, or fracture, there was no difference in pain reduction after 2 hours with ibuprofen-acetaminophen vs three comparison opioid-acetaminophen (paracetamol) combinations.

Why The Research Is Interesting: 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.

Who: 416 patients (ages 21 to 64 years) with moderate to severe acute extremity pain in two urban emergency departments were randomly assigned to receive

400 mg ibuprofen and 1,000 mg acetaminophen

—  5 mg oxycodone and 325 mg acetaminophen

— 5 mg hydrocodone and 300 mg acetaminophen; or

30 mg codeine and 300 mg acetaminophen

When: July 2015 to August 2016

What (Study Measures): The between-group difference in decline in pain two hours after taking the study drugs.

How (Study Design): This was a randomized clinical trial (RCT). Randomized trials allow for the strongest inferences to be made about the true effect of an intervention such as a medication or a procedure. However, not all RCT results can be replicated because patient characteristics or other variables in real-world settings may differ from those that were studied in the RCT.

Authors: Andrew K. Chang, M.D., M.S., of Albany Medical College, Albany, New York, and coauthors

Results: After 2 hours pain was less in all participants, without any important difference in effect between the four groups.

Study Limitations: The results apply only to pain after two hours. About 1 in 5 patients required additional medication to control their pain.

Study Conclusions: There were no important differences in pain reduction after 2 hours with ibuprofen-acetaminophen or opioid-acetaminophen combination pills in emergency department patients with acute extremity pain. 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 research to assess longer-term effect, adverse events and dosing is warranted.

Related material:

The following related elements also are available on the For The Media website:

  • The editorial, “Opioid vs Nonopioid Acute Pain Management in the Emergency Department,” by Demetrios N. Kyriacou, M.D., Ph.D., Senior Editor, JAMA, Chicago; Northwestern University Feinberg School of Medicine, Chicago.

For more details and to read the full study, please visit the For The Media website.


Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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