Ibuprofen vs acetaminophen vs their combination in the relief of musculoskeletal pain in the ED: a randomized, controlled trial

Bondarsky, Eric; Domingo, Anna; Matuza, Nicholas M.; Taylor, Maria; Thode, Henry C.; Singer, Adam J.

doi:10.1016/j.ajem.2013.06.007

Cited by 35 publications

(16 citation statements)

References 14 publications

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“…Oral ibuprofen demonstrated similar efficacy as orally administered morphine in a double-blind trial of children with fractures (Poonai et al, 2014). Oral ibuprofen has also shown analgesic efficacy similar to that of acetaminophen, and no difference in efficacy was observed for the combination of NSAID plus acetaminophen versus either alone in a double-blind trial of adult ED patients with acute musculoskeletal pain (Bondarsky et al, 2013). However, a systematic review suggests that the combination of acetaminophen and an NSAID may improve analgesia versus each drug alone (Ong, Seymour, Lirk, & Merry, 2010).…”

Section: Resultsmentioning

confidence: 99%

Exploring Opioid-Sparing Multimodal Analgesia Options in Trauma: A Nursing Perspective

Sullivan

Lyons

Montgomery

et al. 2016

Journal of Trauma Nursing

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Section: Resultsmentioning

confidence: 99%

Exploring Opioid-Sparing Multimodal Analgesia Options in Trauma: A Nursing Perspective

Sullivan

Lyons

Montgomery

et al. 2016

Journal of Trauma Nursing

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“…In another ED‐based study, the combination of 800 mg of ibuprofen plus 1,000 mg of acetaminophen was no more efficacious than ibuprofen alone among 60 patients with acute musculoskeletal pain. In both groups, the pain decreased by about one‐third 1 hour later . In a study of 25 mg of indomethacin, 25 mg of diclofenac, or 25 mg of diclofenac plus 1 gram of paracetamol among 229 patients with isolated limb injury, there were no important between‐group differences within 2 hours or during the subsequent days …”

Section: Discussionmentioning

confidence: 97%

“…In both groups, the pain decreased by about one-third 1 hour later. 13 In a study of 25 mg of indomethacin, 25 mg of diclofenac, or 25 mg of diclofenac plus 1 gram of paracetamol among 229 patients with isolated limb injury, there were no important betweengroup differences within 2 hours or during the subsequent days. 14 In general, the utility of medications for patients with acute LBP has been underwhelming.…”

Section: Discussionmentioning

confidence: 97%

Ibuprofen Plus Acetaminophen Versus Ibuprofen Alone for Acute Low Back Pain: An Emergency Department–based Randomized Study

Friedman

Irizarry

Chertoff

et al. 2020

Academic Emergency Medicine

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Objectives Patients with low back pain (LBP) are often treated with nonsteroidal anti‐inflammatory drugs (NSAIDs). NSAIDs are modestly effective for LBP, but many patients with LBP continue to suffer despite treatment with these medications. We compared pain and functional outcomes 1 week after emergency department (ED) discharge among patients randomized to a 1‐week course of ibuprofen plus acetaminophen versus ibuprofen plus placebo. Methods This was a randomized, double‐blind study conducted in two urban EDs. Patients presenting with acute, nontraumatic, nonradicular LBP of no more than 2 weeks’ duration were eligible for enrollment immediately prior to discharge from an ED if they had a score > 5 on the Roland Morris Disability Questionnaire (RMDQ), a 24‐item validated instrument, indicating more than minimal functional impairment. All patients were given a standardized 10‐minute LBP educational session prior to discharge. The primary outcome was improvement on the RMDQ between ED discharge and 1 week later. One secondary outcome was pain intensity, as measured on a 4‐point descriptive scale (severe, moderate, mild, none) at 1 week. Results Enrollment began in October 2018. A total of 120 patients met selection criteria and were randomized. Baseline demographic characteristics were comparable between the two groups. By 1 week after the ED visit, patients randomized to ibuprofen plus placebo reported a mean (±SD) improvement in the RMDQ of 11.9 (±9.7), while those randomized to ibuprofen plus acetaminophen reported a mean (±SD) improvement of 11.1 (±10.7). The 95% CI for the between‐group difference of 0.8 was −3.0 to 4.7. At 1 week, moderate or severe pain was reported by 15 of 53 (28%) patients in the ibuprofen plus placebo group and 16 of 57 (28%) patients in the ibuprofen plus acetaminophen group (95% CI for between‐group difference of 0% = −17% to 17%). Conclusion Among ED patients with acute, nontraumatic, nonradicular LBP, adding acetaminophen to ibuprofen does not improve outcomes within 1 week.

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“…The NNT published in this 2015 review was 3.6 for paracetamol (975/1000mg), 2.5 for ibuprofen acid (400mg), 2.1 for ibuprofen fast acting (400mg) and 1.5 for ibuprofen 400mg + paracetamol 1000mg combination. It is not certain if the synergistic effects of adding a NSAID to paracetamol might be different in our study population, since a previous trial by Bondarsky et al also failed to demonstrate superiority for the drug combination for acute musculoskeletal injury [ 33 ]. It was acknowledged that the trial by Bondarsky et al could be underpowered and the negative results could have been contributed by the study design, but it has remained uncertain which patients might benefit from the ibuprofen and paracetamol combination in the ED.…”

Section: Discussionmentioning

confidence: 99%

Oral paracetamol and/or ibuprofen for treating pain after soft tissue injuries: Single centre double-blind, randomised controlled clinical trial

Hung¹,

Graham²,

Lo³

et al. 2018

PLoS ONE

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BackgroundSoft tissue injuries commonly present to the emergency department (ED), often with acute pain. They cause significant suffering and morbidity if not adequately treated. Paracetamol and ibuprofen are commonly used analgesics, but it remains unknown if either one or the combination of both is superior for pain control.ObjectivesTo investigate the analgesic effect of paracetamol, ibuprofen and the combination of both in the treatment of soft tissue injury in an ED, and the side effect profile of these drugs.MethodsDouble-blind, double dummy, placebo-controlled randomised controlled trial. 782 adult patients presenting with soft tissue injury without obvious fractures attending the ED of a university hospital in the New Territories of Hong Kong were recruited. Patients were randomised using a random number table into three parallel arms of paracetamol only, ibuprofen only and a combination of paracetamol and ibuprofen in a 1:1:1 ratio. The primary outcome measure was pain score at rest and on activity in the first 2 hours and first 3 days. Data was analysed on an intention to treat basis.ResultsThere was no statistically significant difference in pain score in the initial two hours between the three groups, and no clinically significant difference in pain score in the first three days.ConclusionThere was no difference in analgesic effects or side effects observed using oral paracetamol, ibuprofen or a combination of both in patients with mild to moderate pain after soft tissue injuries attending the ED.Trial registrationThe study is registered with ClinicalTrials.gov (no. NCT00528658).

show abstract

Ibuprofen vs acetaminophen vs their combination in the relief of musculoskeletal pain in the ED: a randomized, controlled trial

Cited by 35 publications

References 14 publications

Exploring Opioid-Sparing Multimodal Analgesia Options in Trauma: A Nursing Perspective

Exploring Opioid-Sparing Multimodal Analgesia Options in Trauma: A Nursing Perspective

Ibuprofen Plus Acetaminophen Versus Ibuprofen Alone for Acute Low Back Pain: An Emergency Department–based Randomized Study

Oral paracetamol and/or ibuprofen for treating pain after soft tissue injuries: Single centre double-blind, randomised controlled clinical trial

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