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Ibuprofen Best for Kids' Injury Pain

ER study finds over-the-counter painkiller outperformed codeine, acetaminophen

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HealthDay Reporter

MONDAY, March 5, 2007 (HealthDay News) -- The painkiller ibuprofen -- found in over-the-counter Advil and Motrin -- worked better than two other analgesics commonly used in hospital emergency departments to relieve children's pain from musculoskeletal injuries such as sprained ankles, a new Canadian study shows.

A standard OTC dose of ibuprofen was compared to equivalent doses of acetaminophen (the active ingredient in Tylenol) and to codeine, said Dr. Eric Clark, the lead author of the study and an emergency medicine specialist at the University of Ottawa School of Medicine.

The study is published in the March issue of the journal Pediatrics.

"No one had done comparison studies on the pain medications we use [on children] shift after shift," Clark said. "Some of us were already using ibuprofen more than the others, and I think this [study] just confirms our clinical experience."

Clark's team evaluated 300 children, ages 6 to 17, who were brought to the emergency department of the Children's Hospital of Eastern Ontario with pain from a musculoskeletal injury to the extremities, neck or back occurring sometime in the prior 48 hours. Each child was first asked to describe their pain, using a commonly used tool in which they rate their pain, from "no pain" to "the worst pain they have ever felt."

Next, Clark's team randomly assigned the children to one of the three treatment groups. The children, parents and research assistants who asked them about pain did not know which medication each child got. Each was given a standard dose orally, prescribed by the child's weight.

After the children took the medicine, they were asked to describe the pain every 30 minutes for two hours, using the same description as before.

"The primary outcome [we were looking at] was at one hour," Clark said. At the one-hour mark, the ibuprofen group had better pain relief.

"On a 100 millimeter [total possible] pain score, the ibuprofen group dropped by about 24 millimeters on average, the acetaminophen group 12 millimeters and the codeine group 11 millimeters," Clark said.

Those given ibuprofen were least likely to ask for more medicine for pain relief after an hour, they found, another good indication the medicine was working.

A pain score below 30 millimeters is considered adequate relief, Clark said. "About 50 percent of the ibuprofen group got there, but only 36 percent of the acetaminophen group vs. only 40 percent of the codeine group."

The results about which medicine worked best on children's acute pain slightly surprised Dr. Dennis Woo, chair of pediatrics at Santa Monica-UCLA and Orthopaedic Hospital in Santa Monica, Calif. "I would have guessed codeine," Woo said.

Indeed, said Clark, codeine does have the reputation among many doctors of being the better choice.

But the results are actually good news, Woo said. He personally does not like to use codeine for kids' pain management because "it spaces them out," he said.

Will the study results change prescribing habits in emergency departments when kids are brought in acute pain? "I hope so," Clark said. "This is a very common problem that all kinds of doctors and emergency pediatricians see."

In the pediatric department he studied, Clark wrote, about 10 percent of all visits are for these kinds of musculoskeletal injuries.

The take-home message for parents? "When we send parents home with children with bumps, bruises and broken bones, we suggest parents use ibuprofen as well," Clark said. That also goes, he said, for treating musculoskeletal injuries not severe enough to seek medical care.

More information

To learn more about pain relievers, visit the American Academy of Family Physicians.

SOURCES: Eric Clark, M.D., emergency medicine specialist, University of Ottawa School of Medicine, Ottawa, Canada; Dennis Woo, M.D., chair of pediatrics, Santa Monica-UCLA and Orthopaedic Hospital, Santa Monica, Calif.; March 2007, Pediatrics

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