Nonopioid analgesic combinations may be noninferior to opioid/acetaminophen combinations for reducing acute extremity pain at 2 hours following admission to the emergency department, according to findings from a randomized clinical trial published in the Journal of the American Medical Association.

A total of 411 patients presenting to 2 different emergency departments in New York City between July 2015 and August 2016 who had moderate to severe acute extremity pain were randomly assigned to receive 400 mg ibuprofen plus 1000 mg acetaminophen (n=104), 5 mg oxycodone plus 325 mg acetaminophen (n=104), 5 mg hydrocodone plus 300 mg acetaminophen (n=104), or 30 mg codeine plus 300 mg acetaminophen (n=104). Assessment of pain levels 2 hours after medication administration, using the 0 to 10 numeric rating scale (NRS), was the trial’s primary outcome.

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At baseline, the average NRS pain score was 8.7±1.3, indicating a high level of pain intensity. Participants receiving ibuprofen plus acetaminophen experienced a 4.3-point decrease in NRS pain score (95% CI, 3.6-4.9). Similar levels of pain reduction were observed in the oxycodone plus acetaminophen (4.4-point decrease; 95% CI, 3.7-5.0), hydrocodone plus acetaminophen (3.5-point decrease; 95% CI, 2.9-4.2), and codeine plus acetaminophen (3.9-point decrease; 95% CI, 3.2-4.5) groups (P =.053).

“The findings support the inference that there are no clinically meaningful differences between the analgesic effects of these 4 analgesics and suggest that a combination of ibuprofen and acetaminophen represents an alternative to oral opioid analgesics for the treatment of acute extremity pain in the [emergency department],” concluded the researchers.

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Chang AK, Bijur PE, Esses D, Barnaby DP, Baer J. Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department: a randomized clinical trial. JAMA. 2017;318(17):1661-1667.