Acetaminophen plus diclofenac and diclofenac monotherapy are comparable to acetaminophen alone for pain relief in patients with acute blunt minor musculoskeletal extremity trauma, according to findings from a double-blind randomized trial published in the Annals of Emergency Medicine.

Investigators randomly assigned adult patients with minor musculoskeletal extremity trauma to receive acetaminophen (n=182; 4000 mg/day), diclofenac (n=183; 150 mg/day), or 4000 mg acetaminophen plus 150 mg diclofenac per day (n=182).

All patients, healthcare personnel, and outcome assessors were blinded during the randomization phase.

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At 90 minutes with acetaminophen, the average reduction in numeric rating scale (NRS) pain scores at rest and with movement was –1.23 (95% CI, –1.50 to –0.95) and –1.72 (95% CI, –2.01 to –1.44), respectively. Differences of –0.027 (97.5% CI, –0.45 to 0.39) for diclofenac and –0.052 (97.5% CI, –0.46 to 0.36) for combination treatment were observed at rest. In addition, differences of –0.20 (97.5% CI, –0.64 to 0.23) for diclofenac and –0.39 (97.5% CI, –0.80 to 0.018) for combination therapy were observed with movement.

Due to a 15% loss to follow-up during the study’s second phase, the investigators suggest their pain score analysis was underpowered, thus preventing them from adequately formulating definitive statements regarding therapeutic inferiority. Also, the investigators note that their study failed to identify differences in adverse events in the 3 groups, especially since all patients received 20 mg omeprazole once per day during 3 days of the study.

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Due to the similar efficacy rates associated with acetaminophen, diclofenac, and combination therapy, the investigators conclude that “pain treatment in acute minor musculoskeletal extremity trauma in adult patients could initially consist of 1 of these 3 analgesic strategies.”

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Ridderikhof ML, Lirk P, Goddijn H, et al. Acetaminophen or nonsteroidal anti-inflammatory drugs in acute musculoskeletal trauma: A multicenter, double-blind, randomized, clinical trial. Ann Emerg Med [published online October 13, 2017]. doi:10.1016/j.annemergmed.2017.08.041