A dose of ibuprofen 400mg + acetaminophen 1000mg was as good as an oral opiate for extremity pain.
Why does this matter?
We are in an opioid epidemic. Opiate abuse is rampant, and overdose deaths are rising. Even an opiate prescription, given for the right reasons, is not without risk. A recent study concluded that for every 48 people prescribed an opiate in the ED, 1 became a long-term user. But pain is real and needs treatment. How does a non-opiate regimen perform?
Acetaminophen + Ibuprofen = Opiate
This was a multifactorial RCT with 104 per group with acute arm or leg pain, mostly sprain or fracture: 400mg of ibuprofen and 1000 mg of acetaminophen; 5 mg of oxycodone and 325 mg of acetaminophen; 5 mg of hydrocodone and 300 mg of acetaminophen; or 30 mg of codeine and 300 mg of acetaminophen. They used a 0 - 10 pain scale. Baseline pain scores were 8.7 and dropped by about 4 points at two hours for all the analgesic combinations. Administration of rescue oxycodone occurred in about 18% among the groups and was not statistically different. In patients with no contraindication to NSAIDs or acetaminophen, this is an opiate-free option for pain control.
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 Nov 7;318(17):1661-1667. doi: 10.1001/jama.2017.16190.
Peer reviewed by Thomas Davis, MD.