Ibuprofen vs Paracetamol or Codeine for acute pain in children

Ibuprofen vs Paracetamol or Codeine for acute pain in children

A double-blind study published in Pediatrics has investigated the efficacy of single dose paracetamol, codeine and ibuprofen for children presenting with pain from acute musculoskeletal injuries.

Outcome data was presented for 300 patients aged 6 to 17 years who had suffered pain from a musculoskeletal injury (to extremities, neck, and back) that occurred in the preceding 48 hours before presentation in the emergency department. Patients were randomised to receive either 15 mg/kg paracetamol (n=100), 10 mg/kg ibuprofen (n=100), or 1 mg/kg codeine (n=100). The primary outcome was change in pain from baseline to 60 minutes after treatment with study medication as measured by using a visual analogue scale.

The researchers reported that:

• Patients in the ibuprofen group had a significantly greater improvement in pain score (mean decrease: 24 mm) than those in the codeine group (mean decrease: 11 mm; p<0.001) p="0.001" p="0.98).
• At 60 minutes more patients in the ibuprofen group achieved adequate analgesia (as defined by a visual analogue scale <30mm)>vs. codeine (p=0.85); paracetamol vs. ibuprofen (p=0.026); codeine versus ibuprofen (p=0.006) .
• There was no significant difference between patients in the codeine and acetaminophen groups in the change in pain score at any time period or in the number of patients achieving adequate analgesia.

The researchers concluded that for the treatment of acute traumatic musculoskeletal injuries, ibuprofen provides the best analgesia among the 3 study medications.

Pediatrics. 2007 Mar;119 (3):460-7
Link to abstract