Canadian scientists have found that ibuprofen is a more effective pain reliever for children with acute musculoskeletal injuries than acetaminophen and codeine.
The study is published in the online edition of the journal Pediatrics.The research team was led by Dr Eric Clark of the Departments of Pediatrics and Emergency Medicine, University of Ottawa and they recruited 336 children aged from 6 to 17 who had been admitted to the emergency department of the Children’s Hospital of Eastern Ontario in Ottawa.The children were admitted to hospital because of musculoskeletal injury to the extremities, neck and back that had taken place in the preceding 48 hours.Of the 336 randomly assigned to be treated with oral doses of 15mg per kg of acetaminophen, 10 mg per kg of ibuprofen or 1 mg per kg of codeine, 300 were included in the analysis (100 in each drug group).The children in all three groups were similar by age, gender, the types of painkiller they had taken before, the final diagnosis of their injury and their pain levels at baseline time.The trial was designed to be double blind where neither the children’s parents nor the researchers administering the drugs are told which drug group they are in. However in reality about half of them guessed which drug they were using, and this was acknowledged as a potential weakness in the trial, as was its small size and exclusion of many other available participants who would have met the random assignment criteria.The children were periodically asked to show how much pain they were feeling by placing a mark on a horizontal pain intensity scale from 0 to 100. This is known as a “visual analogue scale” and in this case it measured 100 mm wide.The main focus of the study was the pain intensity after 60 minutes from baseline, but the researchers also compared results after this time.The results showed that after 60 minutes, the children who had been given ibuprofen had the largest decrease in pain intensity. Their mean pain level decrease was 24 mm on the 100 mm scale, while the acetaminophen group showed a mean decrease of 12 mm and the codeine group 11 mm at the 60 minute point.The decrease in pain level of the three groups did not change at the 120 minute point.As well as showing the greatest mean decrease in pain level, the ibuprofen group also had more children at the below 30 mm level or the “adequate analgesia” level than the other two groups at 60 minutes.Acetaminophen and codeine did not differ significantly in their ability to reduce pain or bring more children below the adequate analgesia level.The researchers concluded that for treating traumatic musculoskeletal injury in children, ibuprofen is more effective as a pain reliever than either acetaminophen or codeine.But they did point out that only half of the children who took ibuprofen came below the adequate pain threshold, so in some cases ibuprofen may not be enough.Other scientists commenting on the study said that one reason for the differences in the results could be because ibuprofen also reduces inflammation which can exarcebate pain in broken bones and sprains.In the US ibuprofen is marketed as Motrin and Advil, and acetaminophen is marketed as Tylenol. Both are also available in generic form. In the UK acetaminophen is known as paracetamol. Codeine is often used in combination with other painkillers.Many pharmacists advise caution in the administration of codeine to young children, as respiratory depression is a possible side-effect and also the livers of young children may have problems metabolizing the drug.(Source: Paediatrics : University of Ottawa: March 2007.)