A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma
Child; Female; Humans; Male; Pain Measurement; Analgesics; Treatment Outcome; Patient Satisfaction; Acute Disease; adolescent; Administration; Oral; Non-Narcotic/therapeutic use; Dose-Response Relationship; Drug; Opioid/therapeutic use; Pain/diagnosis/drug therapy/etiology; Codeine/therapeutic use; Acetaminophen/therapeutic use; Ibuprofen/therapeutic use; Wounds and Injuries/complications
OBJECTIVE: Our goal was to determine which of 3 analgesics, acetaminophen, ibuprofen, or codeine, given as a single dose, provides the most efficacious analgesia for children presenting to the emergency department with pain from acute musculoskeletal injuries. PATIENTS AND METHODS: Children 6 to 17 years old with pain from a musculoskeletal injury (to extremities, neck, and back) that occurred in the preceding 48 hours before presentation in the emergency department were randomly assigned to receive orally 15 mg/kg acetaminophen, 10 mg/kg ibuprofen, or 1 mg/kg codeine. Children, parents, and the research assistants were blinded to group assignment. The primary outcome was change in pain from baseline to 60 minutes after treatment with study medication as measured by using a visual analog scale. RESULTS: A total of 336 patients were randomly assigned, and 300 were included in the analysis of the primary outcome (100 in the acetaminophen group, 100 in the ibuprofen group, and 100 in the codeine group). Study groups were similar in age, gender, final diagnosis, previous analgesic given, and baseline pain score. Patients in the ibuprofen group had a significantly greater improvement in pain score (mean decrease: 24 mm) than those in the codeine (mean decrease: 11 mm) and acetaminophen (mean decrease: 12 mm) groups at 60 minutes. In addition, at 60 minutes more patients in the ibuprofen group achieved adequate analgesia (as defined by a visual analog scale <30 mm) than the other 2 groups. 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. CONCLUSIONS: For the treatment of acute traumatic musculoskeletal injuries, ibuprofen provides the best analgesia among the 3 study medications.
2007
Clark E; Plint AC; Correll R; Gaboury I; Passi B
Pediatrics
2007
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1542/peds.2006-1347" target="_blank" rel="noreferrer">10.1542/peds.2006-1347</a>
Defining mild, moderate, and severe pain by using the color analogue scale with children presenting to a pediatric emergency department
Child; Female; Humans; Male; Prospective Studies; adolescent; Preschool; Non-U.S. Gov't; Research Support; PedPal Lit; Hospital; Emergency Service; Wounds and Injuries/complications; Pediatrics/methods; Pain Measurement/methods; Abdominal Pain/classification/diagnosis; Arizona; Emergency Medicine/methods; Headache/classification/diagnosis; Pain/classification/diagnosis/etiology
OBJECTIVES: To define in centimeters what constitutes mild, moderate, and severe acute pain in children by using the Color Analogue Scale (CAS) for pain. METHODS: This was a prospective study, using convenience sampling, of all children presenting to a pediatric ED between the ages of 5 and 16 years with a complaint of pain. Children were excluded if they had altered sensorium, were clinically unstable or required admission to the ICU, or were developmentally delayed. Children were asked to mark their pain severity on the standardized 10-cm CAS. To use this measure, children were asked to slide the marker to the point on the scale that best described the pain they were currently experiencing. They then were asked to describe their pain as "none," "mild," "moderate," or "severe." RESULTS: A total of 169 children were enrolled with a mean age of 10.1 years (SD +/- 3.2 years). Males accounted for 94 (55%); 89 (52.7%) were Hispanic, 63 (37.3%) were white, 8 (4.7%) were African American, and 9 (5.3%) were "others." In children who considered their pain to be mild (n = 34), the median score was 3.5 cm, and the mean score was 3.47 cm (95% CI = 2.95 to 3.99). For those with moderate pain (n = 68), the median score was 6.0 cm, the mean score was 6.04 cm (95% CI = 5.67 to 6.41), and if the pain was considered severe (n = 67) the median score was 8.5 cm, and the mean score was 8.28 cm (95% CI = 7.85 to 8.71). CONCLUSIONS: This study quantifies what constitutes mild, moderate, and severe pain on the CAS scale. This information should be used to properly triage children with painful conditions and to identify appropriate patients for enrollment in analgesic studies.
2006
McConahay T; Bryson M; Bulloch B
Academic Emergency Medicine
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article