Vikki Sloviter
When a child is hurt, parents want to do anything to ease his pain. But often they don't know what the best course of action is, or what type of pain medication will work best. Of three well-known analgesics, acetaminophen, ibuprofen and codeine, which one, if any, is best for children? Researchers from the University of Ottawa, Ontario, recently sought to answer that question, and their finding may surprise some parents.
Eric Clark, MD of University of Ottawa and his colleagues evaluated data collected from 300 children ages 6-17 who presented to the emergency department of the Children's Hospital of Eastern Ontario between May 2002 and January 2003 for musculoskeletal injuries to their extremities, neck or back. The children were randomly assigned to one of three groups, each of which received initial oral doses of 15mg of acetaminophen, 10 mg of ibuprofen or 1 mg of codeine. The children rated their pain before they received the pain medication (baseline) and then every 30 minutes for 120 minutes using a visual analog scale (a 100 mm hatched line with "no pain" at one end and "worst pain" at the other). After the first 60 minutes and then every 30 minutes, the children were asked if they needed more pain medication. No more pain medication was administered once the children scored a 30 mm or below on the visual analog scale.
Though there was no statistical difference in pain relief among the three medications after only 30 minutes, 60 minutes later, the average reduction in pain on the visual analog scale was 11 points less for those who were given codeine, 12 points less for those given acetaminophen, but a whopping 24 points less for those given ibuprofen. At one and two hours past the initial administration of any one of the medicines, ibuprofen showed significant pain relief over acetaminophen and codeine in children who had experienced fractures. Interestingly, for children with soft tissue injury, there was no statistical difference in pain relief among the three medications.
There were a few limitations to the study, including the relatively small number of participants. But, the researchers claim the final study group of 336 children (300 of whose data were used for the primary outcome) was a good representation of the 780 children who were originally eligible to participate.
So, the next time your child has a musculoskeletal injury to an extremity, neck or back, a dose of ibuprofen - commonly sold as Motrin, Advil, or Nuprin, and variety of store brands - may help ease the pain.
Pediatrics, 03/07
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