Oral painkillers equally effective, but opioids may cause nausea

Among five oral analgesics used for treating acute musculoskeletal extremity pain in the emergency department, none appears superior to others in terms of relieving pain 1 hour after administration, according to a study. However, more patients treated with opioids experience nausea and vomiting.

The study randomized 600 patients to receive one of the following: 400 mg ibuprofen/1,000 mg acetaminophen, 800 mg ibuprofen/1,000 mg acetaminophen, 30 mg codeine/300 mg acetaminophen, 5 mg hydrocodone/300 mg acetaminophen, or 5 mg oxycodone/325 mg acetaminophen.

The primary outcome of change in pain from baseline to 60 minutes after treatment did not differ by treatment (p=0.69).

Mean changes in pain in numeric rating scale units (ranging from 0 or “no pain” to 10 or “worst imaginable pain”) were 3.0 with 400-mg ibuprofen/1,000-mg acetaminophen, 3.0 with 800-mg ibuprofen/1,000-mg acetaminophen, 3.4 with 30-mg codeine/300-mg acetaminophen, 3.1 with 5-mg hydrocodone/300-mg acetaminophen, and 3.3 with 5-mg oxycodone/325-mg acetaminophen.

Rescue medication was given within 1 hour of analgesic administration in two patients on 400-mg ibuprofen/1,000-mg acetaminophen (1.7 percent), three on 800-mg ibuprofen/1,000-mg acetaminophen (2.5 percent), none of those on 30-mg codeine/300-mg acetaminophen (0.0 percent), three on 5-mg hydrocodone/300-mg acetaminophen (2.5 percent), and none on 5-mg oxycodone/325-mg acetaminophen (0.0 percent; p=0.21).

Nausea or vomiting occurred with greater frequency among patients who received opioids versus other painkillers (6.7 percent versus 1.7 percent). The findings at 2 hours were similar.