BALTIMORE — Codeine combined with ibuprofen did not relieve pain from pediatric acute musculoskeletal injuries any more effectively than ibuprofen alone; however, the combination therapy was associated with fewer side effects, according to findings from a small, randomized controlled trial.
Pain management in children generally tends to be poor, and children presenting with a limb trauma need to receive an opioid, and possibly one that's stronger than codeine, “to better relieve their pain and bring it down to below [a Visual Analog Scale score of] 4,” Sylvie Le May, Ph.D., said.
The study involved 83 children (aged 6–17 years) who presented to the emergency department at CHU Sainte-Justine University Hospital Center, Montreal, with limb fractures, sprains, and contusions between March 2008 and October 2009. At baseline, the children reported having moderate to severe pain (4–10 on the VAS).
In all, 42 patients were randomized to receive codeine and ibuprofen, whereas 41 patients in the control group received ibuprofen and placebo. The children's pain levels were measured at triage, then at the 60-, 90-, and 120-minute marks afterward.
Children in the experimental group had a mean score of 5.9 VAS at triage, then 4.2, 4.0, and 3.5, respectively; those in the control group had mean scores of 5.7, 3.9, 4.1, and 3.8.
Dr. Le May explained that she undertook the study because, in her experience as a nurse, children “with this kind of pain [from] limb trauma should receive an opioid. That's the standard, but physicians are not following the standard.”
Dr. Le May said that her 2005–2007 study of 150 charts of children presenting to EDs with severe sprains, fractures, burns, deep lacerations, and abdominal pain found that only 3% of children received an opioid for their pain.
Disclosures: Dr. Le May reported having no conflicts of interest.