Despite opioids being used first line in emergency settings to treat severe acute extremity pain, there is limited evidence available to inform this practice.
In a study in JAMA (7 November 2017), researchers randomly assigned 416 patients in the emergency department with moderate-to-severe acute extremity pain to one of the following groups: 400mg ibuprofen/1000mg paracetamol; 5mg oxycodone/325mg paracetamol; 5mg hydrocodone/300mg paracetamol; or 30mg codeine/300mg paracetamol
Two hours after administration, there was no statistically nor clinically significant difference in pain score reduction between any of the groups.
The researchers said the results indicate that ibuprofen and paracetamol could be an alternative to opioid-based pain relief for acute extremity pain in the emergency department, but caution is important not to overgeneralise the results to other settings, types of pain or dosing regimens.
 Chang A, Bijur P, Esses D et al. Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department. JAMA 2017;318:1661–1667. doi: 10.1001/jama.2017.16190