The results of a randomized trial published in the CMAJ suggest that ibuprofen is preferable to morphine as a pain reliever for children with broken limbs. Although both drugs provide effective pain relief, ibuprofen is associated with less severe side effects than morphine among this group.

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Oral morphine and other opioids are increasingly being prescribed for pain relief among children.

Fractures account for up to a quarter of all injuries among children, with the most severe pain occurring in the first 48 hours after injury.

As there are safety concerns over the use of codeine among children, there are limited pain relief options for children with broken limbs. The study notes, however, that oral morphine and other opioids are increasingly being prescribed for pain relief among children.

“However,” write the authors, “evidence for the oral administration of morphine in acute pain management is limited. Thus, additional studies are needed to address this gap in knowledge and provide a scientific basis for outpatient analgesic choices in children.”

The researchers – from London Health Sciences Centre and Western University in Ontario, Canada – compared the outcomes of 66 children whose pain was treated using morphine with the outcomes of 68 children who were administered ibuprofen for fracture pain. All participants were aged 5-17 years.

The results demonstrate that, although both of the medications were effective for relieving pain, there were more adverse events – such as drowsiness, nausea and vomiting – associated with morphine.

“Given that morphine was associated with significantly more adverse effects, we conclude that ibuprofen remains a safe and effective therapy for outpatient management of children’s fracture pain,” write the authors.

“We hope that our results will provide clinicians with a foundation for rational analgesic choices for children with fractures who are discharged from the emergency department,” they add.

A 2007 study, published in the journal Pediatrics, found that ibuprofen – compared with acetaminophen and codeine – is the most effective pain reliever for children with acute musculoskeletal injuries.

In that study, 300 children were randomly assigned to be treated with oral doses of either 15 mg per kg of acetaminophen, 10 mg per kg of ibuprofen or 1 mg per kg of codeine.

The children in each group were of similar age and had a similar history of painkiller use, and their injury diagnoses and pain levels at the start of the study were also comparable.

Over a period of 60 minutes following the administration of painkillers, the children were periodically asked to rate their pain levels on a scale from 0 to 100.

The researchers behind this study found that, after 60 minutes, the ibuprofen group reported the largest decrease in pain intensity. Acetaminophen and codeine did not differ significantly in their ability to reduce pain.

However, only half of the children who were administered ibuprofen had a decrease in pain below the “adequate pain threshold.” Consequently, the researchers consider that in some cases, ibuprofen may not be sufficient for treating musculoskeletal pain.

One reason for this could be because the inflammation-reducing effects of ibuprofen can sometimes make pain worse in cases of broken bones and sprains.