Ibuprofen more suitable than oral morphine for pediatric fracture pain

by Bruce Sylvester: While ibuprofen and oral morphine are effective pain relievers for children with broken limbs, ibuprofen is the optimal treatment due to side-effects of morphine, researchers reported in a study published on Oct 27, 2014 in CMAJ (Canadian Medical Association Journal).

“Evidence suggests that orally administered morphine and other opioids are increasingly being prescribed,” said investigator Naveen Poonai, MD, London Health Sciences Centre and Western University, London, Ontario, Canada. “However, 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.”

As background, the authors noted that fracture pain in children is most severe during the first 48 hours post-injury. Due to safety issues about codeine-use for children, pain relief medication choices are limited.

The investigators enrolled 134 children, aged 5 to 17 years who presented at an emergency department with an uncomplicated extremity fracture. Subjects were randomized to receive either morphine (66 subjects, 0.5 mg/kg orally) or ibuprofen (68 subjects, 10 mg/kg) for 24 hours after discharge.

The primary outcome was the change in pain score using the Faces Pain Scale — Revised (FPS-R). Participants gave pain scores just before and 30 minutes each dosing.

The researchers found no significant differences in the change in pain scores between morphine and ibuprofen between groups at any of the 4 time points (p = 0.6). Notably, subjects in the morphine group reported significantly more adverse effects, such as drowsiness, nausea and vomiting, than those in the ibuprofen group (56.1% v. 30.9%, p < 0.01).

“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,” the authors concluded. “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.”