Abstract
Musculoskeletal (MSK) injuries are one of the most frequent reason for pain-related evaluation in the emergency department (ED) in children. There is still no consensus as to what constitutes the best analgesic for MSK pain in children. However, ibuprofen is reported to be the most commonly prescribed analgesic and is considered the standard first-line treatment for MSK injury pain in children, even if it is argued that it provides inadequate relief for many patients. The purpose of this study was to review the most recent literature to assess the efficacy of ibuprofen for pain relief in MSK injuries in children evaluated in the ED. We performed a systematic review of randomized controlled trials on pharmacological interventions in children and adolescents under 19 years of age with MSK injuries according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome was the risk ratio for successful reduction in pain scores. Six studies met the inclusion criteria and provided data on 1028 children. A meta-analysis was not performed since studies were not comparable due to the different analgesic treatment used. No significant difference in term of main pain score reduction between all the analgesics used in the included studies was noted. Patients who received oral opioids had side effects more frequently when compared to children who received ibuprofen. The combination of effect on pain relief and tolerability would suggest ibuprofen as the initial drug of choice in providing relief from mild-to-moderate MSK pain in children in the ED. The results obtained in this review and current research suggest that there’s no straightforward statistically significant evidence of the optimal analgesic agent to be used. However, ibuprofen may be preferable as the initial drug of choice in providing relief from MSK pain due to the favorable combination of effectiveness and safety profile. In fact, despite the non-significant pain reduction as compared to children who received opioids, there are less side effect associated to ibuprofen within studies. The wide range of primary outcomes measured in respect of pain scores and timing of recorded measures warrants a future standardization of study designs.
Highlights
IntroductionStudies have repeatedly demonstrated that analgesia is suboptimal in the pediatric population especially in MSK trauma [5,6,7] and it has been recognized that, besides the fact that today the concept of access to pain management has been accepted and incorporated it into key human rights reports by the United Nations and regional human rights bodies [8], inadequate pain treatment determines significant short- and long-term consequences in children [9] such as slower healing [10] anxiety and hyperesthesia [11], and fear of medical care [12]
Musculoskeletal (MSK) injuries, including sprains, strains and fractures, are one of the most frequent reasons of pain-related evaluation in the emergency department (ED) in children [1]
We aimed to review the current literature focusing on ibuprofen in order to assess its efficacy in pain relief in MSK injuries in children evaluated in the ED and try to clarify if its preferential use is justifiable
Summary
Studies have repeatedly demonstrated that analgesia is suboptimal in the pediatric population especially in MSK trauma [5,6,7] and it has been recognized that, besides the fact that today the concept of access to pain management has been accepted and incorporated it into key human rights reports by the United Nations and regional human rights bodies [8], inadequate pain treatment determines significant short- and long-term consequences in children [9] such as slower healing [10] anxiety and hyperesthesia [11], and fear of medical care [12] Reasons for this surprisingly poor management of pain include a lack of evidence-based guidelines and concerns about risks associated with analgesics prescription [9] pediatric and emergency societies endorse appropriate treatment of pain as a key part of clinical care [13,14,15,16]. The same evidence is not available in children and there is still no consensus as to what constitutes the best analgesic for MSK pain in this population
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