Abstract
BackgroundSoft tissue injuries commonly present to the emergency department (ED), often with acute pain. They cause significant suffering and morbidity if not adequately treated. Paracetamol and ibuprofen are commonly used analgesics, but it remains unknown if either one or the combination of both is superior for pain control.ObjectivesTo investigate the analgesic effect of paracetamol, ibuprofen and the combination of both in the treatment of soft tissue injury in an ED, and the side effect profile of these drugs.MethodsDouble-blind, double dummy, placebo-controlled randomised controlled trial. 782 adult patients presenting with soft tissue injury without obvious fractures attending the ED of a university hospital in the New Territories of Hong Kong were recruited. Patients were randomised using a random number table into three parallel arms of paracetamol only, ibuprofen only and a combination of paracetamol and ibuprofen in a 1:1:1 ratio. The primary outcome measure was pain score at rest and on activity in the first 2 hours and first 3 days. Data was analysed on an intention to treat basis.ResultsThere was no statistically significant difference in pain score in the initial two hours between the three groups, and no clinically significant difference in pain score in the first three days.ConclusionThere was no difference in analgesic effects or side effects observed using oral paracetamol, ibuprofen or a combination of both in patients with mild to moderate pain after soft tissue injuries attending the ED.Trial registrationThe study is registered with ClinicalTrials.gov (no. NCT00528658).
Highlights
Soft tissue injuries comprises of various types of injuries including contusions, sprains, crush injuries, cuts and lacerations
Specific guidelines and recommendations are available for the treatment for low back pain [1,2,3], ankle and foot injuries [4, 5] etc, but oral analgesics are often recommended for the relief of acute pain
Inflammation has been postulated to be the main reason for pain following soft tissue injury, this study has demonstrated that paracetamol is as effective as ibuprofen, a non-steroidal anti-inflammatory drug
Summary
Soft tissue injuries comprises of various types of injuries including contusions, sprains, crush injuries, cuts and lacerations. Non-steroidal anti-inflammatory drugs are not subject to the stringent restrictions of narcotic drug laws, they do not depress respiration or impair gastro-intestinal motility and are not associated with dependence [8,9,10]. They are associated with histamine release and should be avoided in patients with a history of bronchospasm. Soft tissue injuries commonly present to the emergency department (ED), often with acute pain. They cause significant suffering and morbidity if not adequately treated. Paracetamol and ibuprofen are commonly used analgesics, but it remains unknown if either one or the combination of both is superior for pain control
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