Children suffering from a broken arm are surprisingly helped more by over-the-counter painkillers than with dangerously strong prescription drugs, according to a new study by researchers at the Medical College of Wisconsin, Milwaukee, and Children’s Research Institute.
Until now, there has not been an evidence-based pain management regimen for children with simple arm fractures after being released from the emergency department.
“Our study calls into question the practice of using acetaminophen with codeine as a rescue medicine if ibuprofen fails to treat fracture pain for children,” explains Dr. Drendel.
A liquid version of either ibuprofen or the acetaminophen-codeine combination were randomly assigned to 336 children ranging in age from 4 to 18 by researchers, after being treated for a broken arm at Children’s Hospital of Wisconsin.
None of the children, parents, or doctors knew which child received which treatment until the study was over.
While there was no difference in the number of children that failed treatment in the two groups, there was a higher level of function and satisfaction and fewer bad side-effects with children on ibuprofen, when compared to those receiving acetaminophen with codeine.
Study leader Dr. Amy Drendel concluded that the children on ibuprofen did the best.
“They were more likely to play, they ate better and they had fewer adverse effects,” she said.
In the group taking ibuprofen, 29.5 percent reported an adverse effects such as nausea and drowsiness, compared with 50.9 percent of the acetaminophen with codeine group. Also, nearly 90 percent of children treated with ibuprofen said they would rather take the same treatment in the future, compared with only 72 percent of the acetaminophen with codeine group.
Results were published online Tuesday by the Annals of Emergency Medicine. Experts lauded the study as one of the few to have ever offered a comparison of medicines that have been long used in children based solely on how they work in adults.
“We want to start with what’s effective and less likely to cause problems,” and in this case, it turned out to be the least expensive, most accessibly drug, said Dr. Knox Todd, an emergency medicine pain researcher at Beth Israel Medical Center in New York and a member of the American Pain Society’s board of directors.
“A lot of emergency medicine physicians are afraid to give kids narcotics and a lot of parents are uncomfortable with narcotic medicine,” which makes a more effective alternative great news, Drendel said.
The study was funded by the hospital and medical school, and a hospital-related charity paid for $10 Toys R Us gift certificates for each participant.
This study was entirely unrelated to a recent proposal by an advisory panel to the federal Good and Drug Administration about limits on Tylenol for adults, said Todd, who is a member of that panel.
“Acetaminophen when taken as directed is a very safe drug. The problem is people taking too much,” or its inclusion in drugs that people might not be aware of, he explained.
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