Giving children with musculoskeletal injuries (MSK-I) both morphine and ibuprofen
didn’t ease their pain more than giving them just one of the drugs, a study found.
Such injuries are common for children, and researchers set out to see if the combination
of an anti-inflammatory drug and an opioid could provide significant relief.
In a randomized, double-blinded, placebo-controlled trial, they studied 456 emergency
department (ED) patients ages 6-17 years with musculoskeletal injuries and a pain
score of more than 29 mm on a visual analogue scale that went from 0 to 100 mm. About
60% of the children had soft tissue injuries, and 38% had fractures.
Patients were given one of three treatment regimens orally — 0.2 milligrams/kilogram
(mg/kg) of morphine and a placebo, 10 mg/kg of ibuprofen and a placebo, or both drugs.
Neither the families nor the hospital staff treating the patients knew which combination
Researchers deemed the target to be a pain score of less than 30 mm an hour after
treatment. At that time, they found 33% of those receiving ibuprofen/placebo, 30%
of those receiving both drugs and 29% of those receiving morphine/placebo met the
goal. The results were not significantly different. The authors said results may have
been different with a higher dose of morphine.
While pain scores decreased for each group at 60, 90 and 120 minutes, the difference
in pain reduction among the groups was significant only at 120 minutes. At that time,
ibuprofen/placebo reduced pain more than morphine/placebo, but the authors cautioned
more than half of participants had left the study by this point.
Children who were in the two morphine groups had more side effects (nausea, abdominal
pain and drowsiness) than those in the ibuprofen/placebo group, but no children experienced
serious side effects.
Morphine did not prove to be a better pain reliever than ibuprofen in this study,
but due to the nature of the trial, “it is not possible to conclude that both analgesics
have equivalent analgesic properties,” authors wrote.
“Debate regarding ideal pain management for MSK-I in children continues,” they said.
“… Future studies should explore combination therapies that could provide both effective,
timely and sustained analgesia for pain management of MSK-I in children during their