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2007-9-2 10:11:33

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Ibuprofen found in over-the-counter Advil and Motrin was more effective than other two competitors in relieving children's pain from musculoskeletal injuries to extremities, the neck, and the back, a new Canadian study published in the March Issue of the journal Pediatrics.

The researchers came to the conclusion after they compared ibuprofen with acetaminophen - an active ingredient found in Tylenol and codeine at an equivalent OTC dose in children admitted into an emergency department.

"No one had done comparison studies on the pain medications we use [on children] shift after shift,” Dr. Eric Clark, the lead author and an emergency medicine doctor at the University of Ottawa School of Medicine was quoted as saying by

Clark said some doctors have actually used ibuprofen more frequently than other two painkillers, but this study justified such a preference.

In the study, researchers randomly assigned 15 mg/kg acetaminophen, 10 mg/kg ibuprofen, or 1 mg/kg codeine to 330 children aged 6 to 17 admitted to the emergency department of the Children's Hospital department of Eastern Ontario with pain from a musculoskeletal injury that occurred 48 hours before admission into the hospital.

Children's pain at the time of admission and at 60 minutes after treatment was evaluated on a pain scale ranging from 1 to 100 and then compared.   300 children were randomly selected for an analysis.

The researchers found that children in the ibuprofen group had a significantly greater improvement in pain score (pain score decreased by 24 mm) than those in the codeine (11mm) and acetaminophen (12mm).

Additionally at 60 minutes, more children receiving ibuprofen achieved adequate analgesia as defined by a visual analog scale less than 30 mm than other two groups.

There was no significant difference between acetaminophen and codeine in change in pain score at any time or in the number of children experiencing adequate analgesia.

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A Randomized, Controlled Trial of Acetaminophen, Ibuprofen, and Codeine for Acute Pain Relief in Children With Musculoskeletal Trauma
Eric Clark, Amy C. Plint, Rhonda Correll, Isabelle Gaboury, and Brett Passi
Pediatrics 2007; 119: 460-467. [Abstract] [Full text] [PDF]

Ibuprofen: What you need to know?

What is ibuprofen?

Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) originally marketed as ibuprofen. It is used in a variety of brands of painkillers including Advil and Motrin.

What are the symptoms for which ibuprofen can be used?

Ibuprofen can be used to relieve symptoms of arthritis, primary dysmenorrhoea, fever, and as an analgesic, especially where there is an inflammatory component.

What are the common doses of ibuprofen used as a painkiller?

Low doses of ibuprofen, 200 mg or occasionally 400 mg are available over-the-counter. In children, the oral dose of 200-400 mg (5 to 10 mg/kg body weight) for every 4 to 6 hours.

What is the mechanism that explains Ibuprofen's pain relieving effect?

Ibuprofen is believed to work through inhibition of cyclooxygenase (cox), thus inhibiting prostaglandin synthesis.   Its analgesic is achieved principally through COX-2 inhibition.

What are the common side effects of ibuprofen?

The side effects associated with use of ibuprofen include constipation, diarrhea, gas or bloating, dizziness, nervousness and ringing in ears among others.

Infrequent adverse effects include esophageal ulceration, heart failure, renal impairment, confusion, bronchospasm and rash.

Who should not use ibuprofen?

Ibuprofen can impose a serious risk of heart attack in those who have underlying heart problems. Along with other NSAIDs, ibuprofen has been linked with an elevated risk of myocardial infarction in those who chronically use high doses.   Heart attack can be implicated with this medicine without prior signs or warning, potentially resulting in death.

Is ibuprofen toxic?

At low doses such as below 100 mg/kg, toxic effects are not common, but can be severe above 400 mg/kg.   No precise lethal dose has been determined.

What are the possible interactions between ibuprofen and others?

Ibuprofen should not be used as a pain reliever together with aspirin as it will render aspirin useless.

What should I do in case of emergency?

Emergency intervention is needed some times.   Symptoms caused by overdosage include dizziness, fast eye movement, slow breathing and blue color around the lips mouth and nose.

In cases of overdose, call a local poison control center at 1.800.222.1222. But if the patient has collapsed or is not breathing, call 911 immediately.

Is there any warning over the use of ibuprofen?

On April 4 2006, the FDA approved safety labeling revisions for nonprescription pediatric medications containing ibuprofen to warn patients of the potential risks for allergic reactions, and gastrointestinal (GI) adverse events associated with use of ibuprofen in children aged younger than 12 years.