Combining oral paracetamol, ibuprofen and codeine as the initial treatment for pain associated with acute musculoskeletal injuries does not appear to be superior to paracetamol alone for pain reduction at 60 minutes or the need for rescue analgesia

In August 2019 researchers from New Zealand and Australia published the results of their study to compare the use of paracetamol either singly or in combination with ibuprofen and codeine for pain relief in acute minor musculoskeletal injuries. A total of 118 individuals, aged 18 to 65 years, who attended a hospital emergency department with acute (up to 48 hours) closed limb or trunk injuries with moderate pain (greater than 3/10), were included in the study. The individuals were divided into two groups and given either a single combined dose of 1 g of paracetamol, 400 mg of ibuprofen, and 60 mg of codeine, or a single dose of 1 g of paracetamol, placebo ibuprofen, and placebo codeine. The pain was similar in both groups. Results showed that there was a clinically detectable reduction in pain at rest at 60 minutes for both groups. At 120 minutes, there was a slightly higher reduction in pain in the combination group than those who only received the paracetamol. However, rescue painkillers were required by 4 individuals in the paracetamol group and 5 in the combination group.

Gong J et al. Oral Paracetamol Versus Combination Oral Analgesics for Acute Musculoskeletal Injuries. Ann Emerg Med. 2019 Aug 1. [Epub ahead of print]

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