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Emergency care
Combination of ibuprofen and acetaminophen is no different than low-dose opioid analgesic preparations in relieving short-term acute extremity pain
  1. Francesca L Beaudoin1,2
  1. 1 Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
  2. 2 Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
  1. Correspondence to Dr Francesca L Beaudoin, Rhode Island Hospital, Providence, Rhode Island 02903, USA; francesca_beaudoin{at}

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Commentary on: Chang AK, Bijur PE, Esses D, et al. Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department: A Randomized Clinical Trial. JAMA 2017;318:1661-7.


The epidemic of opioid overdoses in the USA has not abated despite recent decreases in the number of opioid analgesics prescribed by US providers.1 Despite millions of patient-years of use, there are relatively few studies comparing the effectiveness and safety of commonly prescribed analgesics for acute pain in the emergency department (ED). Emerging data suggest that opioids initiated for acute pain may carry a subsequent risk of opioid use disorders,2 3emphasising the need for prudent opioid prescribing in acute care settings.


This was a blinded, randomised-controlled trial comparing single doses of four different oral analgesic preparations (non-opioid and opioid) for the treatment of acute extremity pain …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.