Ibuprofen good as morphine and safer for kids with fractures

(Reuters Health) – The narcotic drug morphine is not the best choice for pain relief in kids with broken bones, a new study suggests.

Kids in the study took either morphine or ibuprofen by mouth. The morphine was associated with side effects like drowsiness, nausea and vomiting – but it wasn’t any better than ibuprofen at relieving pain.

“Both ibuprofen and oral morphine provided pain relief but there were no significant differences between the two agents,” said lead author Dr Naveen Poonai, a pediatric emergency physician at the London Health Sciences Centre in Ontario.

“In our study, we found that drowsiness and nausea were the most common side effects but patients also reported dizziness and vomiting,” Poonai told Reuters Health by email.

The study involved 134 children between ages five and 17 who arrived at the emergency department with a broken bone of the arm or leg that didn’t require surgery.

Half of the kids were randomly assigned to receive oral morphine, dosed to 0.5 milligrams per kilogram of the child’s weight, while the others received 10 mg/kg of ibuprofen, every six hours as needed for 24 hours after hospital discharge with a cast or sling. The medicines were not marked or labelled so the children and the parents did not know which painkiller they had received.

Doctors told parents to use acetaminophen if needed for breakthrough pain.

Patients received self-report pain measurement forms and were instructed to rate their pain on a scale of zero to five immediately before and 30 minutes after a painkiller dose.

Both morphine and ibuprofen lowered pain scores by an average of 1 to 1.5 points from before administration to 30 minutes after a dose, according to results in the Canadian Medical Association Journal.

The two groups did not differ in their overall pain reduction or in the use of acetaminophen for breakthrough pain.

More than half of the morphine group reported a side effect of the medicine, most often drowsiness, compared to 31 per cent of the ibuprofen group.

In the morphine group, 18 patients reported nausea, compared to four in the ibuprofen group.

Ibuprofen is a safe and effective choice for managing bone fracture pain for kids, the authors write.

“Ibuprofen is the safer choice for the simple reason that we have a lot more experience with it in children and both health care workers and parents know what to expect when it is given,” Poonai said.

“There is very little pediatric acute pain research done in the ‘at-home’ setting where these analgesics are actually used,” said Amy L Drendel, an associate professor of Pediatric Emergency Medicine at the Medical College of Wisconsin in Milwaukee. “This provides real-life data about how these medications work in the outpatient setting.”

Drendel was not involved in the new study.

“Many variables go into the decisions doctors make about pain management for children,” she told Reuters Health by email. “I always recommend that parents talk with their doctor about their child’s treatment to make sure their child receives the best care possible.”

Although it is understandably a big fear for doctors and parents, there is no evidence that children are at risk of opioid dependence to the same degree as adults, Poonai said.

“Pain in the ER before a fracture is immobilised with a cast or splint is likely more severe than pain at home,” he said. “But in our study we found that over 70 per cent of children had pain severe enough to require pain medication after discharge.”

“This tells us that nurses and doctors should be teaching parents to recognise and manage pain at home and likely offering a dose of ibuprofen at discharge,” he said.

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