Ibuprofen Recommended Over Morphine for Kids' Fracture Pain

Because orally administered morphine is associated with a significantly greater number of adverse events, ibuprofen is the better choice for relieving pain in children with broken bones, a study published on October 27, 2014, in the Canadian Medical Association Journal suggests.

“Although ibuprofen has been cited as the most common agent used by caregivers to treat musculoskeletal pain, there are concerns that its use as monotherapy may lead to inadequate pain management,” the researchers wrote. “Concerns surrounding the safety of codeine in children has left a void in the choices of opioid therapy available for moderate to severe pain. As a possible consequence, some evidence suggests that the use of oral morphine is increasing…However, evidence for the oral administration of morphine in acute pain management is limited.”

To ascertain the superior analgesic agent for reducing fracture-related pain in pediatric outpatients, the researchers compared 66 children aged 5 to 17 years receiving morphine with 68 age-matched subjects taking ibuprofen. All study subjects had presented to the pediatric emergency department with an uncomplicated extremity fracture sustained within the preceding 24 hours.

At the conclusion of the study, the investigators found no difference in analgesic efficacy between the 2 painkillers. However, the morphine group experienced significantly more drowsiness, nausea, and vomiting, among other adverse events.

Responding to those results, the study authors recommended ibuprofen over oral morphine for pain in children with orthopedic injuries that do not require surgery.

“Given ibuprofen’s and morphine’s similar and inexpensive prices…ibuprofen should be the initial drug of choice for acutely painful musculoskeletal trauma in children,” the researchers concluded. “We hope that our results will provide clinicians with a foundation for rational analgesic choices for children with fractures who are discharged from the emergency department.”