Dr. Terry P. Klassen (MD), pediatric emergency physician, professor and provincial department head of pediatrics at the USask College of Medicine.
Dr. Terry P. Klassen (MD), pediatric emergency physician, professor and provincial department head of pediatrics at the USask College of Medicine. (Photo: Dallas Carpenter)

USask part of research team examining pain relief for kids

A large cross-Canadian study led by pediatric emergency physicians determines the best pain medicines to use when treating children with broken bones and sprains.

By College of Medicine Communications

Although ibuprofen is the recommended first-line treatment for children with limb injuries like breaks and sprains, many children still have pain while using it. Understanding if adding other medicines can help is important for both pain management and safe medication use. 
 
To help determine the best treatment for children, Dr. Samina Ali (MD), professor of pediatrics and emergency medicine at the University of Alberta and chair of Pediatric Emergency Research Canada, led the No OUCH study—one of the largest randomized clinical trials ever carried out on pediatric pain in Canada. The study was co-authored by Dr. Terry P. Klassen (MD), pediatric emergency physician, professor and provincial department head of pediatrics at the University of Saskatchewan’s (USask) College of Medicine. 

A total of 699 children aged six to 17 participated in the study. The children had injuries like broken arms and sprained ankles with moderate to severe pain, but did not need surgery or hospital admission. Parents were given the option to participate in a non-opioid trial if they preferred.  
 
“For some time now, I think parents and others have been worried about the use of opioids in that context (children with limb injuries),” said Klassen. “I think the struggle is you would want to use them if the kids need them, but if they don’t need them it would be nice to avoid that and the potential long-term implications.”  
 
The study found that giving children ibuprofen (Advil) plus acetaminophen (Tylenol) or ibuprofen plus hydromorphone (Dilaudid), an oral opioid, provided no better pain relief than giving ibuprofen alone. However, adverse reactions (dizziness, fatigue, nausea, vomiting, etc.) were four to five times more likely in the group that took the oral opioid. 
 
“We found that ibuprofen alone is sufficient to control the pain for children that present with musculoskeletal injuries,” said Klassen. “There is ongoing pain management research (under Dr. Ali’s research program) … but for now this research provides a very clear answer and is something that needs to move to knowledge translation.”  
 
With files from the University of Alberta.