Ibuprofen on par with ketorolac for acute musculoskeletal back pain

Both oral ibuprofen 400 mg and intramuscular (IM) ketorolac 10 mg deliver pain relief to individuals with acute, atraumatic, musculoskeletal back pain presenting to the emergency department (ED), according to a study.

Ninety-three patients participated in the study: 47 in the ibuprofen group and 46 in the ketorolac group. From baseline to 1 h, visual analogue scale (VAS) scale score reduction was 35 with ibuprofen and 32 with ketorolac (95 percent confidence interval, ‒8.03 to 15.03).

Rescue analgesia administration at 60 min did not significantly differ between the two treatment groups. Two patients in the ketorolac group reported adverse reactions (pain at injection site).

This single-centre, double-blind, double-placebo, randomized study included adult patients with atraumatic musculoskeletal back pain presenting to an urban ED. The investigators randomized participants to receive oral ibuprofen 400 mg suspension plus IM placebo injection or IM ketorolac 10 mg plus oral placebo suspension.

Absolute reduction in pain score 1 h after medication administration, as measured by VAS, was the primary outcome, while rescue analgesia administration at 60 min and adverse drug reactions were the secondary outcomes.

“Ibuprofen and ketorolac are NSAIDs commonly used to treat acute back pain in the ED,” the researchers said. “Data comparing pain relief between oral and intramuscular administration at their proposed ceiling doses is lacking.”