Wednesday, December 19, 2012

Pain Control on the Wrong Track

Codeine, the oral narcotic analgesia that is long past its prime.  Approximately 8% of the caucasian population cannot metabolize codeine into morphine – and then a small handful are rapid metabolizers that will overdose on an otherwise therapeutic dose.  But, this didn't stop these folks in Montreal from evaluating its efficacy for pediatric musculoskeletal limb pain.

Pediatric pain is a little odd.  Overall, the Emergency Department does a poor job of treating pain.  Studies in pediatric EDs show significant percentages of injured patients don't receive any pain control. But, then, we all have the anecdotal experience in which a child is sitting on a stretcher watching TV with a fractured arm denying he's in any pain at all – why are you bothering me again?  Spongebob is on.

Long story short, this study randomized children to receive either ibuprofen alone or ibuprofen plus codeine.  At each time point, the difference in pain scales was no different between groups.  Pain scores weren't that high to begin with, and had moderate improvement after either treatment.

For minor pain, acetaminophen and ibuprofen are adequate options.  For more severe pain, intravenous narcotics, intranasal narcotics, or even intramuscular ketamine are probably better options.

"Efficacy of an Ibuprofen/Codeine Combination for Pain Management in Children Presenting to the Emergency Department With a Limb Injury: A Pilot Study"
www.ncbi.nlm.nih.gov/pubmed/23232154

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