Patient-Oriented Evidence That Matters

Equivalent Pain Relief with Different Doses of Ibuprofen


Am Fam Physician. 2020 May 15;101(10):631.

Clinical Question

In patients with acute pain, does a higher dose of ibuprofen produce greater pain relief?

Bottom Line

Higher doses of ibuprofen for acute pain relief offer no more benefit at 60 minutes than a single 400-mg dose. The same has been shown for chronic treatment of osteoarthritis. A higher, anti-inflammatory dose is not needed. Another study showed equivalence between 200-mg and 400-mg doses of ibuprofen. (Level of Evidence = 2b)


The authors enrolled 225 adults who presented to a single emergency department with an acute painful condition (approximately 75% had musculoskeletal pain). The average pain score was between 6 and 7 on a scale of 1 to 10, with higher scores indicating higher pain. Using concealed allocation, patients were randomly assigned to receive a single dose of ibuprofen, 400 mg, 600 mg, or 800 mg. Using intention-to-treat analysis, pain scores after 60 minutes dropped to between 4.36 and 4.50 in all three groups. The study had 80% power to find a difference of at least 1.3 points among the groups.

Study design: Randomized controlled trial (double-blinded)

Funding source: Foundation

Allocation: Concealed

Setting: Emergency department

Reference: Motov S, Masoudi A, Drapkin J, et al. Comparison of oral ibuprofen at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. Ann Emerg Med. 2019;74(4):530–537.

Editor's Note: Dr. Shaughnessy is an assistant medical editor for AFP.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.



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