Equivalent Pain Relief with Different Doses of Ibuprofen

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)

Synopsis

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.