Analgesic class	Efficacy	Side effects	Dosage	Comment
Acetaminophen	Good	Minimal	15 to 20 mg per kg every four to six hours; daily maximum of 4 g	Underused for acute pain6–8
NSAIDs	Excellent	GI, platelet function inhibition, renal dysfunction	400 mg ibuprofen safest inexpensive choice; decreases some adverse GI events with misoprostol 800 mg, H2blockers, and PPI	No evidence that any one NSAID is more effective than another10,12–14,18–20
Selective COX-2 inhibitors	Excellent	Renal dysfunction; hypertension; thrombotic events	Once or twice per day, only advantage over most traditional NSAIDs for acute pain	Expensive22–31,34,35
Opioids	Excellent	Sedation, nausea, vomiting, constipation	No ceiling dose; greater analgesia can be obtained by increasing the dosage with no limit except those imposed by side effects	Recommended: oxycodone, hydrocodone36–38 Not recommended for acute pain: codeine, propoxyphene, pentazocine39–41