Acetaminophen (Paracetamol) or Opioid Analgesia Added to Ibuprofen for Children’s Musculoskeletal Injury

JAMA 2026 Open access

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Authors: Samina Ali, Terry P. Klassen, Patricia Candelaria, Maala Bhatt, Scott Sawyer, Antonia Stang, Maryna Yaskina, Anna Heath, Petros Pechlivanoglou, Martin Offringa, Amy L. Drendel, Serena Hickes
+26 more Naveen Poonai, Manasi Rajagopal, L. Richer, Gareth Hopkin, Jeff Round, Eleanor Pullenayegum, David Rios, Andy Willan, Kelly Kim, Lise Bourrier, Darcy Beer, Candace McGahern, Lauren Dawson, Kamary Coriolano Dasilva, Pamela Thiell, Rick Watts, Rick Watts, Christopher McCabe, Jennifer Thull-Freedman, Patrick McGrath, Timothy AD Graham, Lisa Hartling, Tannis Erickson, Chelsea Bowkett, Kurt Schreiner, Julie Leung
DOI: 10.1001/jama.2025.25033
Cited by: 7
References: 36

Abstract

Importance: Ibuprofen is first-line therapy for musculoskeletal pain. However, two-thirds of children experience inadequate pain relief with ibuprofen monotherapy, and the efficacy of additive medications for moderate to severe musculoskeletal pain is unclear. Objective: To determine whether treatment with an opioid (hydromorphone) plus ibuprofen or nonopioid (acetaminophen [paracetamol]) plus ibuprofen decreased pain scores compared with ibuprofen alone. Design, Setting, and Participants: Two randomized, double-masked, placebo-controlled trials were conducted from April 2019 to March 2023 in 6 university-affiliated, tertiary care Canadian pediatric emergency departments. Children aged 6 to 17 years presenting with a nonoperative acute limb injury (

Fields of Study & Subjects

Pediatric Pain Management Techniques Inflammatory mediators and NSAID effects Thermal Regulation in Medicine

Publication details

Journal / source
JAMA
Publisher
American Medical Association (AMA)
Volume
335
Issue
10
Pages
863–863
Publication date
8 January 2026
Language
EN