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Child health
Combining morphine and ibuprofen does not improve pain control compared with using either drug alone following musculoskeletal injury in children
  1. Cornelius Botha Groenewald
  1. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle Children’s Hospital, Seattle, Washington, USA
  1. Correspondence to Dr Cornelius Botha Groenewald, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle Children’s Hospital Seattle, WA 98402, USA; cornelius.groenewald{at}

Statistics from

Commentary on: Le May S, Ali S, Plint AC, et al. Oral analgesics utilization for children with musculoskeletal injury (OUCH trial): an RCT. Pediatrics 2017;140:e20170186.

Implications for practice and research

  • This study provides firm evidence that adding morphine to ibuprofen does not provide superior pain control compared with ibuprofen alone for children presenting to the emergency department with musculoskeletal injury.

  • Yet, pain control for musculoskeletal injury remains suboptimal. Future research should determine whether other multimodal agents improve pain when used alongside ibuprofen.


Ibuprofen is considered the standard first-line treatment for musculoskeletal injury pain among children, yet provides inadequate relief for many patients.1 Combining morphine with ibuprofen may improve pain. However, there are growing concerns among both the medical community and the public about the risks associated with opioids.2 Thus, before recommending morphine alongside ibuprofen, we first need more information about associated benefits and risks. To fill this gap in knowledge, Le May and colleagues set out to assess whether the …

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