Evidence map›Paper›PMID 25349008›Full record

Trial reportCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2014

Oral administration of morphine versus ibuprofen to manage postfracture pain in children: a randomized trial.

Naveen Poonai, Gina Bhullar, Kangrui Lin, Adam Papini, David Mainprize, Jocelyn Howard, John Teefy, Michelle Bale, Cindy Langford, Rodrick Lim and 3 more

2 registry-linked trialsOpen access · goldAbstract readComparative StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 51 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
51citing papers in PubMed, 5 pooled it
12.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01690780 nacompletednot on this map

Oral Morphine Versus Ibuprofen for Post-fracture Pain Management in Children: a Randomized Controlled Study

TypeinterventionalSponsorNaveen PoonaiRan2012 to 2014Enrolled183ConditionsUpper Extremity Fractures, Analgesia Post FractureArmsOral morphine, Ibuprofen
NCT06060236 phase4unknown statusnot on this mapstarted 2023, after this paper: background citation

Comparison of Analgesic Efficacy of Dexketoprofen and Ibuprofen in Long Bone Fractures: Randomised Controlled Double-blind Study

TypeinterventionalSponsorAnkara City Hospital BilkentRan2023 to 2024Enrolled100ConditionsPain, Bone FractureArmsIbuprofen 800 mg, Dexketoprofen
3 · Its place in the literature

Who cites it

51 citing papers in PubMed, 5 syntheses or guidelines pooled it, 126 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Opioids for chronic non-cancer pain in children and adolescents.The Cochrane database of systematic reviews · 2017
    Pooled it
  4. Pooled it
  5. Pooled it
  6. Trial
  7. Trial
  8. Trial
  9. Trial
  10. Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: a randomized controlled trial.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2017
    Trial
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Review
  18. Fracture nonunion and delayed union.Journal of the Pediatric Orthopaedic Society of North America · 2024
    Article
  19. Article
  20. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 3 institutions in 1 country.

Naveen PoonaiDivision of Emergency Medicine (Poonai, Bhullar, Lin, Papini, Mainprize, Howard, Teefy, Bale, Langford, Lim, Stitt), London Health Sciences Centre; Department of Paediatrics (Poonai, Lim), Schulich School of Medicine and Dentistry, Western University; and Department of Paediatrics (Rieder), Children's Hospital of Western Ontario, London, Ont.; Department of Pediatrics (Ali), University of Alberta; and Women and Children's Health Research Institute (Ali), Edmonton, Alta. naveen.poonai@lhsc.on.ca.
Gina BhullarDivision of Emergency Medicine (Poonai, Bhullar, Lin, Papini, Mainprize, Howard, Teefy, Bale, Langford, Lim, Stitt), London Health Sciences Centre; Department of Paediatrics (Poonai, Lim), Schulich School of Medicine and Dentistry, Western University; and Department of Paediatrics (Rieder), Children's Hospital of Western Ontario, London, Ont.; Department of Pediatrics (Ali), University of Alberta; and Women and Children's Health Research Institute (Ali), Edmonton, Alta.
Kangrui LinDivision of Emergency Medicine (Poonai, Bhullar, Lin, Papini, Mainprize, Howard, Teefy, Bale, Langford, Lim, Stitt), London Health Sciences Centre; Department of Paediatrics (Poonai, Lim), Schulich School of Medicine and Dentistry, Western University; and Department of Paediatrics (Rieder), Children's Hospital of Western Ontario, London, Ont.; Department of Pediatrics (Ali), University of Alberta; and Women and Children's Health Research Institute (Ali), Edmonton, Alta.
Adam PapiniDivision of Emergency Medicine (Poonai, Bhullar, Lin, Papini, Mainprize, Howard, Teefy, Bale, Langford, Lim, Stitt), London Health Sciences Centre; Department of Paediatrics (Poonai, Lim), Schulich School of Medicine and Dentistry, Western University; and Department of Paediatrics (Rieder), Children's Hospital of Western Ontario, London, Ont.; Department of Pediatrics (Ali), University of Alberta; and Women and Children's Health Research Institute (Ali), Edmonton, Alta.
David MainprizeDivision of Emergency Medicine (Poonai, Bhullar, Lin, Papini, Mainprize, Howard, Teefy, Bale, Langford, Lim, Stitt), London Health Sciences Centre; Department of Paediatrics (Poonai, Lim), Schulich School of Medicine and Dentistry, Western University; and Department of Paediatrics (Rieder), Children's Hospital of Western Ontario, London, Ont.; Department of Pediatrics (Ali), University of Alberta; and Women and Children's Health Research Institute (Ali), Edmonton, Alta.
Jocelyn HowardDivision of Emergency Medicine (Poonai, Bhullar, Lin, Papini, Mainprize, Howard, Teefy, Bale, Langford, Lim, Stitt), London Health Sciences Centre; Department of Paediatrics (Poonai, Lim), Schulich School of Medicine and Dentistry, Western University; and Department of Paediatrics (Rieder), Children's Hospital of Western Ontario, London, Ont.; Department of Pediatrics (Ali), University of Alberta; and Women and Children's Health Research Institute (Ali), Edmonton, Alta.
John TeefyDivision of Emergency Medicine (Poonai, Bhullar, Lin, Papini, Mainprize, Howard, Teefy, Bale, Langford, Lim, Stitt), London Health Sciences Centre; Department of Paediatrics (Poonai, Lim), Schulich School of Medicine and Dentistry, Western University; and Department of Paediatrics (Rieder), Children's Hospital of Western Ontario, London, Ont.; Department of Pediatrics (Ali), University of Alberta; and Women and Children's Health Research Institute (Ali), Edmonton, Alta.
Michelle BaleDivision of Emergency Medicine (Poonai, Bhullar, Lin, Papini, Mainprize, Howard, Teefy, Bale, Langford, Lim, Stitt), London Health Sciences Centre; Department of Paediatrics (Poonai, Lim), Schulich School of Medicine and Dentistry, Western University; and Department of Paediatrics (Rieder), Children's Hospital of Western Ontario, London, Ont.; Department of Pediatrics (Ali), University of Alberta; and Women and Children's Health Research Institute (Ali), Edmonton, Alta.
Cindy LangfordDivision of Emergency Medicine (Poonai, Bhullar, Lin, Papini, Mainprize, Howard, Teefy, Bale, Langford, Lim, Stitt), London Health Sciences Centre; Department of Paediatrics (Poonai, Lim), Schulich School of Medicine and Dentistry, Western University; and Department of Paediatrics (Rieder), Children's Hospital of Western Ontario, London, Ont.; Department of Pediatrics (Ali), University of Alberta; and Women and Children's Health Research Institute (Ali), Edmonton, Alta.
Rodrick LimDivision of Emergency Medicine (Poonai, Bhullar, Lin, Papini, Mainprize, Howard, Teefy, Bale, Langford, Lim, Stitt), London Health Sciences Centre; Department of Paediatrics (Poonai, Lim), Schulich School of Medicine and Dentistry, Western University; and Department of Paediatrics (Rieder), Children's Hospital of Western Ontario, London, Ont.; Department of Pediatrics (Ali), University of Alberta; and Women and Children's Health Research Institute (Ali), Edmonton, Alta.
Larry StittDivision of Emergency Medicine (Poonai, Bhullar, Lin, Papini, Mainprize, Howard, Teefy, Bale, Langford, Lim, Stitt), London Health Sciences Centre; Department of Paediatrics (Poonai, Lim), Schulich School of Medicine and Dentistry, Western University; and Department of Paediatrics (Rieder), Children's Hospital of Western Ontario, London, Ont.; Department of Pediatrics (Ali), University of Alberta; and Women and Children's Health Research Institute (Ali), Edmonton, Alta.
Michael J RiederDivision of Emergency Medicine (Poonai, Bhullar, Lin, Papini, Mainprize, Howard, Teefy, Bale, Langford, Lim, Stitt), London Health Sciences Centre; Department of Paediatrics (Poonai, Lim), Schulich School of Medicine and Dentistry, Western University; and Department of Paediatrics (Rieder), Children's Hospital of Western Ontario, London, Ont.; Department of Pediatrics (Ali), University of Alberta; and Women and Children's Health Research Institute (Ali), Edmonton, Alta.
Samina AliDivision of Emergency Medicine (Poonai, Bhullar, Lin, Papini, Mainprize, Howard, Teefy, Bale, Langford, Lim, Stitt), London Health Sciences Centre; Department of Paediatrics (Poonai, Lim), Schulich School of Medicine and Dentistry, Western University; and Department of Paediatrics (Rieder), Children's Hospital of Western Ontario, London, Ont.; Department of Pediatrics (Ali), University of Alberta; and Women and Children's Health Research Institute (Ali), Edmonton, Alta.
London Health Sciences Centre · CAWestern University · CAUniversity of Alberta · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRecent warnings from Health Canada regarding codeine for children have led to increased use of nonsteroidal anti-inflammatory drugs and morphine for common injuries such as fractures. Our objective was to determine whether morphine administered orally has superior efficacy to ibuprofen in fracture-related pain.

methodsWe used a parallel group, randomized, blinded superiority design. Children who presented to the emergency department with an uncomplicated extremity fracture were randomly assigned to receive either morphine (0.5 mg/kg orally) or ibuprofen (10 mg/kg) for 24 hours after discharge. Our primary outcome was the change in pain score using the Faces Pain Scale - Revised (FPS-R). Participants were asked to record pain scores immediately before and 30 minutes after receiving each dose.

resultsWe analyzed data from 66 participants in the morphine group and 68 participants in the ibuprofen group. For both morphine and ibuprofen, we found a reduction in pain scores (mean pre-post difference ± standard deviation for dose 1: morphine 1.5 ± 1.2, ibuprofen 1.3 ± 1.0, between-group difference [δ] 0.2 [95% confidence interval (CI) -0.2 to 0.6]; dose 2: morphine 1.3 ± 1.3, ibuprofen 1.3 ± 0.9, δ 0 [95% CI -0.4 to 0.4]; dose 3: morphine 1.3 ± 1.4, ibuprofen 1.4 ± 1.1, δ -0.1 [95% CI -0.7 to 0.4]; and dose 4: morphine 1.5 ± 1.4, ibuprofen 1.1 ± 1.2, δ 0.4 [95% CI -0.2 to 1.1]). We found no significant differences in the change in pain scores between morphine and ibuprofen between groups at any of the 4 time points (p = 0.6). Participants in the morphine group had significantly more adverse effects than those in the ibuprofen group (56.1% v. 30.9%, p < 0.01).

interpretationWe found no significant difference in analgesic efficacy between orally administered morphine and ibuprofen. However, morphine was associated with a significantly greater number of adverse effects. Our results suggest that ibuprofen remains safe and effective for outpatient pain management in children with uncomplicated fractures.

trial registrationClinicalTrials.gov, no. NCT01690780.

Indexed as

Pain ManagementAdministration, OralAnalgesics, Non-NarcoticAnalgesics, OpioidChildDouble-Blind MethodFemaleFractures, BoneHumansIbuprofenMaleMorphinePainAnalgesics, Non-NarcoticAnalgesics, OpioidIbuprofenMorphine

Identifiers

PMID25349008
PMCPMC4259768
OpenAlexW2169051208

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.