Intravenous ibuprofen versus ketorolac for acute low back pain in the emergency department: a triple-blind randomized clinical trial.

Considering the frequency of recurrence in low back pain (LBP), there is no single medication group with promising efficacy in acute settings. Non-steroidal anti-inflammatory drugs (NSAIDs) provide better pain relief with rather low complications. Since ketorolac has been relatively effective, we compared its safety and efficacy with ibuprofen as an alternative for pain relief in acute LBP. In this multi-centric triple-blind randomized clinical trial, we compared intravenous (IV) ibuprofen and ketorolac in patients with acute LBP presenting to the EDs of three university hospitals. Group 1 received IV ibuprofen (800 mg), and group 2 received IV ketorolac (30 mg), based on a computerized random sequence. Trained head nurses prepared analgesics in blocks of four. Neither patients nor the researcher or the statistician knew about the medication. We applied Visual Analog Scale (VAS) for patients to score their pain at baseline and 10 and 30 min after pain medications. Of 73 enrolled patients, 39 were in the ketorolac group and 34 participants in the ibuprofen group. Pain scores were significantly lower in the ibuprofen group at both 10 min (49.6 vs 57.4; p =0.013) and 30 min (32.2 vs 40.7; p =0.038). Based on the pain intensity after 30 min, the majority of patients in the ibuprofen group (70.6%) rated their pain as mild, while only 35.9% of the ketorolac group reported pain relief to a mild level (p <0.001). The mean ED length of stay was significantly lower in the ibuprofen group, whereas rescue analgesia and adverse events were comparable between the groups. Pain intensity was significantly lower in the ibuprofen group than in the ketorolac group after 10 and 30 min, without a significant difference in side effects. Intravenous ibuprofen can serve as an acceptable alternative and might be more effective than ketorolac in acute LBP in the ED.