"Bottom Line For adults coming to the emergency department for arm or leg pain due to sprain strain or fracture there was no difference in pain reduction after  hours with ibuprofenacetaminophen vs three comparison opioidacetaminophen paracetamol combinations. Why The Research Is Interesting The United States is facing an opioid epidemic with almost  individuals dying from opioid overdoses since . Despite the epidemic opioid analgesics remain a firstline treatment for moderate to severe acute pain in the emergency department. The combination of ibuprofen and acetaminophen may represent an effective nonopioid alternative. Who  patients ages  to  years with moderate to severe acute extremity pain in two urban emergency departments were randomly assigned to receive   mg ibuprofen and  mg acetaminophen   mg oxycodone and  mg acetaminophen   mg hydrocodone and  mg acetaminophen or   mg codeine and  mg acetaminophen When July  to August  What Study Measures The betweengroup difference in decline in pain two hours after taking the study drugs. How Study Design This was a randomized clinical trial RCT. Randomized trials allow for the strongest inferences to be made about the true effect of an intervention such as a medication or a procedure. However not all RCT results can be replicated because patient characteristics or other variables in realworld settings may differ from those that were studied in the RCT. Authors Andrew K. Chang M.D. M.S. of Albany Medical College Albany New York and coauthors Results After  hours pain was less in all participants without any important difference in effect between the four groups. Study Limitations The results apply only to pain after two hours. About  in  patients required additional medication to control their pain. Study Conclusions There were no important differences in pain reduction after  hours with ibuprofenacetaminophen or opioidacetaminophen combination pills in emergency department patients with acute extremity pain. The findings suggest that ibuprofenacetaminophen is a reasonable alternative to opioid management of acute extremity pain due to sprain strain or fracture but further research to assess longerterm effect adverse events and dosing is warranted.  Related material The following related elements also are available on the For The Media website The editorial Opioid vs Nonopioid Acute Pain Management in the Emergency Department by Demetrios N. Kyriacou M.D. Ph.D. Senior Editor JAMA Chicago Northwestern University Feinberg School of Medicine Chicago. For more details and to read the full study please visit the For The Media website. doi.jama.. Editors Note Please see the article for additional information including other authors author contributions and affiliations financial disclosures funding and support etc. Want to embed a link to this study in your story Link will be live at the embargo time httpjamanetwork.comjournalsjamafullarticle.jama.."