Oral Ibuprofen Versus Intramuscular Ketorolac for Acute Musculoskeletal Back Pain in the Emergency Department: A Prospective Analysis

Ibuprofen and ketorolac are nonsteroidal anti-inflammatory drugs (NSAIDs) commonly used to treat acute back pain in the Emergency Department (ED). Data comparing pain relief between oral and intramuscular administration at their proposed ceiling doses is lacking. The aim of this study was to compare oral (PO) ibuprofen 400 mg to intramuscular (IM) ketorolac 10 mg for the treatment of acute, atraumatic, musculoskeletal back pain. This single-center, double-blind, double-placebo, randomized study compared PO ibuprofen 400 mg to IM ketorolac 10 mg for acute, atraumatic musculoskeletal back pain in adult patients presenting to an urban ED. Subjects were randomized to receive PO ibuprofen 400 mg suspension plus IM placebo injection or IM ketorolac 10 mg plus PO placebo suspension. The primary outcome was absolute reduction in pain score 1 hour after medication administration, as measured by visual analog scale (VAS). Secondary outcomes included rescue analgesia administration at 60 minutes and adverse drug reactions. The author's enrolled 93 patients; 47 in the ibuprofen group and 46 in the ketorolac group. VAS score reduction from baseline to 1 hour with ibuprofen or ketorolac was 35 vs 32, respectively (95% Confidence Interval: -8.03 to 15.03). Rescue analgesia administration at 60 minutes was similar between both groups; adverse reactions were reported in the ketorolac group only as pain at injection site in two patients. In this prospective analysis, PO ibuprofen 400 mg and IM ketorolac 10 mg provide comparable pain relief for the treatment of acute, atraumatic, musculoskeletal back pain.