December 2026. Volume 22. Number 4

Acute pain management in musculoskeletal injuries: more analgesics does not mean better analgesia

 
 
 
 
 
 
 
 
 
 
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AVC | Critically appraised articles

Ali S, Klassen TP, Candelaria P, Bhatt M, Sawyer S, Stang A, et al.; KidsCAN PERC Innovative Pediatric Clinical Trials No OUCH Study Team. Acetaminophen (Paracetamol) or Opioid Analgesia Added to Ibuprofen for Children´s Musculoskeletal Injury: Two Randomized Clinical Trials. JAMA. 2026;335:863-73.

Reviewers: Fraile Astorga G1, Suárez Cabezas S2.
1Pediatra. CS Cuellar. Segovia. España.
2Servicio de Pediatría. Hospital Virgen de Altagracia. Manzanares. Ciudad Real. España.
Correspondence: Garazi Fraile Astorga. Email: garazifraile@hotmail.com
Reception date: 13/09/2026
Acceptance date: 20/10/2026
Publication date: 29/10/2026

Abstract

Author’s conclusions: for children with acute nonoperative musculoskeletal injury, pain scores at 60 minutes after drug administration did not improve with ibuprofen plus acetaminophen or ibuprofen plus hydromorphone compared with ibuprofen alone. Adverse events were 4-fold more frequent with hydromorphone.

Reviewers´ commentary: a clinically rigorous trial in which neither paracetamol nor hydromorphone added to ibuprofen improved analgesic outcomes compared with ibuprofen monotherapy; its practical relevance is greatest in healthcare settings with higher reliance on combination analgesics and opioids, less typical in our environment.

How to cite this article

Fraile Astorga G, Suárez Cabezas S. Control del dolor agudo en lesiones musculoesqueléticas: más analgésicos no es sinónimo de más analgesia. Evid Pediatr. 2026;22:39.

AVC | Critically appraised articles

Ali S, Klassen TP, Candelaria P, Bhatt M, Sawyer S, Stang A, et al.; KidsCAN PERC Innovative Pediatric Clinical Trials No OUCH Study Team. Acetaminophen (Paracetamol) or Opioid Analgesia Added to Ibuprofen for Children´s Musculoskeletal Injury: Two Randomized Clinical Trials. JAMA. 2026;335:863-73.

Reviewers: Fraile Astorga G1, Suárez Cabezas S2.
1Pediatra. CS Cuellar. Segovia. España.
2Servicio de Pediatría. Hospital Virgen de Altagracia. Manzanares. Ciudad Real. España.
Correspondence: Garazi Fraile Astorga. Email: garazifraile@hotmail.com
Reception date: 13/09/2026
Acceptance date: 20/10/2026
Publication date: 29/10/2026

How to cite this article

Fraile Astorga G, Suárez Cabezas S. Control del dolor agudo en lesiones musculoesqueléticas: más analgésicos no es sinónimo de más analgesia. Evid Pediatr. 2026;22:39.

29/10/2026

Linked Comment

Methodological note