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Oral ibuprofen 400 mg offers pain control similar to intramuscular ketorolac 10 mg for acute back pain in the emergency department.
A prospective, single-center, randomized study has demonstrated that oral ibuprofen is as effective as intramuscular ketorolac in relieving acute, atraumatic musculoskeletal back pain in adults presenting to the emergency department (ED).
Both ibuprofen and ketorolac are commonly used nonsteroidal anti-inflammatory drugs (NSAIDs). However, comparative data exploring their analgesic potency at ceiling doses across different routes of administration have been limited. Hence, this prospective analysis sought to fill this gap. Overall, 93 adults presenting to an urban ED with acute, atraumatic musculoskeletal back pain were randomly allocated into two groups:
The primary endpoint was the absolute reduction in pain score at 1 hour, measured using the visual analog scale (VAS). Results showed a reduction of 35 points in the ibuprofen group and 32 points in the ketorolac group, with a 95% confidence interval ranging from −8.03 to 15.03—indicating no prominent difference.
Secondary outcomes further supported comparable efficacy. The need for rescue analgesia at 60 minutes was comparable in both groups. Adverse events were minimal, with only two patients in the ketorolac group reporting injection-site pain, while no adverse reactions were noted in the ibuprofen group.
At their respective ceiling doses, oral ibuprofen 400 mg and intramuscular ketorolac 10 mg provide equivalent short-term analgesia for acute, atraumatic musculoskeletal back pain in the ED. These findings support the use of oral ibuprofen as an effective, less invasive alternative to intramuscular therapy in this setting.
Journal of Pharmacy Practice
Oral Ibuprofen Versus Intramuscular Ketorolac for Acute Musculoskeletal Back Pain in the Emergency Department: A Prospective Analysis
Myroslava Sharabun et al.
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