New research found no statistically significant or clinically important differences in pain reduction at 2 hours among single-dose treatment ibuprofen and acetaminophen or with three opioid and acetaminophen combination analgesics for patients presenting to the emergency department (ED) with acute extremity pain. The randomized clinical trial, conducted at two EDs in the Bronx, New York, included 416 adults with moderate-to-severe acute extremity pain. Participants received 400 mg of ibuprofen and 1000 mg of acetaminophen; 5 mg of oxycodone and 325 mg of acetaminophen; 5 mg of hydrocodone and 300 mg of acetaminophen; or 30 mg of codeine and 300 mg of acetaminophen. The baseline mean numerical rating scale (NRS) pain score was 8.7, the researchers report. However at 2 hours, the mean NRS pain score dropped by 4.3 in the ibuprofen and acetaminophen group; by 4.4 in the oxycodone and acetaminophen group; by 3.5 in the hydrocodone and acetaminophen group; and by 3.9 in the codeine and acetaminophen group. According to the authors, from Albany Medical College and Albert Einstein College of Medicine, Montefiore Medical Center, "The findings support the inference that there are no clinically meaningful differences between the analgesic effects of these 4 analgesics and suggest that a combination of ibuprofen and acetaminophen represents an alternative to oral opioid analgesics for the treatment of acute extremity pain in the ED." They suggest that additional study to assess adverse events and other dosing may be useful.