Ibuprofen doses of 400, 600, and 800 mg were found to provide comparable analgesia in adult patients seen in the emergency department (ED) with moderate to severe acute pain, according to study results published in the Annals of Emergency Medicine.

A total of 225 patients with acute pain seeking treatment in an ED were randomly assigned to receive ibuprofen at 400, 600, or 800 mg (n=75 in each group). Baseline characteristics and mean pain scores were comparable among groups. Of the total population, only 2 patients were not available for data analysis. Pain scores were assessed 60 minutes after ibuprofen intake using a 0 to 10 numeric rating scale.

In patients who received 400 mg, 600 mg, and 800 mg ibuprofen, mean pain scores were reduced 60 minutes after dosing compared with baseline levels (ibuprofen 400 mg: 6.48 to 4.36, respectively; 600 mg: 6.35 to 4.50, respectively; 800 mg: 6.46 to 4.50, respectively). There were no significant differences among groups in pain reduction at 60 minutes. The difference in mean pain scores were –0.14 between the 400- and 600-mg groups and between the 400- and 800-mg groups, and 0.00 between the 600- and 800-mg groups.

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No significant differences in mean numeric rating scale scores were observed when dividing patients according to pain scores (ie, ≤5 and ≥6), and no clinically significant adverse events related to study medications were reported.

Study limitations include potential selection bias caused by underrepresentation of patients seeking treatment at different times of day.

“To our knowledge, this is the first study conducted in the ED that supports the concept of an analgesic ceiling dose for 400 mg of ibuprofen. Because oral ibuprofen is the most common analgesic used in the ED and at discharge, we hope that the results of our study will make ED clinicians consider a lower dose of ibuprofen for managing pain,” concluded the study authors.


Motov S, Masoudi A, Drapkin J, et al. Comparison of oral ibuprofen at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. [published online August 2, 2019]. Ann Emerg Med. doi:10.1016/j.annemergmed.2019.05.037

This article originally appeared on Clinical Pain Advisor