Author: Dr. Mollie Chesis

“Comparison of Oral Ibuprofen at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial”


  • Ibuprofen has an analgesic cap at 400 mg per dose
  • Unlike most medications, the therapeutic dose, toxic dose, and lethal dose of ibuprofen are not linear. However, nearly all research on ibuprofen overdosing is in children.
  • Side effects can happen at any dose

Study Question: Is there improved analgesic effect at 400 mg vs. 600 mg vs. 800 mg of ibuprofen for pain in the ED?


  • Double blind randomized control trial, a single center study at a community ED with 120,000 annual visits
  • Inclusion of adults with acute pain who could safely take NSAIDs and has not used NSAIDs or opioids within 4 hrs
  • Assessed initial pain scores against pain scores 60 minutes after receiving ibuprofen

Results: No clinically significant difference between groups. I.E. All groups reported the same amount of improvement in pain.


  • Ibuprofen is a common therapy that often gets overlooked in the ED because we assume patients have tried over-the-counter medications at home. However, there is a reason ibuprofen is everywhere. It works. It is important to add it to acute pain therapy.
  • The generalizability of this study is vast. If you had pain and could safely take ibuprofen—you got to be in the study. That’s most of our ED patients.
  • An uncertainty about the study exists in that 75% of the patients enrolled ultimately were diagnosed with musculoskeletal pain. It is unclear if ibuprofen would be less helpful in non-MSK related complaints. MSK pain was not specifically targeted, however, so it could be that 75% of the patients we would see in the ED anyway would be MSK-related pain.
  • The biggest question mark that comes from this study is not that 400mg is equivalent to 800mg. That’s been documented since 2010. It’s why that has taken so long to change the way medicine is practiced. To me, this comes back to the question of treating pain beyond the physical component. Treating pain is also related to patient comfort and a patient’s belief that their provider cares about them and their needs. When we give someone ibuprofen, patients sometimes refuse it or feel guilty for burdening us—responses to the idea that we are not understanding what brought them here to us in a hospital rather than the medicine cabinet in their homes. We have to spend the extra time emotionally supporting our patients so that we can do what is most appropriate medically if we want to be holistically successful.

Take Away: If prescribing ibuprofen for pain, start at 400mg.


Becker DE. Pain management: Part 1: Managing acute and postoperative dental pain. Anesth Prog. 2010 Summer;57(2):67-78; quiz 79-80. doi: 10.2344/0003-3006-57.2.67. PMID: 20553137; PMCID: PMC2886920.

Motov S, Masoudi A, Drapkin J, Sotomayor C, Kim S, Butt M, Likourezos A, Fassassi C, Hossain R, Brady J, Rothberger N, Flom P, Marshall J. Comparison of Oral Ibuprofen at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med. 2019 Oct;74(4):530-537. doi: 10.1016/j.annemergmed.2019.05.037. Epub 2019 Aug 2. PMID: 31383385.

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