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Ibuprofen may be better than prescription for kids with breaks

Rating

4 Star

Ibuprofen may be better than prescription for kids with breaks

Our Review Summary

This story about a study on pain relief for kids with broken arms is essentially accurate, yet it fails to convey key clinical implications. 

The study and story both conclude that ibuprofen is about as effective a pain reliever as a more powerful narcotic combination drug, acetaminophen/codeine, while producing fewer undesirable side effects. Both state that the simple over the counter medication should be used as a first-line treatment.

Yet the story seizes on the structure of the trial to imply the treatments are used by two warring camps of doctors and that this study settles the dispute. 

But this is not the case. Over-the-counter pain relievers are usually the first line treatment, and the combo drug is usually provided as a fallback in case the first one doesn’t provide sufficient relief. The findings confirm rather than challenge clinical practice.

Along the way, the report suffers from a few omissions:

  • It fails to state high in the story that the two treatments provided similar pain relief–and to report anywhere that both left between 20 and 30 percent of patients seeking a second-line treatment. 
  • We are told that ibuprofen was found to be superior to acetaminophen plus codeine.  We do not know if this was simply a numerical difference, a clinically significant difference or a statistically significant difference.  The story does provide numbers on the differences in side effects, but again does not provide the context.  Was the difference statistically significant or simply a numeric difference.  The story also assumes that all side effects are created equal.  The reader is not provided with any information about the severity of the side effects seen in each study group.  Without that information, the numeric difference may not be clinically important.

That said, the reporter gets extra points for pointing out the study’s limitations–that it speaks only to the narrow question of pain relief for kids with broken arms, that it does not make a broader Advil-vs.-Tylenol comparison, and that it has no bearing on a recent controversy over the dangers of taking too much acetaminophen.

Which is to say: The story does a good job of telling us what the study doesn’t say. It could have done better telling us what it does.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

Ibuprofen costs about a dime per pill, the acetaminophen/codeine combo around a dollar [both vary with dose, quantity and source]. The story makes a brief reference to the price difference, saying the "cheap, over-the-counter" drug was safer and as effective.

The story therefore earns a satisfactory rating, but just barely.

At a time of intense interest in health care costs, reporters should routinely and explicitly report the price of treatments and medications–especially when their effectiveness is being compared.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

Oddly, the story fails to deliver the results of the primary finding–that the kids in both treatment groups experienced about the same pain relief–until the 10th paragraph in a 16-paragraph story.

Twice in the first three sentences it is said the kids taking ibuprofen "did better," which implies they got more pain relief. 

Not until paragraph 11 do we learn that kids "did better" by experiencing fewer side effects–30 percent of patients in the ibuprofen group vs. 50 percent in the combo drug group. 

This is too little quantification too late. Especially given how we’ve seen that subscribers of the AP service often chop off the bottom of the original stories.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The story, like the study itself, focuses on the side effects of both medications.

The report states that the combination drug causes sleepiness and nausea, and that the kids experienced this as problems with eating, sleeping and playing. It says ibuprofen caused similar side effects, but they were not as frequent or troublesome.

Still, there is not enough detail on the negative side effects, given the fact that the difference is the key finding. For instance, one day after discharge, 25 percent of children in the ibuprofen group had problems eating, compared to 45 percent taking the combo drug. The higher satisfaction ratings mostly reflects kids’ preference for the taste of the ibuprofen solution. 

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story is based on a peer-reviewed double-blinded clinical trial. The story provides enough detail to allow readers to appreciate the high quality of evidence. 

The story flags two key limitations of the evidence–that it does not apply to any pain other than broken arms during the first three days of treatment, and that it should not be taken to mean ibuprofen is superior to acetaminophen alone. 

And finally, the reporter gets extra points for mentioning that this evidence has no bearing on a recent FDA committee recommendation about the side effects of acetaminophen. 

Does the story commit disease-mongering?

Satisfactory

The story does nothing to exaggerate the prevalence or severity of kids’ broken bones.

Indeed, it does a good job specifying that up to 1 in 5 kids breaks a bone before 10.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The reporter quotes two physicians, the study leader and a pain researcher.

While the second doctor is presented as an independent authority, in fact he is the study’s supervising editor. This should have been disclosed–or, better, a truly independent source should have been consulted.

Nonetheless, we’ll give the story the benefit of the doubt on this criterion. 

Does the story compare the new approach with existing alternatives?

Satisfactory

The two treatments compared are by far those most commonly used in clincial practice, so it’s not necessary to include other treatment options.

It would have been worth mentioning that a typical post-discharge treatment for pain relief is to use either ibuprofen or acetaminophen alone, with the acetaminophen/codeine offered as a fallback if the first treatment doesn’t provide sufficient relief. 

This would have put the two treatment options in proper context.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story states that ibuprofen is available over the counter, and that acetaminophen/codeine is available by prescription.

Does the story establish the true novelty of the approach?

Not Applicable

The two treatments tested are very common; their novelty is not in question.

Does the story appear to rely solely or largely on a news release?

Satisfactory

There is no evidence that the story draws excessively on the press release.

Total Score: 7 of 9 Satisfactory

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