University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Emergency Medicine


Dr. Kevin Pogreba




The opioid epidemic is profound and described in detail in the current literature. The United States (US) has prescribed more opioids than any other nation. The rise in sales of prescription opioids has increased 4-fold from 1999 to 2010. Roughly half of the 33,000 opioid-related deaths that occur each year in the US can be attributed to prescription opioids. This problem is vital to the practice of Emergency Medicine as pain related complaints are the most common reasons patients seek medical care. Anyone who takes an opioid medication is at risk for addiction. This clinical review article analyzes the question: For individuals presenting to the ED with pain, have over the counter analgesics, such as ibuprofen and acetaminophen, been utilized and shown to help improve symptoms?


This is a literature review seeking to find evidence that shows improvement of pain in Emergency Department patients with ibuprofen and acetaminophen. Randomized control trials, meta analyses, and systematic reviews were utilized to contribute to the conclusion. In PubMed, the search terms “analgesic” and “ibuprofen” and “acetaminophen” and “Emergency department” were used.


Based on review of current literature, three peer-reviewed articles including two randomized control trials, and one systematic review and meta-analysis were used to show there may be utility in starting with non-narcotic medication in the Emergency Department (ED). Further analysis is necessary on this topic as most literature applies to prescription medications.


Most of the research that has been done on the topic of opioid misuse in the ED focuses on prescription medications. However, it is rare that people receive a prescription for opioids prior to having been given them first during their ED visit.

This was not an exhaustive review of all literature on this topic. A better analysis would be a double blinded randomized control trial evaluating the utility of ibuprofen and acetaminophen for symptom improvement in ED patients.


As the opioid epidemic looms, alternatives to narcotic medications are constantly being explored, particularly in the ED. The Joint Commission (JAHCO) identified undertreating pain as a significant problem. Although providers do have a responsibility to address pain, patient education regarding the avoidance of narcotics, discussion of expectations, and improving provider practices are key components in an effort to limit both the supply and demand for narcotics.


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