Paracetamol and ibuprofen combination for the management of acute mild-to-moderate pain in children: expert consensus using the Nominal Group Technique (NGT)

Abstract

Background Acute pain is a common symptom in children of all ages, and is associated with a variety of conditions. Despite the availability of guidelines, pain often remains underestimated and undertreated. Paracetamol and ibuprofen are the most commonly used drugs for analgesia in Pediatrics. Multimodal pain management by using a combination of paracetamol and ibuprofen results in greater analgesia. Methods An investigation using the Nominal Group Technique was carried out between May and August 2022. Two open (non-anonymous) questionnaires were consecutively sent to a Board of ten clinicians to understand their opinions on the use of the oral paracetamol and ibuprofen association. Answers were examined in a final meeting where conclusions were drawn. Results The board achieved a final consensus on a better analgesic power of paracetamol and ibuprofen in fixed-dose combination as compared to monotherapy, without compromising safety. Strong consensus was reached on the opinion that the fixed-dose combination of paracetamol and ibuprofen may be a useful option in case of inefficacy of one or other drug as monotherapy, especially in case of headaches, odontalgia, earache, and musculoskeletal pain. The use of the fixed combination may be also considered suitable for postoperative pain management. Conclusions The use of the fixed-dose combination may represent advantage in terms of efficacy and safety, allowing a better control of the dose of both paracetamol and ibuprofen as monotherapy, thus minimizing the risk of incorrect dosage. However, the limited evidence available highlights the need for future well designed studies to better define the advantages of this formulation in the various therapeutic areas.

Combination Drug Therapy for the Management of Chronic Neuropathic Pain

“…The coadministration of ibuprofen and paracetamol in fixed-dose combinations (FDC) has been suggested for pain management and has demonstrated synergistic efficacy in several contexts. It has been recommended as a preferred option relative to either agent as monotherapy for the treatment of headaches, odontalgia, earache, musculoskeletal pain, and postoperative pain in pediatric patients [134]. This combination has also been evaluated for pain management in adult patients.…”

Synergistic Antinociceptive Effect of β-Caryophyllene Oxide in Combination with Paracetamol, and the Corresponding Gastroprotective Activity

“…Both acute and chronic pain can be treated by multimodal analgesia, which is a pharmacological strategy aimed at providing pain relief [6,7] by combining two or more medications from distinct pharmacological groups [7]. Such a combination may lead to greater effectiveness, lower doses, and/or reduced side effects, which are all key components of the pharmacological treatment of pain [6].…”

“…Paracetamol is combined with other drugs to treat both acute and chronic pain [6,7]. For example, its combination with ibuprofen produces enhanced analgesia compared to its administration alone [7].…”

“…Paracetamol is combined with other drugs to treat both acute and chronic pain [6,7]. For example, its combination with ibuprofen produces enhanced analgesia compared to its administration alone [7]. Among the multimodal applications of paracetamol for chronic pain is its combination with tramadol (an opioid) to treat arthritis and fibromyalgia [6].…”

“…A potential synergistic analgesic effect of paracetamol and β-caryophyllene oxide is worth analyzing, considering the analgesic activity of both compounds and the successful synergistic combination of paracetamol with some other compounds to provide analgesic effects [6,7]. Hence, the aim of the current contribution was to evaluate the anti-nociceptive effect of the treatment of mice (in the formalin model) with a combination of paracetamol and β-caryophyllene oxide.…”