NSAIDs Found Most Effective in Treating Acute Pain in Children: JAMA

A recent clinical review published in the Journal of American Medical Association evaluated the comparative effectiveness and safety of various pharmacologic treatments for acute pain in children. The findings revealed the superiority of nonsteroidal anti-inflammatory drugs (NSAIDs) over other analgesic options in reducing pain while maintaining a favorable safety profile.

The study assessed 41 randomized clinical trials involved a total 4,935 pediatric patients under the age of 18. The analysis found that NSAIDs, ketamine, and mid- to high-potency opioids demonstrated significant pain-relief benefits when compared with placebo. Also, NSAIDs showed the highest pain reduction, with a weighted mean difference (WMD) of -1.29 on a 10 cm visual analog scale. Ketamine and mid- to high-potency opioids followed closely with reductions of -1.12 and -1.19, respectively.

However, NSAIDs stood out as the only pharmacologic option to significantly reduce the need for additional rescue medication, with a relative risk reduction of 69%. This means that patients using NSAIDs were 16% less likely to require additional pain relief.

Also, NSAIDs did not pose an increased risk of short-term gastrointestinal side effects which is a concern often associated with this class of drugs. Acetaminophen also showed no significant increase in adverse events. The study highlighted moderate-certainty data which suggests that other treatments demonstrated little to no significant benefit over placebo or were supported by lower certainty evidence.

Given the robust evidence supporting the effectiveness and safety of NSAIDs, this study recommend them as the first-line therapy for managing acute pediatric pain. Ketamine and opioids may still have a role in specific cases but should be approached with caution given their side-effect profiles.

The findings were derived from rigorous data analysis using a frequentist random-effects model. Pairs of reviewers independently assessed trial eligibility, extracted data, and evaluated the risk of bias. Treatment effects were assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to ensure high-quality conclusions.

Overall, the study provides valuable insights for physicians who manage pediatric pain by emphasizing the need for evidence-based decision-making to prioritize treatments that are both effective and safe for young patients. The results solidify NSAIDs as the preferred choice for acute pain management in children by reducing both pain severity and the need for additional medication without compromising the safety.

Reference:

Olejnik, L., Lima, J. P., Sadeghirad, B., Busse, J. W., Florez, I. D., Ali, S., Bunker, J., Jomaa, D., Bleik, A., & Eltorki, M. (2025). Pharmacologic management of acute pain in children: A systematic review and network meta-analysis. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2024.5920