A commonly held belief among health care providers is that an injectable nonsteroidal anti-inflammatory drug (NSAID) is perceived by patients to be more effective than an oral NSAID, simply because patients think it's stronger. A new study refutes this belief.

Patients with acute musculoskeletal pain being treated in an ED were randomly assigned to receive either a placebo injection or a placebo pill similar in appearance to ketorolac and ibuprofen, respectively. But before receiving the placebo treatment, patients were informed that adequate hydration is important in NSAID therapy and were asked to consume an orange-flavored drink that unbeknownst to either them or their providers contained 800 mg ibuprofen.

After two hours, the visual analog score of pain assessment had decreased in the injection group from 58 to 29 (out of 100) and in the pill group from 60 to 31-no statistical difference.

An injectable NSAID such as ketorolac carries certain drawbacks, including greater pain of administration, greater expense, and the potential for hematoma formation or extravasation; it also exposes the clinician to possible needlestick injury. According to these study results, clinicians can select an oral NSAID instead and obtain the same perceived efficacy among patients.

Schwartz NA, et al. Acad Emerg Med 2000;7(8):857-61.