PATIENTS'
PERCEPTIONS OF ROUTE OF NONSTEROIDAL ANTI-INFLAMMATORY DRUG ADMINISTRATION AND
ITS EFFECT ON ANALGESIA.
Schwartz
NA, et al. Acad Emerg Med 2000 Aug;7(8):857-61
OBJECTIVE:
There is a commonly held belief among health care providers that patients
respond better to parenteral nonsteroidal anti-inflammatory drugs (NSAIDs) than
to oral forms by virtue of the patients' belief that getting an injection means
they are receiving "stronger" medicine. To the authors' knowledge,
this effect has never been adequately documented in the literature. The
objective of this study was to compare the effects of a placebo analgesic
injection vs placebo oral analgesia on patients with acute musculoskeletal
pain.
METHODS:
A convenience sample of emergency department (ED) patients with acute musculoskeletal
pain secondary to trauma were enrolled. Patients received 225 mL of
orange-flavored drink containing 800 mg of ibuprofen. Patients then received
either a physiologically inactive starch tablet resembling ibuprofen 800 mg in
taste and appearance or a physiologically inactive saline intramuscular (IM)
injection resembling ketorolac 60 mg. Both patients and research nurses were
blinded to the addition of ibuprofen to the drink and the inactive nature of
subsequent medication. Pain was evaluated at time 0 and at 30, 60, 90, and 120
minutes on a 10-mm visual analog scale (VAS).
RESULTS:
Sixty-four patients completed the study protocol. The VAS scores between groups
did not differ significantly at baseline or at each subsequent interval (p =
0.86).
CONCLUSIONS:
These results contradict the belief that parenteral medications confer a
selective placebo effect stemming from patients' beliefs regarding route of
administration and efficacy. Therefore, the routine use of IM administration of
NSAIDs for suspected enhanced analgesia appears unwarranted.