Expert consensus on using Paracetamol and ibuprofen combination for acute mild-to-moderate pain in children

Acute pain remains a common symptom in children of all ages and is associated with various conditions. Despite the existence of guidelines, pain often stays underestimated and undertreated. Paracetamol and ibuprofen are the most popular drugs used for analgesia in Pediatrics. Pain management by using a paracetamol and ibuprofen combination imparts greater analgesia.

The study carried out an investigation using the Nominal Group Technique. It sent two open questionnaires to a Board of ten clinicians to comprehend their views on using the oral Paracetamol and ibuprofen combination. The study researchers then examined the Answers in a final meeting and drew conclusions.

The results were as follows-

• The board reached a final consensus on a more promising analgesic power of Paracetamol and ibuprofen in a fixed-dose combination than monotherapy without compromising safety. 
• It gained a strong consensus that the fixed-dose combination of Paracetamol and ibuprofen may be a practical option in case of the inefficacy of one or other drug as monotherapy, particularly concerning headaches, odontalgia, earache, and musculoskeletal pain. 
• The fixed combination may also be suitable for postoperative pain management.

This study confirms that using a fixed-dose combination is advantageous in terms of efficacy and safety, permitting better control of the dose of both Paracetamol and ibuprofen as monotherapy, thus reducing the risk of incorrect dosage. However, the limited evidence highlights the need for future well-designed studies to better describe the advantages of this formulation in the different therapeutic areas.

Parri N, Silvagni D, Chiarugi A. et al. Paracetamol and ibuprofen combination for the management of acute mild-to-moderate pain in children: expert consensus using the Nominal Group Technique (NGT). Ital J Pediatr. 2023;49. https://doi.org/10.1186/s13052-023-01445-4