Single-dose opioid analgesics offer no benefit over non-narcotic analgesia for musculoskeletal pain

For acute muscle pain, what oral analgesic provides the best immediate relief?

A single dose of opioid analgesics provides similar acute pain relief to a single dose of a combination of acetaminophen and ibuprofen in patients with acute musculoskeletal pain in the emergency department. Opioids increase the likelihood of nausea or vomiting. There was no added benefit of 800 mg of ibuprofen as compared with 400 mg. Unfortunately, the study did not investigate the further effect, possibly because of the placebo effect, of an injectable analgesic. These results are similar to those of previous studies of opioids and different doses of ibuprofen.