Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Randomized Controlled Trial of Oral Analgesic Utilization for Pain Management of CHildhood Musculoskeletal Injuries
Brief Summary: Pain management for children presenting to the emergency department (ED) with an injured limb is often under-treated, even though it is known that broken arms and legs cause moderate to severe pain. Further, children are less likely to receive appropriate pain medicine than adults with similar injuries. This study aims to improve the pain treatment of children who present to the ED with a suspected fracture, or broken bone or severe sprain. The investigators will compare the use of 3 different possible medication combinations (ibuprofen alone, oral morphine alone, or combined ibuprofen and oral morphine) to determine which combination is the best at treating children's pain. The investigators also plan to verify the safety of using these different drugs to treat children's pain.

The investigators strongly believe that children's pain should be optimally treated in the ED. Adequately relieving children's pain is crucial, as inadequate pain treatment can have both short and longterm effects on the child. It also generates unnecessary stress for both the child and their caregivers/parents. Given this knowledge, the investigators feel that their study has the potential to impact care provided in EDs, and improve pain management safely, for children.


Options:
A: Inclusion Criteria:

* Patients were eligible for inclusion if they were aged 18 years or older, 65 years or younger
* Isolated traumatic musculoskeletal pain
* Patients who agree to work and receive the approval
* VAS (visual analog scale) score\>5.

Exclusion Criteria:

* Patients with severe liver, kidney,pulmonary and cardiac heartfailure
* To be Pregnancy and breast-feeding
* Have received analgesics in the last 6hours
* Patients of childbearing age who are not using a birth control method.
* Patients with neurological deficits
* Patients with sciatica and back pain
* Patients with cardiac chest pain
* Patients with chronic pain
* Patients with pre-existing dexketoprofen and paracetamol-induced gastrointestinal bleeding and perforation
* Patients with reflected pain
* Patients with neoplastic pain
* Patients with an allergy trait (paracetamol and dexketoprofen)
* Illiterates and patients with vision problems
B: Inclusion Criteria:

* All patients \>16 years presenting to the ED with isolated soft tissue injury without significant fracture
* between 9am to 5pm, Monday to Friday,

Exclusion Criteria:

* History of :

  * peptic ulceration or hemorrhage
  * recent anticoagulation
  * pregnancy
  * adverse reaction to paracetamol or ibuprofen
  * renal or cardiac failure
  * hepatic problems
  * rectal bleeding
  * chronic NSAID consumption
  * asthma
  * chronic obstructive pulmonary disease
  * chronic pain syndromes
  * prior treatment with analgesia for the same injury
  * physical, visual or cognitive impairment making use of the visual analogue scale unreliable
C: Inclusion Criteria

* Patients with acute musculoskeletal pain following an uncomplicated soft tissue injury (within the last 72 hours) which is expected to be self-limiting, requiring short-term treatment with a NSAID.
* Patients' acute musculoskeletal pain at baseline must be ≥ 50 mm on a 0 - 100 mm on a Visual Analogue Scale.
* Patients may have taken analgesic therapy following injury. However, the baseline pain intensity assessment should be taken: (i) 4 hours after the last dose of ≤ 400 mg ibuprofen, ≤ 1000 mg paracetamol, ≤ 600 mg aspirin or ≤ 2 tablets of other over-the-counter analgesic aspirin-based or paracetamol-based combination medications (ii) or 8 hours after the last dose of \> 400 mg ibuprofen or ≤ 50 mg diclofenac

Exclusion Criteria

* Patients whose pain is due to an acute exacerbation of a chronic condition e.g. osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus.
* Patients who have taken non-steroidal anti-inflammatory drugs in the previous 24 hours (other than aspirin, ibuprofen, diclofenac, as described above).

Other protocol-defined inclusion/ exclusion criteria may apply.
D: Inclusion Criteria:

* Between the ages of 6 and 17 years
* Presenting to the ED with a musculoskeletal (MSK) trauma to either of the upper or lower limbs that is neither obviously deformed, nor neurovascularly compromised
* Self-reported pain score \>29 mm on a 0 to 100mm Visual Analogue Scale (VAS)
* Able to understand French or English.

Exclusion Criteria:

* Known allergy to morphine, ibuprofen, or artificial colouring
* MSK trauma that are suspected to be due to child abuse, as determined by the triage nurse
* Inability to self-report pain
* Chronic pain issues that require daily analgesic use
* NSAID or opioid analgesic use within three hours prior to presentation to triage (Exception of acetaminophen)
* Trauma to more than one limb (except fingers and toes)
* Known hepatic or renal disease/dysfunction
* Known bleeding disorder
* Neuro-cognitive disability that precludes patients from assenting and participating to the study.
* Known history of snoring consistently for the past 5 nights

Answer: D