For bone fracture pain, which is better, ibuprofen or Voltaren (diclofenac)?

Ibuprofen is Preferred Over Diclofenac (Voltaren) for Bone Fracture Pain

For bone fracture pain, ibuprofen is preferred over diclofenac (Voltaren) due to its better safety profile and comparable efficacy. 1

Rationale for Recommendation

Safety Considerations

• Ibuprofen has a more favorable cardiovascular risk profile compared to diclofenac
• Guidelines specifically state that "naproxen and ibuprofen are preferred NSAIDs for individuals at high risk for cardiac toxicities" 1
• Proximal femoral fracture management guidelines specifically caution that "non-steroidal anti-inflammatory drugs should be used with extreme caution in hip fracture patients, and are contraindicated in those with renal dysfunction" 1

Efficacy for Bone Pain

• Both medications are effective NSAIDs that work by blocking prostaglandin synthesis to reduce inflammation and pain 1
• Recent research shows that ibuprofen does not impair clinical or radiographic bone healing in fractures 2, 3
• A randomized controlled trial showed that ibuprofen provided effective pain relief for Colles' fractures without delaying bone healing 2

Pain Management Algorithm for Bone Fractures

1. First-line therapy:

   • Regular acetaminophen (paracetamol) 1000-1200mg every 6 hours 1
   • Add ibuprofen 400-600mg every 6-8 hours as needed 1

2. If additional pain control is needed:

   • Consider short-term opioids for breakthrough pain 1
   • Avoid codeine (associated with constipation and cognitive dysfunction) 1

3. For patients with cardiovascular risk:

   • Ibuprofen is specifically preferred over other NSAIDs 1
   • Avoid diclofenac due to higher cardiovascular risk profile

4. For patients with renal impairment:

   • Avoid all NSAIDs if possible 1
   • Use acetaminophen as primary analgesic
   • Consider pain specialist consultation for alternative options

Important Considerations and Precautions

Potential Adverse Effects

• NSAIDs can cause gastrointestinal bleeding, renal toxicity, and cardiovascular complications 1
• Consider proton pump inhibitors for patients at risk of GI complications 1
• Use with caution in patients >60 years, those with compromised fluid status, or renal insufficiency 1

Effect on Bone Healing

• Recent high-quality clinical trials show that short-term ibuprofen use does not delay fracture healing 2, 3
• A triple-blinded RCT found no significant differences in radiological migration, functional outcomes, or bone mineral density between ibuprofen and placebo groups in Colles' fracture patients 2
• In contrast, animal studies have suggested diclofenac may delay fracture healing 4, 5

Special Populations

• For elderly patients (>60 years), use lower doses and shorter duration of NSAIDs 1
• In patients with cardiovascular disease, ibuprofen is specifically recommended over diclofenac 1
• For patients on anticoagulants, all NSAIDs significantly increase bleeding risk 1

Conclusion

Ibuprofen provides effective pain relief for bone fracture pain with a better safety profile than diclofenac, particularly regarding cardiovascular risk. Recent evidence suggests it does not significantly impair bone healing when used appropriately. Always combine with regular acetaminophen for optimal pain control.