From the Research
For children with bone pain, oral NSAIDs are the preferred treatment option due to their superior efficacy in reducing pain and inflammation compared to topical NSAIDs. According to the most recent and highest quality study 1, oral NSAIDs such as ibuprofen (10 mg/kg every 6-8 hours, maximum 600 mg per dose) or naproxen (5-7 mg/kg every 8-12 hours, maximum 500 mg per dose) are recommended as first-line treatments for bone pain in children. These medications work systemically to reduce inflammation and block pain signals at the source of the bone pain.
Some key points to consider when using oral NSAIDs in children include:
- Administering the medication with food to minimize gastrointestinal side effects
- Limiting treatment duration to 3-5 days unless directed otherwise by a healthcare provider
- Combining oral NSAIDs with acetaminophen (15 mg/kg every 4-6 hours, maximum 1000 mg per dose) for enhanced pain relief through different mechanisms of action, if necessary
- Monitoring for signs of underlying conditions that may require specific treatment, as bone pain in children can sometimes be indicative of more serious issues
It's also important to note that topical NSAIDs, such as diclofenac gel, have limited penetration through the skin to reach deeper bone structures, making them less effective for bone pain specifically 2, 3, 4. While they may be useful for superficial musculoskeletal pain, they are not the preferred treatment option for bone pain in children.
In terms of safety and efficacy, the study by 1 found that NSAIDs provide the greatest benefits and least harm, suggesting that they should be the first-line therapy for acute painful conditions in children. Additionally, the study by 5 found that NSAIDs reduced the opioid requirement in children with acute pain, while maintaining pain control and reducing the risk of opioid-associated adverse events.
Overall, the evidence suggests that oral NSAIDs are the preferred treatment option for bone pain in children, due to their superior efficacy and safety profile compared to topical NSAIDs.