A combination of Tylenol and Advil worked just as well as opioids for relief of pain in the emergency room, a randomized trial has found.

Researchers studied 416 men and women who arrived in the E.R. with moderate to severe pain in their arms or legs from sprains, strains, fractures or other injuries. They randomly assigned them to an oral dose of acetaminophen (Tylenol) with either ibuprofen (Advil) or the opioids oxycodone, hydrocodone or codeine. Two hours later, they questioned them using an 11-point pain scale.

The average score was 8.7 before taking medicine. That score decreased 4.3 points with ibuprofen and Tylenol, 4.4 with oxycodone and Tylenol, 3.5 with hydrocodone and Tylenol, and 3.9 with codeine and Tylenol. In other words, there was no significant difference, either statistically or clinically, among any of the four regimens. The study is in JAMA.

The lead author, Dr. Andrew K. Chang, a professor of emergency medicine at Albany Medical College, said that while any single patient might find opioids more effective, on average, even for the severe pain of fractures, non-opioids worked just as well.